Self- and informant-reported perspectives on symptoms of narcissistic personality disorder

Personality traits and personality problems in Korsakoff syndrome patients

Personality research is of relevance because it provides insights into the psychological strengths and vulnerabilities of a person. Korsakoff's syndrome (KS) is a severe neuropsychiatric disorder following acute thiamine deficiency, usually as a consequence of alcohol-use disorders. Research on personality traits of KS patients is currently limited. The aim of the current exploratory study was therefore to examine the personality traits and problems of KS patients. We assessed self-reported and informant-reported personality traits and problems in institutionalized KS patients (n = 30). Results indicate that the psychotic personality organization was more frequently present in KS patients compared to a psychiatric reference population, leading to increased vulnerability for the development of severe psychiatric issues. Informants observed more premorbid and current cluster B ("emotional") and C ("anxious") personality behavior in comparison to the general population. Also, rigid- and socially avoidant behavior in KS patients was observed to increase over the years. They also observed personality problems such as emotional-, unpredictable-, dramatic-, anxious and fearful behavior in the present and in the past. KS patients reported themselves as healthy individuals, indicating a lack of self-awareness. We recommend training programs for the medical team focussed on psycho-education and supportive interventions for patients with complex personality problems concomitant to KS.

Personality disorders in older adults: Differences in self-informant ratings

Previous research on self-informant reports in assessing personality disorders (PDs) has been mainly focused on adults, leaving older adults under-studied. We examined self-informant agreement in PD screening among older adults (≥60 years) using the Gerontological Personality disorders Scale (GPS). Potential differences such as who reports more personality pathology on a PD screener (i.e., GPS), item accessibility and the effect of relational aspects were studied as well. Data of 326 older adult-informant dyads, of which the older adults were sampled from five general practices in the Netherlands, were used. Results indicate that self-informant agreement ranged from r = 0.26-0.73, with lower concordance on the GPS-subscale measuring intrapersonal aspects of personality pathology. Informants were more sensitive to habitual pathological personality features than older adults. Two GPS items showed differential item functioning across self- and informant-report. Of relational aspects, only congeniality affected the GPS-iv scores; lower ratings on congeniality were associated with higher GPS-iv scores (i.e., higher reporting of personality problems).

Traits of narcissistic vulnerability in adults with autism spectrum disorders without intellectual disabilities

The relationship between Autism Spectrum Disorders (ASD) and Narcissistic Personality Disorder (NPD), considering the dimensions of narcissistic grandiosity and vulnerability, represents an important differential diagnosis and potential ground of comorbidity, since both conditions show high grades of pervasiveness, a life-long course, ego-syntonic traits, and difficulties in building up and sustaining interpersonal relationships Although the co-diagnosis rates, according to the categorical criteria in use, are limited (0%-6.4%), it is common to encounter diagnostic doubts in clinical practice. Here we investigated the dimensions of narcissistic vulnerability and grandiosity in a sample of 87 adults diagnosed with ASD without intellectual disabilities through the administration of the Pathological Narcissism Inventory-52 Items (PNI-52). The mean scores of our sample were compared with the normative distribution available in the literature, and we found that individuals with ASD scored significantly higher than neurotypical controls at the Total Score and at the Vulnerable Narcissism subscale, but not at the Grandiose Narcissism subscales. Demographic features did not influence these results. Vulnerable narcissism was significantly associated with the "Ritvo Autism and Asperger Diagnostic Scale - Revised" subscale Social Relatedness. These findings could potentially be indicative of a greater comorbidity rate between the two disorders with respect to the one reported to date, possibly because DSM-5 criteria are mainly focused on the grandiose dimension. Potential explanatory links between ASD phenomenology and vulnerable narcissism, such as the personality dimension of neuroticism, are discussed, together with the possible role of narcissistic vulnerability in mediating internalizing symptoms (e.g., anxiety, depression) in individuals with ASD.

Narcissism in Romantic Relationships: Using Communal Activation to Promote Relationship Enhancing Attitudes

Background: People with elevated vulnerable narcissism (VN) or grandiose narcissism (GN) trait levels tend to experience greater difficulties in their romantic relationships than their counterparts with lower levels of VN or GN. Although there are no evidence-based approaches to alter the interpersonal behavior of persons with VN or GN traits, experimental research shows that it is possible to produce relationship-enhancing attitudes in people with GN traits through communal activation (CA). Objective: We examined whether a CA manipulation in the context of relationship education improves attitudes that promote romantic relationship health, and whether VN and GN would moderate these associations. Method: Participants (Nwomen =148, Nmen = 71) watched psychoeducational videos on relationships and were randomly assigned to either answer questions about the videos' content (control group) or to complete CA exercises (experimental group) in addition to questionnaires to measure empathy, criticism, commitment, desire for closeness, and communication (positive interaction, demand/withdraw communication, criticize/defend communication) before and after the experimental manipulation. Results: There was a main effect of condition, such that, relative to the control group, fewer improvements in perceived demand/withdraw communication were observed in the experimental condition. VN, but not GN, moderated the link between condition and commitment, demand/withdraw and criticize/defend communication, such that elevated VN levels predicted the most improvement in commitment, demand/withdraw and criticize/defend communication in the experimental condition. Discussion: We conclude with recommendations to adopt ego-enhancing reinforcement for communal behaviors with clients who endorse GN traits and considering less personally relevant CA exercises with clients who endorse VN traits.

Psychological Distress Profiles of Young Adults With Vulnerable Narcissism Traits

The current study hypothesizes a mediating role for shame in the association between vulnerable narcissism (VN) and depressive and social anxiety symptoms. A sample of 600 undergraduates was administered psychometrically sound self-reports to assess the study variables. Structural Equation Modeling supported the mediating effect of shame in the association between VN and depressive symptoms, irrespective of the way VN was assessed (i.e., Hypersensitive Narcissism Scale [HSNS] or Pathological Narcissism Inventory). Conversely, shame did not mediate the association with social anxiety when VN was assessed through the (HSNS). A direct effect of VN on both depressive and social anxiety symptoms was also detected. The results are discussed in the context of their implications, while also focusing on the different findings that emerged via the measures used to assess VN.

Insight Regarding the Presence of Antagonism-Related Traits and Their Subsequent Impairment in Relation to Psychopathy, Narcissism, and Machiavellianism

Clinical theory is skeptical of individuals' ability to recognize the presence, severity, and impact of clinical symptoms and pathological traits (Oltmanns & Powers, 2012); however, empirical work has found moderate self-other convergence for reports of pathological traits and for Antagonism-related personality disorder (PD) constructs (i.e., psychopathy, narcissism, and Machiavellianism), which are characterized by low insight. Nevertheless, empirical examinations of insight into perceptions of impairment are scant. Thus, the present study sought to examine individuals' insight regarding pathological traits and related impairment in two samples. In Sample 1, more psychopathic, narcissistic, and Machiavellian individuals reported higher levels of pathological traits and were aware of related impairment. In Sample 2, individuals reported higher levels of pathological traits and, albeit to a lesser degree, more Antagonism-related impairment. Thus, more psychopathic, narcissistic, and Machiavellian individuals possess a reasonable degree of insight into their trait levels and associated impairment.

Narcissism and Quality of Life: The Mediating Role of Relationship Patterns

Pathological narcissism is associated with decreased quality of life, even when accounting for psychiatric comorbidity, but the processes behind this association are unclear. Here, we evaluate whether disturbed relatedness accounts for the negative association between narcissistic pathology and quality of life. Patients in day hospital treatment for personality pathology (N = 218, 70% female; mean age, 37.3 years) completed measures of personality disorder features, quality of life, and global symptoms before beginning treatment. Quality of object relations was assessed through semistructured interviews. Regression-based mediation analyses showed that narcissistic personality traits relate to quality of life through quality of object relations, controlling for other personality disorders and psychiatric distress. These results highlight the importance of problematic relationship patterns for the low quality of life associated with pathological narcissism. Clinicians working with narcissistic individuals should consider psychotherapies that promote mature relatedness and should attend to facilitating the quality of patients' relationships.

Improving Interpretability of Subjective Assessments About Psychological Phenomena: A Review and Cross-Cultural Meta-Analysis

Attempts to understand subjectivity have historically involved distinguishing the strengths of subjective methods (e.g., survey ratings from informants) from those of alternative methods (e.g., observational/performance-based tasks). Yet a movement is underway in Psychology that considers the merits of intersubjectivity: Understanding the space between two or more informant’s subjective impressions of a common person or phenomenon. In mental health research, understanding differences between subjective impressions have less to do with informants’ characteristics and more to do with the social environments or contexts germane to the people or phenomena examined. Our article focuses on one relatively understudied social environment: the cultural context. We draw from seminal work on psychological universals, as well as emerging work on cultural norms (i.e., cultural tightness) to understand intersubjectivity effects through a cross-cultural lens. We report a meta-analysis of 314 studies of intersubjectivity effects in mental health, revealing that (a) this work involves independent research teams in more than 30 countries, (b) informants rating a target person’s mental health (e.g., parent and teacher ratings of a child’s behavior) commonly provide diverging estimates of that person’s mental health, and (c) greater convergence between subjective reports relates to a “tighter” or more norms-bound culture. Our article illustrates strategies for understanding divergence between subjective reports. In particular, we highlight theoretical and methodological frameworks for examining patterns of divergence between subjective reports in relation to data from nonsubjective methods. We also describe how research on intersubjectivity informs efforts to improve the interpretability of subjective assessments in multiple subdisciplines in Psychology.

Informant assessment: The Informant Five-Factor Narcissism Inventory

A series of self-report measures of personality disorder from the perspective of the five-factor model (FFM) have been published; however, no informant-report versions have been developed. An informant version of the Five Factor Narcissism Inventory (FFNI) is particularly apt, given the degree of distortion in self-description inherent to narcissism. The present study provides initial validation for the Informant Five-Factor Narcissism Inventory (IFFNI). In Study 1, informant reports from friends, romantic partners, parents, and other family members were compared with self-reports provided by undergraduate college students on the IFFNI, FFM personality, and social dysfunction. Self-other agreement for IFFNI Grandiose (G) was higher than what has been found with other narcissism measures. No self-informant convergence, though, was found for IFFNI Vulnerable (V). From the informant view, IFFNI-G and V narcissism were associated with social dysfunction, whereas from the self-view only FFNI-V was associated with social dysfunction. In Study 2, grandiose and vulnerable narcissists, identified by participants recruited from MTurk, were described in terms of the IFFNI, FFM, and Pathological Narcissism Inventory (PNI). Results indicated that the IFFNI discriminated well between G and V narcissism for all but a few scales. The exceptions may reflect vulnerable narcissistic traits within grandiose narcissists. In comparison, the PNI obtained a very similar informant profile for the G and V narcissists. In sum, the results of the current study suggest value in having an informant-based measure of narcissism. (PsycINFO Database Record

Does reflective functioning mediate the relationship between attachment and personality?

Mentalization, operationalized as reflective functioning (RF), can play a crucial role in the psychological mechanisms underlying personality functioning. This study aimed to: (a) study the association between RF, personality disorders (cluster level) and functioning; (b) investigate whether RF and personality functioning are influenced by (secure vs. insecure) attachment; and (c) explore the potential mediating effect of RF on the relationship between attachment and personality functioning. The Shedler-Westen Assessment Procedure (SWAP-200) was used to assess personality disorders and levels of psychological functioning in a clinical sample (N = 88). Attachment and RF were evaluated with the Adult Attachment Interview (AAI) and Reflective Functioning Scale (RFS). Findings showed that RF had significant negative associations with cluster A and B personality disorders, and a significant positive association with psychological functioning. Moreover, levels of RF and personality functioning were influenced by attachment patterns. Finally, RF completely mediated the relationship between (secure/insecure) attachment and adaptive psychological features, and thus accounted for differences in overall personality functioning. Lack of mentalization seemed strongly associated with vulnerabilities in personality functioning, especially in patients with cluster A and B personality disorders. These findings provide support for the development of therapeutic interventions to improve patients' RF.

Self and informant report across the borderline personality disorder spectrum

Individuals with borderline personality disorder (BPD) features may be unaware of or unwilling to report their own personality or maladaptive behaviors, which complicates the assessment of BPD. Informants who know the individuals with BPD features may be uniquely suited to aid in the personality assessment of these individuals. The present study analyzed the comparative ability of individuals (targets) and informants to report BPD features across the continuum of BPD severity. The sample consisted of 1387 targets, ages 55 to 65 (56% women), who were recruited for an epidemiological longitudinal study examining the effects of PDs on health and social functioning. Each target nominated an informant who provided information about the target's personality. Results indicated relatively low levels of agreement between perspectives and that informants reported BPD symptoms with more precision and at lower levels of BPD severity than targets. The benefits of including an informant perspective when measuring the BPD continuum are discussed; these benefits may include gains in reliability and improvement in the prediction of outcomes. (PsycINFO Database Record

A Dimensional Comparison of a Self-Report and a Structured Interview Measure of Conduct Disorder

Eligibility for a diagnosis of antisocial personality disorder (ASPD) requires evidence of antecedent conduct disorder (CD). Accurately identifying CD may be influenced by various factors, including assessment methodology. The present study used a two-parameter latent variable model to examine the relative performance of a self-report measure and a structured clinical interview in retrospectively detecting the CD spectrum among adult male offenders (N = 1,159). Self-report and clinical interview tended to converge regarding the rank order of severity indicated by CD symptom criteria. In addition, at relatively low levels of CD severity, self-report provided more information about the CD spectrum than did clinical interview. At relatively higher levels of CD severity, however, clinical interview provided more information about the CD spectrum than did self-report. Latent variable models offer a potential means of combining multiple assessment methods in a way that maximizes information gleaned by capitalizing on the contextual strengths of each approach.

Convergence of Self-Reports and Informant Reports on the Personality Assessment Screener

The present study is the first to investigate the Personality Assessment Screener, a brief self-report measure of risk for emotional and behavioral dysfunction, in relation to the informant report version of this instrument, the Personality Assessment Screener–Other. Among a sample of undergraduate roommate dyads ( N = 174), self-report and informant report total scores on the Personality Assessment Screener/Personality Assessment Screener–Other moderately converged ( r = 0.45), with generally greater agreement between perspectives observed for externalizing behaviors compared with internalizing distress. In addition, selves tended to report more psychological difficulties relative to informant ratings ( d = 0.45) with an average absolute discrepancy between sources of 6.31 ( SD = 4.96) out of a possible range of 66. Discrepancies between self-report and informant report were significantly associated with characteristics of the dyadic relationship (e.g., length of acquaintanceship) as well as the severity of self-reported psychological difficulties and positive impression management.

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.

Aging: empirical contribution. A longitudinal analysis of personality disorder dimensions and personality traits in a community sample of older adults: perspectives from selves and informants

Research has indicated that personality disorders (PDs) and normal-range personality traits generally "get better" with time, as evidenced by mean-level decreases in PD traits and mean-level increases in broad factors such as emotional stability, agreeableness, and conscientiousness. One limitation of many of these studies is their reliance on self reported data. In the current study, the authors analyzed the 2.5-year course of PD dimensions and normal personality traits in a representative sample of adults approaching later life (originally ages 55-65) by using a semistructured diagnostic interview as well as self- and informant-reported data from two personality inventories. Consistent with previous literature, many self-reported PD traits showed mean-level decreases over time, and self-reported normal-range personality traits generally showed positive aging effects (e.g., mean-level increases in emotional stability, agreeableness, and conscientiousness). Surprisingly, however, informant-reported PD traits often demonstrated small but significant increases over time, and informant-reported normal-range personality generally "worsened" with age (e.g., mean-level decreases in extraversion, agreeableness, and conscientiousness). Informant reports may challenge the finding that personality and PDs tend to "improve" over time.

Evidence needed to compare definitions of personality pathology: commentary on "a postmortem and future look at the personality disorders in DSM-5"

Comments on the original article by Widiger (see record 2013-45025-016). As Widiger notes, it is important to compare competing systems for the measurement of personality disorders (PD) using empirical data. The current author comments that classification systems are not right or wrong; they are simply more or less useful. What kind of evidence is needed for these comparisons? Clearly the relevant data will cover a wide range of topics, from basic descriptive information to behavior genetics and treatment outcome data. The current author makes three recommendations regarding studies of this sort. First, evidence regarding the presence of personality pathology should come from all sources, not simply self-report instruments. Second, investigators should study community samples as well as samples composed exclusively of patients who are receiving treatment. The third point is that investigators who compare diagnostic models should consider longitudinal evidence collected across all phases of the life span.

Prevalence of Personality Disorders at Midlife in a Community Sample: Disorders and Symptoms Reflected in Interview, Self, and Informant Reports

This report is concerned with the prevalence of symptoms of specific personality disorders in a representative community sample and draws attention to the importance of different sources of diagnostic information. We recruited a sample of 1,630 people between the ages of 55 and 64 to participate in a study regarding personality and health. Using careful recruitment methods, our participation rate was 43 %. Participants completed the SIDP-IV interview as well as a questionnaire (self-report MAPP). Informants completed the same questionnaire (informant MAPP), describing the participant's maladaptive personality characteristics. According to the diagnostic interview, 7 % of participants met criteria for exactly one PD, 1 % met criteria for 2 or 3 PDs, and 2 % met criteria for PD NOS (defined as 10 or more miscellaneous criteria). Avoidant and obsessive compulsive PDs were the most common types. Correlations between the three sources of information indicated significant agreement among these measurement methods, but they are not redundant. In comparison to interview and self-report data, informants reported more symptoms of personality pathology (except for avoidant PD). Symptoms of personality pathology are continuously distributed, and subthreshold features may have an important impact on health and social adjustment. In this community sample, rates of co-morbidity among PDs and the proportion of PDNOS diagnoses are substantially lower than reported from clinical samples. Future research must evaluate the validity of diagnostic thresholds and competing sources of diagnostic information in relation to important life outcomes.