Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
J Behav Ther Exp Psychiatry. 2013 Mar;44(1):37-47. doi: 10.1016/j.jbtep.2012.07.001. Epub 2012 Jul 21.
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.
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.
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.
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.
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.
自恋型人格障碍（NPD）的特征是报告夸大的优越感和权利感，包括夸大的幻想（DSM-IV-TR，APA，2000）。基于临床理论（例如，Kernberg，1975），许多研究人员认为，自恋者的高外显自尊掩盖了潜在的脆弱性（低内隐自尊）。相反，基于社会学习理论（即，Millon，1981），NPD 患者的特点是内隐的夸大（高内隐自尊）。我们在被诊断为 NPD 的患者中测试了这些相互竞争的假设。
本研究使用内隐联想测验（IAT）和自我报告问卷（SE），比较了 NPD 患者与非临床对照组（边缘型人格障碍，BPD）之间的内隐自尊和外显自尊。
NPD 患者的外显自尊得分低于非临床对照组。与 BPD 患者相比，NPD 患者的外显和内隐自尊得分更高。此外，在 NPD 患者组中，受损的自尊（即低外显、高内隐）与更高的自恋性病理相关。
在两个临床组中，我们都包括了寻求精神科治疗的参与者，这可能会影响外显自尊。需要进行纵向研究，以进一步评估 NPD 患者与对照组之间的自尊稳定性。
我们的发现表明 NPD 患者存在脆弱的方面（即低外显自尊）。此外，受损的自尊与 NPD 组内的特定病理相关。讨论了对 NPD 研究的影响。
