When grandiosity and vulnerability collide: Implicit and explicit self-esteem in patients with narcissistic personality disorder

Background and objectivesNarcissistic personality disorder (NPD) is characterized by reports of grandiosity including exaggerated illusions of superiority and entitlement (DSM-IV-TR, APA, 2000). Based on clinical theories (e.g., Kernberg, 1975), many researchers argue that high explicit self-esteem in narcissists masks underlying implicit vulnerability (low implicit self-esteem). Conversely, based on social learning theories (i.e., Millon, 1981), people with NPD are characterized by implicit grandiosity (high implicit self-esteem). We test these competing hypotheses in patients diagnosed with NPD.MethodsThe present study examined implicit self-esteem (using an Implicit Association Test) and explicit self-esteem (using a self-report questionnaire) in patients with NPD in comparison to non-clinical and clinical, non-NPD (Borderline Personality Disorder, BPD) control groups.ResultsPatients with NPD scored lower on explicit self-esteem than non-clinical controls. In comparison to patients with BPD, NPD patients scored higher on explicit and implicit self-esteem. Moreover, within the group of NPD patients, damaged self-esteem (i.e., low explicit, high implicit) was associated with higher narcissistic psychopathology.LimitationsIn both clinical groups we included participants seeking psychiatric treatment, which might influence explicit self-esteem. Longitudinal studies are needed to further assess self-esteem stability in NPD patients in comparison to the control groups.ConclusionsOur findings are indicative of vulnerable facets in patients with NPD (i.e., low explicit self-esteem). Furthermore, damaged self-esteem is connected to specific psychopathology within the NPD group. Implications for research on NPD are discussed.

► Scientists speculate whether grandiosity in narcissists masks implicit vulnerability. ► We examine explicit and implicit self-esteem in patients with NPD. ► NPD patients show lower explicit self-esteem compared to non-clinical controls. ► NPD patients show higher explicit and implicit self-esteem compared to BPD patients. ► NPD patients with damaged self-esteem exhibit higher pathological narcissism.