Brief Report: Physician Narcissism,Ego Threats,and Confidence in the Face of Uncertainty

Although adequate self‐esteem is essential for psychological health, people with high but fragile self‐esteem have been shown to exhibit defensive, often aggressive behavior when their self‐esteem is threatened. We measured physician narcissism (as a proxy for high but fragile self‐esteem) and used a subtle manipulation to examine how physicians who varied in levels of narcissism responded to an ego threat. We found that physicians high in narcissism, as compared with those lower in narcissism, were more likely to respond to ego threat by attempting to bolster their self‐image. Concerned about self‐image, physicians in this situation may be insufficiently receptive to new information and instead attempt to justify initial opinions.     

Discussion - Evidence Based Psychoanalysis: An Imperative and an Opportunity

Freud published his ''On Narcissism: An Introduction'' in 1914. The writing has many levels, including, among other things, Freud's criticism of his former colleagues, Adler and Jung. Psychoanalysts received the essay with reservations. Ernest Jones, among others, expressed his concerns in his history of psychoanalysis. The aim of this study is to place Heinz Kohut's ideas about narcissism into the context of the history of ideas. Especially, the paper explores, at a theoretical level, the status of the castration complex both in self psychology and Freud's essay as well as seeks reasons why the discussion on narcissism should be continued.     

The Narcissistic Relationship to the Object World

The extension of narcissism into the object is a precondition for every object relation. When narcissism is insufliciently extended onto the object various personality disorders are probable. Using case examples this article describes processes by which narcissism develops in healthy as well as unhealthy patterns, and how therapists may help their patients achieve ego strength.     

Development and Validation of the Childhood Narcissism Scale

In this article, we describe the development and validation of a short (10 item) but comprehensive self-report measure of childhood narcissism. The Childhood Narcissism Scale (CNS) is a 1-dimensional measure of stable individual differences in childhood narcissism with strong internal consistency reliability (Studies 1–4). The CNS is virtually unrelated to conventional measures of self-esteem but is positively related to self-appraised superiority, social evaluative concern and self-esteem contingency, agentic interpersonal goals, and emotional extremity (Study 5). Furthermore, the CNS is negatively related to empathic concern and positively related to aggression following ego threat (Study 6). These results suggest that childhood narcissism has similar psychological and interpersonal correlates as adult narcissism. The CNS provides researchers a convenient tool for measuring narcissism in children and young adolescents with strong preliminary psychometric characteristics.     

Development and validation of the childhood narcissism scale

In this article, we describe the development and validation of a short (10 item) but comprehensive self-report measure of childhood narcissism. The Childhood Narcissism Scale (CNS) is a 1-dimensional measure of stable individual differences in childhood narcissism with strong internal consistency reliability (Studies 1-4). The CNS is virtually unrelated to conventional measures of self-esteem but is positively related to self-appraised superiority, social evaluative concern and self-esteem contingency, agentic interpersonal goals, and emotional extremity (Study 5). Furthermore, the CNS is negatively related to empathic concern and positively related to aggression following ego threat (Study 6). These results suggest that childhood narcissism has similar psychological and interpersonal correlates as adult narcissism. The CNS provides researchers a convenient tool for measuring narcissism in children and young adolescents with strong preliminary psychometric characteristics.     

The Silence of the Body

As a practice meant to release the subject from the narcissism that informs the concerns and preoccupations of her or his ego, psychoanalysis aims at a transformation of the subject comparable to the Buddha's quest for enlightenment. In order to clarify this subtle and difficult dimension of psychoanalytic work, this essay draws upon a clinical example and discusses it in the context of both Freud's and Lacan's ideas about the role of narcissism in the formation of the ego, and the Buddha's doctrine of Anatta, which insists that the concept of the Atman, or self, is based upon an illusory thought.     

The Bright Side of Threatened Narcissism: Improved Performance Following Ego Threat

Narcissistic individuals have highly positive self‐views and overestimate their abilities. Consequently, they tend to react aggressively whenever they receive information that does not match their high self‐views (ego threat). We argue that focusing on aggression merely portrays a one‐sided view of narcissistic individuals and the manner in which they counter ego threats. We propose that following ego threat, narcissism can also fuel performance. In four studies, we measured nonclinical narcissism and allocated Dutch undergraduate university students (N₁ = 175, N₂ = 142, N₃ = 159, N₄ = 174) to either an ego threat or a no ego threat condition. Ego threat involved negative feedback (Studies 1–2) or threat to uniqueness (Studies 3–4). We measured participants’ intentions to complete a challenging task (Study 1), their creative performance (Studies 2–3), and their performance on an anagram task (Study 4). Across Studies 1–3, we consistently found that following ego threat, higher nonclinical narcissism was associated with greater willingness to perform tasks that enabled demonstration of abilities and enhanced creative performance. These results were confirmed using a meta‐analysis. However, anagram performance was not enhanced following ego threat. We provide additional analyses that might help explain this. Our findings thus reveal a more positive side to the way narcissistic individuals manage threats to their self‐image.     

Three strands of narcissism.

The development of narcissism is usually studied from the standpoint of the drives, or more specifically of the libido. This paper considers narcissism from the standpoint of the ego and seeks to delineate separate developmental lines. From this point of view, a variety of forms may be distinguished which are ordinarily structured during the oedipal period. It is postulated that narcissism cannot be considered as truly separable from the vicissitudes of the love and hate of objects. This formulation makes possible consideration of recent observations concerning the 'narcissistic personality' without requiring major new economic, structural, or dynamic metapsychological constructs.     

Narcissism and punitiveness in a non-ego-threatening condition

Punitiveness of overt and covert narcissists was examined in a non-ego-threatening condition. In judging fictitious criminal cases, high scorers in overt narcissism were as punitive as low scorers; this result was independent of crime severity. For covert narcissism, however, high scorers were more punitive toward a serious crime and more lenient toward a mild crime, when compared to low scorers. This study provides pioneering data on narcissists’ punitive judgments in the absence of ego threat, which has been overlooked by previous research. The findings not only support the theoretical distinction between the overt and covert subtypes of narcissism, but also help clarify the meaning of punishment to narcissists.     

A dual conception of narcissism: positive and negative organizations

The author explores Freud's concept of narcissism, as well as other discussions of narcissism in the psychoanalytic literature. He introduces the dual conception of positive narcissism and negative narcissism, illustrated by two clinical vignettes. Subsequent discussion elaborates on these two types of narcissism, and also addresses life narcissism, death narcissism, and primary narcissism. The latter is considered in light of the influence of infant observational research on the prevailing view of this concept and the misunderstandings that arise from that approach.     

The ‘uncanny’, the sacred and the narcissism of culture: The development of the ego and the progress of civilization1

The report by a member of the Brazilian parliament that the rejection of physical deformity is natural and instinctive, and the Muslim reaction to the publication in the Western press of cartoons considered to be offensive to their religion, serve as an introduction to the examination of conflicts in human relations. The two episodes may be classified as representing the sense of the ‘uncanny’, attributed by Freud to the narcissism that remained from primitive cultures, in which the shadow cast by the body and the mirrored reflection of the latter probably generated the idea of soul‐which would be the narcissistic phenomenon causing the illusion of immortality. The presence of this illusion as a support for the beliefs of present‐day civilized peoples makes clear the inopportune influence of primitive mental states in areas where more developed ones should prevail. The persistence of the omnipotent thinking derived from these states provides the possibility of drawing a parallel between the development of the ego‐evolution from narcissism to object relation‐and the progress of civilization. In this context, the majority of social conflicts can be attributed to the deficient object relation resulting from the strength of primary narcissism, which generates a tendency to reject that which is different and to facilitate the emergence of destructive aggressiveness. The progress of civilization would then occur by means of a development of the ego compatible with object relations that lead to a drastic reduction in destructiveness.     

What makes narcissists unhappy? Subjectively assessed intelligence moderates the relationship between narcissism and psychological well-being

We investigated the relations between narcissism, self-assessed intelligence and subjective well-being. In three studies, we aimed to replicate previous findings concerning the relationship between narcissism and both objectively and subjectively assessed intelligence (Study 1), as well as to examine whether the latter influenced narcissists’ satisfaction with life (Study 2) and their mood (Study 3). The results confirmed the positive link between narcissism and self-assessed intelligence. Moreover, we demonstrated that this relationship was independent of actual abilities. In line with existing literature, we also found evidence that satisfying ego needs in this domain was a necessary precondition for narcissists’ well-being. Specifically, the results of Study 2 indicated that narcissists who evaluated their intelligence as low were not satisfied with their life. Similar results were found in Study 3: narcissists evaluating their intelligence as low experienced higher tension and lower hedonic tone.     

Narcissism and Other‐Derogation in the Absence of Ego Threat

The relation between narcissism and other‐derogation has been examined primarily in the context of ego threat. In three studies, we investigated whether narcissistic individuals derogate others in the absence of ego threat. In Study 1, 79 judges watched four videotaped dyadic interactions and rated the personality of the same four people. In Study 2, 66 judges rated the personality of a friend. In Study 3, 72 judges considered the average Northeastern University student and rated the personality of this hypothetical person. Across the three studies, targets' personality characteristics were described on the 100‐item California Adult Q‐Sort (CAQ; Block, 2008). Judges' ratings of targets were compared to a CAQ prototype of the optimally adjusted person to assess target‐derogation. Judges' narcissism and other‐derogation were positively related in Studies 1 and 2. Narcissism positively predicted and self‐esteem negatively predicted target‐derogation after controlling for each other in Study 3. Narcissistic individuals derogate others more than non‐narcissistic individuals regardless of whether ego threat is present or absent.     

The mythic function of narcissism

The paper makes some critical comments on the use Freud makes of myth and examines some of the inconsistencies and contradictions in his conceptualization of narcissism. Using some of the ideas of Bachelard and Hillman on the role of the imaginary, the authors theorize a function of myth that is independent of and not subordinated to the reality function. They suggest that narcissism must be seen not only in terms of individual history but that it has a mythic function; narcissism facilitates the creation of a relationship between the ego and the Self through the mediation of the imaginal world and through the prospective value of images.     

"I had twenty-five piercings and pink hair when . . .": adolescence, transitional hysteria, and the process of subjectivization

The author discusses adolescent and preadolescent development as a transformative experience. The role of the ego ideal in this process, as distinct from the ideal of the ego, is highlighted, and idealization, narcissism, and symbolization are also discussed. Changing representations contribute to what the author describes as a process of subjectivization. An illustrative clinical vignette is presented: that of a 12-year-old girl who developed neurological symptomatology during a crucial period of psychosexual transformation, and whose symptoms rapidly receded after only a few psychoanalytically oriented treatment sessions. The author emphasizes his view of preadolescence as an important passage for the individual's knowledge of the plurality that characterizes him, noting that the recognition of one's own internal multiplicity is characteristic of the psychoanalytic process.     

Narcissism and superego development

To elucidate the role of the superego in th maintenance of narcissistic equilibrium, we reviewed Freud's ideas about narcissism and the superego as well as the relevant theories of Kohut, Kernberg, and certain ego psychologists. These latter authors offer an alternative mode of understanding narcissism more consistent with Freud's structural theory, one in which signal affects and superego functioning play a central role in normal development and in the pathogenesis of narcissistic disturbances. Early steps in superego formation were then examined schematically to elucidate the interaction of environmental influences and emerging psychic structure. We suggested that the first step in a developmental line toward superego formation is based on the affective qualities experienced in the course of self-object differentiation. Subsequent steps examined were introject and ego-ideal formation; compliance with th object; compliance with the introject; identification with the introject and the ego ideal; and finally, with oedipal resolution, the integration of superego nuclei into a progressively structuralized autonomous superego system. This system achieves growing independence from the drives and from pressures from early introjects during the course of latency, and functions to maintain the demands of the conscience and the standards of the ego ideal; rewards or punishments result when these demands and standards are or are not met. The final stage briefly considered here was the revision, modification, and elaboration of moral codes and the ego ideal as part of the adolescent process. Narcissistic vulnerabilities at various stages were pointed out in an attempt to stress that a particular clinical picture in later phases of development or adulthood may derive from any of several development points of origin and from one or more etiological factors.     

Kernberg and Kohut: a test of competing psychoanalytic models of narcissism

Over the past ten years the problem of validating psychoanalytic theory has received increasing attention from psychoanalysts and nonpsychoanalysts alike. Yet, very little research responsive to this question of validation has been produced. During this same period one of the most fertile controversies in contemporary psychoanalysis reached its peak--the Kernberg-Kohut debate concerning the nature of narcissism. However, for the lack of a validation strategy, this debate has become increasingly sterile, degenerating to a theoretical stalemate at this point. This paper addresses the problem of validation by using causal modeling as a mechanism for empirically testing many of the claims of these competing models of narcissism. Although the data provide empirical support for both theories, strategic comparisons tentatively suggest that Kohut's self psychology is more parsimoniously explained as a special case of Kernberg's ego psychology-object relations theory.     

Dreaming as a primordial state of the mind: The clinical relevance of structural faults in the body ego as revealed in dreaming1

Thetherapeuticactionofpsychoanalysis, attributedformanyyearstotheinterpretation of the repressed libido, has shifted its focus to object relationships. Some modern analysts maintain that the primary factor of psychic change is the new model of object relationship provided by analysis, and do not consider signifi cant the knowledge of episodes comprising implicit memories, whose irrecoverable nature is demonstrated by neuroscience. Nevertheless, the author proposes that the knowledge of specifi c archaic events, useless as their interpretation may be, offers a glimpse of the make‐up of the mind, contributing to the improvement of the empathy indispensable for inducing changes in the patient. Episodes linked to absolute narcissism, in the beginnings of the body ego, which do not appear either in associations or in transference, emerge in dreams. Neuroscience has made possible the understanding of aspects of dreaming capable of providing a glimpse of the genesis of the ego, whose development from the bodily phase of absolute narcissism to the psychic object phase can thus be traced. The unearthing of the genesis of primary structural faults in dreaming furnishes the analyst with an estimate of the possibilities for development of the ego, and this knowledge provides fi ne tuning capable of guiding the analyst's conduct. A clinical case illustrates how these phenomena occur, showing the intersubjective relationship as the silent primary generator of psychic changes, consolidated and developed secondarily by means of the analytical dialogue.     

Covert narcissism as a predictor of internalizing symptoms after performance feedback in adolescents

The present study examined the association between covert narcissism and internalizing symptoms (i.e., shame, anxiety) in adolescents following an ego threat. Participants were 132 adolescents (101 males, 30 females, 1 not reported), ages 16-19 (M = 16.81 years, SD = .81), attending a residential program. Participants were randomly assigned to one of three feedback conditions (i.e., positive, negative, or neutral). Contrary to the main hypothesis, Time 2 internalizing symptoms tended to be highest for individuals in the positive feedback condition who had higher levels of narcissism. The implications of this study for understanding the role of narcissism in internalizing symptoms are discussed.     

Narcissism as motive

This essay proposes replacing the traditional concept of narcissism as derived from the theory of drives with a concept of narcissism that is concerned with motives and their correlative meanings-specifically, motives connected to self-organization, self-preservation, self-cohesion, self-valuation, and self-esteem. The reasons for and the metapsychological underpinnings of a motivationally based theory are discussed. This revised motivational view proposes that narcissistic dynamics can be preserved and articulated in exclusively motivational terms. Developmental aspects are explored, including formation and functioning of the ego ideal and self-esteem regulation. Implications for psychoanalytic technique are suggested in discussions of case material.