The one factor model of narcissism puts essentially the whole spectrum of narcissism onto one level. The term "narcissism" is often used as an umbrella term for both minor and extreme (NPD) forms where there's no distinction between different levels of expression.

One Factor Model of Narcissism

In the last twenty years, psychologists have transitioned to a more hierarchical study of narcissism composed of at least two distinct dimensions: grandiose narcissism and vulnerable narcissism. This model provided much needed clarity between the definitions, operations, assessments, and outcomes of narcissism.

Two Factor Model of Narcissism

In recent years, three factor models of narcissism have emerged, which have further clarified its core components. This model is composed of antagonism, agentic extraversion, and narcissistic neuroticism. Individuals with NPD have high scores in all three factors. 

The three factor model demonstrates both what's shared across the dimensions of narcissism and what's unique to grandiose and vulnerable narcissism. It also shows the distinct relationship between narcissism and self esteem, which has been a gray area in the past. 

Three Factor Model of Narcissism

Narcissism isn’t synonymous with high self-esteem; this association depends on which components of narcissism are emphasized.

- High self-esteem
- Grandiose narcissism

Narcissism ≠ High Self Esteem

- Current conceptualization of narcissism's underlying motives
- Narcissistic status pursuit model

Underlying Motives of Narcissism

Not much is known about the social outcomes of vulnerable narcissism. However, there's a dual-pathway approach to the social consequences of grandiose narcissism.

- Admiration pathway
- Rivalry pathway

Social Outcomes of Narcissism

Co-narcissism refers to the unique sets of characteristics exhibited by the offspring of narcissistic parents. Co-narcissism arises as a natural consequence of growing up in an environment dominated by narcissistic parents or as coping with the challenging dynamics of such an environment. 

Co-Narcissism

Many factors contribute to the development of NPD in a person. The following outline some of the potential factors:
- One can be genetically predisposed to NPD;
- Negative events experienced during developmental stages such as being rejected and having low self esteem can lead to NPD in adulthood; 
- Excessive praise as a child.

Potential causes of Narcissistic Personality Disorder

NPD can often occur with other mental health conditions making it challenging to determine which disorder is causing symptoms. Such comorbidities include:
- Substance use disorders;
- Additional personality disorders including antisocial PD, borderline PD, histrionic PD, and schizotypal PD.

Comorbidities in people with NPD

Even though more research is needed to determine if NPD is responsible for neurological differences, one study in Germany indicates it does. Abnormalities found in this study include:
- Differences in grey matter in the prefrontal, insular, right prefrontal, and anterior cingulate areas of the brain;
- Differences in white matter in the frontal lobe.

Differences seen in the brains of people with NPD

Many different methods can be used to diagnose patients with NPD and to rule out other potential diagnoses. The method used will depend on the setting the patient is seen in.

Methods used to diagnose patients with NPD.

Pharmacological treatment for NPD has not been established yet but medicine can be used to treat symptoms. For example, antidepressants, antipsychotics, and mood stabilizers can be prescribed. Additionally, long-term therapy can be used to work on symptoms and develop coping skills. Types of psychotherapy for people with NPD may include psychodynamic, transference-focused, and schema-focused therapy.

Treatment options for people with NPD.

Complications that arise in people with NPD will generally be due to symptoms caused by comorbid conditions. For instance, when NPD is present with substance use disorder hostility is more common. It is also important to note that death by suicide is also common in people with NPD.

Long-term impacts of NPD

The story of neurosurgeon Christopher Duntsch is a good representation of how narcissism can present itself and be harmful to others. There is a documentary called "Dr. Death: The Undoctored Story" that explains this story. Additionally, his story was also told in a TV-Show called "Dr. Death".

Example of Narcissism in Medicine

Narcissism is a personality trait characterized by an inflated self-concept of one’s own worth, a strong sense of entitlement, and a tendency to act selfishly. Narcissism is a spectrum with those at the highest end classified as having narcissistic personality disorder (NPD).

Boston University

One’s description and evaluation of oneself, including psychological and physical characteristics, qualities, skills, roles and so forth. Self-concepts contribute to the individual’s sense of identity over time

Self-Concept 

The dark tetrad is a collection of “dark personality” traits, including psychopathy, everyday sadism, narcissism, and Machiavellianism. High scores in these traits is associated with a statistically higher likelihood of not only engaging in cruel behavior, but also committing violent crimes (i.e. murder).

The Dark Tetrad

Miller, J. D., Back, M. D., & Lynam, D. R. (2021). Corrigendum: Narcissism Today: What We Know and What We Need to Learn. Current Directions in Psychological Science, 30(6), 519–525. https://doi.org/10.1177/09637214221086630

Narcissism Today: What We Know and What We Need to Learn

Self-efficacy is an individual’s subjective perception of his or her capability to perform in a given setting or to attain desired results, proposed by Albert Bandura as a primary determinant of emotional and motivational states and behavioral change.

Self-Efficacy

Narcissism

References for Self Efficacy

- Narcissists are grandiose self-promoters who continually crave attention.
- Machiavellians are master manipulators. At least one of them has cheated you out of something valuable, a fact that you may not have realized until it was too late.
- An everyday sadist has tried to hurt you, verbally or physically, for pure enjoyment (e.g. workplace bullies and internet trolls).
- A psychopath will be the most malevolent; they may have caused you serious harm in an impulsive fit of callous thrill-seeking.

Profiling the Dark Tetrad

The common feature in the dark tetrad is callousness (i.e. a lack of empathy toward others). However, since each trait has different features, they each have different outcomes to their version of callousness.

What Ties the Dark Personality Traits Together?

Dark personalities succeed in getting ahead but fail at getting along. With regard to the Big Five traits, dark personalities score low on agreeableness and conscientiousness.

Links with Broader Models of Personality

Everyday sadism, also known as nonsexual, subclinical sadism, reflects cruelty in everyday life. People of this category experience pleasure from others' physical or psychological pain as they go about daily life. For example, these people might like watching violent movies, seeing a fight outside of a bar, or watching someone mess up a presentation at work. Beyond this, everyday sadists also enjoy doing things to elicit suffering, such as emotional manipulation.

Everyday Sadism

Higher scores in the darker traits are more likely to stalk their partners, have problematic phone and internet use, engage in trolling behaviors online, find media violence funny, have antisocial use of dating apps, and distribute intimate images of other people without consent. Sadism predicts adverse online behavior better than the other dark personality traits, such as cybertrolling, cyberstalking, cyberviolence and cyberbullying.

The Dark Tetrad and Online Behavior

People with higher scores in the Dark Tetrad might use aggression to deal with difficult situations and attain their goals. Dark Tetrad traits have consistently positive associations with aggressive behaviors. Psychopathy and sadism in particular have closer links with various types of aggression, including physical, verbal, between partners, prejudice, bullying, extremism, radicalization, contempt, workplace mistreatment, child corporal punishment, mild and moderate self-harm, and cheating.

The Dark Tetrad and Aggression

- The Dark Tetrad traits are linked to self-preservation and benefit seeking.
- People with higher scores in the traits are often motivated to seek power and control and to display success to receive social approval and esteem. For example, they might view social and romantic relationships as instrumental means of achieving social status. 
- Dark traits correlate with self-direction thoughts (i.e., less open to change), as well as a right-wing political ideology, conservativeness, conspiracist ideation and a competitive view of the world, selective extremism behavior.
- When facing moral dilemmas, the Dark Tetrad traits predict utilitarian decisions and sadism predicts minimizing causal responsibility for harm.
- Machiavellianism and sadism are associated with difficulties in teamwork.
- Psychopathy and sadism are associated with low task performance, and the Dark Tetrad, except narcissism, are associated with high counter-productive work.
- The Dark Tetrad traits are also associated with higher levels of advantageous and disadvantageous risk taking, malevolent creativity, lying and sinning, especially pride, greed, and lust, giving less importance to fairness attitudes and purity values, while tending to not to rely on supernatural beliefs.

The Dark Tetrad and Moral Beliefs/Behaviors

Machiavellianism refers to a duplicitous personality trait, especially in interpersonal style, characterized by a cynical disregard for morality and a focus on self-interest and personal gain.

Machiavellianism

Similar to sociopathy, this condition is a lack of empathy and understanding of others. Emotions may not be experienced much at all in these individuals. However, the emphasis relies more on manipulative behavior. True social connections may not be possible, only feigned. Though manipulative and unempathetic, these individuals can be seen as charming to others and capable of maintaining a relatively normal life. Unlike the sociopath, they tend to be more risk-averse and caring about themselves. 

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