Background: Little is known about narcissistic traits in borderline personality disorder (BPD). This exploratory study aimed to illustrate the associations between total, grandiose, and vulnerable narcissism and gender, diagnostic features of BPD and narcissistic personality disorder (NPD), and psychopathology in BPD patients. Sampling and Methods: The Pathological Narcissism Inventory and psychometric measures for impulsivity, anger, borderline symptom severity, personality organization, depression, and rejection sensitivity were completed by 65 BPD patients. Statistical analyses were conducted using the t test, Pearson correlation, and multivariate regression analyses. Results: Male BPD patients displayed higher narcissistic scores than females (p < 0.01). Grandiose narcissism showed a stronger association with NPD than with BPD (p < 0.01) while vulnerable narcissism was only associated with BPD (p < 0.01). Rejection sensitivity (p < 0.01) and depression (p < 0.001) predicted vulnerable narcissism. Conclusion: Vulnerable narcissism is closely associated with BPD and appears to be more dysfunctional than grandiose narcissism. A comprehensive consideration of both traits is recommended. Our results might help to generate hypotheses for further research on pathological narcissism in the spectrum of personality disorders. Future studies are advised to apply complementary measures and take new diagnostic approaches of DSM-5 and ICD-11 into account.

1.
Ellison WD, Rosenstein L, Chelminski I, Dalrymple K, Zimmerman M: The clinical significance of single features of borderline personality disorder: anger, affective instability, impulsivity, and chronic emptiness in psychiatric outpatients. J Pers Disord 2016; 30: 261–270.
2.
Lenzenweger MF, Clarkin JF, Yeomans FE, Kernberg OF, Levy KN: Refining the borderline personality disorder phenotype through finite mixture modeling: implications for classification. J Pers Disord 2008; 22: 313–331.
3.
Mancke F, Herpertz SC, Kleindienst N, Bertsch K: Emotion dysregulation and trait anger sequentially mediate the association between borderline personality disorder and aggression. J Pers Disord 2016; 31: 256–272.
4.
Staebler K, Helbing E, Rosenbach C, Renneberg B: Rejection sensitivity and borderline personality disorder. Clin Psychol Psychother 2011; 18: 275–283.
5.
Sollberger D, Gremaud-Heitz D, Riemenschneider A, Küchenhoff J, Dammann G, Walter M: Associations between identity diffusion, axis II disorder, and psychopathology in inpatients with borderline personality disorder. Psychopathology 2012; 45: 15–21.
6.
Silk KR: The quality of depression in borderline personality disorder and the diagnostic process. J Pers Disord 2010; 24: 25–37.
7.
Clarkin JF, Levy KN: Psychotherapy for patients with borderline personality disorder: focusing on the mechanisms of change. J Clin Psychol 2006; 62: 405–410.
8.
Gratz KL, Moore KE, Tull MT: The role of emotion dysregulation in the presence, associated difficulties, and treatment of borderline personality disorder. Personal Disord Theor Res Treat 2016; 7: 344–353.
9.
Zanarini MC, Temes CM, Ivey AM, Cohn DM, Conkey LC, Frankenburg FR, Fitzmaurice GM: The 10-year course of adult aggression toward others in patients with borderline personality disorder and axis II comparison subjects. Psychiatry Res 2017; 252: 134–138.
10.
Gunderson JG: Clinical practice. Borderline personality disorder. N Engl J Med 2011; 364: 2037–2042.
11.
Ronningstam E: Beyond the diagnostic traits: a collaborative exploratory diagnostic process for dimensions and underpinnings of narcissistic personality disorder. Personal Disord Theor Res Treat 2014; 5: 434–438.
12.
Sharp C, Wright AG, Fowler JC, Frueh BC, Allen JG, Oldham J, Clark LA: The structure of personality pathology: both general (“g”) and specific (“s”) factors? J Abnorm Psychol 2015; 124: 387–398.
13.
Stinson FS, Dawson DA, Goldstein RB, Chou SP, Huang B, Smith SM, Ruan WJ, Pulay AJ, Saha TD, Pickering RP, Grant BF: Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 2008; 69: 1033–1045.
14.
Diamond D, Levy KN, Clarkin JF, Fischer-Kern M, Cain NM, Doering S, Horz S, Buchheim A: Attachment and mentalization in female patients with comorbid narcissistic and borderline personality disorder. Personal Disord Theor Res Treat 2014; 5: 428–433.
15.
Bateman A, Fonagy P: Mentalization-Based Treatment for Personality Disorders: A Practical Guide, ed 2. Oxford, Oxford University Press, 2016.
16.
Blais MA, Little JA: Toward an integrative study of narcissism. Personal Disord Theor Res Treat 2010; 1: 197–199.
17.
Ackerman RA, Hands AJ, Donnellan MB, Hopwood CJ, Witt EA: Experts’ views regarding the conceptualization of narcissism. J Pers Disord 2016; 31: 346–361.
18.
Miller JD, Campbell WK: Comparing clinical and social-personality conceptualizations of narcissism. J Pers 2008; 76: 449–476.
19.
Levy KN: Subtypes, dimensions, levels, and mental states in narcissism and narcissistic personality disorder. J Clin Psychol 2012; 68: 886–897.
20.
Wink P: Two faces of narcissism. J Pers Soc Psychol 1991; 61: 590–597.
21.
Gabbard GO: Two subtypes of narcissistic personality disorder. B Menninger Clin 1989; 53: 527–532.
22.
Cain NM, Pincus AL, Ansell EB: Narcissism at the crossroads: phenotypic description of pathological narcissism across clinical theory, social/personality psychology, and psychiatric diagnosis. Clin Psychol Rev 2008; 28: 638–656.
23.
Gore WL, Widiger TA: Fluctuation between grandiose and vulnerable narcissism. Personal Disord Theor Res Treat 2016; 7: 363–371.
24.
Raskin R, Terry H: A principal-components analysis of the Narcissistic Personality Inventory and further evidence of its construct validity. J Pers Soc Psychol 1988; 54: 890–902.
25.
APA: Diagnostic and Statistical Manual of Mental Disorders, ed 5. Arlington, American Psychiatric Publishing, 2013.
26.
Pincus AL, Lukowitsky MR: Pathological narcissism and narcissistic personality disorder. Annu Rev Clin Psychol 2010; 6: 421–446.
27.
Olssøn I, Svindseth MF, Dahl AA: Is there an association between the level of grandiose narcissism severity of psychopathology? Nord J Psychiatry 2016; 70: 121–127.
28.
Skodol AE, Bender DS, Morey LC: Narcissistic personality disorder in DSM-5. Personal Disord Theor Res Treat 2014; 5: 422–427.
29.
Miller JD, Lynam DR, Hyatt CS, Campbell WK: Controversies in narcissism. Annu Rev Clin Psychol 2017; 13: 291–315.
30.
Pincus AL, Ansell EB, Pimentel CA, Cain NM, Wright AG, Levy KN: Initial construction and validation of the Pathological Narcissism Inventory. Psychol Assess 2009; 21: 365–379.
31.
Morf CC, Schurch E, Kufner A, Siegrist P, Vater A, Back M, Mestel R, Schroder-Abe M: Expanding the nomological net of the Pathological Narcissism Inventory: German validation and extension in a clinical inpatient sample. Assessment 2016; 24: 419–443.
32.
Ellison WD, Levy KN, Cain NM, Ansell EB, Pincus AL: The impact of pathological narcissism on psychotherapy utilization, initial symptom severity, and early-treatment symptom change: a naturalistic investigation. J Pers Assess 2013; 95: 291–300.
33.
Wright AG: On the measure and mismeasure of narcissism: a response to “measures of narcissism and their relations to DSM-5 pathological traits: a critical reappraisal.” Assessment 2016; 23: 10–17.
34.
Wright AG, Pincus AL, Thomas KM, Hopwood CJ, Markon KE, Krueger RF: Conceptions of narcissism and the DSM-5 pathological personality traits. Assessment 2013; 20: 339–352.
35.
Fernie BA, Fung A, Nikcevic AV: Different coping strategies amongst individuals with grandiose and vulnerable narcissistic traits. J Affect Disord 2016; 205: 301–305.
36.
Dickinson KA, Pincus AL: Interpersonal analysis of grandiose and vulnerable narcissism. J Pers Disord 2003; 17: 188–207.
37.
Pincus AL, Cain NM, Wright AG: Narcissistic grandiosity and narcissistic vulnerability in psychotherapy. Personal Disord Theor Res Treat 2014; 5: 439–443.
38.
Miller JD, Lynam DR: Understanding psychopathy using the basic elements of personality. Soc Personal Psychol Compass 2015; 9: 223–237.
39.
Restek-Petrovic B, Bogovic A, Grah M, Filipcic I, Ivezic E: Personality characteristics of psychotic patients as possible motivating factors for participating in group psychotherapy. Psychiatr Danub 2015; 27: 364–370.
40.
Diguer L, Turmel V, da Silva RL, Mathieu V: Convergent and clinical validity of the Pathological Narcissism Inventory. J Am Psychoanal Assoc 2015; 63: 1–3.
41.
Thomas KM, Wright AG, Lukowitsky MR, Donnellan MB, Hopwood CJ: Evidence for the criterion validity and clinical utility of the Pathological Narcissism Inventory. Assessment 2012; 19: 135–145.
42.
Marcinko D, Jaksic N, Ivezic E, Skocic M, Suranyi Z, Loncar M, Franic T, Jakovljevic M: Pathological narcissism and depressive symptoms in psychiatric outpatients: mediating role of dysfunctional attitudes. J Clin Psychol 2014; 70: 341–352.
43.
Tritt SM, Ryder AG, Ring AJ, Pincus AL: Pathological narcissism and the depressive temperament. J Affect Disord 2010; 122: 280–284.
44.
Miller JD, Dir A, Gentile B, Wilson L, Pryor LR, Campbell WK: Searching for a vulnerable dark triad: comparing factor 2 psychopathy, vulnerable narcissism, and borderline personality disorder. J Pers 2010; 78: 1529–1564.
45.
Krizan Z, Johar O: Narcissistic rage revisited. J Pers Soc Psychol 2015; 108: 784–801.
46.
Keene AC, Epps J: Childhood physical abuse and aggression: shame and narcissistic vulnerability. Child Abuse Negl 2016; 51: 276–283.
47.
Kealy D, Tsai M, Ogrodniczuk JS: Depressive tendencies and pathological narcissism among psychiatric outpatients. Psychiatry Res 2012; 196: 157–159.
48.
Grijalva E, Newman DA, Tay L, Donnellan MB, Harms PD, Robins RW, Yan T: Gender differences in narcissism: a meta-analytic review. Psychol Bull 2015; 141: 261–310.
49.
Roche MJ, Pincus AL, Lukowitsky MR, Menard KS, Conroy DE: An integrative approach to the assessment of narcissism. J Pers Assess 2013; 95: 237–248.
50.
Dawood S, Schroder HS, Donnellan MB, Pincus AL: Pathological narcissism and nonsuicidal self-injury. J Pers Disord DOI: 10.1521/pedi_2017_31_291.
51.
Fydrich T, Renneberg B, Schmitz B, Wittchen H-U: SKID-II. Strukturiertes Klinisches Interview für DSM-IV. Achse II: Persönlichkeitsstörungen Interviewheft. Göttingen, Hogrefe, 1997.
52.
Wittchen H-U, Wunderlich U, Gruschwitz S, Zaudig M: SKID-I. Strukturiertes Klinisches Interview für DSM-IV. Achse I: Psychische Störungen Interviewheft. Göttingen, Hogrefe, 1997.
53.
Wright AG, Lukowitsky MR, Pincus AL, Conroy DE: The higher order factor structure and gender invariance of the Pathological Narcissism Inventory. Assessment 2010; 17: 467–483.
54.
Bohus M, Kleindienst N, Limberger MF, Stieglitz RD, Domsalla M, Chapman AL, Steil R, Philipsen A, Wolf M: The short version of the Borderline Symptom List (BSL-23): development and initial data on psychometric properties. Psychopathology 2009; 42: 32–39.
55.
Patton JH, Stanford MS, Barratt ES: Factor structure of the Barratt Impulsiveness Scale. J Clin Psychol 1995; 51: 768–774.
56.
Hartmann AS, Rief W, Hilbert A: Psychometric properties of the German version of the Barratt Impulsiveness Scale, version 11 (BIS-11) for adolescents. Percept Mot Skill 2011; 112: 353–368.
57.
Forgays DG, Forgays DK, Spielberger CD: Factor structure of the State-Trait Anger Expression Inventory. J Pers Assess 1997; 69: 497–507.
58.
Schwenkmezger P, Hodapp V: A questionnaire for assessing anger and expression of anger (in German). Z Klin Psychol Psychiatr Psychother 1991; 39: 63–68.
59.
Lenzenweger MF, Clarkin JF, Kernberg OF, Foelsch PA: The Inventory of Personality Organization: psychometric properties, factorial composition, and criterion relations with affect, aggressive dyscontrol, psychosis proneness, and self-domains in a nonclinical sample. Psychol Assess 2001; 13: 577–591.
60.
Zimmermann J, Benecke C, Horz-Sagstetter S, Dammann G: Standardization of the German 16-item short version of the Inventory of Personality Organization (IPO-16) (in German). Z Psychosom Med Psychother 2015; 61: 5–18.
61.
Hautzinger M: The Beck Depression Inventory in clinical practice (in German). Nervenarzt 1991; 62: 689–696.
62.
Richter P, Werner J, Heerlein A, Kraus A, Sauer H: On the validity of the Beck Depression Inventory. A review. Psychopathology 1998; 31: 160–168.
63.
Banzhaf A, Ritter K, Merkl A, Schulte-Herbruggen O, Lammers CH, Roepke S: Gender differences in a clinical sample of patients with borderline personality disorder. J Pers Disord 2012; 26: 368–380.
64.
Johnson DM, Shea MT, Yen S, Battle CL, Zlotnick C, Sanislow CA, Grilo CM, Skodol AE, Bender DS, McGlashan TH, Gunderson JG, Zanarini MC: Gender differences in borderline personality disorder: findings from the collaborative longitudinal personality disorders study. Compr Psychiatry 2003; 44: 284–292.
65.
Silberschmidt A, Lee S, Zanarini M, Schulz SC: Gender differences in borderline personality disorder: results from a multinational, clinical trial sample. J Pers Disord 2015; 29: 828–838.
66.
Paris J, Chenard-Poirier MP, Biskin R: Antisocial and borderline personality disorders revisited. Compr Psychiatry 2013; 54: 321–325.
67.
Kealy D, Goodman G, Rasmussen B, Weideman R, Ogrodniczuk JS: Therapists’ perspectives on optimal treatment for pathological narcissism. Personal Disord Theor Res Treat 2017; 8: 35–45.
68.
Miller JD, Widiger TA, Campbell WK: Vulnerable narcissism: commentary for the special series “Narcissistic personality disorder – new perspectives on diagnosis and treatment.” Personal Disord Theor Res Treat 2014; 5: 450–451.
69.
Pincus AL: The Pathological Narcissism Inventory; in Ogrudniczuk J (ed): Understanding and Treating Pathological Narcissism. Washington, American Psychological Association, 2013, pp 93–110.
70.
Herpertz SC, Huprich SK, Bohus M, Chanen A, Goodman M, Mehlum L, Moran P, Newton-Howes G, Scott L, Sharp C: The challenge of transforming the diagnostic system of personality disorders. J Pers Disord 2017; 31: 577–589.
71.
Kanske P, Sharifi M, Smallwood J, Dziobek I, Singer T: Where the narcissistic mind wanders: increased self-related thoughts are more positive and future oriented. J Pers Disord 2016; 31: 553–566.
72.
Thomas J, Hashmi AA, Chung MC, Morgan K, Lyons M: The narcissistic mask: an exploration of “the defensive grandiosity hypothesis.” Personal Ment Health 2013; 7: 160–167.
73.
Krizan Z, Herlache AD: The narcissism spectrum model. Pers Soc Psychol Rev 2018; 22: 3–31.
74.
Ronningstam E: Identifying and Understanding the Narcissistic Personality. Oxford, Oxford University Press, 2005.
75.
Chapman AL, Walters KN, Gordon KL: Emotional reactivity to social rejection and negative evaluation among persons with borderline personality features. J Pers Disord 2014; 28: 720–733.
76.
Peters JR, Smart LM, Baer RA: Dysfunctional responses to emotion mediate the cross-sectional relationship between rejection sensitivity and borderline personality features. J Pers Disord 2015; 29: 231–240.
77.
Ronningstam E: Narcissistic personality disorder: facing DSM-V. Psychiatr Ann 2009; 39: 111–121.
78.
Fossati A, Gratz KL, Borroni S, Maffei C, Somma A, Carlotta D: The relationship between childhood history of ADHD symptoms and DSM-IV borderline personality disorder features among personality disordered outpatients: the moderating role of gender and the mediating roles of emotion dysregulation and impulsivity. Compr Psychiatry 2015; 56: 121–127.
79.
Ferraz L, Portella MJ, Vallez M, Gutierrez F, Martin-Blanco A, Martin-Santos R, Subira S: Hostility and childhood sexual abuse as predictors of suicidal behaviour in borderline personality disorder. Psychiatry Res 2013; 210: 980–985.
80.
Miller JD, Lynam DR, Campbell WK: Rejoinder: a construct validity approach to the assessment of narcissism. Assessment 2016; 23: 18–22.
81.
Jauk E, Weigle E, Lehmann K, Benedek M, Neubauer AC: The relationship between grandiose and vulnerable (hypersensitive) narcissism. Front Psychol 2017; 8: 1–10.
82.
Bender DS: Mirror, mirror on the wall: reflecting on narcissism. J Clin Psychol 2012; 68: 877–885.
83.
Dawood S, Pincus AL: Pathological narcissism and the severity, variability, and instability of depressive symptoms. Personal Disord Theor Res Treat DOI: 10.1037/per0000239.
84.
Dimaggio G, Nicolo G, Fiore D, Centenero E, Semerari A, Carcione A, Pedone R: States of minds in narcissistic personality disorder: three psychotherapies analyzed using the grid of problematic states. Psychother Res 2008; 18: 466–480.
85.
Perroud N, Uher R, Dieben K, Nicastro R, Huguelet P: Predictors of response and drop-out during intensive dialectical behavior therapy. J Pers Disord 2010; 24: 634–650.
86.
Campbell MA, Waller G, Pistrang N: The impact of narcissism on drop-out from cognitive-behavioral therapy for the eating disorders: a pilot study. J Nerv Ment Dis 2009; 197: 278–281.
87.
Fossati A, Somma A, Borroni S, Pincus AL, Markon KE, Krueger RF: Profiling pathological narcissism according to DSM-5 domains and traits: a study on consecutively admitted Italian psychotherapy patients. Psychol Assess 2017; 29: 1400–1411.
88.
Schoenleber M, Roche MJ, Wetzel E, Pincus AL, Roberts BW: Development of a brief version of the Pathological Narcissism Inventory. Psychol Assess 2015; 27: 1520–1526.
89.
Miller JD, Few LR, Wilson L, Gentile B, Widiger TA, Mackillop J, Keith Campbell W: The Five-Factor Narcissism Inventory (FFNI): a test of the convergent, discriminant, and incremental validity of FFNI scores in clinical and community samples. Psychol Assess 2013; 25: 748–758.
90.
Sherman ED, Miller JD, Few LR, Campbell WK, Widiger TA, Crego C, Lynam DR: Development of a short form of the Five-Factor Narcissism Inventory: the FFNI-SF. Psychol Assess 2015; 27: 1110–1116.
91.
Fossati A, Borroni S, Grazioli F, Dornetti L, Marcassoli I, Maffei C, Cheek J: Tracking the hypersensitive dimension in narcissism: reliability and validity of the Hypersensitive Narcissism Scale. Personal Ment Health 2009; 3: 235–247.
92.
Ha C, Balderas JC, Zanarini MC, Oldham J, Sharp C: Psychiatric comorbidity in hospitalized adolescents with borderline personality disorder. J Clin Psychiatry 2014; 75: 457–464.
93.
Miller JD, Lynam DR, Campbell WK: Measures of narcissism and their relations to DSM-5 pathological traits: a critical reappraisal. Assessment 2016; 23: 3–9.
94.
Thomas KM, Wright AG, Lukowitsky MR, Donnellan MB, Hopwood CJ: Correction to “evidence for the criterion validity and clinical utility of the Pathological Narcissism Inventory.” Assessment 2015; 23: 262–263.
95.
Oltmanns TF, Turkheimer E: Perceptions of self and others regarding pathological personality traits; in Krueger RF, Tackett JL (eds): Personality and Psychopathology. New York, Guilford Press, 2006, pp 71–111.
96.
Sleep CE, Sellbom M, Campbell WK, Miller JD: Narcissism and response validity: do individuals with narcissistic features underreport psychopathology? Psychol Assess 2017; 29: 1059–1064.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.