We asked the relatives of people high in narcissistic traits (indexed by scoring above a cut-off on a narcissism screening measure) to describe their relationships (N = 436; current romantic partners [56.2%]; former romantic partners [19.7%]; family members [21.3%]). Participants were asked to describe their relative and their interactions with them. Verbatim responses were thematically analysed.
Participants described ‘grandiosity’ in their relative: requiring admiration, showing arrogance, entitlement, envy, exploitativeness, grandiose fantasy, lack empathy, self-importance and interpersonal charm. Participants also described ‘vulnerability’ of the relative: contingent self-esteem, hypersensitivity and insecurity, affective instability, emptiness, rage, devaluation, hiding the self and victimhood. These grandiose and vulnerable characteristics were commonly reported together (69% of respondents). Participants also described perfectionistic (anankastic), vengeful (antisocial) and suspicious (paranoid) features. Instances of relatives childhood trauma, excessive religiosity and substance abuse were also described.
These findings lend support to the importance of assessing the whole dimension of the narcissistic personality, as well as associated personality patterns. On the findings reported here, the vulnerable aspect of pathological narcissism impacts others in an insidious way given the core deficits of feelings of emptiness and affective instability. These findings have clinical implications for diagnosis and treatment in that the initial spectrum of complaints may be misdiagnosed unless the complete picture is understood. Living with a person with pathological narcissism can be marked by experiencing a person who shows large fluctuations in affect, oscillating attitudes and contradictory needs.
The current diagnostic description of narcissistic personality disorder (NPD) as it appears in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5, 5th edition, ) includes a lot of information about how the person affects others, such as requiring excessive admiration, having a sense of entitlement, interpersonal exploitativeness, showing both a lack of empathy for others and feeling others are envious of their perceived special powers or personality features. Despite these features being important aspects of narcissism that have been validated through empirical research [2, 3], they have been criticised for their emphasis on grandiosity and the exclusion of vulnerability in narcissism [4, 5], a trend that is mirrored in the field more generally and runs counter to over 35 years of clinical theory . The more encompassing term ‘pathological narcissism’ has been used to better reflect personality dysfunction that is fundamentally narcissistic but allows for both grandiose and vulnerable aspects in its presentation .
Recognising the vulnerable dimension of narcissism has significant implications for treatment , including providing an accurate diagnosis and implementing appropriate technical interventions within treatment settings. Vulnerable narcissism, in marked contrast to the overt grandiose features listed in DSM-5 criteria, includes instances of depressed mood, insecurity, hypersensitivity, shame and identification with victimhood [8,9,10,11,12]. Pincus, Ansell  developed the Pathological Narcissism Inventory (PNI) to capture this narcissistic vulnerability in three factors. The factor ‘contingent self-esteem’ (item example: ‘It’s hard for me to feel good about myself unless I know other people like me’) reflects a need to use others in order to maintain self-esteem. The factor ‘devaluing’ includes both devaluation of others who do not provide admiration needs (‘sometimes I avoid people because I’m concerned that they’ll disappoint me’) and of the self, due to feelings of shameful dependency on others (‘when others disappoint me, I often get angry at myself’). The factor ‘hiding the self’ (‘when others get a glimpse of my needs, I feel anxious and ashamed’) reflects an unwillingness to show personal faults and needs. This factor may involve a literal physical withdrawal and isolation  but may also include a subtler emotional or psychic withdrawal due to feelings of inadequacy and shame which may result in the development of an imposter or inauthentic ‘false self’ [11, 15], and which may also include a disavowal of emotions, becoming emotionally ‘empty’ or ‘cold’ . Another aspect described in the literature are instances of ‘narcissistic rage’  marked by hatred and envy in response to a narcissistic threat (i.e. threats to grandiose self-concept). Although commonly reported in case studies and clinical reports, it is unclear if it is a feature of only grandiose presentations or if it may more frequently present in vulnerable presentations .
While the differences in presentation between grandiose and vulnerable narcissism appear manifest, it has been argued that they reflect both sides of a narcissistic ‘coin’  that may be regularly oscillating, inter-related and state dependent [6, 18,19,20,21,22]. As such, it may not be as important to locate the specific presentation of an individual as to what ‘type’ they are (i.e. grandiose or vulnerable), as it is to recognise the presence of both of these aspects within the person . The difficulty for these patients is the pain and distress that accompanies having such disparate ‘split off’ or unintegrated parts of the self, which result in the defensive use of maladaptive intra and interpersonal methods of maintaining a stable self-experience . This defensive operation is somewhat successful, and may give the impression of a coherent and stable identity, however as noted by Caligor and Stern  “manifestly vulnerable narcissists retain a connection to their grandiosity … [and] even the most grandiose narcissist may have internal feelings of inadequacy or fraudulence” (p. 113).
The vulnerable dimension of narcissism, with its internal feelings of emptiness and emotion dysregulation, may reflect a more general personality pathology similar to that of borderline personality disorder (BPD) . For instance, Euler, Stobi  found grandiose narcissism to be related to NPD, but vulnerable narcissism to be related to BPD. In a similar vein, Hörz-Sagstetter, Diamond  proposes grandiosity as a narcissistic ‘specific’ factor that distinguishes it from other disorders (e.g. BPD). This grandiosity, however, “predisposes [these individuals] to respond with antagonism/hostility and reduced reality testing when the grandiose self is threatened” (p.571). This antagonism, hostility and the resultant interpersonal dysfunction are well-documented aspects of pathological narcissism [29,30,31,32], that exacts a large toll on individuals in the relationship [33, 34]. As the specific features of the disorder are perhaps therefore best evidenced within the context of these relationships, gaining the perspective of the ‘other’ in the relationship would present a unique perspective that may not be observable in other contexts (e.g. clinical or self-report research). For example, a recent study by Valashjardi and Charles  provided such a perspective within the context of domestic violence. They found that those in a relationship with individuals with reportedly narcissistic features described overt (e.g. verbal and physical) and covert (e.g. passive-aggressive and manipulative) expressions of abuse and that these behaviours were in response to perceived challenges to authority and to counteract fears of abandonment. As such, informant ratings may be a novel and valid methodology to assess for personality pathology , as documented discrepancies between self-other ratings suggest that individuals with pathological narcissism may not provide accurate self-descriptions . Further, Lukowitsky and Pincus  report high levels of convergence for informant ratings of narcissism, indicating that multiple peers are likely to score the same individual similarly and, notably, individuals with pathological narcissism agreed with observer ratings of interpersonal dysfunction, again highlighting this aspect as central to the disorder . The aim of this study is to investigate the reported characteristics of individuals with pathologically narcissistic traits from the perspective of those in a significant personal relationship with these individuals. For this research, partners and family members will be referred to as ‘participants’. Individuals with pathological narcissism will be referred to as the ‘relative’.
Participants were relatives of people reportedly high in narcissistic traits, and all provided written informed consent to allow their responses to be used in research, following institutional review board approval. The participants were recruited through invitations posted on various mental health websites that provide information and support that is narcissism specific (e.g. ‘Narcissistic Family Support Group’). Recruitment was advertised as being specifically in relation to a relative with narcissistic traits. A number of criteria were applied to ensure that included participants were appropriate to the research. First, participants had to identify as having a ‘significant personal relationship’ with their relative. Second, participants had to complete mandatory questions as part of the survey. Mandatory questions included basic demographic information (age, gender, relationship type) and answers to qualitative questions under investigation. Non-mandatory questions included questions such as certain demographic questions (e.g. occupation) and questions pertaining to their own support seeking. Third, the relative had to have a cumulative score of 36 (consistent with previous methodology, see ) or above on a narcissism screening measure (described in Measures section), as informed by participants.
A total of 2219 participants consented to participate in the survey. A conservative data screening procedure was implemented to ensure that participants were appropriate to the research. First, participants were removed who indicated that they did not have a ‘significant’ (i.e. intimate) personal relationship with someone who was narcissistic (n = 129). Second, participants who clicked on the link to begin the survey but dropped out within the first 1–5 questions were deemed ‘non-serious’ and were removed (n = 1006). Third, participants whose text sample was too brief (i.e. less than 70 words) to analyse were excluded (n = 399) as specified by Gottschalk, Winget . Finally, participants identified as rating relatives narcissism below cut off score of 36 on a narcissism screening measure were removed (n = 249). Inspection of pattern of responses indicated that none of the remaining participants had filled out the survey questions inconsistently or inappropriately (e.g. scoring the same for all questions). The remaining 436 participants formed the sample reported here. Table 1 outlines the demographic information of participants and the relative included in the study.
Two broad overarching dimensions were identified. The first dimension, titled ‘grandiosity’, included descriptions that were related to an actual or desired view of the self that was unrealistically affirmative, strong or superior. The second dimensions, titled ‘vulnerability’, included an actual or feared view of the self that was weak, empty or insecure. Beyond these two overarching dimensions, salient personality features not accounted for by the ‘grandiose’ or ‘vulnerable’ dimensions were included within a category reflecting ‘other personality features’. Themes not relating specifically to personality style, but that may provide insights regarding character formation or expression were included within the category of ‘descriptive themes’.
A total of 1098 node expressions were coded from participant responses (n = 436), with a total of 2182 references. This means participant responses were coded with an average of two to three individual node expressions (e.g. ‘hiding the self’, ‘entitlement’) and there were on average 5 expressions of each node(s) in the text.
Participants described the characterological grandiosity of their relative. This theme was made up of ten nodes: ‘Requiring Admiration’, ‘Arrogance’, ‘Entitlement’, ‘Envy’, ‘Exploitation’, ‘Grandiose Fantasy’, ‘Grandiose Self Importance’, ‘Lack of Empathy’, ‘Belief in own Specialness’ and ‘Charming’.
Participants described their relative as requiring excessive admiration. For instance, “He puts on a show for people who can feed his self-image. Constantly seeking praise and accolades for any good thing he does” (#1256); “He needs constant and complete attention and needs to be in charge of everything even though he expects everyone else to do all the work” (#1303).
Relatives were described as often displaying arrogant or haughty behaviours or attitudes. For instance, “He appears to not be concerned what other people think, as though he is just ‘right’ and ‘superior’ about everything” (#1476) and “My mother is very critical towards everyone around her… family, friends, neighbours, total strangers passing by… everybody is ‘stupid’” (#2126).
Relatives were also described as having a sense of entitlement. For example, “I paid all of the bills. He spent his on partying, then tried to tell me what to do with my money. He took my bank card, without permission, constantly. Said he was entitled to it” (#1787) and “He won’t pay taxes because he thinks they are a sham and he shouldn’t have to just because other people pay” (#380).
Participants described instances of their relative being envious or jealous of others. Jealousy, being in relation to the threatened loss of important relationships, was described by participants. For instance, after describing the abusive behaviours of their relative one participant stated “It got worse after our first son was born, because he was no longer the centre of my attention. I actually think he was jealous of the bond that my son and I had” (#1419). Other participants, despite using the term ‘jealous’, described more envious feelings in their relative relating to anger in response to recognising desirable qualities or possessions of others. For instance, another participant stated “[they have] resentment for people who are happy, seeing anyone happy or doing great things with their life makes them jealous and angry” (#1744). Some participants described their relative believing that others are envious of them, for example “[he] thought everyone was jealous he had money and good looks.” (#979) and “[he] tried to convince everyone that people were just jealous of him because he had a nice truck” (#1149).
Relatives were described as being interpersonally exploitative (i.e. taking advantage of others). For instance, one participant stated “He brags how much he knows and will take someone else’s knowledge and say he knew that or claim it’s his idea” (#1293). Another participant stated “With two other siblings that are disabled, she uses funding for their disabilities to her advantage … I do not think she cares much for their quality of life, or she would use those funds for its intended use.” (#998).
Participants also described their relatives as engaging in unrealistic fantasies of success, power and brilliance. For instance, the response “He believes that he will become a famous film screen writer and producer although he has no education in film” (#1002); “He was extremely protective of me, jealous and woefully insecure. [He] went on ‘missions’ where he was sure [world war three] was about to start and he was going to save us, he really believes this” (#1230).
Relatives were described as having a grandiose sense of self-importance (e.g. exaggerating achievements, expecting to be recognised as superior without commensurate achievements). Examples of this include “He thinks he knows everything … conversations turn into an opportunity for him to ‘educate’ me” (#1046); “He tells endless lies and elaborate stories about his past and the things he has achieved, anyone who points out inconsistencies in his stories is cut out of his life” (#178).
Participants described their relatives as being unwilling to empathise with the feelings or perspectives of others. Some examples include “she has never once apologized for her abuse, and she acts as if it never happened. I have no idea how she can compartmentalize like that. There is no remorse” (#1099) and “[he] is incapable of caring for all the needs of his children because he cannot think beyond his own needs and wants, to the point of his neglect [resulting in] harm to the children” (#1488).
Relatives were described as believing they were somehow ‘special’ and unique. For example, one participant described their relative as fixated with their status as an “important [member] of the community” (#860), another participant stated “he considers himself a cut above everyone and everything… Anyone who doesn’t see him as exceptional will suffer” (#449). Other responses indicated their relatives were preoccupied with being associated with other high status or ‘special’ people. For instance, one participant stated that their relative “likes to brag about how she knows wealthy people as if that makes her a better person” (#318) and another stating that their relative “loves to name drop” (#49).
Participants also described their relative in various positive ways which reflected their relatives’ likeability or charm. For instance, “He is fun-loving and generous in public. He is charming and highly intelligent” (#1401); “His public persona, and even with extended family, is very outgoing, funny and helpful. Was beloved by [others]” (#1046) and “He is very intelligent and driven, a highly successful individual. Very social and personable and charming in public, funny, the life of the party” (#1800).
Participants described the characterological vulnerability of their relative. This theme was made up of nine nodes: ‘Contingent Self Esteem’, ‘Devaluing’, ‘Emotionally Empty or Cold’, ‘Hiding the Self’, ‘Hypersensitive’, ‘Insecurity’, ‘Rage’, ‘Affective Instability’ and ‘Victim Mentality’.
Participants described their relatives as being reliant on others approval in order to determine their self-worth. For instance, “She only ever seems to be ‘up’ when things are going well or if the attention is on her” (#1196) and “He appears to be very confident, but must have compliments and reassuring statements and what not, several times a day” (#1910).
Relatives were described as ‘putting down’ or devaluing others in various ways and generally displaying dismissive or aggressive behaviours. For instance, “On more than one occasion, he’s told me that I’m a worthless person and I should kill myself because nobody would care” (#1078) and “He feels intellectually superior to everyone and is constantly calling people idiotic, moron, whatever the insult of the day is” (#1681).
Relatives were also described as reacting to interpersonal disappointment with shame and self-recrimination, devaluing the self. For instance, “They are extremely [grandiose] … [but] when someone has the confidence to stand up against them they crumble into a sobbing mess wondering why it’s always their fault” (#1744) and “I have recently started to stand up for myself a little more at which point he will then start saying all the bad things are his fault and begging forgiveness” (#274).
Participants described regularly having difficulty ‘connecting’ emotionally with their relative. For instance, one participant described that their relative was “largely sexually disengaged, unable to connect, difficulty with eye contact … he used to speak of feeling dead” (#1365); another stated “he was void of just any emotion. There was nothing. In a situation of distress he just never had any feeling. He was totally void of any warmth or feeling” (#323), another stated “I gave him everything. It was like pouring myself into an emotional black hole” (#627).
Participants reported instances in which their relative would not allow themselves to be ‘seen’, either psychologically or physically. One way in which they described this was through the construction of a ‘false self’. For instance “He comes across very confident yet is very childish and insecure but covers his insecurities with bullish and intimidating behaviour” (#2109). Another way participants described this hiding of self was through a literal physical withdrawal and isolation. For example, “He will also have episodes of deep depression where he shuts himself off from human contact. He will hide in his room or disappear in his sleeper semi-truck for days with no regard for his family or employer” (#1458).
Participants reported feeling as though they were ‘walking on eggshells’ as their relative would respond volatilely to perceived attacks. For instance, “She cannot take advice or criticism from others and becomes very defensive and abusive if challenged” (#1485); “It was an endless mine field of eggshells. A word, an expression would be taken against me” (#532) and “Very irrational and volatile. Anything can set her off on a rage especially if she doesn’t get her way” (#822).
Relatives were described as having an underlying sense of insecurity or vulnerability. For instance “He really is just a scared little kid inside of a big strong man’s body. He got stuck when he was a child” (#1481); “At the core he feels unworthy, like a fake and so pretty much all introspection and self-growth is avoided at all costs” (#532) and “At night when the business clothes come off his fears eat him up and he would feel highly vulnerable and needs lots of reassurance” (#699).
Participants reported that their relatives were particularly prone to displaying explosive bouts of uncontrolled rage. For example, “He has a very fragile ego … he will fly off the handle and subject his target to hours of screaming, insults and tantrum-throwing” (#1078); “he has a temper tantrum-like rage that is frightening and dangerous” (#1476); “He has hit me once. Left bruises on upper arms and back. He goes into rage and has hit walls, hits himself” (#1637).
Relatives were also described as displaying affective instability which may be related to anxiety and depressive disorders. Relatives were commonly described as being ‘anxious’ (#1091) including instances of hypochondria (#1525), agoraphobia (#756), panic (#699) and obsessive compulsive disorder (#2125). Relatives were also commonly described as having episodes of ‘depression’ (#1106) and depressive symptoms such as low mood (#1931), problems sleeping (#1372). Some participants also described their relative as highly suicidal, with suicidality being linked to relationship breakdowns or threats to self-image. For example, “When I state I can’t take any more or say we can’t be together … he threatens to kill himself” (#1798); “If he feels he is being criticised or blamed for something (real or imagined) … his attacks become self-destructive” (#1800).
Participants reported that their relatives often described feeling as though they were the victim of attacks from others or taken advantage of in some way. For instance, “He seems to think that he has been ‘hard done by’ because after all he does for everyone, they don’t appreciate him as much as they should” (#1476); “He will fabricate or twist things that are said so that he is either the hero or the victim in a situation” (#447).
Participants also reported some descriptions of their relative that were not described within prior conceptualisations of narcissism. This theme was made up of 3 nodes: ‘Perfectionism’, ‘Vengeful’ and ‘Suspicious’.
Participants repeatedly described their relative displaying perfectionistic or unrelenting high standards for others. For instance, “I cannot just do anything at home everything I do is not to her standard and perfection” (#1586) and “Everything has to be done her way or it’s wrong and she will put you down. She has complete control over everything” (#1101).
Participants described their relative as being highly motivated by revenge and displaying vindictive punishing behaviours against others. Examples include, “[He] has expressed thoughts of wanting to hurt those who cause him problems” (#230); “He is degrading to and about anyone who doesn’t agree with him and he is very vengeful to those who refuse to conform to his desires” (#600) and “Once someone crosses him or he doesn’t get his way, he becomes vindictive and will destroy their life and property and may become physically abusive” (#707).
Participants described their relative as holding paranoid or suspicious beliefs about others intentions or behaviours. For instance, “He would start fights in public places with people because he would claim they were ‘looking at him and mimicking him’” (#1149) and “She is angry most days, obsessively talking about who wronged her in the past, currently or who probably will in the future” (#2116).
Several salient descriptive themes were also coded from the data that, while not relating directly to the relatives character, may provide peripheral or contextual information.
A number of participants described their relative as having experienced a traumatic or troubled childhood. One participant stated that their relatives’ father “was extraordinarily abusive both emotionally and physically to both him and the mother … [the father] pushed [the relative] as a young boy on prostitutes as a 12th birthday gift … He was beaten on and off from age 6 to 15 when he got tall enough to threaten back” (#1249). Another participant described the emotional upbringing of their relative “[his mother was] prone to being easily offended, fighting with him and cutting off all contact except to tell him what a rotten son he was, for months, then suddenly talking again to him as if nothing had ever happened. His father, he said, was strict and expected a lot of him. Both rarely praised him; whenever he accomplished something they would just demand better instead of congratulating him on his accomplishment” (#1909). Another participant reflected on how their relative’s upbringing may be related to their current emotional functioning, “personally I think he is so wounded (emotional, physical abuse and neglect) that he had to detach from himself and others so much just to survive” (#1640).
While participant’s comments on their relative’s religiosity were common, the content was varied. Some participants described their relative using religion as a mechanism to control, for instance “he uses religion in an extremely malignant way. Manipulating verses and religious sayings and interpret them according to his own will” (#132) and “very religious. She uses scripture to manipulate people into doing what she wants on a regular basis” (#1700). One participant described how their relative’s religiosity became infused with their grandiose fantasy “He has also gone completely sideways into fundamental religious doctrine, as if he knows more than the average ‘Christian’ about End Times, and all kinds of illuminati type conspiracy around that topic. He says God talks to him directly and tells him things and that he has had dead people talk to him” (#1476). Other participants described how their relative’s religiosity was merely an aspect of their ‘false self’, for example “she has a wonderful, loving, spiritual facade that she shows to the world” (#1073).
Participants regularly described their relative as engaging in substance use. Substances most frequently named were alcohol, marijuana, cocaine and ‘pills’. Participants reported that when their relative was using substances their behaviour often became dangerous, usually through drink driving, one participant stated “too much alcohol … he would drive back to [his work] … I was always afraid of [a driving accident]” (#76).
Of 436 participants, a total of 348 unique grandiose node expressions were present and a total of 374 unique vulnerable node expressions were present. Of these, 301 participants included both grandiose and vulnerable descriptions of their relative (69% of sample). Only 47 (11% of sample) focused on grandiose features in their description of their relative, and only 88 participants (20% of sample) focused on vulnerable features.
A cluster analysis dendrogram was generated using Nvivo 11 for purposes of visualising and exploring the underlying dimensions of the data  and is displayed in Fig. 1. Four clusters of nodes and one standalone node can be distinguished. The first cluster, labelled ‘Fantasy Proneness’, includes nodes reflecting the predominance of ‘fantasy’ colouring an individuals interactions, either intrapersonally (‘grandiose self-importance, belief in specialness’) or interpersonally (‘suspicious, envy’). The second cluster, labelled ‘Negative Other’, reflects nodes concerned with a detached connection with others (‘emotionally empty’) and fostering ‘vengeful’ and ‘exploitative’ drives towards others, as well as feelings of victimhood. Interestingly, despite being related to these other aspects of narcissism, ‘perfectionism’ was factored as reflecting its own cluster, labelled ‘Controlling’. The fourth cluster, labelled ‘Fragile Self’, includes nodes indicating feelings of vulnerability (‘affective instability’, ‘insecurity’) and shameful avoidance (‘hiding the self’, ‘false self’, ‘withdrawal’) due to these painful states. The fifth cluster, labelled ‘Grandiose’ reflects a need (‘contingent self-esteem’, ‘requiring admiration’) or expectation (‘entitlement’, ‘arrogance’) of receiving a certain level of treatment from others. It also includes nodes regarding how individuals foster this treatment (‘charming’, ‘rage’, and ‘devaluing’) and a hypervigilance for if their expectations are being met (‘hypersensitive’).
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