What causes narcissism? Why are narcissists so charming and likable (at first)? Do people with have high ? Is narcissism related to psychopathy? Can narcissism be cured—or treated successfully with or ? Might narcissism sometimes be a good thing or is it always harmful? How to deal with narcissists? Many questions about narcissism are difficult to answer, at least in part because narcissism is not clearly defined. To know whether narcissism can be overcome, for instance, we need to really know what narcissism means.

I recently had the privilege of interviewing someone familiar with various conceptualizations of narcissism, including both clinical and social/ views of it. Josh Miller, Ph.D., professor of psychology and Director of Clinical Training at the University of Georgia is a prolific researcher who has published well over 200 peer-reviewed papers and book chapters—a significant number of which concern narcissism and personality disorder.2-5 His research focuses on normal and pathological personality traits, (with an emphasis on narcissism and psychopathy), and externalizing behaviors.

Miller is also Editor-in-Chief of the Journal of Research in Personality, and is on the editorial board of other peer-reviewed journals, including Journal of Abnormal Psychology, Assessment, Journal of Personality, Journal of Personality Disorders, and Personality Disorders: Theory, Research, and Treatment.

Emamzadeh: Since the 1900s, many clinicians and researchers—Sigmund , Harry Guntrip, Heinz Kohut, Otto Kernberg, Glen Gabbard, and Elsa Ronningstam among them—have written on narcissism. Even nowadays, as you noted in your 2017 review paper, “Research on narcissism in all its forms—narcissistic personality disorder (NPD), grandiose narcissism, and vulnerable narcissism—is more popular than ever."2 Why do you think so many researchers, not to mention lay people, are fascinated by narcissism?

Miller: I would argue it is a confluence of factors—researchers interested in parsing narcissism in more nuanced ways (e. ., delineating between grandiose and vulnerable presentations), the inclusion of narcissism in a multi-construct literature called the Dark Triad (study of narcissism, psychopathy, and ) that has gained substantial traction in both the empirical literature and among the lay-public, and discussions of narcissism seen in prominent mainstream public figures. Finally, I think narcissism is a familiar construct in that almost all people can easily conjure up examples of individuals in their own lives who manifest some of these traits—be they family members, friends, or co-workers—and thus it resonates fairly broadly across a spectrum of people including the public, researchers, and clinicians.

Emamzadeh: I have noticed that clinicians, researchers, and writers (including some writing for Psychology Today) do not always use the term “narcissist” consistently. I’ve read views on narcissism as different as the following (A vs B).

A: Narcissists and psychopaths share much in common. Neither truly suffers but both make people around them suffer. We need to learn to identify narcissists so as to protect ourselves from these dangerous and ruthless individuals.

B: Narcissists have fragile egos; their overconfidence is nothing but a mask. We need to have greater compassion for narcissists because they are wounded (even if they won’t admit to it). Narcissists suffer like the rest of us.

Which of these descriptions is closer to the truth?

Miller: My thoughts are generally more consistent with option A in that narcissism and psychopathy are “near neighbor” constructs that overlap quite substantially. Interestingly, probably due to where they’ve typically been studied and how that affected initial theories (narcissism: theories by theorists; psychopathy: settings), there is little of the “vulnerability” or “mask” notion for psychopathy that is found so consistently for narcissism in which we infer negative emotions (e.g., ; ; feelings of deficiency) that drive the grandiosity—ideas that have yet to receive much empirical support despite their longstanding prominence in clinical and lay opinions of narcissism. I think one can have compassion for narcissistic and individuals (although it can be difficult) if one recognizes the harm they do to themselves as well as others and the likelihood that there is some meaningful degree of dyscontrol at play.

Emamzadeh: One word used to describe narcissism, especially in social/personality literature, is grandiosity. The term grandiosity is defined variously as self-importance, self-promotion, and feelings of superiority. But the difference between grandiosity and high self-esteem seems to be a matter of degrees, with grandiosity indicating “exaggerated” or “excessive” self-importance. If this is true, then how can we determine—or who determines—the appropriate level of self-importance?

Source: Photo by courtesy of Dr. Josh Miller

Miller: That’s a great question, which I’m going to dodge at first. I would argue that grandiose narcissism and self-esteem are quite different constructs despite their seeming overlap. We recently conducted a relatively comprehensive empirical comparison of the two constructs across 11 samples (and almost 5000 participants) and found a few key similarities and many important differences.6 The two constructs are only moderately correlated (r ≈ .30), so they are very far from interchangeable. In terms of similarities, individuals who are high in self-esteem and/or grandiose narcissism do share an , , confident interpersonal style. In terms of differences, however, self-esteem is a wholly adaptive construct in terms of interpersonal (relations with others) and intrapersonal correlates (e.g., less likely to experience internalizing or externalizing forms of symptoms) whereas narcissism has a host of maladaptive interpersonal correlates. We believe this is due to a zero-sum interpersonal approach in which narcissistic individuals believe that there can be only one “winner” in any given interaction (e.g., the smartest; the most status; the most power) whereas individuals with high self-esteem but not narcissism are capable of thinking of themselves and others in positive terms (see also Brummelman, Thomaes, & Sedikides, 2016).7

Ultimately, I think it’s OK to have high self-esteem as long as it doesn't come at the expense of others, isn’t predicated on feeling superior to others in such a way that one leaves little room for others to also feel good about themselves, and is built on a multi-pronged foundation that allows one to be more in the face of naturally occurring ego-threats. So, the person whose is built upon being a good friend, spouse, parent, and professional should be able to suffer the slings and arrows of life more successfully than someone whose self-esteem is built more narrowly upon one of those roles.

Emamzadeh: In your 20113 and 20184 papers, you draw a clear boundary between vulnerable and grandiose narcissism. But is it possible for one type to convert to another? For instance, might an older grandiose narcissist who can no longer rely on his previous sources of narcissistic supply (e.g., wealth, good looks) meet the criteria for vulnerable narcissism?

Miller: There aren’t a great deal of data at this time to answer this question. But, using data that are available, I think we can say that more vulnerably narcissistic individuals do not seem to fluctuate towards grandiosity6,8,9 but that grandiose individuals may experience negative emotions, particularly , that some believe suggests underlying vulnerability. It is important also to note that these are not really “types” (grandiose vs. vulnerable) but modestly related dimensions—so one could be highly elevated on one but not the other, elevated on both (or neither), etc. In general, more data are needed using longitudinal approaches to answer questions as to the degree of fluctuation that may occur between grandiose and vulnerable narcissism.10

Emamzadeh: Does the diagnosis of narcissistic personality disorder, as outlined in the (DSM–5),11 identify narcissists who belong to the vulnerable or the grandiose category?

Miller: The DSM-5 criteria certainly emphasize grandiosity to a far greater extent than vulnerability, as it should in my opinion, as those are the defining and central features. Vulnerability is discussed in the text, however, in a manner that accords with classic psychodynamic notions of the disorder in which the grandiosity is a thinly veiled façade protecting a weaker inner sense of self. Assessments of narcissistic personality disorder, however, vary tremendously in the degree to which they assess a more grandiose or vulnerable dimension of narcissism with many popular self-report measures according more with the latter than the former. Given this issue, clinicians and researchers should evaluate which measures they plan to use carefully to ensure that it is well-suited for the task at hand.

**Part 2 of this Q&A on Narcissism**