What is Pathological Narcissism?

Do you know someone who always wants admiration and control and puts down others to get it? You might be dealing with a pathological narcissist. Learn about pathological narcissism, its causes and symptoms, and how to treat this personality disorder.

Narcissism, a term frequently used in everyday language, describes self-absorbed or vain people. However, when so-called normal narcissism crosses the line from a personality trait into a psychological disorder, it becomes a serious mental health condition known as narcissistic personality disorder (NPD). NPD can go on for years, significantly impacting interpersonal relationships and life quality. One specific branch of narcissism, known as pathological narcissism, refers to a more consistent and destructive form of narcissism that infiltrates nearly every aspect of a person’s life, making it a crucial topic within clinical psychology and social psychology. Here is what to expect from a pathological narcissist, signs to look out for, and how to treat pathological narcissism.

What is pathological narcissism?

Pathological narcissism is a deeply ingrained personality disorder demonstrated by extreme self-centeredness, an inflated sense of power, an insatiable need for admiration, and a lack of empathy. Extending beyond narcissistic traits like confidence or vanity, this disorder enters the realm of narcissistic personality pathology (the presence of maladaptive, widespread patterns of thinking, feeling, and behaving associated with narcissism).

Additionally, pathological narcissism leads to considerable interpersonal dysfunction, which refers to persistent difficulties in forming and maintaining healthy, stable relationships with others. 

Understanding pathological narcissism in a clinical context

In a clinical setting, a personality assessment involves specialized tools such as the pathological narcissism inventory (PNI) and the narcissistic personality inventory (NPI) to help identify pathological narcissism. These instruments allow clinicians to identify narcissistic traits along a scale, from normal, adaptive narcissism to the more destructive, pathological forms that lead to dysfunction. The use of these assessments is key to distinguishing pathological narcissism from other mental health conditions that might share overlapping characteristics, such as borderline personality disorder (BPD) or antisocial personality disorder (ASPD).

An understanding of pathological narcissism is important, as it often coexists with other forms of personality pathology, leading to emotional dysregulation and severe interpersonal difficulties. The spectrum-based approach to evaluating narcissistic traits helps clinicians develop tailored treatment strategies that address both the overt grandiosity, or vanity, and the underlying vulnerabilities that fuel destructive behaviors.

Types of pathological narcissism

1. Grandiose narcissism

Grandiose narcissism is characterized by a belief in one’s superiority and inflated sense of self-importance, making it what people typically envision when they hear the term “narcissist.” People with grandiose narcissism are often charming and charismatic, initially drawing people in with their confidence in order to fulfill their narcissistic needs. However, their narcissistic traits, such as exploitation and manipulation, often lead to the collapse of their personal relationships and erosion of self-esteem to the receiver of the narcissistic abuse. 

2. Vulnerable narcissism

In contrast, a vulnerable narcissist does not exhibit overt arrogance or confidence, but instead tends to be shy, insecure, and prone to feelings of inadequacy. Vulnerable narcissists are hypersensitive to criticism and frequently react with narcissistic rage when they feel that their fragile self-image is being threatened, still driving manipulative behavior. Unlike grandiose narcissists, they hide their narcissistic vulnerability behind a facade of confidence to internalize their feelings of worthlessness, making them more susceptible to conditions like depression and anxiety.

3. Covert narcissism

Covert narcissism is a subtype of vulnerable narcissism, where people often mask their sense of superiority under a guise of modesty or victimhood. Covert narcissists might portray themselves as misunderstood geniuses or martyrs, seeking sympathy rather than outright admiration. However, their belief in their own uniqueness remains intact, and their manipulative tendencies are often as strong as those seen in grandiose narcissists.

4. Malignant narcissism

Malignant narcissism is a particularly dangerous form of narcissism that blends traits of NPD with antisocial personality disorder. These people display a toxic combination of arrogance, aggression, and a lack of remorse, and often engage in manipulative behavior in order to exert control over others. Furthermore, a malignant narcissist may end up engaging in abusive or criminal behavior due to the enjoyment they get from putting others down. 

Narcissistic traits in personality disorders

Narcissism exists on a spectrum, from healthy narcissism to pathological narcissism. The term “healthy narcissism” refers to the normal part of human development; maintaining a stable sense of self-esteem and asserting their needs without disregarding others. On the opposite end of the spectrum is pathological narcissism, where narcissistic traits become so extreme that they impair mental health and interpersonal functioning.

Personality traits such as self-confidence and ambition are not inherently negative, however, when these traits dominate someone’s personality, it becomes a form of personality pathology. When pathological narcissists crave power and put others down in order to achieve it, their ability to empathize or form meaningful relationships can be  impacted. Clinicians rely on tools like the NPI and PNI to measure the severity of these narcissistic traits and determine whether or not they have reached a pathological level.

Risk factors for pathological narcissism

The development of pathological narcissism is influenced by multiple factors, ranging from genetic makeup to environmental experiences. Additionally, social science research indicates that people with narcissistic traits often have a distorted view of themselves, shaped by unresolved emotional trauma or insecurities. Here are the main risk factors for pathological narcissism.

Genetic predisposition

In some cases, inherited traits such as high extroversion, low agreeableness, or emotional instability can play a role in susceptibility to developing narcissistic behaviors. While these traits aren’t necessarily dangerous at first, the chance of them becoming narcissistic pathology increases with a family history of narcissism. These behaviors can influence how a person responds to criticism or vulnerability, potentially leading to grandiosity, entitlement, or the constant need for admiration. 

Environmental influences

Early childhood experiences are pivotal in shaping how a person’s behaviors are expressed and reinforced throughout life. Parenting styles, in particular, are critical for shaping a child. For example, constantly praising a child without realistic feedback can foster a sense of entitlement in that child. On the other hand, neglect or emotional abuse can lead a child to feelings of inadequacy, driving them to adopt narcissistic defenses, such as inflated self-importance, to protect a fragile self-esteem. 

The impact of pathological narcissism on mental health

Pathological narcissism can lead to a wide range of mental disorders such as, depression, anxiety, and other mood disorders due to their inability to form fulfilling relationships or experience emotional intimacy. This lack of interpersonal functioning and empathy further isolates them, creating a vicious cycle of emotional instability and self-centered behavior. As these emotional patterns persist, people with pathological narcissism may develop maladaptive coping mechanisms, such as substance abuse or compulsive behaviors, in an attempt to manage their overwhelming feelings of inadequacy and emptiness. 

Additionally, co-occuring conditions such as bipolar disorder and antisocial personality disorder often complicate the clinical picture, as the interaction between them can result in heightened emotional dysregulation and increased risk of harmful behaviors, both toward themselves and others.

Treatment and management of pathological narcissism

In many cases, people with pathological narcissism are reluctant to seek help, as they do not believe they have a problem. Their inflated sense of self and need to maintain a facade of superiority often prevents them from acknowledging their vulnerabilities or recognizing the negative impact their behavior has on others.  

1. Psychotherapy

Psychotherapy is the most common treatment for NPD, particularly in the form of cognitive behavioral therapy (CBT), to help them recognize and change their narcissistic grandiosity, improve emotional regulation, and develop healthier interpersonal behaviors. Furthermore, CBT can help the narcissistic patient develop empathy, encouraging them to understand others’ perspectives, recognize the impact of their actions on relationships, and cultivate more compassionate and meaningful interactions with those around them. 

2. Medication

While there is no specific medication to treat pathological narcissism itself, it can be used to treat co-occurring disorders commonly associated with it, such as depression, anxiety, or mood swings. These medications may be prescribed to help manage the emotional instability that often accompanies pathological narcissism, particularly when the person is dealing with feelings of inadequacy, irritability, or intense stress. Consequently, addressing these underlying symptoms with medication can improve emotional regulation and make psychotherapy more effective, allowing the person to engage more constructively in treatment. 

How Charlie Health can help

If you or a loved one are struggling with a mental health disorder, Charlie Health is here to help. Charlie Health’s virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for dealing with serious mental health conditions. Our expert clinicians incorporate evidence-based therapies into individual counseling, family therapy, and group sessions. With treatment, managing your mental health is possible. Fill out the form below or give us a call to start healing today.