Multiple Faces of Narcissism: Toward A Conceptual Integration-View Presentation

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Video Summary

The presentation by Dr. Brent Menninger provides a comprehensive exploration of pathological narcissism and narcissistic personality disorder (NPD), integrating empirical research with clinical insights. He distinguishes between normal (healthy) narcissism—characterized by stable, realistic self-esteem—and pathological narcissism, which involves maladaptive self-esteem regulation manifesting as excessive needs for validation, maladaptive behaviors to fulfill these needs, and dysregulated responses when needs are unmet.<br /><br />Pathological narcissism presents through two core traits: grandiosity (e.g., entitlement, exploitation, self-enhancement) and vulnerability (e.g., low self-esteem, shame, dysregulation). Importantly, vulnerability is often underrecognized despite its centrality to clinical presentations, especially when patients seek help during vulnerable states.<br /><br />Dr. Menninger critiques the DSM-5 categorical criteria for NPD as overly focused on grandiosity and insufficiently addressing vulnerability, emotional distress, self-regulation difficulties, and severity variability. He highlights the DSM-5 Alternative Model for Personality Disorders (AMPD) as an advancement, emphasizing impairments in self and interpersonal functioning plus pathological traits, with severity levels that better capture the disorder’s complexity.<br /><br />Using clinical vignettes, the talk illustrates diverse NPD presentations—from overt grandiosity to covert vulnerability—showing how grandiosity and vulnerability coexist and fluctuate, linked by an underlying identity pathology centered on a fragile grandiose self requiring external validation.<br /><br />Dr. Menninger integrates object relations theory, explaining NPD as a disorder of identity formation marked by dissociated grandiose and devalued self-states, with severity linked to interpersonal dysfunction, moral impairment, aggression, and risk of malignant narcissism.<br /><br />He underscores the importance of recognizing NPD’s dimensional severity for prognosis and treatment and addresses challenges including co-occurring substance abuse, flawed self-awareness in patients, and diagnostic communication. The talk advocates a nuanced, functionally oriented understanding to better manage and empathically engage patients with pathological narcissism and NPD.

Keywords

pathological narcissism

narcissistic personality disorder

NPD

healthy narcissism

self-esteem regulation

grandiosity

vulnerability

DSM-5 criteria

Alternative Model for Personality Disorders

clinical vignettes

object relations theory

identity pathology

dimensional severity