NPD: Is it Low Self-Esteem or High Self-Esteem?

A research review by Quercus

Does someone suffering from Narcissistic Personality Disorder have inherently high self-esteem (do they really believe that they are special beyond measure, a super-human?) or catastrophically low self-esteem for which they over-compensate (do they merely act like the greatest to hide the deep-seated insecurity that they are feeling?). Or to put it more concisely, does the 'grandiosity' that narcissists show stem from pure egoism, or is it all a facade to hide their crippling insecurity?

Are they giants or ants on the inside? We all know what they are on the outside, which typically trends toward the tyrannical in nature. This is arguably all that matters to us - they act like monsters and should be interacted with as such. They are frightening people, eager to control you, to dominate you.

But of their self-image; what do they feel they are on the inside, truly? Strong or embarrassingly weak?

This debate may never end. How do you conclude that someone has high self-esteem or low self-esteem? Unlike a cholesterol test, there isn't an easy and reliable way to measure the amount of pride someone has. There are psychological assays and surveys that can be rigorously applied, though what the results mean can be somewhat open to interpretation.

In this quick literature review of the available peer-reviewed scientific research, I've learned that 'self-esteem' can be implicit or explicit: implicit self-esteem is the spontaneous, gut-feeling evaluation of your own merit and abilities which tends to be higher than your explicit self-esteem, which is in contrast assessed by way of self-reflection (retrospectively). Interestingly, implicit self-esteem can be culturally biased; in Western cultures where individuality is praised, implicit self-esteem is higher. In Eastern cultures, where the community at large is praised more highly than the individual, implicit self-esteem is lower. (Psychologists tested this anomaly further by studying immigrants moving from East to West; sure enough, implicit self-esteem rose while 'implicit group-esteem' fell as the person adjusted to their adopted culture).

Although there are variations in implicit self-esteem across the human spectrum, these scores are often contrasted against the person's assessed explicit self-esteem. Some researchers think that implicit and explicit self-esteem are established at different times in life (which I suppose could very well tie into the idea that narcissists have arrested development in some key areas). There are also several ways of assessing implicit self-esteem, just to further muddy the waters.

Implicit and explicit self-esteem are not correlated; that is, when one goes up, the other doesn't have to go down (or up, or vice versa). It means that these two measurements aren't linked - a person can have any combination of implicit and explicit self-esteem (high/high; low/low; high/low; low/high; etc.).

• Fragile self-esteem = low implicit, high explicit (the idea is that they 'mask' their insecurities with false 'high' self-esteem). This is associated by 'defensiveness' in the individual to protect against threats to their egos. Bosson, 2003; Jordan 2003; McGregor & Marigold 2003
• Damaged self-esteem = high implicit, low explicit (their explicit self-esteem has been damaged and decreases over time, while their spontaneous assessment of their selves, the implicit self-esteem, stays relatively high and steady) Schroder-Abe, 2007
• Congruent high (or congruent low) = high implicit, high explicit (or low implicit, low explicit). This is a balanced combination.

With all these tests and studies, what's been the general consensus on the self-esteem of people with NPD? Hang onto your hats, because you're in for a roller coaster ride of research findings!


Kernberg et al. 1975 - High Explicit Self-Esteem Masks Low Implicit Self-Esteem

In 1975, the prevailing clinical theory put forth by Kernberg suggested that narcissists do indeed overcompensate for "low self-esteem". In this case, they reached the conclusion that the deep-seated feelings of someone with NPD reflect those of someone who isn't secure with themselves (via implicit self-esteem). When given the chance to 'reflect' upon themselves (explicit self-esteem), the narcissists tailored their reality to make themselves look good, presumably to counter their actual low-esteem felt in the present-tense.

And so for many years, this theory persisted; narcissists feel pretty darn insecure about themselves and suffer from low self-esteem in the present. They compensate for this by inflating their self-esteem retroactively - their view of themselves seems to be much more secure when they reflect upon 'who they are' (explicit) versus what they instinctively feel of themselves in the present (implicit).

Kernberg also addressed the potential root causes of NPD, specifically that the narcissist as a child likely experienced invalidating and inconsistent parenting behaviours, which leads to feelings of inferiority. The grandiosity exhibited by the narcissist is a defense-mechanism against this inferiority.


Millon et al. 1981 - Narcissists are Implicitly Grandiose (have High Implicit Self-Esteem)

Social learning theories applied to narcissists showed something completely different to Millon et al. in the 80's; he saw in their models that the grandiosity the narcissists feel stems from high implicit self-esteem! Theodore Millon may be a name you are already familiar with - he's the guy who came up with the four Narcissistic personality subtypes of: Amorous, Elitist, Unprincipled, and Compensatory, as well as subtypes for all manner of personality disorders (check out the link).

Millon said something quite different about the potential root causes of NPD. He asserted that over-indulgent parenting results in a child with an inflated sense of self-worth (grandiosity). Unconditional praise and excessively positive over-evaluation of the child's successes is, in fact, still 'invalidation', since the actions of the child and the positive over-reaction of the parent do not represent reality.

As you can see, this assertion of Millon's is the opposite of what Kernberg et al. proposed in 1975! And since then, this debate has raged on.


I've personally always been partial to Kernberg's findings - I feel my NMother has a terrible self-image on an acute basis (i.e. she feels very insecure right now). I think she'd probably have a 'fragile' self-esteem (low implicit, high explicit). Because she doesn't enjoy feeling vulnerable, she goes on the attack - she tries to tear me (and others) down to her level, or below it. She was always happiest and most content when I was sad or crying. In fact, she was probably quite 'nice' to me by society's standards in moments where I was completely vulnerable and hurting. She is also very defensive when she feels 'threatened' (when I'm happy and secure), and that's when the attacks happen.

My gut instinct says to me that the combination of vulnerability, and the inherent sense of entitlement all narcissists have, results in a more dangerous offender; someone desperate to counter their feelings of supreme inadequacy will lash out at others. I have a hard time believing that someone who is truly grandiose would even bother to attack others since that person would be so smug and 'above us' - why exert themselves? For what purpose? Seeing us sad and disheartened wouldn't give them much joy; they already would pity us lowly creatures to begin with, wouldn't they? Or ignore us outright. Or view us as worthy of their contempt, passively speaking.

To me, the dangerous, malignant narcissist has to be motivated by desperation. Which is why I personally favour Kernberg's assumptions.


Vater et al. 2012 - "When Grandiosity and Vulnerability Collide"

The most up-to-date study on self-esteem and NPD shows something a little more complex; Vater et al. in the publication "When grandiosity and vulnerability collide: Implicit and explicit self-esteem in patients with narcissistic personality disorder" studied a whole variety of people (those clinically and non-clinically assessed for personality disorders), including people without personality disorders ('normal controls' for the study).

This study attempted to clear up whether or not "pathological narcissism is associated with deep-seated feelings of insecurity", and asserted that if this is true, then someone with NPD would have a 'vulnerable facet' to their psyche.

Basically, Vater and her colleagues were out to finally prove who was right: Kernberg or Millon.

Vater et al. studied people with BPD (borderline personality disorder) as well as those with NPD and 'normal' people (controls). They included people with BPD so that they could be sure that the their findings would be specific to NPD, and not reflective of general personality disorders. For instance, if they found the same results in people with NPD and BPD, but different to what they saw in the 'normal' people, they would say that "People with personality disorders like NPD and BPD have_______". But if the results are different between NPD and BPD, they can say for sure that what they found represents pathological narcissists. They chose BPD because there is 'comorbidity' with NPD, meaning that often they go together (someone could have both BPD and NPD, and it isn't a rare combination).

What did they find from their study?

• In general, if you have higher explicit self-esteem, you have less severe symptoms of depression and psychological impairment.
• NPD patients had lower scores of explicit self-esteem compared to 'normal' controls, but it was higher than those with BPD.
• NPD patients scored lower than BPD patients in severity of depressive symptoms and psychological impairment.
• People with NPD have a variety of self-esteem balances (fragile, damaged, congruent high, congruent low).
• NPD patients who had "damaged self-esteem" (high implicit, low explicit) had higher narcissism scores than NPD patients with congruent low self-esteem.
• NPD patients who had "fragile self-esteem" (low implicit, high explicit) didn't score higher on the narcissism scores than NPD patients who had congruent high self-esteem.

and in summary....

• Patients with NPD have on average the same amount of implicit self-esteem as 'normal' people.
• Patients with NPD have less explicit self-esteem than 'normal' people.
• Patients with NPD have more implicit and more explicit self-esteem than patients with BPD.
• NPD patients with high implicit and low explicit ('damaged' self-esteem) are the most narcissistic of all the NPD patients (which vary in their self-esteem profiles).

And they wondered about these results - NPD patients have less explicit self-esteem than 'normal' people? Really? Well one reason might be because their study is skewed - these 'patients' are people with NPD that are receiving treatment! Would your narcissistic parent accept treatment for their NPD? Probably not, right? The authors are saying that the people with NPD that they studied were in a state of crisis, and may have artificially low explicit self-esteem as a result. They suggest that another study be done - to retest the same NPD patients after they are released from clinical care (do they get more conceited?).

Or, people with NPD might really have low explicit self-esteem, because they might always see themselves as 'failing' to meet their own impossibly high standards. High implicit and low explicit self-esteem has been attributed to 'perfectionism' as well, in a different study by Zeigler-Hill & Terry in 2007.


So who won - Kernberg or Millon?

I'll let you decide based on this excerpt from Vater et al.'s paper:

Based on the social learning theory of Millon (1981), one might assume that patients with NPD formerly possessed high explicit and high implicit self-esteem but are currently experiencing a temporary decrease in explicit self-esteem due to current negative life events. From the perspective of psychoanalytical models, however, the results of this study raise serious questions about the credibility of the mask model (Kernberg,1975), which suggests that a combination of low implicit and high explicit self-esteem should characterize patients with NPD.

Darn, I was so sure Kernberg had it right. Then again, I'm not a psychologist!

I personally don't believe that this is the end of this debate, though I do think Vater's research is critical to the world's understanding of what makes a pathological narcissist tick.

One of the things I take away is that there truly are different subtypes of people with NPD. I'm still convinced my NMom has a 'fragile self-esteem', but now I'm not so sure that I'm right about that configuration being the most dangerous.

Then again, this study didn't look at parenting ability and NPD. Maybe the 'more narcissistic' damaged self-esteem variety of NPD isn't the most dangerous to children growing up under them. I'm not sure that's known yet.

One of my problems with Vater's study is this: if people with NPD have different profiles, shouldn't we consider splitting them up? I still feel that my NMom with her fragile self-esteem does indeed fit with Kernberg's assertions (and her father, a terrible narcissist, wouldn't have been overly-supportive of her as a child - I can't see Millon's theory applying to her and her family).

Maybe we need new terms? Like NPD-DSE (Damaged Self-Esteem) and NPD-FSE (Fragile Self-Esteem). If you broke the NPD patients into those two groups and looked at the data again, does one group support Millon's theory and the other Kernberg's?

Is maybe "NPD" becoming the new "autism" -  a catch-all category that consists of very different varieties of cognitive impairment? We hear from Vater's research that people with lower explicit self-esteem have more psychological impairment - so do we have 'high' and 'low' functioning narcissists just as autistic children are labelled 'high-functioning' and 'low-functioning'?

I think it's high time another clinical psychology research group went farther and tried to empirically study the differences seen here in self-esteem profiles. (I guess I really want Kernberg's theory to be supported, too! It just makes sense to me!).

Anna Valerious's blog "Narcissists Suck" is probably my all-time favourite blog. She talks about the self-esteem of a narcissist from a wholly different (and vital) perspective - ours. Link here to her post, "The Narcissist's Self-Esteem".

What do you make of this? Please share your comments, questions, opinions! More importantly, should we even care what the root psychological causes of our parent's terrible personalities are? Are we seeking to let them off the hook for the abuses they've dished out? Make sure it's sheer morbid curiosity that motivates your thirst for knowledge; just because they have low self-esteem, doesn't mean they couldn't have sought therapy for themselves rather than taking it out on you, their innocent child.