What is Narcissism?

Upon seeing a clear, glassy pool in the forest, young Narcissus bent towards the water to take a drink. He caught sight of a handsome young man and became enraptured with the vision. Days passed, yet Narcissus remained, cursed to gaze upon his own reflection forever. This is the Greek myth of Narcissus, the namesake of the personality trait known as narcissism.

The most well-known form of narcissism is grandiose narcissism, which is characterized by heightened self-confidence, entitlement, and lack of empathy [1]. However, this narcissistic behavior is also associated with vulnerability, with individuals demonstrating above-average levels of insecurity and doubt. These paradoxical patterns are the focus of a field of study within neuroscience that seeks to reconcile these two aspects of narcissism. Insight into this contradiction can support the development of therapeutic approaches and mitigate the many issues intertwined with narcissism, such as addiction, compulsive behaviors, and self-imposed social isolation [1]. Identifying mechanisms and triggers of narcissistic behavior can lead to more effective treatment, helping both narcissistic individuals and their peers [2].

How is Narcissism Diagnosed and Portrayed?

The majority of neuroscientific studies on grandiose narcissism use the Narcissistic Personality Inventory (NPI), which scores people on criteria that investigate entitlement, exploitativeness, exhibitionism, and lack of empathy. This assessment asks a patient how much they relate to certain statements such as, “If I ruled the world it would be a better place [2].” 

Generally, narcissistic individuals self-report high levels of life satisfaction and self-esteem [3]. They also demonstrate self-inflating tendencies, such as rating themselves as more intelligent or attractive than others may perceive them [4]. Overall, individuals exhibiting grandiose narcissism appear to be prideful and overconfident. However, another dimension of narcissism is key to understanding the trait: inhibition and vulnerability [4]. 

How Can a Negative Self-image Exist Within Narcissism? 

Narcissism is traditionally associated with a grandiose self-view. However, studies have indicated negative responses to self-referential material, such as photos or videos of oneself, in individuals scoring high on the NPI. These results suggest that the processes behind self-perception in narcissism are complex and are still a current area of focus in neuroscience research.

A study investigating narcissism’s effect on the viewing of self-referential material placed subjects under fMRI while they looked at photos of themselves, loved ones, and strangers [4]. These scientists found that when viewing photos of themselves, participants who scored higher on the NPI experienced higher activation of what they called the social pain network, a group of brain regions that also respond to social anxiety and exclusion [4]. This result can be interpreted in many ways, with most hypothesizing that aversion to looking at one’s own face stems from the need to maintain a high self-image. Researchers suggest that viewing “real” material could contradict the grandiose image held by a narcissistic individual, causing distress [4] .

Individuals scoring higher on the NPI also exhibited different facial processing in an electroencephalogram (EEG) study, which measured bulk electrical activity in their brains when looking at their own faces compared to those of celebrities [5]. There is a characteristic signal on an EEG recording, known as a P1 component, that reflects early stage processing of a face. When individuals with high scores on the NPI viewed their own face, they experienced a lower P1 component as compared to when they saw a celebrity. An interpretation of these findings is that narcissism is associated with an inhibition of early stage processing of one’s own face in order to maintain the grandiose self-image [5].

How do Narcissistic Individuals Internalize Rejection?

While we mainly perceive individuals with narcissistic tendencies as having inflated self-confidence, there are some documented connections with low self-esteem and a lack of trust in others [6]. This dynamic between social interaction and narcissism has been closely investigated, leading to the overarching question: how do narcissistic individuals respond to interpersonal rejection and stressful situations? Narcissists are commonly portrayed in the media as callous and cold, but some current research suggests this may be less clearly defined. When in socially exclusive or stressful situations, they demonstrate higher levels of sensitivity and markers of stress, and understanding these responses may help with the development of treatment [1][7][8]. For example, some studies have examined biological markers in response to induced situations of rejection. One such study investigated the effects of narcissism on neural responses to rejection in adolescent males [1]. Subjects were assigned to play a game called Cyberball while undergoing functional magnetic resonance imaging (fMRI), a technique that gives insight into brain region activity by imaging oxygenated blood flow in the brain. Cyberball is a virtual ball game in which you can choose to toss the ball to any of your fellow participants. However, while subjects were told that they would play against live people, the study had in reality matched them against a program that arranged periods of inclusion and exclusion. This allowed the researchers to see neural responses during these contrasting situations. The fMRI data suggested that individuals who scored higher on the NPI tended to demonstrate higher activation of the social pain network throughout the game. Increased activation of the social pain network has been suggested in other studies as a neural response in induced periods of exclusion, and activation of one of the regions in the social pain network, the dorsal anterior cingulate cortex, has also been correlated with self-reported feelings of exclusion [1]. Individuals scoring high on the NPI also display higher stress reactions when interacting with rejection or material about rejection [8]. When reading stories about rejection by a romantic partner, the individuals reported higher levels of anger and elevated blood pressure [8]. These emotional and physical responses suggest hypersensitivity to ostracism, contradicting the self-reports of narcissistic individuals. 

One study also showed an elevated stress response in narcissistic individuals when placed under the Trier Social Stress Test (TSST) [7]. In this test, individuals are assigned to do stressful tasks such as public speaking or doing mental math in front of an audience. While this test evokes stress responses in most individuals, it was found that narcissistic men experienced more pronounced responses, as measured by salivary levels of cortisol, a marker of stress [7]. Overall, these studies suggest that increased levels of distress are associated with experiences that threaten to affect social standing or perception of self in narcissistic individuals.

How do Narcissistic Individuals React to Rejection?

Narcissistic individuals are known for retaliatory acts of aggression and manipulation [9]. They can be secretive and erratic, making them challenging to treat [9]. Understanding how disproportionate distress in response to certain situations affects narcissistic behavior is key for future treatments. 

A subsequent study to the one that linked social pain network activation and narcissism made alterations to the Cyberball game in order to investigate the relationship between exclusion and aggression in narcissistic individuals [9]. By adjusting Cyberball to allow participants to issue loud noise blasts when frustrated by the other players, researchers were able to investigate whether there was a relationship between participants' neural activity and the administration of these blasts. Researchers saw that individuals with higher social pain network activation were also more likely to show aggression than those who had lower levels of activation [9]. The combined results of the Cyberball studies suggest that increased hypersensitivity to exclusion may be a sign of distress when faced with a real versus perceived self-image. Exclusion threatens the inflated self-image, leading to more intense reactions and increased reactive aggression [9]. 

These results have been applied to interpret actions in subsequent research. One study investigated how threatening the status of children with narcissistic tendencies affected behavior [10]. A large sample of children was randomly ranked into “low” or “high” social status groups, and their behaviors were analyzed. Children who scored high on the 10‐item Childhood Narcissism Scale, an assessment similar to the NPI, demonstrated stronger hostile responses when placed in a “low” status group. This aligned with the hypothesis that exclusion triggers more intense and thus larger acts of retaliation in those with higher levels of narcissism [10].

Clinical Narcissism: Narcissistic Personality Disorder

When narcissism exists at a clinical level, medical practitioners diagnose it as Narcissistic Personality Disorder (NPD). Current therapeutic treatments for NPD remain largely ineffective. Therapy tends to induce only slow improvements in the manifestation of this disorder, and estimates show that the dropout rate is around 64% [11]. Current practice involves attempting to develop a close alliance between the provider and patient as a strategy to build trust and increase the effectiveness of treatment. No medications have been FDA-approved for the treatment of NPD, but some individuals have benefitted from medication that treats borderline personality disorder, which shares the symptoms of inappropriate anger and manipulative tendencies [12]. Future research will hopefully further clarify the motivations and biological mechanisms behind the behavior of those with NPD, aiding in the development of therapeutic and pharmacological approaches. While many studies are performed on subclinical narcissism rather than NPD, they can still help to inform treatment on the disorder.

Future Directions

The applications of neuroscientific studies in narcissism treatment show great promise. By exploring the complex dynamic of negative self-view and narcissism, studies have revealed the extreme sensitivity to exclusion and self-referential material of narcissistic individuals. The responses of these participants give insight into the thoughts behind narcissistic behavior. These studies do, however, have limitations: many have small sample sizes and investigate very subtle connections, making it difficult to draw overarching conclusions. In addition, relying on self-reporting methodology is complex, as responses may be influenced by the tendency to mask certain feelings to maintain a grandiose self-image. However, all progress must start somewhere. Even initial findings can help medical professionals to better understand narcissism and aid in the development of more effective therapeutic treatments. 

References

  1. Cascio, C. N., Konrath, S. H., & Falk, E. B. (2015). Narcissists' social pain seen only in the brain. Social cognitive and affective neuroscience, 10(3), 335–341. https://doi.org/10.1093/scan/nsu072
  2. Miller, J. D. , McCain, J. , Lynam, D. R. , Few, L. R. , Gentile, B. , MacKillop, J. , & Campbell, W. K. (2014). A comparison of the criterion validity of popular measures of narcissism and narcissistic personality disorder via the use of expert ratings. Psychological Assessment, 26, 958–969. doi.org/10.1037/a0036613
  3. Limone, P., Sinatra, M., & Monacis, L. (2020). Orientations to Happiness between the Dark Triad Traits and Subjective Well-Being. Behavioral sciences (Basel, Switzerland), 10(5), 90. https://doi.org/10.3390/bs10050090 
  4. Jauk, E. , Benedek, M. , Koschutnig, K. , Kedia, G. , & Neubauer, A. C. (2017). Self-viewing is associated with negative affect rather than reward in highly narcissistic men: An fMRI study. Scientific Reports, 7. doi.org/10.1038/s41598-017-03935-y
  5. Mück, M. , Ohmann, K. , Dummel, S. , Mattes, A. , Thesing, U. , & Stahl, J. (2020). Face perception and narcissism: Variations of event-related potential components (P1 & N170) with admiration and rivalry. Cognitive, Affective, & Behavioral Neuroscience. doi.org/10.3758/s13415-020-00818-0
  6. Kaufman, S. B., Weiss, B., Miller, J. D., & Campbell, W. K. (2020). Clinical Correlates of Vulnerable and Grandiose Narcissism: A Personality Perspective. Journal of personality disorders, 34(1), 107–130. https://doi.org/10.1521/pedi_2018_32_384
  7. Edelstein, R. S. , Yim, I. S. , & Quas, J. A. (2010). Narcissism predicts heightened cortisol reactivity to a psychosocial stressor in men. Journal of Research in Personality, 44, 565–572. doi.org/10.1016/j.jrp.2010.06.008
  8. Sommer, K. L. , Kirkland, K. L. , Newman, S. R. , Estrella, P. , & Andreassi, J. L. (2009). Narcissism and cardiovascular reactivity to rejection imagery. Journal of Applied Social Psychology, 39, 1083–1115. doi.org/10.1111/j.1559-1816.2009.00473.
  9. Chester, D. S., & DeWall, C. N. (2016). Sound the Alarm: The Effect of Narcissism on Retaliatory Aggression Is Moderated by dACC Reactivity to Rejection. Journal of personality, 84(3), 361–368. https://doi.org/10.1111/jopy.12164
  10. Grapsas, S. , Denissen, J. J. A. , Lee, H. Y. , Bos, P. A. , & Brummelman, E. (2020). Climbing up or falling down: Narcissism predicts physiological sensitivity to social status in children and their parents. Developmental Science. doi.org/10.1111/desc.13062
  11. Jauk, E., & Kanske, P. (2021). Can neuroscience help to understand narcissism? A systematic review of an emerging field. Personality neuroscience, 4, e3. https://doi.org/10.1017/pen.2021.1
  12. Caligor, E., Levy, K. N., & Yeomans, F. E. (2015). Narcissistic personality disorder: diagnostic and clinical challenges. The American journal of psychiatry, 172(5), 415–422. https://doi.org/10.1176/appi.ajp.2014.14060723