Le narcissisme malin : synthèse intégrative des connaissances conceptuelles, cliniques et empiriques et étude des liens avec la santé physique et psychologique

Abstract

Goal

Malignant narcissism is a personality disorder that has been extensively discussed in conceptual and clinical literature for decades. The syndrome is postulated to be both severe and extremely difficult to treat. In recent years, the notion of malignant narcissism has gained momentum in the popular discourse, and efforts at empirically studying the syndrome have been undertaken. This paper is organized in two parts. Part I is dedicated to an integrative synthesis of conceptual, clinical, and empirical literature on malignant narcissism, while Part II covers an empirical study on the associations between malignant narcissism, and physical and psychological health.

Part I

Literature on malignant narcissism originated from the psychodynamic paradigm. Seminal writings on malignant narcissism highlight the underlying role of two intrapsychic structures and related processes: the grandiose self and an unintegrated superego. The observable manifestations of these underlying organizations are distributed across five dimensions: narcissism, psychopathy, aggression, sadism, and paranoia. Three measures relying on the dimensional model of personality disorders have been proposed to assess malignant narcissism. The first measure is the Composite Index of Malignant Narcissism, which relies on the Narcissism and Paranoid Proneness scales from the International Personality Disorder Examination, and the Fearless Dominance and Coldheartedness scales from the Psychopathic Personality Inventory-Revised. The second measure developed is a scoring procedure for malignant narcissism based on 11 of the 25 facets assessed in the Personality Inventory for DSM-5 selected through an expert consensus following a prototype matching approach. The third measure is based on the three scales from the Psychopathic Personality Inventory-Revised, Fearless Dominance, Coldheartedness, and Self-Centered Impulsivity, as well as the two scales of the Pathological Narcissism Inventory, Grandiose and Vulnerable Narcissism. The three measures showed promising results, although the Composite Index of Malignant Narcissism was introduced in a heuristic perspective and has yet to be thoroughly validated, while the index based on the Psychopathic Personality Inventory-Revised and the Pathological Narcissism Inventory was only validated in a small sample. In contrast, the scoring procedure for malignant narcissism based on the Personality Inventory for DSM-5 has been validated in large samples and has showed strong psychometric properties. Measures of malignant narcissism, especially the latter, have been used to empirically document the correlates of malignant narcissism. Research shows that the syndrome is linked to sociodemographic characteristics, personality functioning, and multiple psychological symptoms. Data also support the distinction between malignant narcissism and the closely related narcissistic personality disorder and psychopathy. A potential correlate of malignant narcissism that has yet to be studied is psychological and physical health.

Part II, Background

Personality disorders in general present with physical health problems as well as lower psychological health. Accordingly, malignant narcissism is postulated to be linked to behaviors that can damage physical health, as well as various psychological difficulties. However, global physical and psychological health in MNARC have yet to be empirically studied.

Methods

A total of 288 participants (178 women, 110 men; M_age = 33.66, SD = 10.54) with a personality disorder were recruited in a specialized clinic for personality disorders in the province of Quebec, Canada. They completed the French adaptation of the Personality Inventory for DSM-5 Faceted Brief Form to compute malignant narcissism scores according to the scoring procedure for malignant narcissism based on the Personality Inventory for DSM-5. They also completed the French adaptation of the Medical Outcomes Study Short-Form Health Survey, which assesses physical and psychological health.

Results and Discussion

Significant negative bivariate Pearson correlations of weak amplitude indicated that malignant narcissism is linked to poorer physical and psychological health, as well as impaired social functioning (General Health, Mental Health, and Social Functioning scales of the Medical Outcomes Study Short-Form Health Survey). The uncovered links between malignant narcissism and physical health are coherent with previous literature on personality disorders. The few and low associations with physical health can be explained by the fact that (a) malignant narcissism comprises both primary and secondary psychopathy, although evidence suggest that it is more specifically the latter that is linked to physical health; and (b) the sample was relatively young, while the links between personality disorders and physical health problems increase with age. Assessing specific physical health diagnoses would have provided a more fine-grained assessment. Significant but low associations with psychological health and social functioning were expected since malignant narcissism is postulated to be associated with limited subjective distress.