The narcissistic self and its psychological and neural correlates: an exploratory fMRI study

Neural rhythms of narcissism: Facets of narcissism are associated with different neural sources in resting-state EEG

Trait narcissism is characterized by significant heterogeneity across individuals. Despite advances in the conceptualization of narcissism, including the increasing recognition that narcissism is a multidimensional construct, the sources of this heterogeneity remain poorly understood. Here, we used a neural trait approach to help better understand "how," and shed light on "why," individuals vary in facets of trait narcissism. Participants (N = 58) first completed personality measures, including the Narcissistic Personality Inventory (NPI), and then in a second session sat passively while resting-state electroencephalography (rs-EEG) was recorded. We then regressed source-localized rs-EEG activity on the distinct facets of narcissism: Grandiose Exhibitionism (GE), Entitlement/Exploitativeness (EE), and Leadership/Authority (LA). Results revealed that each facet was associated with different (though sometimes overlapping) neural sources. Specifically, GE was associated with reduced activation in the dorsomedial prefrontal cortex (DMPFC). EE was associated with reduced activation in the DMPFC and right lateral PFC. LA was associated with increased activation in the left anterior temporal cortex. These findings support the idea that trait narcissism is a multidimensional construct undergirded by individual differences in neural regions related to social cognition (the DMPFC), self-regulation (right lateral PFC), and self-referential processing (left anterior temporal cortex).

Narcissistic Personality Disorder as Prodromal Feature of Early-Onset, GRN-Positive bvFTD: A Case Report

Background

Behavioral variant frontotemporal dementia (bvFTD) typically involves subtle changes in personality that can delay a timely diagnosis.

Objective

Here, we report the case of a patient diagnosed of GRN-positive bvFTD at the age of 52 presenting with a 7-year history of narcissistic personality disorder, accordingly to DSM-5 criteria.

Methods

The patient was referred to neurological and neuropsychological examination. She underwent 3 Tesla magnetic resonance imaging (MRI) and genetic studies.

Results

The neuropsychological examination revealed profound deficits in all cognitive domains and 3T brain MRI showed marked fronto-temporal atrophy. A mutation in the GRN gene further confirmed the diagnosis.

Conclusions

The present case documents an unusual onset of bvFTD and highlights the problematic nature of the differential diagnosis between prodromal psychiatric features of the disease and primary psychiatric disorders. Early recognition and diagnosis of bvFTD can lead to appropriate management and support for patients and their families. This case highlights the importance of considering neurodegenerative diseases, such as bvFTD, in the differential diagnosis of psychiatric disorders, especially when exacerbations of behavioral traits manifest in adults.

The Neural Correlates of Narcissism: Is There a Connection with Desire for Fame and Celebrity Worship?

(1) Objective: Narcissism is characterized by emotional regulation deficits, a lack of empathy for others, and extreme self-focus. Narcissism has also been linked to an increased desire for fame and celebrity worship. Here, the neuroscience underlying narcissism is examined in order to determine what regions and networks of the brain are altered when non-narcissistic individuals are compared to participants with both grandiose and vulnerable narcissism. (2) Methods: The behavioral relationships between grandiose narcissism and desire for fame and vulnerable narcissism and celebrity worship are explored, along with a possible relationship at the neural level between these constructs. In this paper, we review research demonstrating that increased levels of grandiose narcissism are associated with an increase in obsession with fame, while vulnerable narcissism is associated with celebrity worship. (3) Results: Based on current data, the frontal regions underlie narcissism and also likely underlie celebrity worship and desire for fame. This tenuous conclusion is based on a limited number of studies. (4) Conclusions: The brain areas associated with grandiose narcissism may be associated with an intense desire for fame as well, while brain regions associated with vulnerable narcissism may be similar in celebrity worshipers. Future research studies on the brain that are specifically designed to test these relationships at a neurological level are needed.

Structural connectivity of grandiose versus vulnerable narcissism as models of social dominance and subordination

Social dominance and subordination have been linked to fronto-limbic and fronto-thalamic networks and are related to phenotypes such as grandiose vs. vulnerable narcissistic traits. The latter have been linked to clinical features such as empathy and emotional regulation. In this study we tested the hypotheses that narcissistic traits are associated with white matter integrity in fasciculus uncinate, cingulum, and anterior thalamic radiation (ATR). We applied the Pathological Narcissism Inventory (PNI) to assess narcissistic traits in a sample of 267 psychiatrically healthy individuals. We used 3 T MRI to acquire Diffusion Tensor Imaging data for analysis with TBSS in FSL applying TFCE to test for correlations of fractional anisotropy (FA) and PNI scales. We detected a significant positive correlation of PNI total and FA in the right posterior cingulum. PNI Vulnerability was significantly correlated with FA in the left anterior and right posterior cingulum. We did not find overall correlations with PNI Grandiosity, but additional analyses showed significant effects with FA of ATR. Our results strengthen network models for narcissism underlying both personality variation and pathology. Especially associations of narcissistic vulnerability within fronto-limbic tracts suggest overlaps within neural correlates of related phenotypes like neuroticism, social subordination, and negative emotionality.

The dark side of empathy in narcissistic personality disorder

Narcissistic personality disorder is characterized by self-absorption, grandiosity, exploitation of others and lack of empathy. People with that disorder may switch from an overt form, mainly with grandiosity, to a covert presentation, with fears, hypersensitivity and dependence from others. Empathy represents a key point in detecting people affected by narcissistic personality disorder because, even if it is described as reduced, it plays a fundamental role in exploitation and manipulation. A systematic search of Literature without any language or time restriction, was performed combining thesaurus and free-search indexing terms related to Narcissistic personality disorder and empathy and produced 531 results. Fifty-two papers that analyzed possible issues in the empathic attitude of people with narcissistic personality disorder were included in this narrative review. Empathy is the capability of understating and feeling others emotions. It is not a unitary construct and can be distinguished in cognitive and affective. It might be channeled into prosocial and antisocial behaviors. A crucial trait identified in narcissistic empathy is affective dissonance that is closely related to rivalry as part of the dark tetrad (narcissism, machiavellianism, psychopathy, and sadism). Subjects affected by narcissistic personality disorder show greater impairment in affective aspects while their cognitive part of empathy appears preserved. Saving at least the cognitive aspects of empathy may contribute to therapeutic improvement of affective aspects.

The role of the salience network in cognitive and affective deficits

Analysis and interpretation of studies on cognitive and affective dysregulation often draw upon the network paradigm, especially the Triple Network Model, which consists of the default mode network (DMN), the frontoparietal network (FPN), and the salience network (SN). DMN activity is primarily dominant during cognitive leisure and self-monitoring processes. The FPN peaks during task involvement and cognitive exertion. Meanwhile, the SN serves as a dynamic "switch" between the DMN and FPN, in line with salience and cognitive demand. In the cognitive and affective domains, dysfunctions involving SN activity are connected to a broad spectrum of deficits and maladaptive behavioral patterns in a variety of clinical disorders, such as depression, insomnia, narcissism, PTSD (in the case of SN hyperactivity), chronic pain, and anxiety, high degrees of neuroticism, schizophrenia, epilepsy, autism, and neurodegenerative illnesses, bipolar disorder (in the case of SN hypoactivity). We discuss behavioral and neurological data from various research domains and present an integrated perspective indicating that these conditions can be associated with a widespread disruption in predictive coding at multiple hierarchical levels. We delineate the fundamental ideas of the brain network paradigm and contrast them with the conventional modular method in the first section of this article. Following this, we outline the interaction model of the key functional brain networks and highlight recent studies coupling SN-related dysfunctions with cognitive and affective impairments.

Narcissism and the perception of failure - evidence from the error-related negativity and the error positivity

The literature on narcissism suggests two contradictory ways how highly narcissistic individuals deal with their failures: They might avoid consciously recognising their failures to protect their ego or they might vigilantly turn towards their failures to process cues that are important for maintaining their grandiosity. We tried to dissolve these contradictory positions by studying event-related potential components of error processing and their variations with narcissism. With a speeded go/no-go task, we examined how the error-related negativity (Ne; reflecting an early, automatic processing stage) and the error positivity (Pe; associated with conscious error detection) vary with Admiration and Rivalry, two narcissism dimensions, under ego-threatening conditions. Using multilevel models, we showed that participants with high Rivalry displayed higher Ne amplitudes suggesting a heightened trait of defensive reactivity. We did not find variations of either narcissism dimension with the Pe, which would have pointed to weaker error awareness. Thus, our results only supported the second position: a heightened vigilance to errors in narcissism at early, rather automatic processing stages.

Self-Enhancement and the Medial Prefrontal Cortex: The Convergence of Clinical and Experimental Findings

Self-enhancement (SE) is often overlooked as a fundamental cognitive ability mediated via the Prefrontal Cortex (PFC). Here, we present research that establishes the relationship between the PFC, SE, and the potential evolved beneficial mechanisms. Specifically, we believe there is now enough evidence to speculate that SE exists to provide significant benefits and should be considered a normal aspect of the self. Whatever the metabolic or social cost, the upside of SE is great enough that it is a core and fundamental psychological construct. Furthermore, though entirely theoretical, we suggest that a critical reason the PFC has evolved so significantly in Homo sapiens is to, in part, sustain SE. We, therefore, elaborate on its proximate and ultimate mechanisms.

Flights and Perchings of the BrainMind: A Temporospatial Approach to Psychotherapy

This article introduces a process-oriented approach for improving present moment conceptualization in psychotherapy that is in alignment with neuroscience: the Temporospatial movements of mind (TSMM) model. We elaborate on seven temporal movements that describe the moment-to-moment morphogenesis of emotional feelings and thoughts from inception to maturity. Temporal refers to the passage of time through which feelings and thoughts develop, and electromagnetic activity, that among other responsibilities, bind information across time. Spatial dynamics extend from an undifferentiated to three dimensional experiences of emotional and cognitive processes. Neurophysiologically, spatial refers to structures within the brain and their varying interactions with one another. This article culminates in the development of an atheoretical temporospatial grid that may help clinicians conceptualize where patients are in their cognitive and emotional development to further guide technique.

The Transdiagnostic Relevance of Self-Other Distinction to Psychiatry Spans Emotional, Cognitive and Motor Domains

Self-other distinction refers to the ability to distinguish between our own and other people's physical and mental states (actions, perceptions, emotions etc.). Both the right temporo-parietal junction and brain areas associated with the human mirror neuron system are likely to critically influence self-other distinction, given their respective contributions to theory of mind and embodied empathy. The degree of appropriate self-other distinction will vary according to the exact social situation, and how helpful it is to feel into, or remain detached from, another person's mental state. Indeed, the emotional resonance that we can share with others affords the gift of empathy, but over-sharing may pose a downside, leading to a range of difficulties from personal distress to paranoia, and perhaps even motor tics and compulsions. The aim of this perspective paper is to consider how evidence from behavioral and neurophysiological studies supports a role for problems with self-other distinction in a range of psychiatric symptoms spanning the emotional, cognitive and motor domains. The various signs and symptoms associated with problematic self-other distinction comprise both maladaptive and adaptive (compensatory) responses to dysfunction within a common underlying neuropsychological mechanism, compelling the adoption of more holistic transdiagnostic therapeutic approaches within Psychiatry.

Functional MRI findings in personality disorders: A review

Personality disorders (PDs) have a prevalence of approximately 10% in the United States, translating to over 30 million people affected in just one country. The true prevalence of these disorders may be even higher, as the paucity of objective diagnostic criteria could be leading to underdiagnosis. Because little is known about the underlying neuropathologies of these disorders, patients are diagnosed using subjective criteria and treated nonspecifically. To better understand the neural aberrancies responsible for these patients' symptoms, a review of functional MRI literature was performed. The findings reveal that each PD is characterized by a unique set of activation changes corresponding to individual structures or specific neural networks. While unique patterns of neural activity are distinguishable within each PD, aberrations of the limbic/paralimbic structures and default mode network are noted across several of them. In addition to identifying valuable activation patterns, this review reveals a void in research pertaining to paranoid, schizoid, histrionic, narcissistic, and dependent PDs. By delineating patterns in PD neuropathology, we can more effectively direct future research efforts toward enhancing objective diagnostic techniques and developing targeted treatment modalities. Furthermore, understanding why patients are manifesting certain symptoms can advance clinical awareness and improve patient outcomes.

Narcissistic personality traits and prefrontal brain structure

Narcissistic traits have been linked to structural and functional brain networks, including the insular cortex, however, with inconsistent findings. In this study, we tested the hypothesis that subclinical narcissism is associated with variations in regional brain volumes in insular and prefrontal areas. We studied 103 clinically healthy subjects, who were assessed for narcissistic traits using the Narcissistic Personality Inventory (NPI, 40-item version) and received high-resolution structural magnetic resonance imaging. Voxel-based morphometry was used to analyse MRI scans and multiple regression models were used for statistical analysis, with threshold-free cluster enhancement (TFCE). We found significant (p < 0.05, family-wise error FWE corrected) positive correlations of NPI scores with grey matter in multiple prefrontal cortical areas (including the medial and ventromedial, anterior/rostral dorsolateral prefrontal and orbitofrontal cortices, subgenual and mid-anterior cingulate cortices, insula, and bilateral caudate nuclei). We did not observe reliable links to particular facets of NPI-narcissism. Our findings provide novel evidence for an association of narcissistic traits with variations in prefrontal and insular brain structure, which also overlap with previous functional studies of narcissism-related phenotypes including self-enhancement and social dominance. However, further studies are needed to clarify differential associations to entitlement vs. vulnerable facets of narcissism.

Can neuroscience help to understand narcissism? A systematic review of an emerging field

Narcissism is a Janusian personality construct, associated with both grandiose self-assuredness and dominance, as well as vulnerable insecurity and reactivity. Central questions of intra- and interpersonal functioning in narcissism are still a matter of debate. Neuroscience could help to understand the paradoxical patterns of experience and behavior beyond the limitations of self-reports. We provide a systematic review of 34 neuroscience studies on grandiose, vulnerable, pathological narcissism, and Narcissistic Personality Disorder (NPD), spanning experimental investigations of intra- and interpersonal mechanisms, research on neurophysiological and neuroendocrine aspects of baseline function, and brain structural correlates. While neuroscience has scarcely directly studied vulnerable narcissism, grandiose narcissism is associated with heightened vigilance to ego threat and stress responses following ego threat, as well as heightened stress indicators in baseline measures. Such responses are not commonly observed in self-reports, highlighting the potential of neuroscience to augment our understanding of self-regulatory dynamics in narcissism. Interpersonal functioning is characterized by deficits in social-affective processes. Both involve altered activity within the salience network, pointing to a double dissociation regarding the expression of narcissism and self/other oriented situational focus. Findings are summarized in an integrative model providing testable hypotheses for future research along with methodological recommendations.

Self-serving social strategies: A systematic review of social cognition in narcissism

Narcissistic Personality Disorder is characterised by inflated self-importance, an excessive need for admiration, and a lack of empathy. The interpersonal difficulties associated with narcissistic personality may be becoming more widespread given its increasing prevalence within the general population. This systematic review investigated the relationship between narcissistic personality traits and social cognition (i.e. theory of mind; emotion recognition; empathy; emotional intelligence) in clinical and non-clinical samples. Cognitive empathy (i.e. perspective taking) appears unlikely to be impaired, while affective empathy (relating to another’s emotion state) may be reduced in association with narcissism. Those with grandiose narcissism rate their empathic skills more highly than those with vulnerable narcissism, but concurrent administration of objective measures is rare, limiting insight into the validity of self-ratings. Rather than deficits in aspects of social cognition, the overall pattern could reflect motivation, or advantageous use of social cognitive skills to serve the self. Indeed, interpersonal strategies associated with narcissism (e.g. deception; manipulation) suggest the application of understanding another’s beliefs or desires in the context of low empathy. Further research should seek to explore performance on a wider range of emotion recognition and theory of mind tasks, and whether characteristics such as excessive jealousy and paranoia could reflect hyper-mentalizing.

Healing the next generation: an adaptive agent model for the effects of parental narcissism

Parents play an important role in the mental development of a child. In our previous work, we addressed how a narcissistic parent influences a child (online/offline) when (s)he is happy and admires the child. Now, we address the influence of a parent who is not so much pleased, and may curse the child for being the reason for his or her unhappiness. An abusive relationship with a parent can also cause trauma and poor mental health of the child. We also address how certain coping behaviors can help the child cope with such a situation. Therefore, the aim of the study is threefold. We present an adaptive agent model of a child, while incorporating the concept of mirroring through social contagion, the avoidance behaviors from a child, and the effects of regulation strategies to cope with stressful situations.

Gray matter asymmetry in the orbitofrontal cortex in relation to psychopathic traits in adolescents

BACKGROUND

Structural abnormalities in the orbitofrontal cortex (OFC) of incarcerated psychopaths have been well documented. However, the neural correlates of psychopathic traits in younger and nonclinical samples remain poorly understood.

AIM

The present study aimed to examine the structural brain asymmetry in the OFC in relation to dimensions of psychopathic traits in adolescents from the community.

METHOD

In 29 youths from the community, childhood psychopathic traits including narcissism, impulsivity, and callous-unemotional traits were assessed when they were 7- to 10 years old (Time 1), and their gray matter (GM) volumes were measured using structural Magnetic Resonance Imaging when they were 10- to 14 years old (Time 2).

RESULTS

After controlling for age, sex, IQ, pubertal stage, and whole-brain volumes, callous-unemotional traits were associated with right-left asymmetry in the medial OFC (mOFC), that is, smaller right mOFC GM as compared to the left. Impulsivity was associated with left-right asymmetry in the mOFC, that is, smaller left mOFC than the right. Narcissism was not associated with any GM asymmetry measure. No significant association was found for the lateral OFC, amygdala, caudate and putamen.

CONCLUSION

The present findings provide further support that dimensions of psychopathic traits may have distinct neurobiological correlates.

A Potential Tension in DSM-5: The General Definition of Mental Disorder versus Some Specific Diagnostic Criteria

The general concept of mental disorder specified in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders is definitional in character: a mental disorder might be identified with a harmful dysfunction. The manual also contains the explicit claim that each individual mental disorder should meet the requirements posed by the definition. The aim of this article is two-fold. First, we shall analyze the definition of the superordinate concept of mental disorder to better understand what necessary (and sufficient) criteria actually characterize such a concept. Second, we shall consider the concepts of some individual mental disorders and show that they are in tension with the definition of the superordinate concept, taking pyromania and narcissistic personality disorder as case studies. Our main point is that an unexplained and not-operationalized dysfunction requirement that is included in the general definition, while being systematically violated by the diagnostic criteria of specific mental disorders, is a logical error. Then, either we unpack and operationalize the dysfunction requirement, and include explicit diagnostic criteria that can actually meet it, or we simply drop it.

The Tango of Problem Formulation: A Patient's/Researcher's Reflection on an Action Design Research Journey

This paper reports on the reflection of the lead researcher, a 48-year-old patient with cystic fibrosis (CF), and aims to portray his real-life experience of a 10-month action design research (ADR) project. Playing a dual role, as both a patient and researcher, the lead researcher reflects deeply on his ADR experience with particular emphasis on the problem formulation stage of creating a simple yet impactful checklist to aid memory recall of CF patients or caregivers during a medical appointment. Using Driscoll's model of reflection, a real-life unsanitized ADR experience is carefully imparted via a series of 4 vignettes, including 4 key learnings, which highlight the connection between a meticulous considered approach to problem formulation and truly effective outcomes. By providing this rich account of problem formulation within ADR, it is hoped that this reflection will help researchers to better understand the complexity of problem formulation in design-oriented research; to avoid making assumptions and becoming fixated on solutions; and to move instead to an end point where several possible ways of examining a problem have been considered, explored, and understood-an end point where successful end results are reached through grit and determination. This paper advocates for the inclusion and portrayal of the actual realities or ups and downs of this dynamic and evolving stage of ADR, capturing the often-tacit knowledge of problem formulation and begetting a sense of realism and humanity to ADR serving as knowledge contributions in their own right. The lead researcher is the patient and researcher in this ADR project. This is my story!

Internal Processing in Patients With Pathological Narcissism or Narcissistic Personality Disorder: Implications for Alliance Building and Therapeutic Strategies

Pathological narcissism (PN) and narcissistic personality disorder (NPD) have primarily been identified by striking external features, such as superiority, attention seeking and a critical or condescending attitude, and less attention has been paid to the internal processing contributing to this particular personality functioning. High dropout from treatment and challenges in building a therapeutic alliance with these patients call for further understanding of the complexity of disordered narcissism. Recent research on neuropsychological underpinnings to narcissistic pathology have provided valuable information that can inform therapeutic interventions for patients with this personality pathology. Internal processing in patients with PN or NPD is specifically influenced by compromised emotion processing and tolerance, identity diffusion, fluctuating sense of agency, reflective ability, perfectionism-related self- esteem, and ability to symbolize. The aim of this article is to review research studies with relevance for internal processing related to disordered narcissism and integrate findings with therapeutic strategies in alliance building with these patients.

Mentalization-Based Treatment for Pathological Narcissism

Despite the growing cultural and empirical interest in pathological narcissism (PN), effective treatment guidelines for PN have not yet been established. This article develops mentalization-based treatment (MBT), a leading evidence-based therapy for borderline personality disorder, as a primary intervention for PN. Synthesizing research on parenting styles, attachment patterns, and empathy in PN, the authors propose a developmental model of narcissism centering on impairments in mentalization. Core therapeutic techniques of MBT for PN are outlined, including clinical examples to illustrate practical implementation. As an accessible, easy-to-operationalize, and resource-sensitive therapeutic approach, MBT offers considerable promise for future empirical investigation and clinical applications in the treatment of patients with pathological narcissism.

Individualized prediction of trait narcissism from whole-brain resting-state functional connectivity

Narcissism is one of the most fundamental personality traits in which individuals in general population exhibit a large heterogeneity. Despite a surge of interest in examining behavioral characteristics of narcissism in the past decades, the neurobiological substrates underlying narcissism remain poorly understood. Here, we addressed this issue by applying a machine learning approach to decode trait narcissism from whole-brain resting-state functional connectivity (RSFC). Resting-state functional MRI (fMRI) data were acquired for a large sample comprising 155 healthy adults, each of whom was assessed for trait narcissism. Using a linear prediction model, we examined the relationship between whole-brain RSFC and trait narcissism. We demonstrated that the machine-learning model was able to decode individual trait narcissism from RSFC across multiple neural systems, including functional connectivity between and within limbic and prefrontal systems as well as their connectivity with other networks. Key nodes that contributed to the prediction model included the amygdala, prefrontal and anterior cingulate regions that have been linked to trait narcissism. These findings remained robust using different validation procedures. Our findings thus demonstrate that RSFC among multiple neural systems predicts trait narcissism at the individual level.

Examining sex differences in DSM-IV-TR narcissistic personality disorder symptom expression using Item Response Theory (IRT)

The limited published literature on the subject suggests that there may be differences in how females and males experience narcissistic personality disorder (NPD) symptoms. The aim of this study was to use methods based on item response theory to examine whether, when equating for levels of NPD symptom severity, there are sex differences in the likelihood of reporting DSM-IV-TR NPD symptoms. We conducted these analyses using a large, nationally representative sample from the USA (n=34,653), the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). There were statistically and clinically significant sex differences for 2 out of the 9 DSM-IV-TR NPD symptoms. We found that males were more likely to endorse the item 'lack of empathy' at lower levels of narcissistic personality disorder severity than females. The item 'being envious' was a better indicator of NPD severity in males than in females. There were no clinically significant sex differences on the remaining NPD symptoms. Overall, our findings indicate substantial sex differences in narcissistic personality disorder symptom expression. Although our results may reflect sex-bias in diagnostic criteria, they are consistent with recent views suggesting that narcissistic personality disorder may be underpinned by shared and sex-specific mechanisms.

Alexithymia as a Transdiagnostic Precursor to Empathy Abnormalities: The Functional Role of the Insula

Distorted empathic processing has been observed across multiple psychiatric disorders. Simulation theory provides a theoretical framework that proposes a mechanism through which empathy difficulties may arise. Specifically, introspection-centric simulation theory (IST) predicts that an inability to accurately interpret and describe internal affective states may lead to empathy difficulties. The purpose of this review is to synthesize and summarize an empirical literature suggesting that simulation theory provides insights into a cognitive and neurobiological mechanism (i.e., alexithymia and insula pathology) that negatively impacts empathic processing, in addition to how disruptions in these processes manifest across psychiatric disorders. Specifically, we review an emerging non-clinical literature suggesting that consistent with IST, alexithymia and associated insula pathology leads to empathy deficits. Subsequently, we highlight clinical research suggesting that a large number of disorders characterized by empathy pathology also feature alexithymia. Collectively, these findings motivate the importance for future work to establish the role of alexithymia in contributing to empathy deficits across clinical symptoms and disorders. The current review suggests that simulation theory provides a tractable conceptual platform for identifying a potential common cognitive and neural marker that is associated with empathy deficits across a wide array of diagnostic classes.

How spontaneous brain activity and narcissistic features shape social interaction

There is an increasing interest in how ongoing spontaneous brain activity and personality provide a predisposition for the processing of environmental demands. It further has been suggested that the brain has an inherent sensitivity to the social environment. Here we tested in healthy volunteers if spontaneous brain activity contributes to a predisposition for social behavior and how this is modulated by narcissistic personality features associated with poor interpersonal functioning. Functional magnetic resonance imaging included a resting state and an experimental paradigm focusing on the anticipation of actively touching an animate (human hand) versus an inanimate target (mannequin hand). The experimental task induced a significant modulation of neural activity in left postcentral gyrus (PostCG), right culmen and, co-varying with narcissistic features, in right anterior insula (AI). Neural activity in anticipation of the animate target significantly correlated with spontaneous activity during the resting state indexed by the Power Law Exponent (PLE) in PostCG and AI. Finally, the correlation between spontaneous and task-induced activity in AI was mediated by narcissistic features. These findings provide novel evidence for a relationship between intrinsic brain activity and social behavior and show how personality could contribute to individual differences in our predisposition to approach the animate world.

Neural functional correlates of empathic face processing

OBJECTIVES

Empathy is a human trait related to the ability to share someone else's feelings, and emotional face processing is one of its measures. Functional Magnetic Resonance Imaging (fMRI) studies showed significant neural correlates of empathic face processing. We aimed to identify those brain areas most consistently involved in empathy for emotional faces.

METHODS

We carried ALE meta-analysis of whole-brain data from fMRI studies during empathic face-processing tasks. We included 23 studies conducted on a total of 568 participants (247 males and 321 females, mean age 32.2 years).

RESULTS

Emotional vs. control faces processing significantly correlated with activations of the left anterior cingulate cortex (BA 32), right precentral gyrus (BA 6), left amygdala, right superior frontal gyrus (BA 9), left middle occipital gyrus (BA 37), right insula (BA 13), left putamen, and left posterior cingulate cortex (BA 31).

CONCLUSIONS

Empathy is a complex process correlating with bi-hemispheric cortico-limbic activations involved in emotional cue processing, self-other/same-different discrimination, perspective-taking, theory of mind, emotional arousal, and decision-making.

Differentiating Community Dwellers at Risk for Pathological Narcissism From Community Dwellers at Risk for Psychopathy Using Measures of Emotion Recognition and Subjective Emotional Activation

The Italian translations of the Pathological Narcissism Inventory (PNI) and Triarchic Psychopathy Measure (TriPM) were administered to 609 community dwelling adults. Participants who scored in the upper 10% of the distribution of the PNI total score were assigned to the group of participants at risk for pathological narcissism, whereas participants who scored in the upper 10% of the distribution of the TriPM total score were assigned to the group of participants at risk for psychopathy. The final sample included 126 participants who were administered the Reading the Mind in the Eyes Test (RMET) and emotion-eliciting movie clips. Participants at risk for pathological narcissism scored significantly lower on the RMET total score than participants who were not at risk for pathological narcissism. Participants at risk for psychopathy showed a significant reduction in the subjective experience of disgust, fear, sadness, and tenderness compared to participants who were not at risk for psychopathy.

Insula and somatosensory cortical myelination and iron markers underlie individual differences in empathy

Empathy is a key component of our ability to engage and interact with others. In recent years, the neural mechanisms underlying affective and cognitive empathy have garnered intense interest. This work demonstrates that empathy for others depends upon a distributed network of regions such as the insula, parietal cortex, and somatosensory areas, which are also activated when we ourselves experience an empathized-with emotion (e.g., pain). Individuals vary markedly in their ability to empathize with others, which predicts the tendency to help others and relates to individual differences in the neuroanatomy of these areas. Here, we use a newly developed, high-resolution (800 μm isotropic), quantitative MRI technique to better elucidate the neuroanatomical underpinnings of individual differences in empathy. Our findings extend previous studies of the neuroanatomical correlates of cognitive and affective empathy. In particular, individual differences in cognitive empathy were associated with markers of myeloarchitectural integrity of the insular cortex, while affective empathy was predicted by a marker of iron content in second somatosensory cortex. These results indicate potential novel biomarkers of trait empathy, suggesting that microstructural features of an empathy and body-related network are crucial for understanding the mental and emotional states of others.

Intersect between self-esteem and emotion regulation in narcissistic personality disorder - implications for alliance building and treatment

Building an alliance with patients with pathological narcissism or narcissistic personality disorder, NPD, can be challenging and include avoidance, negative reactivity and disruptions. A main contributing factor can be the complex interaction between emotion and self-esteem regulation, which affects patients' ability to engage in a therapeutic alliance and treatment. Recent studies, especially in neuroscience have identified functional characteristic and compromises in self-esteem and emotion regulation related to NPD. Self-enhancement, hyper reactivity and need for control, which patients within the range of disordered narcissism often present, can have different roots and underpinnings that require thorough exploration in the process of building the therapeutic alliance and promote change in treatment. Clinical examples with treatment implications and strategies will be discussed to highlight both internal fluctuations and external features and shifts in narcissistic personality functioning.

Neural Correlates of the Appraisal of Attachment Scenes in Healthy Controls and Social Cognition-An fMRI Study

The human attachment system is activated in situations of danger such as potential separation, threats of loss of a significant other and potential insecurity on the availability of the attachment figure. To date, however, a precise characterization of the neural correlates of the attachment system in healthy individuals is lacking. This functional magnetic resonance imaging (fMRI) study aims at characterizing the distinctive neural substrates activated by the exposure to attachment vs. non-attachment scenes. Healthy participants (N = 25) were presented scenes from the Adult Attachment Projective Picture System (AAP), a validated set of standardized attachment-related pictures extended by a control picture stimulus set consisting of scenes without attachment-related content. When compared to the control neutral pictures, attachment scenes activated the inferior parietal lobes (IPLs), the middle temporal gyrus (MTG), and the anterior medial prefrontal cortex (mPFC). These areas are associated with reasoning about mental representations, semantic memory of social knowledge, and social cognition. This neural activation pattern confirms the distinctive quality of this stimulus set, and suggests its use as a potential neuroimaging probe to assess social cognition/mentalizing related to attachment in healthy and clinical populations.

Reduced frontal cortex thickness and cortical volume associated with pathological narcissism

Pathological narcissism is often characterized by arrogant behavior, a lack of empathy, and willingness to exploit other individuals. Generally, individuals with high levels of narcissism are more likely to suffer mental disorders. However, the brain structural basis of individual pathological narcissism trait among healthy people has not yet been investigated with surface-based morphometry. Thus, in this study, we investigated the relationship between cortical thickness (CT), cortical volume (CV), and individual pathological narcissism in a large healthy sample of 176 college students. Multiple regression was used to analyze the correlation between regional CT, CV, and the total Pathological Narcissism Inventory (PNI) score, adjusting for age, sex, and total intracranial volume. The results showed that the PNI score was significantly negatively associated with CT and CV in the right dorsolateral prefrontal cortex (DLPFC, key region of the central executive network, CEN), which might be associated with impaired emotion regulation processes. Furthermore, the PNI score showed significant negative associations with CV in the right postcentral gyrus, left medial prefrontal cortex (MPFC), and the CT in the right inferior frontal cortex (IFG, overlap with social brain network), which may be related to impairments in social cognition. Together, these findings suggest a unique structural basis for individual differences in pathological narcissism, distributed across different gray matter regions of the social brain network and CEN.

Genetic and Neuroimaging Features of Personality Disorders: State of the Art

Personality disorders often act as a common denominator for many psychiatric problems, and studies on personality disorders contribute to the etiopathology, diagnosis, and treatment of many mental disorders. In recent years, increasing evidence from various studies has shown distinctive features of personality disorders, and that from genetic and neuroimaging studies has been especially valuable. Genetic studies primarily target the genes encoding neurotransmitters and enzymes in the serotoninergic and dopaminergic systems, and neuroimaging studies mainly focus on the frontal and temporal lobes as well as the limbic-paralimbic system in patients with personality disorders. Although some studies have suffered due to unclear diagnoses of personality disorders and some have included few patients for a given personality disorder, great opportunities remain for investigators to launch new ideas and technologies in the field.

Narcissistic vulnerability is a common cause for depression in patients with Gilles de la Tourette syndrome

The aim of this study was to assess for the first time different dimensions of narcissistic self-regulation in a large cohort of adult patients with Gilles de la Tourette syndrome (GTS) (n=50). From preliminary studies it is suggested that narcissistic personality trait and disorder, respectively, are relatively uncommon and occur in only 6-10% of GTS patients. In this study we used the Narcissism Inventory (NI), a 163-items questionnaire that measures four different dimensions of narcissism. The main result was that the prevalence of narcissism strongly depends on the subtype of narcissism: while the vulnerable narcissism ("threatened self" and "hypochondriac self") was common, the "classic narcissistic self" (grandiose narcissism) was rare. From our data an association between comorbid depression and increased values of the "threatened self" and comorbid OCD with increased values of the "hypochondriac self" is suggested. Narcissism correlated positively with the personality domain neuroticism and had a significantly negative impact on patients' quality of life. Therefore it can be speculated that vulnerable narcissism is - among several others - one cause for depression in patients with GTS. These findings may open new psychotherapeutic perspectives in the treatment of depression in patients with GTS.

Gender differences in brain structure and resting-state functional connectivity related to narcissistic personality

Although cognitive and personality studies have observed gender differences in narcissism, the neural bases of these differences remain unknown. The current study combined the voxel-based morphometry and resting state functional connectivity (rsFC) analyses to explore the sex-specific neural basis of narcissistic personality. The VBM results showed that the relationship between narcissistic personality and regional gray matter volume (rGMV) differed between sexes. Narcissistic scores had a significant positive correlation with the rGMV of the right SPL in females, but not in males. Further analyses were conducted to investigate the sex-specific relationship between rsFC and narcissism, using right SPL/frontal eye fields (FEF) as the seed regions (key nodes of the dorsal attention network, DAN). Interestingly, decreased anticorrelations between the right SPL/FEF and areas of the precuneus and middle frontal gyrus (key nodes of the the default mode network, DMN) were associated with higher narcissistic personality scores in males, whereas females showed the opposite tendency. The findings indicate that gender differences in narcissism may be associated with differences in the intrinsic and dynamic interplay between the internally-directed DMN and the externally-directed TPN. Morphometry and functional connectivity analyses can enhance our understanding of the neural basis of sex-specific narcissism.

Brain structure in narcissistic personality disorder: a VBM and DTI pilot study

We analysed T1-weighted MRI scans using voxel-based morphometry (VBM) and tract-based spatial statistics (TBBS) on diffusion tensor images (DTI) in narcissistic personality disorder (NaPD) patients and healthy controls. Grey matter deficits include right prefrontal and bilateral medial prefrontal/anterior cingulate cortices, and decreased fractional anisotropy in right frontal lobe white matter.

Distress from Motivational Dis-integration: When Fundamental Motives Are Too Weak or Too Strong

Past research has shown that satisfying different kinds of fundamental motives contributes to well-being. More recently, advances in motivational theory have shown that z is also tied to the integration of different motives. In other words, well-being depends not only on maximizing effectiveness in satisfying specific motives, but also on ensuring that motives work together such that no individual motive is too weak or too strong. In this chapter, we review existing research to show that specific forms of psychological distress can be linked to specific types of motivational imbalance or dis-integration. Such disintegration can arise from either excessive weakness of a specific motive or the excessive strength and/or dominance of a specific motive, thereby inhibiting other motives. Possible neural correlates and avenues of intervention are discussed.

Fear and decision-making in narcissistic personality disorder-a link between psychoanalysis and neuroscience

Linking psychoanalytic studies with neuroscience has proven increasingly productive for identifying and understanding personality functioning. This article focuses on pathological narcissism and narcissistic personality disorder (NPD), with the aim of exploring two clinically relevant aspects of narcissistic functioning also recognized in psychoanalysis: fear and decision-making. Evidence from neuroscientific studies of related conditions, such as psychopathy, suggests links between affective and cognitive functioning that can influence the sense of self-agency and narcissistic self-regulation. Attention can play a crucial role in moderating fear and self-regulatory deficits, and the interaction between experience and emotion can be central for decision-making. In this review we will explore fear as a motivating factor in narcissistic personality functioning, and the impact fear may have on decision-making in people with pathological narcissism and NPD. Understanding the processes and neurological underpinnings of fear and decision-making can potentially influence both the diagnosis and treatment of NPD.

Moving Narcissus: Can Narcissists Be Empathic?

Empathy plays a critical role in fostering and maintaining social relations. Narcissists lack empathy, and this may account for their interpersonal failures. But why do narcissists lack empathy? Are they incapable, or is change possible? Three studies addressed this question. Study 1 showed that the link between narcissism and low empathy generalizes to a specific target person presented in a vignette. The effect was driven by maladaptive narcissistic components (i.e., entitlement, exploitativeness, exhibitionism). Study 2 examined the effect of perspective-taking (vs. control) instructions on self-reported responses to a video. Study 3 examined the effect of the same manipulation on autonomic arousal (heart rate [HR]) during an audio-recording. Perspective-taking ameliorated negative links between maladaptive narcissism and both self-reported empathy and HR. That is, narcissists can be moved by another's suffering, if they take that person's perspective. The findings demonstrate that narcissists' low empathy does not reflect inability, implying potential for intervention.

Narcissistic personality disorder: an integrative review of recent empirical data and current definitions

Although concepts of pathological narcissism are as old as psychology and psychiatry itself, only a small number of clinical studies are based on the criteria for narcissistic personality disorder (NPD), as defined in the Diagnostic and Statistical Manuals of Mental Disorders (DSM). As a result, NPD appears to be one of the most controversially discussed nosological entities in psychiatry. Whereas the majority of empirical studies used self or other ratings of NPD criteria to address issues of reliability and validity of the diagnostic category (i.e., internal consistency, factor structure, discriminant validity), only recent research has applied experimental designs to investigate specific features of NPD (e.g., self-esteem, empathy, shame). The aim of this review is to summarize available empirical data on NPD and relate these findings to current definitions of NPD (according to the DSM-5, [1]). In order to do so, this review follows the five steps to establishing diagnostic validity proposed by Robins and Guze [2], i.e., (1) clinical description, (2) laboratory studies, (3) delimitation from other disorders, (4) family studies, and (5) follow up studies. Finally, this review suggests pathways for future research that may assist further nosological evaluation of NPD and contribute to the overall goal, the improvement of treatment for patients.