Experience of Shame Mediates the Relationship Between Pathological Narcissism and Suicidal Ideation in Psychiatric Outpatients

Can clinical and subclinical forms of narcissism be considered risk factors for suicide-related outcomes? A systematic review

BACKGROUND

Clinical and subclinical forms of narcissism may increase suicide risk. However, little is known and there are controversies on this topic. This systematic review aims at providing an overview of studies investigating this association.

METHODS

We used PubMed, Scopus, and PsycInfo databases and followed PRISMA. We focused on cohort, case-control, cross-sectional and case series studies. We referred to both clinical (i.e., narcissistic personality disorder (NPD) and/or NPD criteria) and subclinical forms (i.e., grandiose and vulnerable narcissistic traits) of narcissism. Moreover, we considered: Suicidal Ideation (SI), Non-Suicidal Self-Injury(s) (NSSI), Deliberate Self-Harm (DSH), Suicide Attempt(s) (SA), Suicide Risk (SR), and Capability for Suicide.

RESULTS

We included 47 studies. Lack of association between NPD diagnosis/criteria and suicide-related outcomes (SI) or mixed results (SA) were found. Higher homogeneity emerged when considering narcissistic traits. Vulnerable narcissism was associated with SI, less impulsive NSSI, and DSH. Grandiose narcissism was associated with severe NSSI and multiple SA with high intent to die, but it was protective against SI and SR. Vulnerable narcissism seemed to be associated with suicide-related outcomes characterized by low intent to die, while grandiose narcissism seemed to be a risk factor for outcomes with high planning and severity.

LIMITATIONS

Between-study heterogeneity and lack of longitudinal studies.

CONCLUSIONS

Assessing suicide risk in subjects with clinical or subclinical forms of narcissism may be useful. Moreover, considering the most vulnerable form of narcissism, and not just the grandiose one, may contribute to a more nuanced risk stratification and to the identification of distinct therapeutic approaches.

Scarcity of research on psychological or psychiatric states using validated questionnaires in low- and middle-income countries: A ChatGPT-assisted bibliometric analysis and national case study on some psychometric properties

Background

It is vital to assess whether research on psychological or psychiatric states using validated questionnaires is still lagging in low- and middle-income countries and to what degree, and to continue to assess the psychometric properties of the most informative questionnaires.

Methods

We performed a bibliometric analysis of Web of Science Core Collection for all years to determine the number of studies performed in each country that used an inventory or a questionnaire on aggression, anxiety, depression, borderline personality, narcissism, self-harm, shame, or childhood trauma. We conducted a simple observational analysis of distributions by countries to derive the main overall conclusions, assisted by ChatGPT to test its ability to summarise and interpret this type of information. We also carried out a study in Croatia to examine some psychometric properties of five commonly used questionnaires, using Cronbach's α coefficient and zero-order correlations.

Results

We observed a concentration of research activity in a few high-income countries, primarily the United States and several European nations, suggesting a robust research infrastructure and a strong emphasis on studying psychological and psychiatric states within their population. In contrast, low- and middle-income countries were notably under-represented in research on psychological and psychiatric states, although the gap seems to be closing in some countries. Turkey, Iran, Brazil, South Africa, Mexico, India, Malaysia and Pakistan have been consistently contributing an increasing number of studies and catching up with the most research-intensive high-income countries. The national case study in Croatia confirmed adequate psychometric properties of the most frequently used questionnaires.

Conclusions

Addressing research gaps in low- and middle-income countries is crucial, because relying solely on research from high-income countries may not fully capture the nuances of psychological and psychiatric states within diverse populations. To bridge this gap, it is essential to prioritise mental health research in low-resource settings, provide training and resources to local researchers, and establish international collaborations. Such efforts can lead to the development of culturally valid questionnaires, an improved understanding of psychological and psychiatric states in diverse contexts, and the creation of effective interventions to promote mental well-being on a global scale.

Measurement Invariance of the Pathological Narcissism Inventory and Multimethod Examination of Narcissistic Presentations in Community and Clinical Samples

The Pathological Narcissism Inventory (PNI) is extensively used in recent empirical literature on pathological narcissism. However, most studies using the PNI are community-based, and no studies have used the PNI to investigate narcissistic presentations in personality disordered patients. This study investigates measurement invariance of the PNI in community participants and patients with personality disorders, and examines differences of narcissistic presentations in these samples through a multimethod approach. Results show that the PNI can be used reliably to measure and compare traits of pathological narcissism in community participants and patients with personality disorders. Personality disordered patients show higher traits reflecting vulnerable narcissism and overt manifestations of grandiose narcissism, compared with controls. Finally, network analysis indicates that traits of grandiose fantasies and entitlement rage have a central role in defining manifestations of PNI pathological narcissism, regardless of the presence of an underlying personality disorder. Research and clinical implications are discussed.

Validation of the pathological narcissistic inventory (PNI) and its brief form (B-PNI) in the Arabic language

BACKGROUND

The Pathological Narcissism Inventory (PNI) is a multidimensional measure developed to assess narcissistic grandiosity and narcissistic vulnerability. We aimed to validate the Arabic version of the original Pathological Narcissistic Inventory (PNI) and its brief form (B-PNI) in a community sample of Lebanese adults.

METHODS

The English language PNI items were translated into Arabic following a rigorous translation, back-translation, and linguistic evaluation. A total of 401 participants were administered the translated PNI, as well as previously validated Arabic versions of the Big Five Inventory-2, the Rosenberg Self-esteem Scale, the Patient Health Questionnaire (PHQ-9), and the Impulsivity-8 Scale.

RESULTS

Exploratory and confirmatory analyses supported the existence of seven first-order and two second-order factors of the PNI and B-PNI. Except for exploitativeness where females scored lower than males, no other significant differences by gender were observed for the remaining PNI subscale scores. Additionally, scores on all the subscales exhibited good reliability, while the associations with external measures supported the concurrent validity of the translated instrument.

CONCLUSION

The results of this study suggest that scores on the PNI and B-PNI are highly reliable with satisfactory concurrent and factorial validity, providing an assessment of broadly defined pathological narcissism among the Lebanese young adult population. The availability of the Arabic PNI and its brief form should facilitate improved understanding of pathological narcissism in Arabic cultures and the different factors that govern narcissistic personality pathology.

Childhood emotional neglect and depressive and anxiety symptoms among mental health outpatients: the mediating roles of narcissistic vulnerability and shame

BACKGROUND

Theorized to stem from experiences of childhood emotional neglect, narcissistic vulnerability has been identified as contributing to expressions of psychiatric distress such as depressive and anxiety symptoms, particularly due to shame-proneness.

AIMS

To investigate narcissistic vulnerability and shame as mediators between perceived childhood emotional neglect and depressive and generalized anxiety symptoms among psychiatric outpatients.

METHODS

Adults (N = 137) attending community mental health services completed self-report measures at intake. Mediation analyses tested the indirect effect of perceived emotional neglect on depressive and generalized anxiety symptom severity through narcissistic vulnerability; shame was added to subsequent models to examine narcissistic vulnerability and shame as sequential mediators.

RESULTS

Perceived emotional neglect was significantly associated with narcissistic vulnerability, which in turn was linked with depressive and generalized anxiety symptoms as separate dependent variables. Indirect effects were significant in each model, indicating narcissistic vulnerability as a significant mediator. With the inclusion of shame, narcissistic vulnerability and shame were significant as sequential mediators.

CONCLUSION

Narcissistic vulnerability and shame may operate as mechanisms in conferring affective symptom severity from perceived childhood emotional neglect. Narcissistic vulnerability and susceptibility to shame may thus be important treatment targets when addressing psychological distress in the context of childhood adversity.

The nonlinear association between grandiose and vulnerable narcissism: An individual data meta-analysis

OBJECTIVE

Narcissism can manifest in grandiose and vulnerable patterns of experience and behavior. While largely unrelated in the general population, individuals with clinically relevant narcissism are thought to display both. Our previous studies showed that trait measures of grandiosity and vulnerability were unrelated at low-to-moderate levels of grandiose narcissism, but related at high levels.

METHOD

We replicate and extend these findings in a preregistered individual data meta-analysis ("mega-analysis") using data from the Narcissistic Personality Inventory (NPI)/Hypersensitive Narcissism Scale (HSNS; N = 10,519, k = 28) and the Five-Factor Narcissism Inventory (FFNI; N = 7,738, k = 17).

RESULTS

There was strong evidence for the hypothesis in the FFNI (β_{Grandiose < 1 SD}  = .08, β_{Grandiose > 1 SD}  = .36, β_{Grandiose > 2 SD}  = .53), and weaker evidence in the NPI/HSNS (β_{Grandiose < 1 SD}  = .00, β_{Grandiose > 1 SD}  = .12, β_{Grandiose > 2 SD}  = .32). Nonlinearity increased with age but was invariant across other moderators. Higher vulnerability was predicted by elevated antagonistic and low agentic narcissism at subfactor level.

CONCLUSION

Narcissistic vulnerability increases at high levels of grandiosity. Interpreted along Whole Trait Theory, the effects are thought to reflect state changes echoing in trait measures and can help to link personality and clinical models.

Personality Organization and Depressive Symptoms Among Psychiatric Outpatients: The Mediating Role of Shame

ABSTRACT

Previous research has demonstrated relations between lower level of personality organization (PO) and multiple indices of mental health disturbances. The goal of this research was to examine whether experience of shame would mediate the relationship between PO and depressive symptoms in a sample of 321 Croatian psychiatric outpatients (64% female; mean age, 38.67 years). The total PO level exhibited positive associations with depressive symptoms and with all three subscales of shame ( p < 0.01). Characterological, behavioral, and bodily shame showed significant mediating effects in the PO-depression relationship, while controlling for the influence of age and sex. PO level seems to be strongly related to depressive disturbances, with the experience of shame representing one of the underlying mechanisms of this relationship. Given that patients with personality disorders ( i.e. , low PO level) suffer from poorer treatment outcomes for major mental disorders, more emphasis should be placed on psychotherapeutic management of shame-proneness.

Using Pathological Traits for the Assessment of Suicide Risk: A Suicide Indicator Proposal for the Dimensional Clinical Personality Inventory 2

This study aimed to investigate the discriminative capacity of IDCP-2 factors to identify people with suicide risk. Moreover, we are providing a suicide total score for IDCP-2. Participeted 346 people aged between 18 and 72 years who responded to ASIQ, IDCP-2, and PID-5. We divided participants into three groups: low-risk group moderate-risk and high-risk group. We conducted mean comparisons, linear regression analysis, and ROC curve verification. The IDCP-2 factors were able to discriminate between the groups, with the high-risk presenting the highest means. The regression indicated Self-devaluation and Hopelessness as variables with a significant single contribution in explaining suicidal behavior. Suicide risk indicators demonstrated adequate performance in identifying people according to the risk group. Our findings indicate that the IDCP-2 factors can discriminate groups of people according to suicidal behavior. Besides, the index developed showed sensitivity in the identification of people who reported attempted suicide.   How to cite this article: Gonçalves, A.P., Machado, G.M., Pianowski, G., Carvalho, L.F. Using pathological traits for the assessment of suicide risk: a suicide indicator proposal for the Dimensional Clinical Personality Inventory 2. Revista Colombiana de Psicología, 31 (1), 65-76. https://doi.org/10.15446/rcp.v31n1.85513

Contemporary psychological perspectives of personality disorders

PURPOSE OF REVIEW

The aim of this study was to review the recent literature on contemporary psychological perspectives of personality disorders, including novel psychotherapeutic interventions aimed at these vulnerable individuals.

RECENT FINDINGS

Among the various psychological theories and models of personality disorders, still the most popular and researched are psychodynamic, cognitive and interpersonal perspectives. More specifically, object relations theory, cognitive schema conceptualization and interpersonal circumplex model have produced the most empirical investigations of personality disorders in recent years. Latest work has suggested that all three perspectives have contributed to and are compatible with the dimensional personality disorders framework in DSM-5-AMPD and ICD-11 (including level of personality functioning and personality traits). These models have yielded specific psychological treatments of personality disorders; although most psychotherapies have been constructed for patients with borderline personality disorder (BPD), there is an increasing number of treatment modalities aimed at individuals with other forms of personality disorder, such as those with narcissistic or antisocial traits/disorders. More research into their effectiveness and long-term benefits is necessary.

SUMMARY

Novel research keeps updating our knowledge on the cause, manifestations and psychological treatments of personality disorders, particularly from psychodynamic, cognitive and interpersonal perspectives.

Emotion dysregulation acts in the relationship between vulnerable narcissism and suicidal ideation

Suicide behaviors are peculiar aspects of several cluster B disorders, including Narcissistic Personality Disorder. To date, it is still unclear which facet of narcissism is more related to the desire to die and which other factors are involved in this relationship. This study aims to offer preliminary empirical evidences concerning the relationship between narcissism, emotion dysregulation and suicide ideation. We administered the Pathological Narcissism Inventory (PNI), Difficulties in Emotion Regulation Scale (DERS), PID‐5‐BF (Personality Inventory for DSM‐5‐Short Form) and Beck Scale for Suicide ideation (BSI) to a sample of individuals with suicide ideation (n = 70) and a sample of community participants (n = 154). Controlling for age, gender and Negative Affectivity, we found that BSI scores correlated significantly with the vulnerable dimension of narcissism, but not with the grandiose one, and with all DERS dimension, apart from Awareness. Nevertheless, emotion dysregulation moderates the relationship between vulnerable narcissism and suicide ideation. Suicide ideation seems to be deeply connected with the vulnerable dimension of pathological narcissism and the relationship between the constructs is totally mediated by emotion dysregulation. Future directions and clinical implications are discussed.

Exploring the Impact of Shame on Health-Related Quality of Life in Older Individuals

PURPOSE

To explore the relationship between shame, ageing, physical disease, and quality of life in Greek older people.

DESIGN AND METHODS

A cross-sectional design using a stratified random cluster sample of older adults from Open Care Centers for the Elderly in the region of Epirus, Greece. Data were collected using (a) the Short Form-36 Health Survey, (b) the Other As Shamer Scale, and (c) the Experience of Shame Scale. Data were analyzed using SPSS software.

RESULTS

Internal shame was positively correlated with external shame (Pearson's r(177) =, p < .01), with negative effect on the mental component in both men and women (effect on women b_W = -0.173, p_W = .004, effect on men b_M = -0.138, p_​M = .047), b = path analysis beta coefficient and with a significant negative effect on the physical health component for men. External shame was found to have a significant negative effect on women's mental health (b = -0.266, p = .002) and a nonsignificant effect on the physical health component. Age was negatively related with the physical health component in both groups (b_W = -0.392, p_W = .002 and b_M = -0.384, p_M = .003), while the presence of a bodily disease corresponded with a lower physical health component score for men (b = -4.267, p = .033).

CONCLUSION

Shame in older individuals is present in both sexes. Older males suffering from a physical disease displayed a greater decline of the health-related quality of life on physical health components, leading to greater internal shame. Older females suffering from a physical disease displayed a greater decline of health-related quality of life on mental health components, leading to greater external shame.

CLINICAL RELEVANCE

These results indicate the need for developing assessment and care plans for older individuals that incorporate in them the concept of shame as a factor in dealing with and adapting to physical disease.

Clinical and personality profile of depressed suicide attempters: A preliminary study at the open-door policy Mood Disorder Unit of San Raffaele Hospital

Suicidal behavior is a complex phenomenon with high rates among psychiatric inpatients. Mood disorders and personality dysfunctions represent relevant risk factors for suicides attempts and suicidal ideation. Our study aims to investigate the role of the co-occurrence of clinical variables (duration of depressive state, previous suicide attempts), socio-demographic variables (gender, employment and civil status) and narcissistic personality features in the suicide risk of admitted psychiatric patients affected by a mood disorder. The sample was composed of 93 patients consecutively admitted in an open ward psychiatric Unit. Forty-eight participants had a positive history of previous suicide attempts: the suicide attempters (SA) were mostly female, unemployed and married. The SA group were observed to have suffered from a depressive episode with a longer duration; moreover in the SA group, the presence of active suicidal ideation was significantly related to a higher number of previous suicide attempts. In the whole sample, suicidal ideation was significantly related to narcissistic vulnerability personality features. Using a multidimensional approach, the present study allows a preliminary profiling of patients at risk for suicidal behavior during hospitalization.

Shame and Suicidal Ideation among Undergraduates in China: The Mediating Effect of Thwarted Belongingness and Perceived Burdensomeness

Undergraduate students with shame are more likely to experience suicidal ideation, but there remains a lack of research investigating the factors underlying this relationship. The interpersonal theory of suicide posits that suicidal ideation is influenced by the simultaneous presence of thwarted belongingness and perceived burdensomeness. We examined the prevalence of suicidal ideation among undergraduate students in China and examined the association between shame and suicidal ideation mediated by perceived burdensomeness and thwarted belongingness. A survey was conducted in July 2018 involving 2320 undergraduate students, and the twelve-month prevalence of suicidal ideation was 8.95%. Shame played a crucial role in predicting suicidal ideation, and the mediating effects of perceived burdensomeness and thwarted belongingness between shame and suicidal ideation were significant. Suicidal ideation is common among undergraduate students in China and merits greater attention. Shame, perceived burdensomeness, and thwarted belongingness may be important factors to assess among undergraduate students in suicide risk assessment and psychological intervention.