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

J Behav Ther Exp Psychiatry. 2013 Mar;44(1):37-47. doi: 10.1016/j.jbtep.2012.07.001. Epub 2012 Jul 21.


Background and objectives: Narcissistic personality disorder (NPD) is characterized by reports of grandiosity including exaggerated illusions of superiority and entitlement (DSM-IV-TR, APA, 2000). Based on clinical theories (e.g., Kernberg, 1975), many researchers argue that high explicit self-esteem in narcissists masks underlying implicit vulnerability (low implicit self-esteem). Conversely, based on social learning theories (i.e., Millon, 1981), people with NPD are characterized by implicit grandiosity (high implicit self-esteem). We test these competing hypotheses in patients diagnosed with NPD.

Methods: The present study examined implicit self-esteem (using an Implicit Association Test) and explicit self-esteem (using a self-report questionnaire) in patients with NPD in comparison to non-clinical and clinical, non-NPD (Borderline Personality Disorder, BPD) control groups.

Results: Patients with NPD scored lower on explicit self-esteem than non-clinical controls. In comparison to patients with BPD, NPD patients scored higher on explicit and implicit self-esteem. Moreover, within the group of NPD patients, damaged self-esteem (i.e., low explicit, high implicit) was associated with higher narcissistic psychopathology.

Limitations: In both clinical groups we included participants seeking psychiatric treatment, which might influence explicit self-esteem. Longitudinal studies are needed to further assess self-esteem stability in NPD patients in comparison to the control groups.

Conclusions: Our findings are indicative of vulnerable facets in patients with NPD (i.e., low explicit self-esteem). Furthermore, damaged self-esteem is connected to specific psychopathology within the NPD group. Implications for research on NPD are discussed.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Depression / complications
  • Depression / psychology
  • Female
  • Humans
  • Male
  • Personality Disorders / complications
  • Personality Disorders / diagnosis*
  • Personality Disorders / psychology*
  • Personality Inventory
  • Psychiatric Status Rating Scales
  • Self Concept*
  • Self Report
  • Surveys and Questionnaires
  • Young Adult