The hidden face of pathological narcissism: the vulnerable narcissist

The last decade has seen a growing interest from scientific literature in the construct and diagnosis of narcissistic personality disorder (Yakeley, 2018). This interest spread through popular books and television works that brought this diagnosis to the attention of the general public, often highlighting the negative elements on the social and relational level, unfortunately overshadowing the complexity of this diagnosis and the discomfort it entails.

The diagnosis of narcissistic personality disorder

According to the DSM-5 auditor (2022), the Narcissistic personality disorder It is characterized by unstable self -esteem and attempts to regulate it through the search for attention and approval or through manifest or hidden grandeur.

In particular, at least five of the following characteristics must be present:

1. Great sense of importance
2. Successful fantasies, power, unlimited charm or ideal love that absorb the person
3. Beliefs about one’s specialty and uniqueness and to be able to be understood by equally special people
4. Excessive requests for admiration
5. Unreasonable expectation of receiving favor treatments
6. Exploitation of interpersonal relationships for their purposes
7. Difficulty in recognizing or identifying with the feelings of others
8. Feelings of envy or feeling of being envied
9. Arrogant and presumptuous attitudes

Beyond the, albeit necessary, diagnostic classification, literature identifies the heart of the narcissistic personality disorder with a psychopathological nucleus consisting of an instability of self -image that oscillates between superiority and ferocious criticism.

The fear of feeling inadequate, inamable or unworthy It is such that the narcissistic person develops strategies and automatisms that can protect it from such experiences.

In general, the desire to maintain a positive self -image is shared by each human being. Each person searches, to some extent, validation and acceptance, as well as approval and recognition of their own autonomy (Pincus, 2013).

In the person with a narcissistic personality disorder, this purpose assumes such importance as to become regulatory of one’s choices, aspirations and relationships.

Vulnerable grandeur or grandiose vulnerability?

Literature is more and more frequently detecting the presence of two key elements of the narcissistic disorder of personality apparently incompatible with each other: the theme of grandeur and that of vulnerability (Pincus and Lukowitsky, 2010).

As highlighted by Pincus and Roche in 2012, grandeur and vulnerabilitythey can be read as themes generated by the need to maintain a good self-image that is pursued with self-exaltation aspects (grandiose aspects), but which can expose to deep alarm and hyper-video states connected to the fear of receiving criticism, pity or aggressions (vulnerable aspects).

It is necessary to underline how on the diagnostic level we have not yet reached an official distinction with respect to any Narcissistic personality disorder subtypes. Literature, however, seems to agree in grasping the differences and shades of different presentations of the disorder which, while contemplating the same psychopathological nucleus, are expressed at a cognitive, emotional and behavioral level in different ways.

Greatness

The theme of grandeur is historically associated with the narcissistic personality disorder since its first definition. Grandiness is the result of an attempt at self-exaltation that involves a sense of superiority and contempt for others. The other is seen essentially as a source of admiration without regard for his expectations, feelings and points of view.

Vulnerability

As mentioned, pursuing a positive self -image is a natural need for every human being, in the narcissistic personality disorder, however this assumes such an importance as to condition the entire existence by dominating the patient’s emotional world. The greater the tendency of the person to perceive a threat to the self -image, the greater the presence of moments and experiences of vulnerability (Pincus and Roche, 2012).

When the self -image is threatened, they can take action in the person with narcissistic disorder of intense personality lived of envy, frustration, anger flanked by devitalizing emotions such as impotence, sense of emptiness, shame and social retreat (Miller et al., 2017).

Two sides of the same medal

Here, therefore, that grandeur and vulnerability represent antithetical methods, but connected to maintain a positive self -image and good self -esteem.

It would be a mistake, however, to consider the labels “grandiose narcissism” and “vulnerable narcissism” as separate and autonomous manifestations of the same nucleus.

On the contrary, literature (Pincus et al., 2014) indicates how openly grandiose manifestations can appear simultaneously or coexisting in short arches of time with typical demonstrations of vulnerability.

The preferentiality with which great and vulnerable aspects are manifested in a person defines the subtype to which it can belong without excluding, however, temporary transitions in manifestations of the opposite “sign”.

For example, although an individual with vulnerable pathological narcissism can be submissive and condescending with colleagues, it could become openly devaluing with the partner once returned home.

The vulnerable narcissist

The person with a vulnerable narcissistic disorder is characterized by a high sensitivity to the threat and the tendency to use reaction strategies marked by attack and escape (Gray, 1982).

Unlike the grandiose subtype, the vulnerable narcissist tends to take on a more conservative attitude aimed at preventing any damage to the image of himself. In this sense, it is characterized by introverted behaviors, shyness and condescending that can, at the same time, take traits of contempt for the other.

Grandiness and envy are hidden, frequently lived in grandiose patterns centered on the revenge and social redemption.

The personality vulnerable narcissist He can fear to engage in activities for the fear of failing, except, then, to feel car resentment and straight for a recognition and admiration not obtained.

As is imaginable, another important aspect typical of people with vulnerable narcissism is that the self -image is highly dependent on the signals coming from the context. Having an unstable idea of ​​self, attention is paid extremely to social context in order to prevent threats and disapproval. Here, therefore, that these individuals are extremely sensitive to both praise and criticism.

Relationships with intense anxiety live (sometimes managed with detachment and divestment from the relationship) and with a deep distrust in the other which becomes a source of validation, but at the same time of fear and envy. It is no coincidence that many patients with social anxiety disorder have this type of personological structure.

The vulnerable narcissist, in fact, while wishing approval and validation comes to demand it within relationships as if it were a right by implementing manipulative and passive-aggressive behaviors.

This attitude generates in the other anger and distance which, unconsciously, confirm the idea of ​​the vulnerable narcissistic person to be defective.

The treatment of vulnerable narcissism

As already mentioned, if on the one hand the vulnerable sub-spirit of the narcissistic personality disorder is not officially recognized, on the other it is important to remember that a share of narcissistic aspects can be functional to the well-being and conservation of self-esteem.

Therefore, the intervention on these traits should be taken into consideration if persistent and pervasive compromises emerge in the quality of life, in the relationships and well -being of the person.

The treatments for the narcissistic personality disorder currently with greater evidence of efficacy are within the family of cognitive-behavioral therapies, of which the CBT for personality disorders (Matusiewicz et al., 2010) are examples,, 2010), interpersonal metacognitive therapy (Carcione & Semerari, 2017) and the Therapy scheme (Young et al.. Al., 2018).

Despite through different techniques and priorities of intervention, each approach to the narcissistic personality disorder has the person’s increase in the ability of the person to read his mental content, developing the ability to manage relationships and achievement of life objectives in a more functional way.

For example, within the theoretical frame of the Therapy schemethe treatment of the narcissistic disorder of vulnerable personality can be divided into some phases:

• Discovery of the psychological functioning of the person in terms of mental states including the typical experiences of vulnerable narcissism of humiliation, distance from others and envy.
• I work on the internal dialogue, often critical and devaluing, which the person addresses himself and to others in order to understand birth and function.
• Exploration of emotional experiences, both on the side of anger and sadness, which are activated in situations perceived as difficult.
• Development of interior content management skills, the so -called functional adult, in order to reduce automatic both internal (thoughts and negative) and behavioral emotions responses (coping fashions) in the different life situations.

In conclusion, the narcissistic disorder of personality vulnerable phenotype is one of the multiple expressions of a complex personality organization. A personality centered on self -defense and one’s image. Psychotherapy, therefore, can provide a relational opportunity to reduce this sense of threat and build new spaces of personal choice beyond what has been learned during the first relational experiences.

Bibliographic references

• American Psychiatric Association Publishing. (2022). Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR.
• Carcione, A., & Semerari, A. (2018). Narcissism and its disorders: interpersonal metacognitive therapy. Erickson.
• Matusiewicz, Ak, Hopwood, CJ, Banducci, An, & Lejuez, CW (2010). The Effectiveness of Cognitive Behavoral Therapy for Personality Disorders. Psychiatric Clinics of North America, 33(3), 657–685. https://doi.org/10.1016/j.psc.2010.04.007
• Miller, JD, Lynam, Dr, Hyatt, CS, & Campbell, WK (2017). Controversies in Narcissism. Annual Review of Clinical Psychology, 13(1), 291–315. https://doi.org/10.1146/annurev-clinpsy-032816-045244
• Pincus, al (2013). The Pathological Narcissism Inventory. Undersanding and Treating Pathological Narcissism.93–110. https://doi.org/10.1037/14041-006
• Pincus, al, & Lukowitsky, Mr (2010). Pathological Narcissism and Narcissistic Personality Disorder. Annual Review of Clinical Psychology, 6(1), 421–446. https://doi.org/10.1146/annurev.clinpsy.121208.131215
• Pincus, Al, & Roche, MJ (2012). Narcissistic grandiosity and narcissistic vulnerability. The Handbook of Narcissism and Narcissistic Personality Disorder31–40. https://doi.org/10.1002/97811118093108.ch4
• Pincus, Al, Cain, Nm, & Wright, AG (2014). Narcissistic grandization and narcissistic vulneratability in Psychotherapy. Personality Disorders: Theory, Research, and Treatment, 5(4), 439–443. https://doi.org/10.1037/per0000031
• Rodiger, E., Stevens, B., & Brockman, R. (2018). Contextual Therapy Scheme: an supplementary approach to Personality Disorders, Emotional Dysreguration, and Interpersonal Functioning. Context Press.
• Yakeley, J. (2018) “Current Understanding of Narcissism and Narcissistic Personality Disorder,” Bjpsych Advances24 (5), pp. 305–315. Available at: https://doi.org/10.1192/bja.2018.20.
• Young, Je, Klosko, Js, & Weishaar, Me (2003). Therapy scheme: a Practitioner’s Guide. Guilford Press.