Pathological narcissism and narcissistic personality disorder

The associations between pathological narcissism, alexithymia and disordered eating attitudes among participants of pro-anorexic online communities

PURPOSE

This study investigated the relationships between pathological narcissism, alexithymia, and disordered eating attitudes among participants of pro-anorexic online communities. Specifically, we explored the possible moderating role of alexithymia in the relationships between narcissistic vulnerability and disordered eating attitudes.

METHODS

Participants included 97 Israeli female young adults who are active participants in pro-anorexic online communities. These participants completed a battery of self-reported questionnaires: The Pathological Narcissism Inventory (PNI); The Eating Attitudes Test-26 (EAT-26); and The Toronto Alexithymia Scale (TAS-20).

RESULTS

Narcissistic grandiosity, vulnerability, and alexithymia were positively related to disordered eating attitudes. Alexithymia moderated the relationships between narcissistic vulnerability and the total score of disordered eating attitudes. Furthermore, alexithymia moderated the relationships between both narcissistic vulnerability and grandiosity and the oral control subscale of EAT-26.

CONCLUSIONS

These findings highlight the interaction between the pathological narcissism and the fundamental trait of alexithymia that might put individuals at risk for disordered eating.

Refining a complex diagnostic construct: subtyping Dysthymia with the Shedler-Westen Assessment Procedure-II

OBJECTIVE

We sought to determine whether meaningful subtypes of Dysthymic patients could be identified when grouping them by similar personality profiles.

METHOD

A random, national sample of psychiatrists and clinical psychologists (n=1201) described a randomly selected current patient with personality pathology using the descriptors in the Shedler-Westen Assessment Procedure-II (SWAP-II), completed assessments of patients' adaptive functioning, and provided DSM-IV Axis I and II diagnoses.

RESULTS

We applied Q-factor cluster analyses to those patients diagnosed with Dysthymic Disorder. Four clusters were identified-High Functioning, Anxious/Dysphoric, Emotionally Dysregulated, and Narcissistic. These factor scores corresponded with a priori hypotheses regarding diagnostic comorbidity and level of adaptive functioning. We compared these groups to diagnostic constructs described and empirically identified in the past literature.

CONCLUSIONS

The results converge with past and current ideas about the ways in which chronic depression and personality are related and offer an enhanced means by which to understand a heterogeneous diagnostic category that is empirically grounded and clinically useful.

Child maltreatment, personality pathology, and stalking victimization among male and female college students

Self-report college student surveys on childhood maltreatment, and borderline and narcissistic personality features are examined to determine their influence on stalking victimization vulnerability. Stalking victimization was measured using Spitzberg and Cupach's (2008) Obsessive Relational Intrusion scale. Ordinary least squares (OLS) regression models were run separately for men (N = 677) and women (N = 1,017). Results indicated childhood sexual maltreatment and borderline traits were associated with stalking victimization among both men and women. These were the only significant relationships for men (R2 = .10). For women, stalking victimization was also associated with narcissistic grandiosity and vulnerability and with a child sexual abuse by borderline features interaction (R2 = .13), demonstrating women reporting prior sexual abuse and borderline personality pathology are especially vulnerable. Methodological and policy implications are discussed.

Hubris in leadership: A peril of unbridled intuition?

Research attests to the perils of hubristic leadership in politics, the military and business organizations, however whilst researchers have identified hubris’ correspondences with personality disorders and various organizational and individual level factors, the cognitive and affective antecedents of hubris have been largely overlooked. In this paper we argue that intuition, existing as it does at the nexus of cognition and affect, is a central factor and that when intuition becomes misunderstood, unchecked or unbridled within the ‘cognitive economy’ of a powerful individual hubristic behaviour is more likely to appear. In what follows we will: review the concepts of hubris, Hubris Syndrome and intuition; propose intuition as an overlooked cognitive and affective source of leaders’ hubris; discuss the relationship between unbridled intuition and hubris; suggest how the perils of hubristic leadership stemming from unbridled intuition might be avoided or mitigated.

Gray matter abnormalities in patients with narcissistic personality disorder

BACKGROUND

Despite the relevance of narcissistic personality disorder (NPD) in clinical settings, there is currently no empirical data available regarding the neurobiological correlates of NPD. In the present study, we performed a voxel-based morphometric analysis to provide initial insight into local abnormalities of gray matter (GM) volume.

METHODS

Structural brain images were obtained from patients with NPD (n = 17) and a sample of healthy controls (n = 17) matched regarding age, gender, handedness, and intelligence. Groups were compared with regard to global brain tissue volumes and local abnormalities of GM volume. Regions-of-interest analyses were calculated for the anterior insula.

RESULTS

Relative to the control group, NPD patients had smaller GM volume in the left anterior insula. Independent of group, GM volume in the left anterior insula was positively related to self-reported emotional empathy. Complementary whole-brain analyses yielded smaller GM volume in fronto-paralimbic brain regions comprising the rostral and median cingulate cortex as well as dorsolateral and medial parts of the prefrontal cortex.

CONCLUSION

Here we provide the first empirical evidence for structural abnormalities in fronto-paralimbic brain regions of patients with NPD. The results are discussed in the context of NPD patients' restricted ability for emotional empathy.

Toward a model-based approach to the clinical assessment of personality psychopathology

Recent years have witnessed tremendous growth in the scope and sophistication of statistical methods available to explore the latent structure of psychopathology, involving continuous, discrete, and hybrid latent variables. The availability of such methods has fostered optimism that they can facilitate movement from classification primarily crafted through expert consensus to classification derived from empirically based models of psychopathological variation. The explication of diagnostic constructs with empirically supported structures can then facilitate the development of assessment tools that appropriately characterize these constructs. Our goal in this article is to illustrate how new statistical methods can inform conceptualization of personality psychopathology and therefore its assessment. We use magical thinking as an example, because both theory and earlier empirical work suggested the possibility of discrete aspects to the latent structure of personality psychopathology, particularly forms of psychopathology involving distortions of reality testing, yet other data suggest that personality psychopathology is generally continuous in nature. We directly compared the fit of a variety of latent variable models to magical thinking data from a sample enriched with clinically significant variation in psychotic symptomatology for explanatory purposes. Findings generally suggested a continuous latent variable model best represented magical thinking, but results varied somewhat depending on different indexes of model fit. We discuss the implications of the findings for classification and applied personality assessment. We also highlight some limitations of this type of approach that are illustrated by these data, including the importance of substantive interpretation, in addition to use of model fit indexes, when evaluating competing structural models.

New directions for an old construct: Depressive personality research in the DSM-5 era

The DSM-5 Personality and Personality Disorders Work Group has suggested that the DSM-IV depressive personality disorder (DPD) construct be assessed within a proposed set of trait domains, which include anxiousness, depressivity, and anhedonia, and that the diagnostic category itself be removed from the DSM-5. A review of studies on DPD has demonstrated many challenges and limitations to DPD research, despite strong evidence of its validity and clinical utility. Nevertheless, there remains much interest in how a depressive personality construct fits into a dimensionalized framework of assessing psychopathology. In this paper, I offer three major research directions that can help advance our understanding of the depressive personality construct. These directions can inform researchers and clinicians how depressive personality fits within broad trait dimensions of classification, as well as the internal psychological processes, dynamics and content that characterize this type of psychopathology.

Mysticism, motherhood, and pathological narcissism? A Kohutian analysis of Marie de l'Incarnation

The following paper makes use of Kohutian self-psychology as a hermeneutic for interpreting Marie de l'Incarnation and her perplexing decision to abandon her young son Claude in favor of religious life. The author argues that filtered through the lens of Kohutian self-psychology, Marie de l'Incarnation emerges as a pathological narcissist and the decision to abandon Claude symptomatic of a narcissistic grandiosity.

The narcissistic mask: an exploration of 'the defensive grandiosity hypothesis'

Narcissism has been conceptualized as involving attempts to defend against negative self-schemata (implicit negative beliefs about one's own self-worth). This idea has been termed the 'mask model of narcissism'. This study explores the mask model, examining the association between extreme narcissistic personality traits and performance on a task purported to assess the influence of negative self-schemata. Participants (n = 232) from the UK and the UAE completed the Narcissistic Personality Inventory and also performed an incidental learning task involving the surprise recall of self-referential adjectives (traits). A greater recall of negative adjectives was viewed as indicative of negative self-schemata. Looking at the sample as a whole, there were no associations between narcissistic traits and negative adjective recall. However, amongst those scoring in the upper quartile of the Narcissistic Personality Inventory, narcissism scores were positively correlated with the recall of negative adjectives even after controlling for age and memory. Narcissism may reflect self-enhancement strategies rooted in negative self-beliefs.

Emotional reactivity and the association between psychopathy-linked narcissism and aggression in detained adolescent boys

Different patterns of emotional reactivity characterize proactive and reactive functions of aggressive behavior, and theory also suggests a link of both types with narcissism. How people with narcissistic traits respond emotionally to competitive scenarios could influence their aggressiveness. Participants were 85 adolescent boys from a detention center. Several indices of emotional functioning were assessed, including attentional bias to negative emotional stimuli and psychophysiological responding. In addition, we included self-report and laboratory measures of aggression and measures of psychopathy-linked narcissism, callous–unemotional traits, and impulsivity. Psychopathy-linked narcissism was uniquely related to unprovoked aggression (i.e., proactive aggression) and to heightened attention to pictures depicting others’ distress. Compared with those scoring low on narcissism, those high on narcissism, who were the least physiologically reactive group, evinced greater proactive aggression, whereas those showing a pattern of coactivation (i.e., sympathetic and parasympathetic autonomic reactivity) evinced greater reactive aggression. Results are consistent with descriptions of narcissistic individuals as being hypervigilant to negative cues and exhibiting poor emotion regulation. These characteristics may lead to aggressive and violent behavior aimed at maintaining dominance over others.

Conceptions of narcissism and the DSM-5 pathological personality traits

The Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) features two conceptions of Narcissistic Personality Disorder (NPD), one based on the retained DSM-IV's categorical diagnosis and the other based on a model that blends impairments in personality functioning with a specific trait profile intended to recapture DSM-IV NPD. Nevertheless, the broader literature contains a richer array of potential conceptualizations of narcissism, including distinguishable perspectives from psychiatric nosology, clinical observation and theory, and social/personality psychology. This raises questions about the most advantageous pattern of traits to use to reflect various conceptions of narcissistic pathology via the Personality Inventory for the DSM-5 (PID-5). In this study, we examine the associations of the Personality Disorder Questionnaire-Narcissistic Personality Disorder scale, Narcissistic Personality Inventory-16, and the Pathological Narcissism Inventory and the PID-5 dimensions and facets in a large sample (N = 1,653) of undergraduate student participants. Results point to strong associations with PID-5 Antagonism scales across narcissism measures, consistent with the DSM-5's proposed representation of NPD. However, additional notable associations emerged with PID-5 Negative Affectivity and Psychoticism scales when considering more clinically relevant narcissism measures.

An integrative approach to the assessment of narcissism

Narcissism research is poorly calibrated across fields of study in part due to confusion over how to integrate normal and pathological descriptions of narcissism. We argue that pathological and normal narcissism can be integrated in a single model that organizes around self-regulation mechanisms. We present theoretical and empirical support for this interpretation, and demonstrate that modeling pathological and normal narcissism as 2 dimensions underlying the narcissistic character can help to resolve some of the inconsistencies in the field regarding how to best assess adaptive and maladaptive expressions of narcissism.

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

BACKGROUND AND OBJECTIVES

Narcissistic 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.

METHODS

The 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.

RESULTS

Patients 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.

LIMITATIONS

In 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.

CONCLUSIONS

Our 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.

Narcissism in midlife: longitudinal changes in and correlates of women's narcissistic personality traits

We examined changes in and correlates of 3 kinds of narcissism--hypersensitivity, willfulness, and autonomy--during middle adulthood. Few studies have examined narcissistic personality traits beyond young adulthood, and none has assessed longitudinal changes in narcissism during midlife. In a sample of 70 college-educated women, we found that observer ratings of hypersensitive narcissism were associated with more negative outcomes at ages 43 and 53 (i.e., more depressive symptoms and physical health problems, lower life satisfaction and well-being). Ratings of willfulness and autonomy predicted more positive outcomes. All 3 kinds of narcissism showed considerable rank-order stability over 10 years, but there were also mean-level changes: Hypersensitivity and autonomy decreased, whereas willfulness increased. More positive outcomes were associated with decreases in hypersensitivity and increases in willfulness and autonomy. However, in multivariate analyses, autonomy did not show any significant associations with women's health and well-being outcomes, suggesting that it may have less predictive utility compared to hypersensitivity and willfulness. Our findings highlight developmental changes in and correlates of women's narcissistic personality traits and the importance of assessing different aspects of narcissism in midlife.

An update on narcissistic personality disorder

PURPOSE OF REVIEW

This article will discuss the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5 proposal for narcissistic personality disorder (NPD), and highlight some of the advantages of introducing a dual diagnostic approach that includes a dimensional conceptualization for identifying and diagnosing pathological narcissism and NPD, in addition to specific traits.

RECENT FINDINGS

Reviews and studies have specifically highlighted how people with NPD behave and are observed by others, and the negative consequences of their behavior. Accounts on the subjective perspectives of pathological narcissism stem foremost from psychoanalytic and psychodynamic accounts, but they have remained relatively separated from diagnostic and empirical studies.

SUMMARY

The new diagnostic approach to NPD can encourage a better integration of the clinicians' observations of indicators of pathological narcissism from an external perspective and the patients' formulations of their own subjective experiences and understanding of their problems.

Pathological narcissism and acute anxiety symptoms after trauma: a study of Israeli civilians exposed to war

OBJECTIVE

Diathesis-stress models of posttraumatic stress disorder (PTSD) hypothesize that exposure to trauma may interact with individual differences in the development of PTSD. Previous studies have not assessed immediate responses to a proximate stressor, but the current "natural laboratory" study was designed to empirically test the role that individual differences in pathological narcissism may play in the development of acute anxiety symptoms among civilians facing rocket and missile fire.

METHOD

We assessed demographic features, trauma exposure severity, narcissistic personality features, and acute anxiety symptoms (PTSD and General Anxiety Disorder [GAD]) among 342 Israeli female adults during the November 2012 eruption of violence in the Middle East.

RESULTS

Results demonstrate an association between exposure severity and acute anxiety symptoms (both PTSD and GAD) for individuals with high levels of pathological narcissism but not for those with low levels of pathological narcissism. These results suggest that individuals with narcissistic personality features are at high risk for the development of acute anxiety symptoms following exposure to uncontrollable and life-threatening mass trauma.

CONCLUSION

The findings underscore the role of intra-personal resources in the immediate psychological aftermath of war by highlighting the increased risk associated with narcissistic personality features. Theoretical and clinical implications of the findings are discussed.

Qualitative and quantitative distinctions in personality disorder

The categorical-dimensional debate has catalyzed a wealth of empirical advances in the study of personality pathology. However, this debate is merely one articulation of a broader conceptual question regarding whether to define and describe psychopathology as a quantitatively extreme expression of normal functioning or as qualitatively distinct in its process. In this article I argue that dynamic models of personality (e.g., object relations, cognitive-affective processing system) offer the conceptual scaffolding to reconcile these seemingly incompatible approaches to characterizing the relationship between normal and pathological personality. I propose that advances in personality assessment that sample behavior and experiences intensively provide the empirical techniques, whereas interpersonal theory offers an integrative theoretical framework, for accomplishing this goal.

Retention or deletion of personality disorder diagnoses for DSM-5: an expert consensus approach

One of the official proposals for the fifth edition of the American Psychiatric Association's (APA) diagnostic manual (DSM-5) is to delete half of the existing personality disorders (i.e., dependent, histrionic, narcissistic, paranoid, and schizoid). Within the APA guidelines for DSM-5 decisions, it is stated that there should be expert consensus agreement for the deletion of a diagnostic category. Additionally, categories to be deleted should have low clinical utility and/or minimal evidence for validity. The current study surveyed members of two personality disorder associations (n = 146) with respect to the utility, validity, and status of each DSM-IV-TR personality disorder diagnosis. Findings indicated that the proposal to delete five of the personality disorders lacks consensus support within the personality disorder community.

A glimpse behind the mask: facets of narcissism and feelings of self-worth

This study examined the connections that the facets of narcissism captured by the Narcissistic Personality Inventory (NPI; Raskin & Hall, 1979) and the Pathological Narcissism Inventory (PNI; Pincus et al., 2009) have with self-esteem. This was accomplished by asking 372 participants to complete measures of narcissism and self-esteem level as well as daily diary measures concerning their state self-esteem and daily experiences. Our analyses found that the facets of narcissism differed in their associations with average level of self-esteem, fluctuations in state self-esteem over time, and self-esteem reactions following daily events. These results suggest that it is important to consider specific facets of narcissism when examining feelings of self-worth rather than relying on broader composite measures of narcissistic personality features. Implications of these results for our understanding of the dynamics of the narcissistic personality are discussed.

Predicting overt and cyber stalking perpetration by male and female college students

In this study, self-report student surveys on early childhood maltreatment, attachment styles, alcohol expectancies, and narcissistic personality traits are examined to determine their influence on stalking behavior. Two subtypes of stalking were measured using Spitzberg and Cupach's (2008) Obsessive Relational Intrusion: cyber stalking (one scale) and overt stalking (comprised of all remaining scales). As t tests indicated that men and women differed significantly on several variables, OLS regression models were run separately for men (N = 807) and women (N = 934). Results indicated that childhood sexual maltreatment predicted both forms of stalking for men and women. For men, narcissistic vulnerability and its interaction with sexual abuse predicted stalking behavior (overt stalking R² = 16% and cyber stalking R² = 11%). For women, insecure attachment (for both types of stalking) and alcohol expectancies (for cyber stalking) predicted stalking behavior (overt stalking R² = 4% and cyber stalking R² = 9%). We discuss the methodological and policy implications of these findings.

Subtypes, dimensions, levels, and mental states in narcissism and narcissistic personality disorder

Various conceptualizations of subtypes, levels, and dimensions of narcissism and narcissistic personality disorder (NPD) are considered with a particular focus on overt grandiose presentations and covert vulnerable presentations. Evidence supporting this distinction and clinical vignettes to illustrate it are presented as well as their implications for clinical work with NPD patients. The research and clinical evidence points to the conclusion that these broad categorical subtypes are better conceptualized as dimensions on which individual patients vary on relative levels, thus suggesting that grandiose and vulnerable presentations represent two sides of the same coin. A case example and clinical implications are provided and discussed.

Narcissistic pathology as core personality dysfunction: comparing the DSM-IV and the DSM-5 proposal for narcissistic personality disorder

Narcissistic personality disorder and related concepts have a complex history and have been subject to extensive theoretical discourse but relatively little empirical research. An initial proposal for the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) that suggested eliminating this disorder as a discrete personality disorder type met with considerable controversy that ultimately led to its reinstatement in subsequent proposals. Nonetheless, the DSM-5 proposal for personality disorders as a whole would involve a significantly different formulation of narcissistic personality from that described in DSM-IV-one that places a greater emphasis on shared deficits among all personality disorders that tap elements thought to fall on the narcissistic spectrum, such as deficits in empathic capacity. This article describes this revised formulation, and presents a case study that illustrates the similarities and differences in the DSM-IV and proposed DSM-5 portrayal of narcissistic issues and related clinical problems over the course of a particular treatment.

Grandiose and vulnerable narcissism and the DSM-5 pathological personality trait model

The Diagnostic and Statistical Manual of Personality Disorders (4th ed., American Psychiatric Association, 2000) personality disorders (PDs) that will be included in the DSM-5 will be diagnosed in an entirely different manner; the explicit criterion sets will be replaced with impairments in self and interpersonal functioning and personality traits from a 25-trait dimensional model of personality pathology. From a trait perspective, narcissistic personality disorder (NPD), the focus of this study, is assessed using 2 specific traits: grandiosity and attention seeking. Using a sample collected online from Amazon's Mechanical Turk (MTurk; N=306), we examined the relations among traits from a new measure of DSM-5's trait model--the Personality Inventory for DSM-5 (PID5; Krueger, Derringer, Markon, Watson, & Skodol, in press)--and grandiose and vulnerable narcissism. The 25 traits from PID5 captured a significant portion of the variance in grandiose and vulnerable factors, although the 2 specific facets designated for the assessment of NPD fared substantially better in the assessment of grandiose rather than vulnerable narcissism. These results are discussed in the context of improving the DSM-5's ability to capture both narcissism dimensions.

An interpersonal analysis of pathological personality traits in DSM-5

The proposed changes to the personality disorder section of the Diagnostic and statistical manual of mental disorders (5th ed.) places an increased focus on interpersonal impairment as one of the defining features of personality psychopathology. In addition, a proposed trait model has been offered to provide a means of capturing phenotypic variation on the expression of personality disorder. In this study, the authors subject the proposed DSM-5 traits to interpersonal analysis using the inventory of interpersonal problems-circumplex scales via the structural summary method for circumplex data. DSM-5 traits were consistently associated with generalized interpersonal dysfunction suggesting that they are maladaptive in nature, the majority of traits demonstrated discriminant validity with prototypical and differentiated interpersonal problem profiles, and conformed well to a priori hypothesized associations. These results are discussed in the context of the DSM-5 proposal and contemporary interpersonal theory, with a particular focus on potential areas for expansion of the DSM-5 trait model.

DSM-5 personality traits and DSM-IV personality disorders

Two issues pertinent to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) proposal for personality pathology, the recovery of DSM-IV personality disorders (PDs) by proposed DSM-5 traits and the validity of the proposed DSM-5 hybrid model, which incorporates both personality pathology symptoms and maladaptive traits, were evaluated in a large undergraduate sample (N = 808). Proposed DSM-5 traits as assessed with the Personality Inventory for DSM-5 explained a substantial proportion of variance in DSM-IV PDs as assessed with the Personality Diagnostic Questionnaire-4+, and trait indicators of the 6 proposed DSM-5 PDs were mostly specific to those disorders with some exceptions. Regression analyses support the DSM-5 hybrid model in that pathological traits, and an indicator of general personality pathology severity provided incremental information about PDs. Findings are discussed in the context of broader issues around the proposed DSM-5 model of personality disorders.

Depressive tendencies and pathological narcissism among psychiatric outpatients

This study examined the relationship between components of pathological narcissism and types of depressive tendencies among a sample of 117 psychiatric outpatients. Findings revealed that depressive themes concerning dependency were associated with narcissistic grandiosity. Depressive tendencies concerning self-criticism were positively associated with narcissistic vulnerability.

Evidence for the criterion validity and clinical utility of the Pathological Narcissism Inventory

In this study, the authors evaluated aspects of criterion validity and clinical utility of the grandiosity and vulnerability components of the Pathological Narcissism Inventory (PNI) using two undergraduate samples (N = 299 and 500). Criterion validity was assessed by evaluating the correlations of narcissistic grandiosity and narcissistic vulnerability with established indices of normal personality traits, psychopathology and clinical concerns, and pathological personality traits. Overall, the pattern of correlations supported the convergent and discriminant validity of grandiose and vulnerable conceptualizations of pathological narcissism as measured by the PNI. Clinical utility was assessed by evaluating the extent to which clinicians without specific training in pathological narcissism as well as clinicians with expertise in pathological narcissism could accurately predict the correlates of PNI grandiosity and vulnerability with normal and pathological personality traits and psychopathology. The r(contrast-cv) coefficient provided a global index of accuracy in clinicians' predictions that was more fully elaborated by examining systematic discrepancies across groups. Overall, novice and expert clinicians were generally able to predict criterion correlations, with some exceptions (e.g., counter to predictions, pathological narcissism was negatively associated with treatment resistance). These results provide further evidence regarding the validity and utility of the narcissistic grandiosity and narcissistic vulnerability constructs as measured by the PNI.