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. Author manuscript; available in PMC: 2012 Jun 6.
Published in final edited form as: Personal Disord. 2011 Apr;2(2):113–127. doi: 10.1037/a0021870

Parallel Syndromes: Two Dimensions of Narcissism and the Facets of Psychopathic Personality in Criminally-Involved Individuals

PMCID: PMC3368369  NIHMSID: NIHMS381183  PMID: 22448731

Abstract

Little research has examined different dimensions of narcissism that may parallel psychopathy facets in criminally-involved individuals. The present study examined the pattern of relationships between grandiose and vulnerable narcissism, assessed using the Narcissistic Personality Inventory-16 and the Hypersensitive Narcissism Scale, respectively, and the four facets of psychopathy (interpersonal, affective, lifestyle, and antisocial) assessed via the Psychopathy Checklist: Screening Version (PCL:SV). As predicted, grandiose and vulnerable narcissism showed differential relationships to psychopathy facets, with grandiose narcissism relating positively to the interpersonal facet of psychopathy and vulnerable narcissism relating positively to the lifestyle facet of psychopathy. Paralleling existing psychopathy research, vulnerable narcissism showed stronger associations than grandiose narcissism to 1) other forms of psychopathology, including internalizing and substance use disorders, and 2) self- and other-directed aggression, measured using the Life History of Aggression and the Forms of Aggression Questionnaire. Grandiose narcissism was nonetheless associated with social dysfunction marked by a manipulative and deceitful interpersonal style and unprovoked aggression. Potentially important implications for uncovering etiological pathways and developing treatment interventions for these disorders in externalizing adults are discussed.

Keywords: Grandiose narcissism, vulnerable narcissism, psychopathy, forensic, aggression

In its original Greek form, narcissism reflected a perception and presentation of oneself as superior and worthy of admiration and special treatment. Current conceptualizations of and research regarding narcissism, however, suggest that not all individuals with narcissism solely display a grandiose sense of self (APA, 2000). Rather, there seems to be two fairly distinct dimensions of narcissism: grandiose and vulnerable narcissism (e.g., Wink, 1991). Grandiose narcissism refers to the openly arrogant and superior presentation, whereas vulnerable narcissism is characterized by conflict between a grandiose and an inferior sense of self (e.g., Kernberg, 1975). Thus, individuals high on grandiose narcissism are poised, self-confident, and exhibitionistic (Wink, 1991). In contrast, those scoring high on vulnerable narcissism can be exploitative and entitled, but the hallmark symptoms involve hypersensitivity to criticism, fear of rejection, and a fragile self-esteem (Akhtar & Thomson, 1982; Wink, 1991).

Both narcissism dimensions are currently embedded in narcissistic personality disorder (NPD) as a single syndrome (APA, 2000). However, conflating the grandiose and vulnerable dimensions is potentially problematic for clinicians, as these dimensions may have very distinct functional impairments that require different treatment interventions. Scarce empirical evidence exists on the two dimensions of narcissism, making it difficult to ascertain the clinical significance of the grandiose and vulnerable manifestations of the disorder. Further, the research that has been conducted on narcissism is relatively limited in scope in that it has relied primarily on convenience samples without severe functional impairments (e.g., undergraduate samples) and measures of narcissism that mostly assess grandiose traits (e.g., the Narcissistic Personality Inventory; Bushman et al., 2009; Pincus et al., 2009). Although these studies provide preliminary data, more research aimed at delineating the nomological networks of the grandiose and vulnerable dimensions is needed to begin to understand the clinical relevance of these constructs.

This distinction between grandiose and vulnerable narcissism to some extent parallels research on primary and secondary variants of psychopathy, which have a rich theoretical and empirical literature (e.g., Blackburn, 1975; Karpman, 1941; Lykken, 1995; Skeem, Johansson, Andershed, Kerr, Louden, 2007). Primary psychopathy is theorized to stem from a core set of manipulative interpersonal traits and deficits in empathy, whereas secondary psychopathy is theorized to develop out of an impulsive/aggressive lifestyle and deficits in emotion regulation (e.g., Hare, 1991). Given the potential parallels between the narcissism dimensions and psychopathy variants, it may be useful to apply an established psychopathy framework in the study and understanding of grandiose and vulnerable narcissism. Thus, the present study sought to expand current conceptualizations of grandiose and vulnerable narcissism by drawing on the extensive research literature on psychopathy to form and test hypotheses about the narcissism dimensions as they manifest in criminally-involved individuals. Narcissism and psychopathy have been linked in the literature already, as evidenced by research on the “dark triad” (i.e. narcissism, psychopathy, and Machiavellianism; e.g., Paulhus & Williams, 2002). In addition, psychopathy was selected as a theoretical framework for examining narcissism in an externalizing sample due to symptom overlap among the disorders and their respective associations with heightened risk for aggression and engagement in illegal behavior (Bushman & Baumeister, 1998; Hare, 2003; Edens, Hart, Johnson, Johnson, & Oliver, 2000; Jones & Paulhus, 2010). Thus, we sought to determine whether it is fruitful to use psychopathy as a framework for understanding narcissism dimensions, particularly among criminally-involved individuals.

Utilizing Psychopathy as a Theoretical Framework

There is both conceptual and empirical overlap among narcissism and psychopathy in forensic samples, suggesting these disorders may share underlying vulnerabilities for personality pathology. For instance, psychopathy is a marked by a constellation of interpersonal (e.g., grandiosity, deceitfulness, superficial charm), affective (e.g., shallow affect, callousness, remorselessness), lifestyle (e.g., risk-taking, irresponsibility, aggressiveness, unrealistic goals), and antisocial (e.g., criminal versatility, repeated incarcerations) traits that, like narcissism, increase risk for engagement in antisocial behavior (e.g., Bushman & Baumeister, 1998; Cleckley, 1976). Further, narcissism and psychopathy converge at the trait-level of personality in that both disorders are marked by grandiosity, manipulativeness, and callousness (APA, 2000; Hare, 2003) and with the five-factor model dimensions of low agreeableness and high extraversion (e.g., Samuel & Widiger, 2008; Lynam, 2002). Finally, as described above, research suggests that psychopathy is also multidimensional (Cooke & Michie, 2001; Hare, 2003; Hill, Neumann, & Rogers, 2004) with the primary and secondary variants of psychopathy representing separable etiological pathways to the disorder. Unlike narcissism, however, extensive research has been conducted to delineate the nomological networks associated with the primary and secondary dimensions of psychopathy, making the psychopathy literature a potentially informative framework for examining distinctions between grandiose and vulnerable narcissism.

Empirical investigations of the external correlates of the primary and secondary dimensions validate their theoretical distinctions. For instance, research indicates individuals with primary psychopathic traits exhibit lower levels of anxiety, social withdrawal (Skeem, et al., 2007), and emotional reactivity (Blair, 2005; Kiehl, 2006; Patrick, Bradley, & Lang, 1993) than those with secondary psychopathic traits. In contrast, secondary psychopathy is associated with emotional and behavioral dysregulation, including increased risk for suicidality, alcohol and substance use disorders, and impulsivity (Lorber, 2004; Patrick, Hicks, Krueger, & Lang, 2005; Sellbom & Verona, 2007; Smith & Newman, 1990; Vanman, Mejia, Dawson, Schell, & Raine, 2003; Verona, Hicks, & Patrick, 2005; Verona, Patrick, Joiner, 2001). In terms of violence, both primary and secondary dimensions of psychopathy are found to predict reactive violence and aggression (Hart, 1998; Walsh & Kosson, 2008). However, individuals with primary psychopathic traits are more likely to engage in unprovoked, instrumental forms of aggression than those with secondary psychopathic traits (Skeem, Poythress, Edens, Lilienfeld, & Cale, 2003; Williamson, Hare, & Wong, 1987; Woodworth & Porter, 2002). In sum, the extant literature indicates that primary psychopathy is related to emotional stability, lack of anxiety, and unprovoked/instrumental aggression, whereas secondary psychopathic traits are associated with psychopathological dysfunction marked by emotional and behavioral dysregulation.

Narcissism – Psychopathy Parallels

Preliminary research on the association of narcissism with psychopathy has produced mixed results. Although several studies indicate that narcissism is associated with primary psychopathy (e.g., Benning, Patrick, Blonigen, Hicks, & Iacono, 2005; Cale & Lilienfeld, 2002; Hart & Hare, 1989; McHoskey, Worzal, & Szyarto, 1998; Rutherford, et. al., 1996), the association of narcissism with secondary psychopathy is less consistent. For instance, while some studies find comparable relationships between narcissism and primary and secondary psychopathy (e.g., Rutherford, et. al., 1996), several studies report relatively weaker (Study 1 in Benning, et. al., 2005; McHoskey, et. al., 1998; Miller, Dir, Gentile, Wilson, Pryor, & Campbell, in press) or nonexistent relationships between narcissism and secondary psychopathy (Study 2 in Benning, et. al., 2005; Hart & Hare, 1989). The mixed findings across studies may be due to the fact that the grandiose and vulnerable dimensions of narcissism were not differentiated. Indeed, with a few exceptions (e.g., Miller et al., in press), existing research has focused on grandiose narcissism without giving sufficient attention to vulnerable narcissism.

Another way to examine parallels between psychopathy and narcissism dimensions is to investigate whether grandiose and vulnerable narcissism show similar relationships to external correlates as primary and secondary psychopathy, respectively. Epidemiological research indicates that NPD evidences high comorbidity with internalizing disorders (20.6% major depressive disorder, 54.7% anxiety disorders) and externalizing disorders (64.2% substance use disorder overall, 30.6% alcohol dependence; 25% antisocial personality disorder; Gunderson, Ronningstam, & Smith, 1991; Stinson et al., 2008; Widiger & Corbitt, 1993). However, given that NPD combines grandiose and vulnerable features, it is unclear what aspects of narcissism account for comorbidity with internalizing and externalizing disorders. A few studies have examined narcissism dimensionally, and at least one study found a positive relationship between depression and vulnerable narcissistic traits in clinical samples (r = .57; Watson, Sawrie, Greene, & Arredondo, 2002). Further, a small literature suggests that vulnerable, but not grandiose, narcissism shows a positive relationship with shame (e.g. Cheek & Hendin, 1996; Gramzow & Tangney, 1992; Hibbard, 1992), which is ubiquitous among internalizing psychopathology (e.g., Tangney & Dearing, 2002). These findings suggest that, like secondary psychopathy, vulnerable narcissism, but not grandiose narcissism, represents risk for internalizing psychopathology.

Research in undergraduates has shown that narcissistic traits may also increase risk for aggression (e.g. Locke, 2009; Jones & Paulhus, 2010; Paulhus, Robins, Trzesniewski, & Tracy, 2005), and theory suggests that aggressive tendencies influence the degree to which narcissism is pathological (Kernberg & Caligor, 2005). For instance, Bushman, Baumeister, and colleagues provide evidence that the grandiose features of narcissism can promote aggression, especially when an individual’s self-esteem is threatened (e.g. Bushman et al., 2009; Bushman & Baumeister, 1998). There is very limited empirical evidence on the relationship between vulnerable narcissism and aggression, but preliminary data with the Pathological Narcissism Inventory indicates that vulnerable narcissism is associated with homicidal ideation as well as self-directed violence, including suicide attempts (Pincus, et. al., 2009). More systematic research is needed to determine whether vulnerable narcissism, like secondary psychopathy, relates to reactive forms of aggression and self-harm, whereas grandiose narcissism, like primary psychopathy, is associated with mostly unprovoked acts of violence.

Present Study

Given the similarities between the narcissism and psychopathy constructs as well as the lack of systematic research on the narcissism dimensions, we were interested in further delineating the relationships between grandiose and vulnerable narcissism and the facets of psychopathy. In our effort to examine the parallels between narcissism and psychopathy, we investigated not only whether the facets of psychopathy were differentially associated with dimensions of narcissism but also whether the latter would show relationships to external criteria (e.g. psychological disorders, forms of aggression) that would be expected if grandiose and vulnerable narcissism paralleled primary and secondary psychopathy, respectively.

Research on narcissism to date has relied almost exclusively on a diagnosis of narcissism, which confounds grandiose and vulnerable narcissism, or on the Narcissistic Personality Inventory (NPI; Raskin & Hall, 1979; 1981), which measures only grandiose aspects of narcissism. We sought to remedy this limitation by assessing both grandiose and vulnerable narcissism using two separate measures designed specifically to assess these dimensions -- the 16-item version of the NPI and the Hypersensitive Narcissism Scale (HSNS; Hendin & Cheek, 1997), respectively. Another contribution of the present study involves examining relationships between narcissism and psychopathy in a forensic sample recruited through legal and treatment agencies in the community, instead of relying on a convenience sample as has been typical in research on dimensions of narcissism. Importantly, a criminally-involved sample should evidence greater variability in the symptoms and behaviors of interest (narcissism, psychopathy, aggression) than would a typical undergraduate sample.

We expected that the two dimensions of narcissism would be differentially associated with the facets of psychopathy, with grandiose narcissism showing relationships to the facets of primary psychopathy (interpersonal and affective) and vulnerable narcissism showing relationships to the facets of secondary psychopathy (lifestyle and antisocial). We further hypothesized that the two dimensions of narcissism would parallel research on psychopathy in terms of external correlates. Grandiose narcissism was expected to be associated with fewer psychopathology symptoms, particularly internalizing, and higher unprovoked aggression, whereas vulnerable narcissism was expected to be associated with heightened emotional problems, comorbid psychopathology, and reactive aggression.

Methods

Participants and Procedures

Participants consisted of 343 men (67.1 %) and women (32.7 %) ranging in age from 18 to 61 (M = 30.23, SD = 9.0). To enhance recruitment of externalizing individuals, we recruited adults 1) incarcerated in county jails (n = 140; 40.8%), 2) in substance use treatment (n = 27; 7.9%), and 3) on parole/probation or with a history of legal convictions (n = 170; 51.3%). Despite the different recruitment sites, the three subsamples evidenced similar demographic characteristics and similar histories of violence and legal involvement1. About half of participants were African-American (n = 186, 54.4 %), followed by Caucasian (n = 128, 37.4 %), mixed-ethnicity/other (n = 17, 5.6 %), and Hispanic (n = 9, 2.6 %) adults. The sample was diverse in terms of education level, with approximately one-third reporting that they did not complete high school (n = 121, 35.6 %), 20.7 % earning a high school diploma (n = 71), one-third completing some college (n = 114, 33.5 %), 5.5 % holding a Bachelor’s degree (n = 19), and 4.1 % currently in college (n =14). Individuals with a lifetime diagnosis of a psychotic (non-substance-induced), bipolar, or pervasive developmental disorders were ineligible to participate, as the acute effects of these disorders can artificially inflate scores on measures of psychopathy (e.g., antisocial behavior during mania). Those who participated but were later found to have one of these exclusionary criteria were omitted from analysis (less than 3% of participants).

Participants were administered questionnaires to measure narcissistic personality features, a semi-structured diagnostic interview to assess Axis I disorders, and a separate life history interview to assess psychopathy, antisocial personality disorder, conduct disorder, and lifetime history of aggression and violence. The interviews and self-report questionnaires were administered during one session that lasted from approximately 2 to 4 hours. Participants provided informed consent, and the study was approved by the university’s Institutional Review Board prior to data collection.

Independent Measures of the Narcissism Dimensions

The 16-item Narcissistic Personality Inventory (NPI-16; Ames, Rose, & Anderson, 2006) was created from the longer 40-item Narcissistic Personality Inventory (Raskin & Terry, 1988) to index the grandiose narcissism domains of self-ascribed authority, superiority, entitlement, and self-absorption (Ames, et al., 2006). Ames et al. (2006) found that the short version of the NPI had good face, predictive, and discriminant validity and is thus a good alternative to the NPI-40 for use in a long assessment protocol as the one conducted for the present study. As would be expected, the NPI shows positive relationships to measures of narcissistic personality, such as the scales from the Schedule for Nonadaptive and Adaptive Personality (e.g. r = .52), the Minnesota Multiphasic Inventory-2 (e.g. r = .62), the Millon Clinical Multiaxial Inventory-III (e.g. r = .58), and the Personality Diagnostic Questionnaire-4 (e.g. r = .29; Samuel & Widiger, 2008; and rs = .20 and .43; Miller & Campbell, 2008). For each item on the NPI, participants were asked to read two statements and choose the one that best describes them. One choice represents a narcissistic response (“I know that I am good, because everybody keeps telling me so”) and the other a non-narcissistic response (“When people compliment me, I sometimes get embarrassed”). The number of narcissistic responses endorsed was summed to create a NPI-16 total score. A Cronbach’s alpha of .72 was obtained for the total score in the present sample, which is comparable to that of the validation studies (α = .65-.78; Ames et al., 2006).

The Hypersensitive Narcissism Scale (HSNS; Hendin & Cheek, 1997) consists of 10 items that were specifically selected to assess vulnerable or covert forms of narcissism. The HSNS was used in the present study, because items on this scale related more to hypersensitivity to rejection (“My feelings are easily hurt by ridicule or the slighting remarks of others”) than to self-centeredness or grandiosity. In fact, the HSNS is expected to be generally uncorrelated with measures of grandiose narcissism, and this lack of correlation has been found in previous work (e.g. r = .02 in Hendin & Cheek, 1997). For the HSNS, participants were asked to indicate how often they generally experience these feelings on a scale from 1 (“Very Uncharacteristic or Very Strongly Disagree”) to 5 (“Very Characteristic or Very Strongly Agree”). Responses were summed to create a HSNS total score (α = .75).

Psychopathy Facets

The Psychopathy Checklist: Screening Version (PCL: SV; Hart, Cox, & Hare, 1999) is a measure designed to index psychopathic traits in samples without access to institutional files, such as prison records. Although a review of public criminal records was conducted in the present study, use of the PCL: SV (rather than the full Psychopathy Checklist – Revised) was necessary, because the information gathered from these sources was limited. Information about psychopathic traits was collected from a semi-structured interview and used to rate participants on 12 psychopathic traits. Criminal history information provided by the participant was verified from the public criminal records review (online county, state, and federal criminal records), which were unavailable for 11.4% of the sample2. Each trait on the PCL: SV was rated on a three-point scale ranging from 0 (“Not at all characteristic”) to 2 (“Extremely characteristic”) by trained doctoral students or Ph.D.-level raters. We calculated a total PCL: SV psychopathy score by summing across ratings for these 12 traits. As research (e.g. Hill et al., 2004) indicates the PCL: SV has up to four facets, with the interpersonal and affective facets representing aspects of primary psychopathy and the lifestyle and antisocial facets representing aspects of secondary psychopathy, we calculated separate scores for the interpersonal, affective, lifestyle, and antisocial facets. The interpersonal facet score included ratings for superficial charm, grandiosity, and deceitfulness/conning. The affective facet included lack of remorse, lack of empathy/shallow affect, and failure to assume responsibility for antisocial behavior. The lifestyle facet included impulsivity/need for stimulation, irresponsibility, and lack of reasonable goals. Finally, the antisocial facet included lack of behavioral control as well as antisocial behaviors during adolescence and adulthood. Inter-rater reliability was available for 20% of interviews, which resulted in an intra-class correlation of .98 for PCL: SV total score, and .95, .94, .85, and .97 for the interpersonal, affective, lifestyle, and antisocial facets, respectively.

Antisocial Personality Disorder (APD) and Conduct Disorder (CD) were also assessed using interview data, and threshold symptom counts (i.e., the number of symptoms endorsed at threshold levels) of Adult Antisocial Behavior (AAB) and CD were coded separately. Inter-rater reliability was available for 20% of interviews. Intra-class correlations in the sample for AAB and CD symptom counts (our primary measures) were .93 and .96, respectively. APD and CD were reliably diagnosed, as evidenced in the diagnostic concordance rates of 96% for APD and 98% for CD across raters. As would be expected in a largely forensic sample, 174 individuals (54.0%) met criteria for past CD and 164 (51.3%) met criteria for APD.

Symptoms of Psychopathology

The Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I; First, Spitzer, Gibbon, & Williams, 2002) was used to assess for the psychological disorders of major depressive disorder (MDD), generalized anxiety disorder (GAD), lifetime alcohol dependence (AD), and lifetime drug dependence (DD) as described by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; APA, 2000). Interviews were conducted by trained doctoral students or Ph.D.-level raters. Inter-rater reliability was available for 26% of interviews, which resulted in the following intra-class correlations for symptom counts: MDD = .94, GAD = .91, AD = .98, and DD = .98. For the analyses in the present study, we used symptom counts for these Axis I disorders and AAB and CD (described above) to create two composite psychopathology scores – an internalizing symptom composite and an externalizing symptom composite. The internalizing symptom composite consisted of symptom counts for 1) current MDD ranging from 0 to 9 and 2) current GAD ranging from 0 to 3. The externalizing symptom composite consists of symptom counts for 1) AD, 2) DD, and 3) AAB, all ranging from 0 to 7, as well as 4) past CD ranging from 0 to 15. To ensure that all of these disorders received equal weight in the calculation of their respective composite scores, we transformed the symptom counts to z-scores before summing.

Of the 343 participants in the present sample, 24 (7.5%) met criteria for current MDD, and 22 (6.8%) met criteria for current GAD. As would be expected from a sample of individuals with a criminal history and/or those seeking substance use treatment, a substantial number of participants met criteria substance use disorders. In this sample, 141 (43.8%) met for lifetime AD, and 192 (59.6%) met for lifetime DD.

Other- and Self-Directed Aggression

Forms of Aggression Questionnaire (FOA; Verona, Sadeh, Case, Reed, & Bhattacharjee, 2008). The FOA consists of 40 items that measure engagement in various forms of reactive aggression, including physical aggression (“I start fights.”; α = .92), verbal aggression (“I curse them out.”; α = .89), relational aggression (“I ruin their friendships with other people.”; α = .85), passive-rational aggression (“I take my time doing things they want me to do, just to show them.”; α = .85), and aggression directed toward property (“I start a fire that causes damage.”; α =.83). Participants rated each item on a 5-point scale ranging from “Almost Never” to “Always” to convey how frequently they act aggressively when they are upset or angry. Participants in the present study endorsed range of severity on the FOA subscales; for example, scores on the physical aggression subscale ranged from 6 to 38 (out of a possible 40). Research indicates the FOA shows convergent validity with other measure of aggression, including the Aggression Questionnaire (Buss & Warren, 2000; r = .65 with FOA total score), and taps into personality traits related to low agreeableness, low conscientiousness, and high neuroticism (Verona, et al., 2008). Thus, this measure assesses mostly hostile or reactive aggression that is manifested in various forms (e.g., physical, verbal, relational).

Life History of Aggression (LHA; Coccaro, Berman, & Kavoussi, 1997). The LHA was developed as an interview-based measure of trait aggressive behavior, with research showing that it predicts overt aggression and personality disorders characterized by suicidality and violence (Coccaro et al., 1997). In the present study, the LHA was used to assess unprovoked (non-reactive) violence against others, self-harm, and suicide attempts, constructs not explicitly assessed with the above measures of psychopathology or aggression. Items were rated by a diagnostic interviewer on a scale from 0 to 5 according to how frequently the individual engaged in that type of behavior since the age of 13 (from “Never” to “Too many times to count”). Participants were asked to report the number of times they 1) attacked another person without provocation (e.g., “jumping” someone); 2) injured themselves on purpose without the intention of killing themselves (e.g., burning, cutting); and 3) attempted to kill himself or herself (whether or not it occurred during a depressive episode). Many of the participants in the present sample reported engaging in these behaviors frequently; for example, 49.6% reported engaging in unprovoked assaults, 18.3% reported self-harming, and 21.5% reported attempting suicide.

Results

We examined the relationships among the dimensions of narcissism and the four facets of psychopathy to begin to assess convergence among these constructs. Zero-order correlations, as well as descriptive statistics for these variables, can be found in Table 1. Grandiose and vulnerable narcissism were not significantly associated with each other (r =.08, p = n.s.), consistent with previous research using these two measures (Hendin & Cheek, 1997) and suggesting they tap into independent dimensions of narcissism. These dimensions also showed differential relationships to psychopathic personality facets. The interpersonal, affective, and antisocial facets of psychopathy were all associated with grandiose narcissism at the zero-order level (rs = .21, .14, and .16, respectively, all ps < .01), whereas the lifestyle facet was solely associated with vulnerable narcissism (r = .27, p < .01).

Table 1.

Descriptive Statistics and Correlations between Narcissism Dimensions and Psychopathy Facets

Narcissism
 PCL: SV Facets
Grandiose Vulnerable Interpersonal Affective Lifestyle Antisocial Total
Narcissism
 Grandiose -- .08 .21** .14** .06 .16* .19**
 Vulnerable -- -.04 .10 .27** .09 .14*
PCL: SV Facets
 Interpersonal -- .49** .30** .33** .71**
 Affective -- .40** .56** .81**
 Lifestyle -- .42** .68**
 Antisocial -- .79**
 Total --
Mean 4.5 27.1 2.2 2.6 3.5 3.5 11.8
SD 3.1 7.4 1.7 1.5 1.5 1.8 4.8
Minimum 0 10 0 0 0 0 1
Maximum 14 50 6 6 6 6 22
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Note: N = 343. PCL: SV = Psychopathy Checklist: Screening Version.

*

p < .05

**

p < .01

Psychopathy Facets Contribute to Narcissism Dimensions

To determine whether the four psychopathy facets would uniquely contribute to grandiose and/or vulnerable narcissism after taking demographic variables into account, we ran separate hierarchical multiple regressions for each of the narcissism dimensions. We entered age, gender, and recruitment sample in the first step and the four PCL: SV facets in the second step. Results are displayed in Table 2. Age was a significant predictor of grandiose narcissism, with younger participants scoring higher on the NPI. For vulnerable narcissism, both gender and recruitment sample were significant predictors. Females evidenced greater levels of vulnerable narcissism, and individuals recruited through the substance use treatment center evidenced greater vulnerable narcissism than did those recruited while in jail, with the parole/probation sample not differing from the other two samples.

Table 2.

Summary of Hierarchical Multiple Regression Analyses with Psychopathy Facets Predicting Dimensions of Narcissism (N = 340)

Grandiose
Narcissism
 Vulnerable
Narcissism
Variable ß R2 /ΔR2 ß R2 /ΔR2
Step 1 .06** .05**
 Age −.22** −.06
 Gender .10 −.17**
 Recruitment Sample .06 −.14**
Step 2 .06** .09**
 Interpersonal Facet .24** −.11
 Affective Facet −.01 .10
 Lifestyle Facet .01 .24**
 Antisocial Facet .03 .05
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Note.

*

p < .05

**

p < .001

Gender was coded as follows: female = 0, male = 1; Sampling group was coded as follows: recruited from local jails = 1, recruited while on parole/probation or with history of incarceration = 0, recruited through substance use treatment = −1.

As for psychopathy effects, analyses revealed that the interpersonal facet was primarily responsible for the relationship between psychopathy and grandiose narcissism (ß = .24, p < .001). Therefore, grandiose narcissism was expectedly associated with psychopathic traits of charm, grandiosity, and duplicity. In contrast, elevations in vulnerable narcissism were positively associated with the lifestyle facet (ß = .24, p < .001), indicating vulnerable narcissism is characterized primarily by impulsivity, irresponsibility, and unrealistic goals. Importantly, a similar pattern of results was found across the three recruitment samples, though the results for the sample recruited through the substance use treatment center were all non-significant due to the small sample size (N = 27). In particular, grandiose narcissism showed a positive relationship to the interpersonal facet in all 3 samples (ßs = .23 - .25). Overall, vulnerable narcissism tended to be positively associated with the lifestyle facet (ßs = .34 and .35 for those on parole/probation and those in substance use treatment, respectively), though this association was somewhat weaker and non-significant for participants recruited while in jail (ß = .12).

Psychopathology and Aggression Correlates of Grandiose and Vulnerable Narcissism

Correlations between internalizing and externalizing symptom composites and the two dimensions of narcissism are presented in Table 3. Also in Table 3 are the correlations between several forms of aggression, as measured by the LHA and the FOA, and the two narcissism dimensions. We determined whether the correlations for grandiose narcissism were significantly different from those for vulnerable narcissism, following Steiger (1980). Due to multiple testing and because these analyses were exploratory in nature, we applied a Bonferroni correction to the alpha level for the correlations depicted in Table 3. We used p-values of .002 and .0003 (i.e., .05/32 and .01/32, respectively) for the zero-order correlations and .003 and .0006 (i.e., .05/16 and.01/16, respectively) for the comparisons of these correlations.

Table 3.

Psychopathology, Suicidality, and Violence Correlates of Grandiose and Vulnerable Narcissism

Grandiose
Narcissism		 Vulnerable
Narcissism		 t
(difference)
Internalizing Symptoms −.03 .40** 5.9**
 Major Depressive Disorder .01 .34** 4.8**
 Generalized Anxiety Disorder −.07 .32** 5.2**
Externalizing Symptoms .12* .24** 1.6
 Alcohol Dependence −.00 .24** 3.2*
 Illicit Drug Dependence −.02 .23** 3.3**
 Conduct Disorder .20** .02 2.4
 Adult Antisocial Behavior .14* .16** .27
Life History of Aggression
 Assaults on Self .04 .19** 2.0
 Suicide Attempts −.04 .20** 3.2*
 Unprovoked Assaults on Others .19** .03 2.4
Forms of Aggression Questionnaire
 Verbal Aggression .10 .36** 3.5**
 Relational Aggression .10 .38** 3.9**
 Passive-Rational Aggression .13* .37** 3.3**
 Aggression Against Property .15** .23** 1.5
 Physical Aggression .25** .21** .40
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Note: Ns = 339-342 .

*

p < .002 for zero-order correlations and .003 for differences in t

**

p < .0003 for zero-order correlations and .0006 for differences in t.

As shown in Table 3, only vulnerable narcissism was associated with the internalizing composite as well as MDD and GAD symptom counts, with all of these correlations being significantly different from those seen for grandiose narcissism. Vulnerable narcissism was also associated with the externalizing composite, specifically with lifetime alcohol and drug dependence. Importantly, the correlations between vulnerable narcissism and drug and alcohol use symptom counts were significantly greater than those for grandiose narcissism. Grandiose narcissism was instead associated with past CD, and this correlation did not differ between the two narcissism dimensions. Both grandiose and vulnerable narcissism were also significantly related to AAB symptom counts. In summation, vulnerable narcissism was more strongly associated with other psychopathology, both internalizing and substance use disorders, although grandiose narcissism was associated with childhood conduct problems and adult antisocial behavior. Moreover, the associations between vulnerable narcissism and internalizing and substance use disorders tended to be significantly greater than those between grandiose narcissism and internalizing and substance use disorders.

Finally, we examined the dimensions of narcissism in relation to both self- and other-directed aggression. As depicted in Table 3, vulnerable narcissism was associated with acts of self-harm according to the LHA, both in the form of non-suicidal self injury and suicide attempts. Moreover, the correlation between suicide attempts and vulnerable narcissism was significantly greater than that for grandiose narcissism. As for other-directed aggression, vulnerable narcissism was associated with all forms of reactive aggression on the FOA, and its associations with verbal, relational, and passive-rational aggression were significantly greater than those seen for grandiose narcissism. In contrast, elevations in grandiose narcissism were associated with more frequent unprovoked assaults against other people on the LHA and physical aggression (against people and property) on the FOA.3 Importantly, even when psychopathy facets are taken into account, all but one of the grandiose and vulnerable narcissism relations to unprovoked attacks and reactive aggression, respectively, remain. Only the very modest relationship between grandiose narcissism and passive-rational aggression is non-significant after taking psychopathy into account. Thus, vulnerable narcissism shows a stronger relationship with self-harm and aggressive traits, particularly those that are reactive in nature, even when psychopathy facets are accounted for. In contrast, although grandiose narcissism showed some association to reactive physical aggression, it was not associated with self-directed aggression and instead was associated with unprovoked assaults on others – a relationship not seen for vulnerable narcissism.

Discussion

The present study is one of the first to examine the relations between dimensions of narcissism and facets of psychopathy in a forensic sample, where these disorders are frequently diagnosed and cause impairments in functioning, especially in regards to illegal behavior. Consequently, the findings contribute to the literature by providing novel information regarding the extent to which narcissism and psychopathy converge in a high-risk sample, research that has implications for understanding the etiology of and designing treatments for these disorders. Our research supports studies that have found an association between grandiose narcissism and primary psychopathy (Benning, et. al., 2005; McHoskey, et. al., 1998) and advances knowledge of vulnerable narcissism by informing its parallels with secondary psychopathy, a relatively understudied area of research.

Implications for Personality Disorder Research

As predicted, the two forms of narcissism showed differential relationships to the psychopathy facets, with grandiose narcissism relating positively to the interpersonal facet, and vulnerable narcissism relating positively to the lifestyle facet. The divergent findings for grandiose and vulnerable narcissism underscore the need to disentangle the heterogeneous nature of narcissistic personality disorder as manifested in externalizing individuals. Specifically, our results suggest that grandiose narcissism and primary psychopathy converge to the extent that both are characterized by superficial charm, haughty arrogance, and interpersonal duplicity, whereas vulnerable narcissism and secondary psychopathy share traits related to impulsivity and irresponsibility in criminally-involved adults. Although modest in size, these congruous associations that emerged between the narcissism dimensions and psychopathy facets suggest that the larger research literature on psychopathic personality disorder can serve to inform the distinctions between the grandiose and vulnerable narcissism dimensions in externalizing adults.

In particular, our results suggest that both narcissism and psychopathy share vulnerabilities that can be conceptualized in terms of broader theoretical constructs in the personality literature, including a recent theoretical formulation of antisocial/psychopathic tendencies by Patrick, Fowles and Krueger (2009). In their model, three phenotypic components associated with antisocial/psychopathic tendencies are advanced, including disinhibition (problematic impulse control), meanness (callousness, coldheartedness, antagonism), and boldness (social dominance and emotional resiliency). In this regard, grandiose narcissism appears to relate to the construct of boldness, as we found that grandiose narcissism was associated with social dominance (e.g., charm and duplicity) and fewer problems in psychological functioning (i.e., internalizing symptoms, alcohol and drug problems, and self-directed violence) compared to vulnerable narcissism, which parallels research on the differential correlates of the psychopathy facets (Patrick, et. al., 2005; Verona et al., 2001, 2005). By contrast, vulnerable narcissism seems to be marked by high levels of disinhibition. Like secondary psychopathy (Hill et. al., 2004; Skeem & Mulvey, 2001), vulnerable narcissism showed robust associations with outcomes generally associated with impulsivity, including reactive aggression and substance use. Both narcissism dimensions contain characteristics of meanness (e.g., callousness, coldheartedness, antagonism), with grandiose narcissism demonstrating more proactive (and perhaps more callous) forms and vulnerable narcissism showing more reactive forms of this trait. This type of conceptualization would be another step toward dimensional or spectrum models of personality to characterize the overlap across the personality disorder categories currently in the DSM. The present results provide preliminary evidence that narcissism and psychopathy share vulnerabilities potentially consistent with dimensional models of personality.

Parsing the Etiology of Narcissism via Psychopathy

Extensive work has been done on the etiology of psychopathy, with research suggesting distinct etiological pathways for the primary and secondary manifestations of the disorder. For instance, primary psychopathy traits are theorized to result from deficits in the emotional circuitry of the brain postulated to modulate the experience of fear (e.g., amygdala, paralimbic system; Birbaumer et al., 2005; Blair, 2005; Kiehl, 2006), and the allocation of attentional resources to motivationally-salient stimuli to the neglect of contextual stimuli (Newman, 1998; Sadeh & Verona, 2008). To the extent that the construct of grandiose narcissism measures similar pathology to that of primary psychopathy in criminally-involved individuals, the same or similar etiological mechanisms may be at play for both diagnoses but result in different manifestations depending on other traits and developmental pathways. Future research can address this question by further examining whether the grandiose dimension of narcissism is associated with comparable behavioral and psychophysiological abnormalities as primary psychopathy, such as deficient aversive conditioning (Flor, Birbaumer, Hermann, Ziegler, & Patrick, 2002), anticipation of threat (Hare, 1965), attentional processing (Hiatt, Schmitt, & Newman, 2004; Sadeh & Verona, 2008), and startle reactivity to threatening cues (Levenston, Patrick, Bradley, & Lang, 2000; Patrick, Bradley, & Lang, 1993). While preliminary research is being conducted with undergraduate samples on the psychophysiological correlates of grandiose narcissism versus antisocial traits (Kelsey, Ornduff, McCann, & Reiff, 2001; Kelsey, Ornduff, Reiff, & Aurther, 2002; Sylvers, Brubaker, Alden, Brennan, & Lilienfeld, 2008), additional research is needed to fully explicate these relationships in ecologically-valid samples.

In contrast to the primary variant, research indicates secondary psychopathic traits are associated with deficits in executive functioning and cognitive control (Raine et al., 1998; Sellbom & Verona, 2007), potentially governed by dorsolateral prefrontal cortex (Dolan & Park, 2002; Morgan & Lilienfeld, 2000). Secondary psychopathy is theorized to be conceptually similar to the externalizing spectrum of psychopathology (Krueger et al., 2002; Patrick, et. al., 2005) and to share etiological vulnerabilities with disorders on this spectrum, including antisocial personality disorder and substance use. It is possible that vulnerable narcissism may be a related indicator of this latent externalizing dimension (e.g., Miller et al., in press). A putative endophenotype of the externalizing spectrum is reduced P300 amplitude (Iacono, Malone, & McGue, 2003; Patrick et al., 2006), an ERP index of working memory functioning that is thought to have neural generators in the lateral prefrontal cortex (Nieuwenhuis, Aston-Jones, & Cohen, 2005) and anterior cingulate cortex (Dien, Spencer, & Donchin, 2003). One potential avenue for future research is to explore the extent to which individuals high on vulnerable narcissism evidence reduced P300 amplitude, which would shed light on the etiological overlap between vulnerable narcissism and externalizing disorders.

Strengths, Limitations, and Clinical Implications

The present study has several strengths, including the investigation of narcissistic and psychopathic personality traits in a large sample of externalizing adults where extremes on these personality features are prevalent and have serious consequences for both the individual and society. Further, we were able to examine a number of external criteria in relation to the lesser studied narcissism dimensions, which provides insight into the nomological network associated with the constructs of grandiose and vulnerable dimensions.

As with any investigation, however, this study also has limitations. First, our sample included more men than women, which may have overrepresented the manifestation of narcissism and psychopathy in men. Although the number of men in this sample are disproportionate to the general population, our recruitment procedures over sampled women relative to their representation in the legal system (FBI, 2008). Second, the use of self-report data for our measure of the narcissism dimensions is a limitation (e.g. Oltmanns & Strauss, 1998; Oltmanns & Turkheimer, 2009), and future research can include structured diagnostic assessments of narcissism symptoms. Our use of clinician-rated psychopathy and psychopathology assessments, however, helped limit the extent to which common method variance contributed to the associations between the narcissism dimensions and psychopathy facets.

Despite these limitations, the results of the current study provide important information about the extent to which narcissism and psychopathy converge and are potentially mutually informative in externalizing samples. The present findings also have implications for clinicians treating individuals with narcissistic traits. If, as the present findings suggest, grandiose and vulnerable narcissism and primary and secondary psychopathy manifest similarly among externalizing individuals, clinicians attempting to treat grandiose narcissistic traits may want to emphasize building empathy for others and decreasing interpersonal exploitation. In contrast, those treating vulnerable narcissism may want to focus on controlling emotional outbursts and impulsive behavior, as well as the comorbid symptoms of depression that are often observed in those with vulnerable narcissism. A divergence in coping strategies utilized by vulnerable and grandiose narcissists could explain the differential risk for internalizing psychopathology, and this information on coping strategies can be incorporated in treatment interventions that decrease emotional distress in the former and increase emotional engagement in the latter. Thus, the current study advances the literature by illuminating commonalities in the manifestation and potential treatment of personality pathology in externalizing adults and suggests that shared vulnerabilities may underlie narcissism and psychopathy in criminally-involved individuals.

Footnotes

1

Because regression analyses indicated that Recruitment Sample (county jail, probation/ parole, substance use center) did not interact with the PCL: SV facets to predict grandiose (|βs| < .12, ps > .50) or vulnerable (|βs| < .24, ps > .13) narcissism, all analyses were collapsed across recruitment samples. There were no group differences between those recruited through the substance use treatment center and those recruited while on parole/probation on the main study variables. However, individuals recruited while in jail had mean levels on grandiose narcissism, as well as on the affective and antisocial facets of psychopathy that were significantly higher than those recruited while on parole/probation or through substance use treatment centers (ts = 2.1 – 3.5, all ps < .05). Jail inmates were also lower on vulnerable narcissism and the lifestyle facet of psychopathy relative to the substance use sample (ts = 2.3 and 2.3, respectively, ps < .05).

2

We examined whether the absence of collateral information in the form of public records affected the relationship of the PCL: SV facets and narcissism dimensions. Regression analyses indicated that access to public record information did not interact with the PCL: SV facets to predict grandiose (|βs| < .25, ps > .32) or vulnerable (|βs| < .22, ps > .25) narcissism.

3

We also considered whether age may be impacting the correlations between the narcissism dimensions and the aggression variables by separating our sample into two groups, individuals age 30 and below (N = 197) and those over the age of 30 (N = 146). Following Steiger (1980), a comparison of the narcissism-aggression correlations for younger and older adults revealed no significant differences.

References

  1. Akhtar S, Thomson JA. Overview: Narcissistic personality disorder. The American Journal of Psychiatry. 1982;139:12–20. doi: 10.1176/ajp.139.1.12. [DOI] [PubMed] [Google Scholar]
  2. American Psychiatric Association (APA) Diagnostic and statistical manual of mental disorders. 4th edition. Author; Washington, DC: 2000. Text Revision. [Google Scholar]
  3. Ames DR, Rose P, Anderson CP. The NPI-16 as a short measure of narcissism. Journal of Research in Personality. 2006;40:440–450. [Google Scholar]
  4. Benning SD, Patrick CJ, Blonigen DM, Hicks BM, Iacono WG. Estimating facets of psychopathy from normal personality traits: A step toward community epidemiological investigations. Assessment. 2005;12:3–18. doi: 10.1177/1073191104271223. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Birbaumer N, Veit R, Lotze M, Erb M, Hermann C, Grodd W, Flor H. Deficient fear conditioning in psychopathy: A functional magnetic resonance imaging study. Archives of General Psychiatry. 2005;62:799–805. doi: 10.1001/archpsyc.62.7.799. [DOI] [PubMed] [Google Scholar]
  6. Blackburn R. An empirical classification of psychopathic personality. British Journal of Psychiatry. 1975;127:456–460. doi: 10.1192/bjp.127.5.456. [DOI] [PubMed] [Google Scholar]
  7. Blair RJR. Applying a cognitive neuroscience perspective to the disorder of psychopathy. Development and Psychopathology. 2005;17:865–891. doi: 10.1017/S0954579405050418. [DOI] [PubMed] [Google Scholar]
  8. Bushman BJ, Baumeister RF. Threatened egotism, narcissism, self-esteem, and direct and displaced aggression: Does self-love or self-hate lead to violence? Journal of Personality and Social Psychology. 1998;75:219–229. doi: 10.1037//0022-3514.75.1.219. [DOI] [PubMed] [Google Scholar]
  9. Bushman BJ, Baumeister RF, Thomaes S, Ryu E, Begeer S, West SG. Looking again, and harder, for a link between low self-esteem and aggression. Journal of Personality. 2009;77:427–446. doi: 10.1111/j.1467-6494.2008.00553.x. [DOI] [PubMed] [Google Scholar]
  10. Buss AH, Warren WL. Aggression questionnaire. Western Psychological Services; Los Angeles: 2000. [Google Scholar]
  11. Cale EM, Lilienfeld SO. Histrionic personality disorder and antisocial personality disorder. Journal of Personality Disorders. 2002;16:52–72. doi: 10.1521/pedi.16.1.52.22557. [DOI] [PubMed] [Google Scholar]
  12. Cheek JM, Hendin HM. Shyness, shame, and narcissism. In: Paulhus D, editor. The social cognition of shyness and social anxiety; Symposium conducted at the meeting of the American Psychological Association; Toronto, Canada. 1996, August; Chair. [Google Scholar]
  13. Cleckley H. The mask of sanity. 5th ed. St. Louis, MO; Mosby: 1976. [Google Scholar]
  14. Coccaro EF, Berman ME, Kavoussi RJ. Assessment of life-history of aggression: Development and psychometric characteristics. Psychiatry Research. 1997;73:147–157. doi: 10.1016/s0165-1781(97)00119-4. [DOI] [PubMed] [Google Scholar]
  15. Cooke DJ, Michie C. Refining the construct of psychopathy: Towards a hierarchical model. Psychological Assessment. 2001;13:171–188. [PubMed] [Google Scholar]
  16. Dien J, Spencer KM, Donchin E. Localization of the event-related potential novelty response as defined by principal components analysis. Cognitive Brain Research. 2003;17(3):637–650. doi: 10.1016/s0926-6410(03)00188-5. [DOI] [PubMed] [Google Scholar]
  17. Dolan M, Park I. The neuropsychology of antisocial personality disorder. Psychological Medicine. 2002;32:417–427. doi: 10.1017/s0033291702005378. [DOI] [PubMed] [Google Scholar]
  18. Edens JF, Hart SD, Johnson DW, Johnson JK, Olver ME. Use of the Personality Assessment Inventory to assess psychopathy in offender populations. Psychological Assessment. 2000;12:132–139. doi: 10.1037//1040-3590.12.2.132. [DOI] [PubMed] [Google Scholar]
  19. Federal Bureau of Investigation . Crime in the United States, 2007. U.S. Department of Justice; Washington, DC: 2008. [Google Scholar]
  20. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I) 2002 [Google Scholar]
  21. Flor H, Birbaumer N, Hermann C, Ziegler S, Patrick CJ. Aversive Pavlovian conditioning in psychopaths: Peripheral and central correlates. Psychophysiology. 2002;39:505–518. doi: 10.1017.S0048577202394046. [DOI] [PubMed] [Google Scholar]
  22. Gramzow R, Tangney JP. Proneness to shame and the narcissistic personality. Personality and Social Psychology Bulletin. 1992;18:369–376. [Google Scholar]
  23. Gunderson JG, Ronningstam E, Smith LE. Narcissistic personality disorder: A review of data on DSM-III-R descriptions. Journal of Personality Disorders. 1991;5:167–177. [Google Scholar]
  24. Hare RD. Temporal gradient of fear arousal in psychopaths. Journal of Abnormal Psychology. 1965;70:442–445. doi: 10.1037/h0022775. [DOI] [PubMed] [Google Scholar]
  25. Hare RD. Manual for the Hare Psychopathy Checklist-Revised. Multi-Health Systems; Toronto, Ontario, Canada: 1991. [Google Scholar]
  26. Hare RD. Psychopathy Checklist-Revised. 2nd Ed. Multi-Health Systems; Toronto: 2003. [Google Scholar]
  27. Hart SD. The role of psychopathy in assessing risk for violence: Conceptual and methodological issues. Legal and Criminological Psychology. 1998;3:121–137. [Google Scholar]
  28. Hart SD, Cox DN, Hare RD. The Hare PCL:SV: Psychopathy Checklist: Screening Version. 1995 [Google Scholar]
  29. Hart SD, Hare RD. Discriminant validity of the Psychopathy Checklist in a forensic psychiatric population. Psychological Assessment: A Journal of Consulting and Clinical Psychology. 1989;1:211–218. [Google Scholar]
  30. Hendin HM, Cheek JM. Assessing hypersensitive narcissism: A reexamination of Murray’s Narcism Scale. Journal of Research in Personality. 1997;31:588–599. [Google Scholar]
  31. Hiatt KD, Schmitt WA, Newman JP. Stroop tasks reveal abnormal selective attention in psychopathic offenders. Neuropsychology. 2004;18:50–59. doi: 10.1037/0894-4105.18.1.50. [DOI] [PubMed] [Google Scholar]
  32. Hibbard S. Narcissism, shame, masochism, and object relations: An exploratory correlational study. Psychoanalytic Psychotherapy. 1992;9:489–508. [Google Scholar]
  33. Hill CD, Neumann CS, Rogers R. Confirmatory factor analysis of the Psychopathy Checklist: Screening Version in offenders with Axis I disorders. Psychological Assessment. 2004;16:90–95. doi: 10.1037/1040-3590.16.1.90. [DOI] [PubMed] [Google Scholar]
  34. Iacono W, Malone S, McGue M. Substance use disorders, externalizing psychopathology and P300 event-related potential amplitude. International Journal of Psychophysiology. 2003;48:147–178. doi: 10.1016/s0167-8760(03)00052-7. [DOI] [PubMed] [Google Scholar]
  35. Jones DN, Paulhus DL. Different provocations trigger aggression in narcissists and psychopaths. Social Psychological and Personality Science. 2010;1:12–18. [Google Scholar]
  36. Karpman B. On the need of separating psychopathy into two distinct clinical types: the symptomatic and the idiopathic. Journal of Criminal Psychopathology. 1941;3:112–137. [Google Scholar]
  37. Kelsey RM, Ornduff SR, McCann CM, Reiff S. Psychophysiological characteristics of narcissism during active and passive coping. Psychophysiology. 2001;38:292–303. [PubMed] [Google Scholar]
  38. Kelsey RM, Ornduff SR, Reiff S, Arthur CM. Psychophysiological correlates of narcissistic traits in women during active coping. Psychophysiology. 2002;39:322–332. [PubMed] [Google Scholar]
  39. Kernberg OF. Borderline conditions and pathological narcissism. Jason Aronson; New York: 1975. [Google Scholar]
  40. Kernberg OF, Caligor E. A psychoanalytic theory of personality disorders. In: Lenzenweger MF, Clarkin JF, editors. Major theories of personality disorder. 2nd Ed. Guilford Press; New York: 2005. pp. 14–156. [Google Scholar]
  41. Kiehl KA. A cognitive neuroscience perspective on psychopathy: Evidence for paralimbic system dysfunction. Psychiatry Research. 2006;142:107–128. doi: 10.1016/j.psychres.2005.09.013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Krueger RF, Hicks BM, Patrick CJ, Carlson SR, Iacono WG, McGue M. Etiologic connections among substance dependence, antisocial behavior, and personality: Modeling the externalizing spectrum. Journal of Abnormal Psychology. 2002;111:411–424. [PubMed] [Google Scholar]
  43. Levenston GK, Patrick CJ, Bradley MM, Lang PJ. The psychopath as observer: Emotion and attention in picture processing. Journal of Abnormal Psychology. 2000;109:373–385. [PubMed] [Google Scholar]
  44. Locke KD. Aggression, narcissism, self-esteem, and the attribution of desirable and humanizing traits to self versus others. Journal of Research in Personality. 2009;43:99–102. [Google Scholar]
  45. Lorber MF. Psychophysiology of aggression, psychopathy, and conduct problems: A meta-analysis. Psychological Bulletin. 2004;130:531–552. doi: 10.1037/0033-2909.130.4.531. [DOI] [PubMed] [Google Scholar]
  46. Lykken DT. The antisocial personalities. Lawrence Erlbaum Associates; Hillsdale, NJ: 1995. [Google Scholar]
  47. Lynam DR. Psychopathy from the perspective of the Five-Factor Model of personality. In: Costa PT, Widiger TA, editors. Personality disorders and the Five-Factor Model of personality. American Psychological Association; Washington, DC: 2002. 2nd volume. [Google Scholar]
  48. McHoskey JW, Worzel W, Szyarto C. Machiavellianism and psychopathy. Journal of Personality and Social Psychology. 1998;74:192–210. doi: 10.1037//0022-3514.74.1.192. [DOI] [PubMed] [Google Scholar]
  49. Miller JD, Campbell WK. Comparing clinical and social-personality conceptualizations of narcissism. Journal of Personality. 2008;76:449–476. doi: 10.1111/j.1467-6494.2008.00492.x. [DOI] [PubMed] [Google Scholar]
  50. Miller JD, Dir A, Gentile B, Wilson L, Pryor LR, Campbell WK. Searching for a vulnerable dark triad: Comparing factor 2 psychopathy, vulnerable narcissism, and borderline personality disorder. Manuscript in press at the Journal of Personality. doi: 10.1111/j.1467-6494.2010.00660.x. in press. [DOI] [PubMed] [Google Scholar]
  51. Morgan AB, Lilienfeld O. A meta-analytic review of the relation between antisocial behavior and neuropsychological measures of executive function. Clinical Psychology Review. 2000;20:113–156. doi: 10.1016/s0272-7358(98)00096-8. [DOI] [PubMed] [Google Scholar]
  52. Newman JP. Psychopathic behavior: An information processing perspective. In: Cooke DJ, Hare RD, Forth A, editors. Psychopathy: Theory, Research and Implications for Society. Kluwer Academic Publishers; The Netherlands: 1998. pp. 81–104. [Google Scholar]
  53. Nieuwenhuis S, Aston-Jones G, Cohen JD. Decision Making, the P3, and the locus coeruleus-norepinephrine system. Psychological Bulletin. 2005;131:510–532. doi: 10.1037/0033-2909.131.4.510. [DOI] [PubMed] [Google Scholar]
  54. Oltmanns TF, Strauss ME. Peer assessment of personality traits and pathology in female college students. Assessment. 1998;5:53–65. doi: 10.1177/107319119800500108. [DOI] [PubMed] [Google Scholar]
  55. Oltmanns TF, Turkheimer E. Person perception and personality pathology. Current Directions in Psychological Science. 2009;18:32–36. doi: 10.1111/j.1467-8721.2009.01601.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  56. Patrick CJ, Fowles DC, Krueger RF. Triarchic conceptualization of psychopathy: Developmental origins of disinhibition, boldness, and meanness. Development and Psychopathology. 2009;21:913–938. doi: 10.1017/S0954579409000492. [DOI] [PubMed] [Google Scholar]
  57. Patrick CJ, Hicks BM, Krueger RF, Lang AR. Relations between psychopathy facets and externalizing in a criminal offender sample. Journal of Personality Disorders. 2005;19:339–356. doi: 10.1521/pedi.2005.19.4.339. [DOI] [PMC free article] [PubMed] [Google Scholar]
  58. Patrick CJ, Bradley MM, Lang PJ. Emotion in the criminal psychopath: Startle reflex modulation. Journal of Abnormal Psychology. 1993;102:82–92. doi: 10.1037//0021-843x.102.1.82. [DOI] [PubMed] [Google Scholar]
  59. Paulhus DL, Robins RW, Trzesniewski KH, Tracy JL. Two replicable suppressor situations in personality research. Multivariate Behavioral Research. 2004;39:303–328. doi: 10.1207/s15327906mbr3902_7. [DOI] [PubMed] [Google Scholar]
  60. Paulhus DL, Williams KM. The Dark Triad of personality: Narcissism, Machiavellianism, and psychopathy. Journal of Research in Personality. 2002;36:556–563. [Google Scholar]
  61. Pincus AL, Ansell EB, Pimentel CA, Cain NM, Wright AGC, Levy KN. Initial construction and validation of the Pathological Narcissism Inventory. Psychological Assessment. 2009;21:365–379. doi: 10.1037/a0016530. [DOI] [PubMed] [Google Scholar]
  62. Raine A, Meloy R, Bihrle S, Stoddard J, LaCasse L, Buchsbaum M. Reduced prefrontal and increased subcortical brain functioning assessed using positron emission tomography in predatory and affective murders. Behavioral Sciences and Law. 1998;16:319–332. doi: 10.1002/(sici)1099-0798(199822)16:3<319::aid-bsl311>3.0.co;2-g. [DOI] [PubMed] [Google Scholar]
  63. Raskin R, Hall CS. A narcissistic personality inventory. Psychological Reports. 1979;45:590. doi: 10.2466/pr0.1979.45.2.590. [DOI] [PubMed] [Google Scholar]
  64. Raskin R, Hall CS. The Narcissistic Personality Inventory: Alternative form reliability and further evidence of construct validity. Journal of Personality Assessment. 1981;45:159–162. doi: 10.1207/s15327752jpa4502_10. [DOI] [PubMed] [Google Scholar]
  65. Raskin R, Terry H. A principal-components analysis of the Narcissistic Personality Inventory and further evidence of its construct validity. Journal of Personality and Social Psychology. 1988;54:890–902. doi: 10.1037//0022-3514.54.5.890. [DOI] [PubMed] [Google Scholar]
  66. Rutherford MJ, Alterman AI, Cacciola JS, McKay JR. Validity of the Psychopathy Checklist-Revised in male methadone patients. Drug and Alcohol Dependence. 1996;44:143–149. doi: 10.1016/s0376-8716(96)01329-4. [DOI] [PubMed] [Google Scholar]
  67. Sadeh N, Verona E. Psychopathy traits and selective impairments in attentional functioning. Neuropsychology. 2008;22:669–680. doi: 10.1037/a0012692. [DOI] [PMC free article] [PubMed] [Google Scholar]
  68. Samuel DB, Widiger TA. Convergence of narcissism measures from the perspective of general personality functioning. Assessment. 2008;15:364–374. doi: 10.1177/1073191108314278. [DOI] [PubMed] [Google Scholar]
  69. Sellbom M, Verona E. Neuropsychological correlations of psychopathic traits in a non-incarcerated sample. Journal of Research in Personality. 2007;41:276–294. [Google Scholar]
  70. Skeem JL, Johansson P, Andershed H, Kerr M, Louden JE. Two subtypes of psychopathic violent offenders that parallel primary and secondary variants. Journal of Abnormal Psychology. 2007;116:395–409. doi: 10.1037/0021-843X.116.2.395. [DOI] [PubMed] [Google Scholar]
  71. Skeem JL, Mulvey EP. Psychopathy and community violence among civil psychiatric patients: Results from the MacArthur Violence Risk Assessment Study. Journal of Clinical and Consulting Psychology. 2001;69:358–374. [PubMed] [Google Scholar]
  72. Skeem JL, Poythress N, Edens JF, Lilienfeld SO, Cale EM. Psychopathic personality or pesonalities? Exploring potential variants of psychopathy and their implications for risk assessment. Aggression and Violent Behavior. 2003;8:513–546. [Google Scholar]
  73. Smith SS, Newman JP. Alcohol and drug abuse-dependence disorders in psychopathic and nonpsychopathic criminal offenders. Journal of Abnormal Psychology. 1990;99:430–439. doi: 10.1037//0021-843x.99.4.430. [DOI] [PubMed] [Google Scholar]
  74. Steiger JH. Tests for comparing elements of a correlation matrix. Psychological Bulletin. 1980;87:245–251. [Google Scholar]
  75. Stinson FS, Dawson DA, Goldstein RB, Chou SP, Huang B, Smith SM, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry. 2008;69:1033–1045. doi: 10.4088/jcp.v69n0701. [DOI] [PMC free article] [PubMed] [Google Scholar]
  76. Sylvers P, Brubaker N, Alden SA, Brennan PA, Lilienfeld SO. Differential endophenotypic markers of narcissistic and antisocial personality features: A psychophyisological investigation. Journal of Research in Personality. 2008;42:1260–1270. [Google Scholar]
  77. Tangney JP, Dearing RL. Shame and guilt. Guilford Press; New York: 2002. [Google Scholar]
  78. Vanman EJ, Mejia VY, Dawson ME, Schell AM, Raine A. Modification of the startle reflex in a community sample: Do one or two dimension of psychopathy underlie emotional processing? Personality and Individual Differences. 2003;35:2007–2021. [Google Scholar]
  79. Verona E, Hicks BM, Patrick CJ. Psychopathy and suicidality in female offenders: Mediating influences of personality and abuse. Journal of Consulting and Clinical Psychology. 2005;73:1065–1073. doi: 10.1037/0022-006X.73.6.1065. [DOI] [PMC free article] [PubMed] [Google Scholar]
  80. Verona E, Patrick CJ, Joiner TE. Psychopathy, antisocial personality, and suicide risk. Journal of Abnormal Psychology. 2001;110:462–470. doi: 10.1037//0021-843x.110.3.462. [DOI] [PubMed] [Google Scholar]
  81. Verona E, Sadeh N, Case SM, Reed A, Bhattacharjee A. Self-reported use of different forms of aggression in late adolescence and emerging adulthood. Assessment. 2008;15:493–510. doi: 10.1177/1073191108318250. [DOI] [PubMed] [Google Scholar]
  82. Walsh Z, Kosson DS. Psychopathy and violence: The importance of factor level interactions. Psychological Assessment. 2008;20:114–120. doi: 10.1037/1040-3590.20.2.114. [DOI] [PubMed] [Google Scholar]
  83. Watson PJ, Sawrie SM, Greene RL, Arredondo R. Narcissism and depression: MMPI-2 evidence for the continuum hypothesis in clinical samples. Journal of Personality Assessment. 2002;79:85–109. doi: 10.1207/S15327752JPA7901_06. [DOI] [PubMed] [Google Scholar]
  84. Widiger TA, Corbitt EM. Antisocial personality disorder: Proposal for DSM-IV. Journal of Personality Disorders. 1993;7:65–77. [Google Scholar]
  85. Williamson S, Hare RD, Wong S. Violence: Criminal psychopaths and their victims. Canadian Journal of Behavioral Science. 1987;19:454–462. [Google Scholar]
  86. Wink P. Two faces of narcissism. Journal of Personality and Social Psychology. 1991;61:590–597. doi: 10.1037//0022-3514.61.4.590. [DOI] [PubMed] [Google Scholar]
  87. Woodworth M, Porter S. In cold blood: Characteristics of criminal homicides as a function of psychopathy. Journal of Abnormal Psychology. 2002;111:436–445. doi: 10.1037//0021-843x.111.3.436. [DOI] [PubMed] [Google Scholar]

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