This is the first published study to examine the neural correlates of narcissistic “self-admiration” using fMRI. We conducted a carefully designed experiment in which extreme groups of high and low narcissism (assessed with the NPI, the long-time standard measure of subclinical narcissism), viewed images of themselves, close friends, and similarly attractive strangers. By these means, we sought to uncover the neural responses of visual self-recognition in narcissistic individuals, which might help to better understand the phenomenon of narcissism beyond the limits of self-reports (cf. ref. 18). Based on social-cognitive and psychodynamic theories of narcissism, we expected that highly narcissistic individuals would either display neural activation indicating self-gratification (subcortical dopaminergic regions; refs 19, 20) or negative affect and conflicting emotional processing (anterior cingulate18).

Our results support the hypothesis of negative affect rather than self-admiration: Highly narcissistic men displayed increased activation in the dorsal and ventral ACC. While anterior midline regions are known to be generally involved in self-referential processing29, 35, interindividual differences in d/vACC activation might be associated with more specific psychological processes: The dorsal ACC is a key region in conflict monitoring36, expectancy violation37, and negative affect38. All of these can be considered relevant to self-referential processing (which implies evaluative processing; see below), but their actual degree of involvement might depend upon interindividual differences. For example, the dorsal ACC has been associated with the experience of social exclusion in individuals with low self-esteem39. Recently, in a similar vein, Cascio and colleagues18 reported that narcissistic individuals display increased activation in the “social pain network” (dorsal ACC, subgenual ACC, and anterior insula) following social exclusion in a cyberball paradigm. Importantly, highly narcissistic individuals did not report elevated feelings of social exclusion in a self-report measure, which lead the authors to conclude that “narcissists’ social pain [is] seen only in the brain” (p. 335). Visual self-recognition may induce similar distress in narcissistic individuals, because narcissists might engage in greater self-monitoring, which is consistent with the adaptive control hypothesis of ACC function38. Interestingly, dACC activation is also associated with self-viewing when being observed by others, which may lead to the experience of embarrassment, in which “the ACC might […] serve as a hub, integrating information about the reflective self that is used in evaluating perceptual self-face images” (ref. 40, p. 570).

The view that narcissistic self-processing is accompanied by negative affect or emotional conflict is further substantiated by the activation in the ventral ACC in highly narcissistic individuals. The ventral ACC is specifically involved in processing negative self-referential material41, particularly when this material is self-relevant 42. This implies that visual self-recognition is a potentially threatening situation to narcissistic individuals, which are known to be overly sensitive to ego-threat43.

Grandiose narcissism thus may encompass vulnerable aspects as well, though these might not be apparent in self-report research. Our results point to subclinical narcissism being not qualitatively but rather quantitatively different from clinical narcissism, for which “many contemporary clinical experts on narcissistic personality disorder now recognize that grandiose self-states oscillate or co-occur with vulnerable self-states and affective dysregulation” (ref. 4, p. 428).

A recent structural diffusion tensor imaging study found that narcissism goes along with weakened frontostriatal connectivity of white matter tracts44. The authors interpret their findings in terms of a neural disconnect between brain regions responsible for self-representation (medial frontal cortex) and reward (ventral striatum). This finding might help to understand why one of our initial hypotheses, the “self-reward-hypothesis”, did not hold true: Narcissists seem to habitually lack an intrinsic system for self-rewarding activity, why they strive for reward from their external (social) environment11. In order to receive reward in terms of positive social feedback, highly narcissistic individuals must be very concerned about their (visual) self-presentation45. Narcissists thus have a pronounced disposition to self-evaluation, which may lead to increased (voluntary or involuntary) self-monitoring46. This explains why highly narcissistic individuals display neural activation that points to negative affect in the course of evaluative processes rather than self-reward and/or liking (which appears to be intrinsically reduced on a brain structural level). Considering the two versions of the ancient myth of Narcissus, our results are in favor of the less prominent version, in which Narcissus is shocked to death by the ugliness of his mirror image when a leaf drops into the water. This myth can be seen to metaphorically reflect the ongoing critical self-monitoring that narcissists display when confronted with self-relevant material, presumably due to a lowered intrinsic coupling between self-representation and self-reward/liking.

Activation differences pointing to expectancy violation and affective dysregulation were apparent only in men, but not in women, in this study. It has long been hypothesized that narcissism might qualitatively differ between men and women, with men displaying more emotionally dysfunctional characteristics (e.g., ref. 11). Recent empirical evidence indicates that male narcissists display lower performance on measures of emotional intelligence, which is not the case in women10. Most strikingly, it was also found that narcissism is accompanied by general elevations in cortisol levels and exaggerated physiological stress responses, but only in men33, 34. Taken together with our fMRI findings, these results underpin the presumption that narcissism is qualitatively different in women and men, with primarily men showing increased sensitivity to potentially threatening situations and maladaptive affective regulation. The question remains, however, why our experiment – like previous ones33, 34 – did not unveil any dissociation between high and low narcissistic women. Reinhard and colleagues34 argued that sex differences in distress indicators associated with narcissism (higher basal cortisol levels in men) might be explained along different narcissistic strategies associated with male and female gender roles: While masculinity is associated with independence and agency, thus promoting individualism over the acceptance of social support, femininity encourages seeking social support. By this means, women might, on average, develop higher resilience towards potentially stressful situations. Future studies could investigate gender roles as potentially mediating variables between sex and physiological outcomes associated with narcissism; it might be the case that women with a more masculine attitude display similar effects as men do. Also, considering gender roles might help to unveil other – probably more subtle – behavioral and neural mechanisms associated specifically with female narcissism.

There are some limitations to this study. Most notably, the sample under study was rather small, but nonetheless carefully selected with respect to large (about 4 SD) and stable differences in narcissism. Using these extreme groups and a two-step fMRI data analysis procedure (whole brain and ROI analyses), it was possible to obtain robust results that satisfy the most conservative statistical criteria. Another limitation can be seen in that this study focused on grandiose narcissism, though increasing efforts are devoted to the study of vulnerable narcissism as an independent trait in narcissism research. However, our results strengthen the notion that grandiose narcissism entails vulnerable aspects when it comes to involuntary neurophysiological reactions, which points to a general mechanism underlying both traits. Future studies could use the experimental paradigm in an extended design encompassing grandiose and vulnerable aspects of narcissism to further elucidate their similarities and differences.

Finally, it shall be acknowledged that ACC activation cannot unambiguously be attributed to any single mental process36. As outlined above, the (d) ACC is generally involved in (visual or non-visual) self-processing29, but has also been associated with conflict monitoring, expectancy violation, pain, and negative affect36,37,38. Since processing of self-referential information might always involve some degree of self-evaluation, and thus, conflicting emotional processing or negative affect, these functions might not be as different as they might seem in the first place. In line with this, it has been proposed that the dACC might act as a hub integrating information for self-evaluative processing40. Importantly, though the ACC is generally involved in self-processing, the degree of ACC activation might still relate to interindividual differences18. For the interpretation of these interindividual differences, it seems most important that ACC activation is related to processes with negative emotional valence, especially in the context of conflict monitoring38. However, the ACC has not only been associated with self-referential processing and negative affect, but also with reward (particularly the ventral ACC; ref. 36), which could be seen as supporting the self-reward hypothesis rather than the negative affect/emotional conflict hypothesis. However, we did not observe significant group differences in the more unambiguously reward-related midbrain cluster. In complemental analyses, we also investigated other reward-related areas such as the nucleus accumbens and the caudate nucleus, but did not find any significant activation (small volume correction). Finally, the results observed here closely resemble those of Cascio and colleagues18, who related ACC activation in narcissistic individuals to negative affect (social exclusion). Taken together, the data are clearly more in line with the notion of negative affect or emotional conflict than the self-reward hypothesis.

This study set out to explore the neural correlates of narcissistic “self-admiration” within the normal personality variation of narcissism. Contrary to what would be expected on the basis of self-reports, we found that highly narcissistic men display brain activation patterns that point to prevailing negative affect or emotional conflict during visual self-recognition. These results are more in line with psychodynamic than social-cognitive theories on narcissism. While previous social-cognitive research used to focus on voluntary and conscious aspects of narcissism by means of self-report, our neurophysiological results point to latent affective dysregulation in the processing of self-relevant material.