The Handbook of Narcissism and Narcissistic Personality Disorder: Theoretical Approaches, Empirical Findings, and Treatments (2011) is a comprehensive academic reference edited by Campbell and Miller. It reviews theoretical models, empirical findings, and treatment approaches to narcissism, making it one of the most cited and authoritative works on the subject.

FULL SUMMARY

About the Author:
The handbook is an edited volume, with individual chapters contributed by various leading scholars and experts in narcissism and personality disorders.
The two editors are:

W. Keith Campbell, Ph.D. – Professor of Psychology at the University of Georgia, widely recognized for his research on narcissism, personality, and cultural change. Author of The Narcissism Epidemic and other influential works.

Joshua D. Miller, Ph.D. – Professor of Psychology at the University of Georgia, specializing in personality assessment, narcissism, and clinical psychology. Known for his empirical research on personality disorders and their measurement.

🙋🏼‍♂️ Note: we moved and nested some chapters to improve reading experience and flow.

Chapter 1, 2, 3: History, DSM, Psychiatric Classifications

Authors: Kenneth N. Levy, William D. Ellison, Joseph S. Reynoso

The concept of narcissism evolved from ancient myth to a recognized psychiatric diagnosis.
Across the 20th century, narcissism shifted from myth and metaphor to clinical construct, with contributions from psychoanalysis, social psychology, and psychiatry.

• Mythic origins: The story of Narcissus introduced themes of self-love, fragility, and despair, which later influenced psychoanalytic views (Hamilton, 1942; Ovid, 8 C.E.).
• Psychoanalytic development: Freud conceptualized narcissism as both normal (developmental) and pathological (defensive withdrawal, inflated self). Rank, Horney, Winnicott, and Kernberg elaborated on its defensive and relational functions.
• From personality style to disorder: Clinicians such as Wälder, Reich, and Kernberg described narcissism as a personality type marked by grandiosity, lack of empathy, and aggression. Kohut reframed it as a developmental failure of healthy self-integration.
• Cultural expansion: From Lasch’s “culture of narcissism” to Twenge & Campbell’s “narcissism epidemic,” the construct has been used to describe both individuals and society (Lasch, 1979; Twenge & Campbell, 2009).

Chapter 2: Narcissism in the DSM

Authors: Elizabeth K. Reynolds, Carl W. Lejuez

Narcissistic Personality Disorder (NPD) became an official diagnosis in DSM-III (1980).
Its evolution across DSM editions reflects ongoing negotiations between clinical theory and empirical research. Earlier versions emphasized observable grandiosity, while later revisions streamlined criteria but downplayed vulnerability and dynamic shifts. DSM-5 proposed a hybrid dimensional model, integrating personality functioning and traits, to capture narcissism more flexibly.

• DSM-III (1980): First official inclusion of NPD, influenced by Kernberg, Kohut, Millon, and empirical trait research.
• DSM-III-R and DSM-IV: Narrowed to overt grandiosity, reducing recognition of vulnerable forms.
• DSM-5 proposals: Move toward dimensional assessment, aiming to capture narcissistic functioning beyond rigid categories.
  Current conceptions of DSM-5 do not include NPD among the five major personality disorder types.

Chapter 3: Narcissism in Official Psychiatric Classification Systems

Authors: Susan South, Nicholas Eaton, Robert Krueger

This chapter situates NPD in the broader landscape of psychiatric classification. While DSM traditionally emphasized categorical diagnosis, narcissism is increasingly viewed as dimensional — existing along a spectrum of severity.
The challenge is to integrate clinical richness (grandiosity, vulnerability, oscillations) into empirically valid diagnostic systems.

• Dimensional approach: Narcissism may be better understood as variation across traits rather than a binary disorder.
• Future direction: Hybrid models combining categorical clarity with dimensional nuance.

Chapter 4: Narcissistic Grandiosity and Narcissistic Vulnerability

Authors: Aaron L. Pincus, Michael J. Roche

Narcissism is not a single phenomenon but a dual expression: grandiosity and vulnerability. Grandiosity involves arrogance, dominance, and entitlement, while vulnerability manifests as hypersensitivity, insecurity, and withdrawal.
Both forms share self-absorption and fragile self-esteem regulation, but they differ in outward style. Research supports treating them as distinct yet related dimensions of dysfunction.

• There is no gold standard definition: there is no gold standard as to the meaning of narcissism and thus whether it is clinically described or empirically measured
  • Diverse conceptualizations include Nature (normal, pathological), Phenotypic Description (grandiosity, vulnerability), Expressive Modality (overt, covert), and Structure (category, dimension, prototype).
• Phenotypic description:
  • Grandiose narcissists appear confident and demanding;
  • Vulnerable narcissists appear defensive, anxious, and sensitive to criticism.
• DSM limits: Diagnostic manuals have traditionally emphasized grandiosity, underrepresenting vulnerability.
• Oscillations between grandiose and vulnerable: Although the clinical literature often employs typological distinctions, many contemporary clinical experts on narcissism now recognize that grandiose self-states oscillate with vulnerable self-states and affective dysregulation within the same person.
  • Classifications are of relative levels: narcissistic patients are best differentiated from each other based on relative levels of grandiosity and vulnerability rather than categorical classifications (Pincus & Lukowitsky, 2010).
• Clinical recommendation: Understanding both forms is crucial for treatment, as patients often shift between grandiosity and vulnerability.

I found the authors’ definitions to be good:

We propose that narcissism be defined as one’s capacity to maintain a relatively positive self-image through a variety of self-regulation, affect-regulation, and interpersonal processes, and it underlies individuals’ needs for validation and admiration, as well as the motivation to overtly and covertly seek out self-enhancement experiences from the social environment (Pincus et al., 2009).

And about pathological narcissism:

From our perspective, the fundamental dysfunction associated with pathological narcissism is related to intense needs for validation and admiration that energize the person to seek out self-enhancement experiences. Such needs and motives are normal aspects of personality, but they become pathological when they are extreme and coupled with impaired regulatory capacities.
(…) in the ability to manage and satisfy needs for validation and admiration, such that self-enhancement becomes an overriding goal (…) sought in maladaptive ways and in inappropriate contexts.

Chapter 5: Psychoanalytic Theories on Narcissism and Narcissistic Personality

Authors: Elsa Ronningstam

Psychoanalytic theories shaped early conceptualizations of narcissism.
Contemporary psychoanalysis frames narcissism as a failure in self-structure and relationships, driven by unresolved trauma, self-esteem dysregulation, and defensive grandiosity.

• Freud: Saw narcissism as a universal stage of development, but also pathological when excessive, tied to ego ideals and defense against feelings of insignificance (Freud, 1914/1957).
• Kernberg: Conceptualized narcissism as pathological grandiosity rooted in cold, rejecting parenting, leading to compensatory grandiose self-images.
• Kohut: Emphasized developmental failure of the “grandiose self” when parental idealization fails, producing dependency on others for self-esteem regulation.
• Other contributions: Horney stressed self-inflation without genuine self-love; Winnicott focused on the false self; Reich and others highlighted oscillations between grandiosity and despair.
• Clinical implication: Therapy approaches use empathic confrontation, helping patients integrate fragmented self-states and reduce defensive reliance on grandiosity.

🙋‍♂️Lucio’s Take: Not a big proponent of non-empirical theories

Lucio:
Although some psychoanalytic insights into narcissism were sharp — even ahead of their time — the approach as a whole suffers from a lack of rigorous empirical testing.

Without evidence, many ideas remain speculative at best, and some have even been contradicted by later research.

To stay relevant today, psychoanalysis should discard what cannot be tested, update or abandon what evidence disproves, and ground itself in empirically supported theories while framing the rest as hypotheses to be tested.

Chapter 6: Narcissism from the Perspective of the Dynamic Self-Regulatory Processing Model

Authors: Carolyn C. Morf, Eva Schürch, Loredana Torchetti

The dynamic self-regulatory processing model presents a unifying framework for the analysis of the self-regulation processing dynamics that characterize not just narcissism, but diverse personality types.

Narcissists strive to maintain a grandiose self-image by seeking validation, reacting defensively to threats, and amplifying their sense of superiority. Rather than being stable traits, narcissistic behaviors are strategic responses to protect self-esteem in real time.

The authors claim that from the 2001 Psychological Inquiry target article by Morf and Rhodewalt, research on has yielded extensive empirical support for the self-regulatory dynamics proposed by the model.

A key feature of the narcissistic system seems to be the conjoint striving for grandiosity at overt explicit levels juxtaposed with a much more concealed implicit vulnerability, which leads them to be highly vigilant to opportunities to bolstering the self, but simultaneously also highly sensitive to potential threats.

• Dynamic cycle: Narcissists pursue admiration, react with hostility or withdrawal to criticism, and reinforce grandiose self-concepts through feedback loops.
• Self-regulation strategies: Attention-seeking, charm, aggression, and withdrawal are used flexibly depending on the context.
• Heuristic utility: Explains how narcissism can look adaptive (confidence, leadership) yet lead to dysfunction when validation is lacking.
• Future directions: Research should track how narcissists shift between grandiosity and vulnerability across social interactions.

Tactics to maintain high self-regard

The authors list a set of tactics that seem to be a mix of potentially adaptive, and some with larger social costs and potentially toxic to others:

• Disparaging outperformers: To diffuse negative social comparison, narcissists openly disparage an outperforming other—even directly to their face (Morf & Rhodewalt, 1993; South, Oltmanns, & Turkheimer, 2003).
• Hostility and aggression under threat of negative evaluation or rejection, including toward displaced aggression (Bushman & Baumeister, 1998; Bushman et al., 2009; Penney & Spector, 2002; Reidy, Zeichner, Foster, & Martinez, 2008; Twenge & Campbell, 2003).
• Unforgiving and vengeful: Narcissists frequently perceive interpersonal transgressions, and in response, they tend to be unforgiving and vengeful (McCullough, Emmons, Kilpatrick, & Mooney, 2003; Brown, 2004; Exline, Baumeister, Bushman, Campbell, & Finkel, 2004).
• Low accommodation in conflicts: In the face of romantic conflicts, narcissists report less accommodative behavior—that is, fewer constructive reactions to potentially negative partner behavior (Campbell & Foster, 2002).
• Psychological control as parents: When children fail to meet expectations, narcissistic mothers often react by inducing guilt and exerting psychological control through hostility, intrusiveness, and withdrawal of love (Schürch & Morf, 2010).

🙋🏼‍♂️ Lucio’s note: integrating vulnerable and grandiose narcissism may be a weakness
Hansen Brown in The Handbook of Trait Narcissism notes that the dynamic self-regulatory processing model conceptualizes narcissism as both grandiose and vulnerable simultaneously rather than as two separate subtypes. I also felt this was a possible weakness

Great First Impressions, Poor Long-Term Relationships

At first encounter, narcissists often make a strikingly positive impression.
They come across as charming, attractive, humorous, and confident, and others see them as agreeable, competent, and leadership material (Paulhus, 1998; Oltmanns, Friedman, Fiedler, & Turkheimer, 2004; Back, Schmukle, & Egloff, 2010; Brunnell et al., 2008; Judge, LePine, & Rich, 2006).

Yet this favorable impression tends not to last.
With more exposure, others begin to view narcissists as arrogant, hostile, and boastful (Paulhus, 1998). Supervisors, unlike co-workers, are quick to note their poor leadership quality and deviant workplace behavior (Judge et al., 2006).
The same pattern emerges in close relationships. Romantic partners often find the start of a relationship with a narcissist more exciting than average, but satisfaction declines as intimacy and emotional bonding fail to develop (Foster, Shrira, & Campbell, 2003, as cited in Campbell et al., 2006). Over time, partners report feeling deceived, manipulated, and undervalued by the narcissist (Campbell, Foster, & Finkel, 2002; Torchetti & Morf, 2010).
However, and some studies do not find negative relationship satisfaction in their partners (Sedikides et al., 2004). The authors suggest it’s because narcissists tend to date other narcissists, and because when partners elicited communal thoughts and feelings, narcissists’ low commitment was no longer apparent (Finkel, Campbell, Buffardi, Kumashiro, & Rusbult, 2009).

👉 It’s a pattern of early attraction followed by eventual disappointment: narcissists shine in first impressions but lose their appeal as deeper flaws surface.

Chapter 7: Trait Personality Models of NPD, Grandiose Narcissism, and Vulnerable Narcissism

Authors: Joshua D. Miller, Jessica Maples

Narcissism can be understood through the lens of trait personality models, especially the Five-Factor Model (FFM).
Grandiose narcissism aligns with high extraversion, dominance, and low agreeableness, whereas vulnerable narcissism aligns with high neuroticism, low extraversion, and hypersensitivity.
Viewing NPD dimensionally helps capture individual differences and overlap with broader personality traits.

Ultimately, Paulhus’ (2001) description of grandiose narcissists as “disagreeable extraverts” seems quite accurate.

• Grandiose narcissism: Assertive, dominant, extraverted, socially bold, but antagonistic.
• Vulnerable narcissism: Withdrawn, insecure, emotionally unstable, hypersensitive to rejection.
• Trait narcissism’s measurements align with grandiose: The vast majority of empirical research on trait narcissism has used the NPI, which measures a grandiose variant of narcissism
• Trait integration: Both types share antagonism (low agreeableness), which may be the core feature of narcissism.
• Trait narcissism vs NPD: trait narcissism is considered a dimensional personality trait that exists to varying degrees in all individuals

Note: FFM and NPD: Domains (weighted average from Samuel & Widiger’s, 2008, and Saulsman & Page’s, 2004, meta analyses; facet level effect sizes were taken from Samuel & Widiger’s, 2008, meta-analysis). FFM facets and Vulnerable Narcissism: Relations come from Miller, Dir, et al. (in press) and Miller, Hoffman et al. (2010). In parentheses, first number represents meta-analytic effect sizes from measures of the FFM (NEO PI- R; NEO-FFI). The second number represents meta-analytic effect sizes from non-FFM measures, primarily the Big Five Inventory (John, 1991).

The Big 5 Underestimate Narcissism’s Downsides

NPI measures of grandiose narcissism often appear adaptive because they correlate with high self-esteem, well-being, and low psychological distress (Cain et al., 2008; Trull & McCrae, 2002; Bosson et al., 2008; Sedikides, Rudich, Gregg, Kumashiro, & Rusbult, 2004), but they miss key pathological features.

The Big Five framework emphasizes high Extraversion and low Neuroticism while underestimating low Agreeableness because it doesn’t capture deceitfulness, callousness, and immodesty—core interpersonal and externalizing traits of narcissism (Miller, Campbell, et al., 2009).

Same as for psychopathy, the authors also caution to not equate low distress with psychological health, as seen in prototypical psychopathy (Cleckley, 1941; Miller, Lynam, Widiger, & Leukefeld, 2001).

Vulnerable Narcissism Is Closer to Borderline Personality Disorder

Research suggests that vulnerable narcissism is largely distinct from grandiose narcissism and NPD.

From a Five-Factor Model perspective, it presents high negative emotionality—depression, anxiety, hypersensitivity, stress, anger, and self-consciousness—and low interpersonal trust rather than grandiosity or dominance.
Vulnerable narcissists often display a hostile attribution bias, interpreting others’ actions as malevolent, leading to problematic interpersonal behaviors (Miller, Dir, et al., 2010; Dodge, Price, Bachorowski, & Newman, 1990; Miller, Lynam, & Jones, 2008). Etiological factors such as abuse or harsh discipline are linked to these tendencies (Dodge, Pettit, Bates, & Valente, 1995).

Trait profiles of vulnerable narcissism closely resemble Borderline Personality Disorder rather than NPD or grandiose narcissism (r = .93; Miller, Dir, et al., 2010) and align more with expert FFM profiles for Borderline PD (r = .71) than for NPD (r = .06).

Chapter 8: Narcissism, the Agency Model, and Approach-Avoidance Motivation

Authors: Joshua D. Foster, James C. Brennan

The agency model highlights how narcissists are driven by approach-oriented motives: pursuing rewards, recognition, and dominance.
Narcissists rarely focus on avoidance (preventing harm) but instead on achieving visibility and success. This bias explains their bold risk-taking in areas like finance, relationships, and leadership, though it also exposes them to failures and social costs.

• Agency model: Narcissists orient their lives around personal agency — achievement, control, power, and recognition.
• Approach-avoidance balance: Narcissists strongly favor approach motivation, leading to overconfidence and risky decisions.
• Narcissism may precipitate financial crisis: anecdotal evidence suggesting that investor narcissism and overconfidence may have fueled some of the risky financial decisions that contributed to the recent collapse of the world economy (Cohan, 2009; Gladwell, 2009).
• Application: In financial choices, narcissists pursue high-reward opportunities while neglecting potential losses.
• Implication: This approach orientation explains both the charisma and recklessness associated with narcissism.

Chapter 9: Behind the Mask

Authors: Virgil Zeigler-Hill, Christian H. Jordan

This chapter explores the “mask model” of narcissism, which proposes that narcissists’ overt confidence conceals fragile self-esteem. The model suggests a discrepancy between explicit (conscious) self-esteem, which is high, and implicit (unconscious) self-esteem, which may be low or unstable. However, empirical evidence is mixed: some studies support the fragile high self-esteem view, others find narcissists report genuinely high implicit self-regard.

• Mask model: Overt grandiosity hides insecurity, shame, or low implicit self-esteem.
• Mixed empirical findings: Some research supports fragile self-esteem; other studies suggest narcissists’ implicit self-esteem can be as high as explicit self-esteem.
• Fragile high self-esteem: Narcissists’ confidence collapses when challenged, fueling defensiveness or aggression.
• Conclusion: The link between narcissism and implicit self-esteem is inconsistent, suggesting subtypes or contextual effects.

Chapters 10, 11, 12, 13: Assessments and Measurement of NPD

Authors: Chris Watson, R. Michael Bagby

Assessing NPD is challenging because narcissism exists on a spectrum from normal to pathological. Traditional categorical diagnosis often misses nuances. Dimensional approaches, structured interviews, and self-report measures improve reliability. Assessment should capture both grandiosity and vulnerability as well as interpersonal dysfunction.

• Dimensional vs. categorical: Dimensional assessment better reflects narcissistic traits across severity levels.
• Structured interviews: Tools like SCID-II provide standardized NPD diagnoses.
• Self-report: Measures such as the Personality Diagnostic Questionnaire highlight narcissistic traits but risk self-presentation bias.
• Future direction: Combine self-reports with informant ratings for more accurate assessment.

Chapter 11: The Measurement of Trait Narcissism in Social-Personality Research

Authors: Michael Tamborski, Ryan P. Brown

Trait narcissism is usually measured with self-report scales, the most widely known being the Narcissistic Personality Inventory (NPI). Other measures capture vulnerable narcissism, pathological forms, or domain-specific expressions. Researchers debate whether narcissism is one construct or a family of related but distinct tendencies.

• NPI: Captures grandiose traits like exhibitionism, dominance, and entitlement.
• Pathological Narcissism Inventory (PNI) captures both grandiosity and vulnerability.
• Choice of measure influences findings, since different scales tap different narcissistic expressions.

Chapter 12: Of Tails and their Dogs

Authors: Simine Vazire, Laura Naumann, Joey T. Cheng, Jason P. Martens

This chapter critiques narcissism scales, arguing that measures can shape theories rather than reflect reality — the “tail wagging the dog.” Researchers must ensure scales measure narcissism itself rather than assumptions embedded in item wording.

Chapter 13: Addressing Criticisms of the Narcissistic Personality Inventory (NPI)

Authors: Richard W. Robins, Laura Naumann

The NPI is the most used narcissism measure but also the most criticized. Critics argue it conflates healthy self-confidence with pathology. Defenders emphasize its predictive power for real-world outcomes. The chapter concludes that the NPI is valuable but incomplete.

• Validity questions: Debate over whether the NPI measures narcissism or simply extraversion + self-esteem.
• Support: NPI predicts leadership, risk-taking, and interpersonal dominance, consistent with narcissism theory.
• Conclusion: NPI remains useful, but complementary measures are needed to capture vulnerability.

Chapter 14, 15: Sociodemographic Correlates of NPD

Authors: Attila J. Pulay, Risë B. Goldstein, Bridget F. Grant

Large epidemiological surveys reveal that NPD is more prevalent in younger adults, men, and certain sociodemographic groups. Prevalence is lower among older adults, suggesting either remission or cohort differences. Findings highlight the social context of narcissistic expression.

• Prevalence: NPD affects roughly 1–6% of the population, depending on definitions.
• Age: Higher in younger adults; decreases with age.
• Gender: More common in men than women.

Chapter 14: Assessment of Youth Narcissism

Authors: Christopher T. Barry, Lisa L. Ansel

Studying narcissism in youth is complex, as traits shift with development. Early self-focus may be normal, but extreme entitlement, lack of empathy, and aggression can signal emerging narcissism. Reliable youth measures are needed to track risks without pathologizing normal development.

• Risk of over-pathologizing normal adolescent self-focus.

Chapter 16: Parenting as a Cause of Narcissism

Authors: Robert S. Horton

Parenting practices contribute significantly to narcissism development. Clinical theories propose two routes: overindulgence (teaching a child they are special without limits) and rejection (driving the child to compensate with grandiosity). Empirical research supports both, though effects vary by child temperament.

• Overindulgence hypothesis: Excessive praise fosters entitlement and unrealistic self-views.
• Rejection hypothesis: Cold or inconsistent parenting leads to defensive grandiosity to protect fragile self-worth.
• Conclusion: Both indulgence and neglect can cultivate narcissism, depending on context.

Chapter 17: Examining “Developmental Me”

Authors: Patrick L. Hill, Brent W. Roberts

Narcissism develops across the lifespan, peaking in adolescence and early adulthood when identity and status-seeking are central. It tends to decline with age as individuals invest in long-term roles (career, family).
This trajectory aligns with social investment theory: commitments to stable roles reduce narcissistic traits.

• Childhood: Self-focus is common but usually transitory.
• Adolescence: Narcissism peaks, especially in status-seeking and self-promotion.
• Adulthood: Narcissism declines as individuals invest in social roles and responsibilities.
• Social investment theory: roles (family, career) reduces narcissistic self-focus.

Chapter 18: Narcissism and Culture

Authors: Jean M. Twenge

Cultural forces contribute to shaping narcissism in individuals and societies.
Societies that emphasize individualism, materialism, and self-expression tend to foster higher narcissism. Cross-cultural studies show variations, and generational analyses suggest increases in narcissism among younger cohorts in the U.S. and other Western countries.

• Both genes and culture matter: Like many personality traits, narcissism appears to have a large genetic component (Vernon, Villani, Vickers, & Harris, 2008).
• Cultural products: Media, advertising, and celebrity culture reinforce self-focus.
• Individualistic vs collectivist cultures: Individualistic cultures show higher narcissism than collectivist ones.
• Generational rise: Evidence suggests narcissism has increased among U.S. college students since the 1980s (Twenge & Campbell, 2009).

Individualistic Cultures Have Upsides

An insightful point from the authors I also agree with:

Individualistic cultures have enormous upsides, among them less prejudice and greater opportunities for people regardless of their backgrounds. Once a culture becomes so individualistic that it is narcissistic, however, negative outcomes are likely to follow.
A society of narcissistic individuals might seem sexy and fun in the short term, but in the long term society breaks down

Chapter 19: The Evolution of Narcissism and Short-Term Mating

Authors: Nicholas S. Holtzman, Michael J. Strube

This chapter applies evolutionary psychology: narcissism may be adaptive for short-term mating strategies. Traits like charm, boldness, and exploitation facilitate sexual opportunities but hinder long-term bonds. Narcissism thus persists as a mixed reproductive strategy.

• Empirical evidence: Narcissists report more short-term relationships, higher mating success in the short run.
• Evolutionary logic: Grandiose self-presentation attracts mates but undermines stability.
• Prediction: Narcissism should correlate with sexual opportunism, infidelity, and risk-taking.

Read more:

• Love role in dating
• Short-term mating psychology

Status-Enhancing Strategy

narcissists tend to engage in numerous competitive behaviors that could potentially be viewed as manifestations of a STM strategy.
For example, narcissists tend to exhibit status-striving (Wallace & Baumeister, 2002), other-derogation (Morf & Rhodewalt, 1993), and physical aggression (Bushman & Baumeister, 1998a; Donnellan, Trzesniewski, Robins, Moffitt, & Caspi, 2005; Twenge & Campbell, 2003a), all of which could elevate narcissists to a top position in a social hierarchy, potentially increasing STM opportunities.

Evolved Adaptations for Short-Term Mating

The authors mention that narcissist may have evolved adaptations to facilitate successful short-term mating:

Narcissists may have different sperm qualities than non-narcissists, such as qualities that facilitate rapid fertilization following one-time intercourse.
In contrast, non-narcissists may have evolved defensive sperm, more designed to block the successful one-time insemination by male narcissists.

Male narcissists may have larger testicles for higher amounts of sperm production, to facilitate insemination.
This hypothesis can be derived from the primate literature in which it is evident that STM species tend to have larger testicles (Buss, 2007).

Also, male narcissists self-report larger penile size (Moskowitz, Rieger, & Seal, 2009); if true, this structure may help remove competitors’ semen and increase insemination likelihood for one’s own semen (Schmitt, 2005; Shackelford et al., 2005).

🙋‍♂️Lucio’s Take: Interesting, but still speculative

Lucio:
I do think narcissists are more short-term oriented and that this may have an evolutionary basis. But physical adaptations remain largely speculative.

Larger studies would be needed, and for now these remain hypotheses.
The penis size link is intriguing, but it’s correlational—causality could run the other way (e.g., men with larger penises may develop higher self-esteem, which then registers as narcissism on certain scales).
And as far as I know, there’s no solid evidence for “sperm blocking.”

Chapter 31: Narcissism and Sexuality

Authors: Laura Widman, James K. McNulty

Narcissism strongly influences sexual attitudes and behaviors. Narcissists are more likely to pursue short-term, exploitative sex, prioritize personal gratification, and engage in risky behavior.

• Sexual attitudes: Narcissists endorse permissive and game-playing views of sex.
• Behaviors: More infidelity, risky sex, and focus on performance rather than intimacy.
• Outcome: Narcissists report more partners but less relational satisfaction.

Chapter 20: Correlates of Narcissism and Psychopathy

Authors: Elizabeth A. Krusemark

Neuroscientific research shows that narcissism involves atypical patterns of brain activity related to reward, emotion, and self-referential processing. Overlaps exist with psychopathy, especially in reward sensitivity and reduced empathy.

• Neuroscience of narcissism: Greater activation in reward systems when receiving admiration.
• Overlap with extraversion: Similar neural correlates in approach/reward circuits.
• Psychopathy link: Shared deficits in empathy and heightened reward drive.

Chapter 21: Comorbidity between Narcissistic Personality Disorder and Axis I Diagnoses

Authors: Sebastian Simonsen, Erik Simonsen

NPD frequently co-occurs with Axis I disorders, complicating diagnosis and treatment. Narcissism can amplify vulnerability to mood, anxiety, substance, and eating disorders. Comorbidity worsens prognosis and requires integrated treatment approaches.

• Schizophrenia: Narcissistic traits complicate engagement and compliance.
• Mood disorders: Narcissism linked with bipolar swings and depressive episodes when grandiosity collapses.
• Anxiety/eating/substance use: Narcissists may use substances or control eating as self-regulation strategies.
• Conclusion: Comorbidity highlights the need for comprehensive, multi-diagnostic assessment.

Chapter 22: The Comorbidity of Narcissistic Personality Disorder with Other DSM-IV Personality Disorders

Authors: Thomas A. Widiger

NPD overlaps with other personality disorders, especially histrionic, antisocial, and borderline. This raises the issue of whether NPD is distinct or part of a broader antagonistic spectrum.

• Histrionic PD: Shared attention-seeking and superficiality.
• Antisocial PD: Shared exploitation and lack of empathy.
• Borderline PD: Shared instability and vulnerability, though narcissists externalize blame more.
• Conclusion: NPD is best seen as distinct but overlapping within the antagonistic and dramatic cluster.

Chapter 23: “I Love Me Some Me” (Narcissism & Self-Esteem)

Authors: Jennifer K. Bosson, Jonathan R. Weaver

This chapter examines the complex link between narcissism and self-esteem. Narcissists often report high explicit self-esteem but remain dependent on external validation.
Measures of the grandiose dimension tend to correlate positively with self-esteem, and measures of the vulnerable dimension correlate negatively or not at all with self-esteem and positively with shame-proneness.

• High self-esteem appearance: Narcissists score high on explicit measures.
• Instability: Their self-worth fluctuates strongly with feedback.
• Conclusion: Narcissism involves self-esteem that is elevated but fragile.

Chapter 24: Psychopathy and Narcissism

Authors: Donald Lynam

Psychopathy and narcissism overlap conceptually and empirically, especially in traits like callousness, entitlement, and exploitation. However, psychopathy includes broader antisociality and emotional deficits, whereas narcissism centers on self-image.

• Theoretical overlap: Both involve antagonism and lack of empathy.
• Differences: Psychopathy shows more impulsivity and criminality; narcissism is more image-focused.
• FFM view: Both share low agreeableness; psychopathy adds low conscientiousness.

Two Too-Broad Constructs For Any Significant Contributions

Narcissism and psychopathy are not unidimensional constructs but composites of more basic personality traits, which makes direct comparisons misleading.
A single correlation between them is uninformative because the overlap could stem from low agreeableness, high extraversion, low neuroticism, or some mix of these factors.

The problem is compounded by the fact that different measures capture different traits: for example, PPI Factor 1 diverges from traditional psychopathy factors, while NPD and the NPI each capture different sides of narcissism.

As a result, their observed overlap comes from different sources—NPD aligns with psychopathy mainly through low agreeableness, while the NPI’s link to PPI Factor 1 comes from low neuroticism and high extraversion.

Given these discrepancies, working at the level of such broad constructs may never yield a deep understanding, making trait-level analyses more promising.

🙋🏼‍♂️ Lucio’s note: I agree with the authors, casual comparisons between the two at their broader level reek of pop-psychology over-simplification.

Chapter 25, 26: Self-Perceptions & Self-Other Discrepancies

Authors: Erika N. Carlson, William D. Ellison, Simine Vazire

Narcissists’ self-perceptions differ from how others see them.
They see themselves as charming, competent, and assertive. Others often agree at first but later view them as arrogant, selfish, and difficult. Narcissists also misjudge how they are seen, overestimating their positive impression.

• Self-perception: Inflated, focused on superiority.
• Others’ perception: Initially positive, later negative as exploitation emerges.
• Meta-perception: Narcissists assume others admire them more than they do.
• Narcissists know others see them as narcissists

Positive Impressions Fade Over Time

Initially seen as likable and competent, they are later perceived as poor performers, less agreeable, less warm, and more arrogant and hostile (Paulhus, 1998).
Research on self-enhancers—closely linked to narcissism—shows the same pattern: after a few months, acquaintances and even friends view them more negatively, describing them as condescending, manipulative, hostile, and prone to overreacting (Kwan et al., 2004; Kwan et al., 2008; Colvin et al., 1995).

Chapter 26: Self-Other Discrepancies

Authors: Thomas F. Oltmanns, Erin M. Lawton

Narcissists’ views of themselves differ from peers and clinicians. They underestimate interpersonal impairment and overestimate competence. These discrepancies contribute to conflicts and poor outcomes.

• Peer vs. self: Others see narcissists as arrogant and difficult, unlike their own self-view.
• Self-reported questionnaires raise concern: The emphasis on self-report questionnaires for the assessment of narcissistic personality disorder (NPD) is surprising because many personality disorders involve distortions of self-perception and an inability to assess accurately one’s effect on others (Oltmanns & Turkheimer, 2009).
• Clinical view: Interviewers detect dysfunction narcissists deny.
• Impact: Discrepancies fuel social impairment.

Chapter 27: Narcissistic Self-Enhancement

Authors: Harry M. Wallace

Self-enhancement is central to narcissism: exaggerating achievements, claiming superiority, and seeking admiration. These strategies can bring short-term gains but often backfire long term.

• Strategies: Boasting, credit-taking, self-promotion.
• Trophy wives and husbands: Narcissists seek romantic partners who offer self-enhancement value either as sources of fawning admiration, or as human trophies (e.g., by possessing impressive wealth or exceptional physical beauty) (Campbell, 1999; Tanchotsrinon, Maneesri, & Campbell, 2007).
• Competing explanations: Self-deception vs. deliberate manipulation.
• Lower long-term competence paradox: Self-enhancement helps in the short term but undermines long-term competence when narcissists deflect blame and lose an opportunity for self-improvement
  🙋🏼‍♂️ Lucio’s note: Unfortunately this may not always mean lack of results. sometimes ‘long term’ is nothing but the sum of short-term boosts. If we look at Trump, he managed to reach the top despite unaddressed competence gaps

Narcissists Lack Calibration

Says the author:

Narcissists’ self-enhancement prospects are also limited by the inflexibility of their approach toward attaining self-enhancement.
Behavior that elicits admiration in one context could induce the opposite response from observers in different situations, so admiration-seekers would be wise to calibrate their self-presentation to match their environment. Narcissists apparently lack this wisdom. They employ the same unsubtle, exhibitionistic style of self-promotion regardless of the situation (Campbell et al., 2000; Collins & Stukas, 2008).
In effect, narcissists’ primary technique for convincing others of their greatness involves bluntly proclaiming their greatness.

Chapter 28: Narcissistic Ego Deflates, Narcissistic Aggression Inflates

Authors: Brad J. Bushman, Sander Thomaes

Narcissism predicts aggression when ego is threatened. Grandiosity makes narcissists hypersensitive to criticism, fueling rage, hostility, and even violence when self-image collapses.

• Self-esteem theory: Low self-esteem does not predict aggression; threatened egotism does (Baumeister, 1997).
• Findings: Narcissists react aggressively to insults, rejection, or status loss.

Chapter 29: The Emotional Dynamics of Narcissism

Authors: Jessica L. Tracy, Joey T. Cheng, Jason P. Martens

Tracy and Chen, also authors of The Psychology of Status, explain that narcissists depend on pride to sustain self-worth but collapse into shame when criticized. Shame often fuels defensive anger and hostility.

the narcissistic personality may be a result of the same selection pressures that led to a dominance-based hierarchical system, with narcissists best characterized as individuals whose trait profiles and early-life experiences make them prone to chronic shame and hubristic pride, and to seek dominance as an adaptive solution.

• Shame: Central emotion of vulnerability, often masked by grandiosity.
• Pride: Authentic pride (achievement-based) vs. hubristic pride (arrogance)

Guilt Motivates Improvement & Apologies, Shame Doesn’t

Studies have found that attributing failure to unstable, specific, controllable aspects of the self promotes the negative self-conscious emotion of guilt, rather than shame (Brown & Weiner, 1984; Covington & Omelich, 1981; Jagacinski & Nicholls, 1984; Niedenthal et al., 1994; Tracy & Robins, 2006).
Guilt, in turn, promotes a wide range of positive social behaviors, ranging from apology and confession to empathy and altruism (Batson, 1987; Baumeister, Stillwell, & Heatherton, 1994; Tangney & Dearing, 2002). Furthermore, proneness to guilt is positively related to self-esteem, but generally unrelated to narcissism (Gramzow & Tangney, 1992).

🙋🏼‍♂️ Lucio’s note: gaslighters cannot own up and apologize
This is something we have noticed in our research and community as well. For example, in gaslighting dynamics and gaslighting signs we explain that some negative personalities may resort to gaslighting because they cannot own up and apologize.

Chapter 30: Narcissism and Romantic Relationships

Authors: Amy B. Brunell, W. Keith Campbell

Narcissism undermines close relationships. While initial charm attracts partners, long-term patterns of exploitation, lack of empathy, and self-focus erode intimacy.

• Agency model: Narcissists pursue relationships for status and self-image reinforcement.
• Contextual reinforcement model: Partners reinforce narcissists’ self-focus by admiring their charm.
• Chocolate cake model: Relationships start sweet and appealing but end bitter and destructive. People reported that narcissists used them and played games with them
• Can narcissists change? Evidence suggests low motivation to change, but some improvement is possible with awareness and effort.

Participants’ Ratings of the Partner During the Relationship, from Brunell, Campbell, Smith, & Krusemark (2004).

Participants’ Ratings of Their Negative Feelings at the End of Their Relationships, from Brunell, Campbell, Smith, & Krusemark (2004).

🙋‍♂️Lucio’s Take: Chart seems to disprove the chocolate cake model?

Lucio:
While the theory and description seem to add up, the chart presented from the authors’ study seemed to contract the model of ‘great relationship start’, with the non-narcissists slightly eding out the narcissists:

Participants’ Ratings of How Satisfied They Were at the Beginning and End of the Relationship

I can think of some plasible explanations of why this is the case, but I wished the authors addressed it.

Narcissists Rarely Change

Unfortunately, because narcissism is a feature of one’s personality, it is extremely hard to change. Furthermore, (grandiose) narcissists feel good about themselves (Bosson et al., 2008), and this reduces motivation to change. Why should narcissists want to change when they believe they are better than everyone else is?

Chapter 32: Narcissism and Social Networks

Authors: Allan Clifton

Narcissists use social networks to maximize attention and status. In both sociocentric (group-based) and egocentric (personal) networks, they position themselves to gain visibility and influence.

• Network position: Narcissists seek central roles to maximize recognition.
• Egocentric focus: Relationships serve self-promotion more than mutual support.

Chapter 33: Narcissism and World Wide Web

Laura Buffardi notes that Narcissists post more attractive pictures, more frequent updates, and boastful content.

Chapter 34: Narcissism and Brand Name Consumerism

Authors: Constantine Sedikides, Sylwia Cisek, Claire M. Hart, Eva Schürch

Narcissists prefer luxury and brand-name goods as a way to signal status and superiority. Materialism and consumption serve self-enhancement but rarely increase long-term happiness.

Brand names provide the platform through which narcissists shine, announcing their uniqueness, haughtiness, and dominance to the world. Brand names are just aids in the narcissistic pursuit of public affirmation and glory.

• Brand preference: Narcissists equate expensive brands with self-worth.
• Inner fragility: Consumption compensates for insecurity.
• Happiness paradox: Pursuit of brands rarely delivers genuine well-being.

Chapter 35: Leadership

Authors: Robert Hogan, James Fico

Narcissists often rise to leadership due to charisma, confidence, and dominance. However, their leadership is a double-edged sword: can be effective in crises or short-term goals, but harmful in the long run due to exploitation and poor empathy.

From a study of 111 CEO (Chatterjee and Hambrick, 2007):

narcissists changed strategy more frequently, made more and more expensive acquisitions, and their decisions yielded high variability in performance. Moreover, the relationship was linear, so that the more narcissism, the more extreme the firm’s performance.

• Strengths: Vision, boldness, persuasiveness.
• Weaknesses: Arrogance, insensitivity, exploitation.
• Implication: Narcissistic leaders succeed initially but risk organizational collapse.

Also read:

• Dark triads at the top: the myth of emotional intelligence

Interesting Notes

• Appeal to their self-enhancement needs: When coaching narcissists, one must appeal only to their self-interest. We find it useful to tell narcissists that certain behaviors will harm their careers, and certain others will enhance them.

Chapter 36: Celebrity and Narcissism

Authors: Brittany Gentile

Celebrity culture both attracts narcissists and fosters narcissism. The entertainment industry rewards self-promotion and attention-seeking, creating a feedback loop between celebrity and narcissistic traits.

Although disadvantageous in the long run, narcissists may do well as celebrities where they have to continually turn on the charm for new audiences. Each new performance offers the opportunity for narcissists to self-enhance, and they will exploit it to the fullest.

• Appeal: Fame offers validation and admiration.
• Success: Narcissists thrive in entertainment industries that reward visibility.
• Consequence: Celebrity life exacerbates narcissism, isolation, and instability.

Interesting Notes

• Extrinsic vs. Intrinsic motivation inverts for narcissists: Morf, Weir, and Davidov (2000) framed tasks in terms of either intrinsic or extrinsic goals. Participants high in narcissism enjoyed most the tasks in which ego goals were made salient and were motivated by the chance to be evaluated. In contrast, participants low in narcissism enjoyed the tasks most when completed for their own sake, without evaluation.
• Poor team players but good stars: When narcissists were led to believe that they would receive group recognition for their performance, they outperformed all others in the group. When told that no one would be evaluated or that only the group’s performance as a whole would be announced, they performed poorly. This drive to perform in front of an audience makes narcissism a potentially important personality characteristic to have as an entertainer (Wallace & Baumeister, 2002)

Chapter 37: Narcissism and Spirituality

Authors: Steven J. Sandage, Shane P. Moe

Narcissists may pursue spirituality for self-enhancement rather than humility. Genuine practices of self-compassion and humility counteract narcissistic tendencies.

• Religion: Can be co-opted for self-aggrandizement.
• Self-compassion: Opposite of narcissism; linked to healthier outcomes.
• Humility: Protective against narcissistic entitlement.

Chapter 39: Attachment Theory and Narcissistic Personality Disorder

Authors: Björn Meyer, Paul A. Pilkonis

Narcissism can stem from insecure attachment — either avoidant (detachment, superiority) or anxious (hypersensitivity, vulnerability). Attachment-informed therapies encourage trust, emotional openness, and secure bonds.

• Subtypes: Avoidant vs. anxious narcissism.
• Evidence: Attachment therapy fosters more stable self-esteem and relationships.

Summary of studies:

Chapters 38, 40, 41, 42, 43: Therapy for Narcissism

The last chapters review several treatment options for narcissism, including some excellent case studies.

Treating most narcissists remains challenging though:

even when patients with NPD do commence treatment, they are often armed with enough arrogance and entitlement to blame not only everyone else for their circumstances, but the therapist as well.

the majority of therapists choose to not work with patients with NPD, and many of those who do will feel relief when the patient ultimately ends the therapy (as is often the case).

Levels of Narcissism

From chapter 38 by Diana Diamond, Frank Yeomans, and Kenneth N. Levy:

Healthy narcissism

Integrated sense of self (accepts strengths and weaknesses).

• Stable self-esteem regulation.
• Ability to maintain values, relationships, ambition, and creativity.
• Can live in harmony with principles and enjoy fulfilling connections.

Neurotic-level narcissism

Grandiose self is present but identity remains relatively integrated.

• Excessive need for admiration, entitlement, envy, and lack of empathy.
• Outwardly adapted and can maintain stable self-esteem, but relationships remain shallow.
• Often seek treatment only after failures or crises expose the fragility of their grandiosity.

Borderline-level narcissism

Typical narcissistic personality disorder features: poor anxiety tolerance, impulsivity, and chronic failures in work and intimacy.

• Severe reliance on grandiose self, splitting of idealized vs. devalued self-aspects, with negatives projected onto others.
• Retreat into omnipotence and denial of dependency.
• Relationships are impoverished, others seen as either idealized or worthless.

Malignant narcissism

Most severe form.

• Ego-syntonic aggression, paranoia, and antisocial traits.
• Grandiose self fused with aggression and punitive internal objects.
• Need to dominate others, sometimes even sabotaging therapy through self-destructive acts.

SHARPEST INSIGHTS

These are the insights that struck us the most.
We use the authors’ quotes and research, but the titles and interpretations are our own—and may not reflect the authors’ intent.
Credit for the insight goes to them; blame for the interpretation is on us.

Narcissists Lose Out to Machiavellians

From Harry M. Wallace in chapter 27:

Narcissists report Machiavellian willingness to manipulate others for personal gain (e.g., Paulhus & Williams, 2002), but their perpetual grandstanding regardless of context suggests that they lack the craftiness required to exploit others in ways that maximize self-benefits.
For example, narcissists would likely have trouble resisting their impulse to claim superiority long enough to make allies and disarm opponents with tactics like ingratiation or feigning incompetence that require displays of modesty.

I agree with this, and I’ve often seen neediness for admiration and neediness to display superiority as a major weakness in narcissism.
📽️ Video example here.

Narcissists Beat ‘Too Nice Guys’ In Dating

From chapter 30, by Amy B. Brunell, W. Keith Campbell

To test the Chocolate Cake Model, we asked individuals to reflect on past dating relationships with narcissistic and non-narcissistic partners.
These individuals reported that they were attracted to narcissists because of the narcissists’ charm, popularity, and sexual attractiveness (Brunell, Campbell, Smith, & Krusemark, 2004). By contrast, their attraction to their non-narcissistic partners was far less exciting; the non-narcissistic ex-partner was frequently described as “nice” (e.g., the boy/girl-next-door type).

Narcissists Undermine Their Colleagues

From Harry M. Wallace:

Teammates of narcissists can expect to eventually be victimized by narcissists’ tactic of self-promoting by denigrating and exploiting others (e.g., Campbell, Reeder, Sedikides, & Elliot, 2000; Kernis & Sun, 1994).

The More You Talk, The More Leadership You Gain

From chapter 35 by Robert Hogan, James Fico.
Contrary to popular ‘laws‘, talking more during group formation is associated with leadership emergence:

A study by Sorrentino and Boutillier (1975) essentially brought leaderless group discussion research to an end, but for an interesting reason.
Sorrentino and Boutillier reported that ratings of leadership emergence were related to how much a person talked, and not to the content of his or her remarks. Narcissists say that they are usually the first person to speak in a group of strangers; thus, leaderless group discussions are a good way to identify narcissists.

QUOTES

On the inherent neediness of narcissism’s ‘quicksands’:

It is as if the narcissistic self was being constructed on quicksand, continually needing to be refortified and built higher, but never succeeding because simultaneously it is eroding below.
These efforts are endless not only because they often misfire, but also because narcissists seem never to be able to persuade themselves of their own grandiosity

A woman to a cat:

Not on this skirt. It’s Armani! —A (narcissistic, presumably) woman brushing a cat from her knee

On negative judgments that narcissists may not care about:

Affluent individuals are also judged as less considerate (e.g., less kind, likable, or honest; Christopher & Schlenker, 2000), but these are communal attributes that narcissists do not value (Campbell et al., 2002).

🙋🏼‍♂️ Lucio’s Analysis

The Narcissism Construct Needs Updating

This book makes a strong case that narcissism is a complex, multifaceted construct.

In fact, the case was eveb too convincing—highlighting how problematic it is to lump together grandiosity and vulnerability under the same label. Even if there are overlaps, the differences are substantial enough to produce very different real-world outcomes and research findings.

Unless studies focus strictly on the shared core, combining the two risks muddying results—much like what happened in the past with research on self-esteem.

A cleaner solution may be to treat grandiose and vulnerable narcissism as distinct categories rather than forcing them under a single umbrella.

REVIEW

The Handbook of Narcissism and Narcissistic Personality Disorder is a rigorous scientific compendium and one of the most comprehensive resources on the topic.

It’s one of the backbones for many of our articles on narcissism, and we are deeply thankful to the authors and editors for their outstanding contribution to the field.

Get this book on Amazon or check:

• Best psychology books
• Best dark triad books