Mirror, Mirror, In the Eyes: Mental State Decoding Abilities in Pathological Narcissism

Objective: This study sought to examine the relationship between pathological narcissism and mental state decoding abilities. Methods: 145 undergraduate students participated in a laboratory experiment for course credit. Narcissism was assessed with the Pathological Narcissism Inventory (PNI) and mental state decoding abilities were assessed with the Reading the Mind in the Eyes (RME) task. Procedure: Participants were presented with photographs of human faces on a computer screen, and were asked to pair words to the photographs, which were cropped to the eye region of the face. The valence of each face was categorized as positive, negative, and neutral. Hypotheses: It was hypothesized that a negative correlation would be observed in the relationship between the PNI and the RME, such that higher levels of narcissism would be associated with decreased levels in mental state decoding accuracy. It was also hypothesized that a positive correlation existed in the PNI and in RME targets of positive valence, such that higher levels of narcissism would be associated with increased mental state decoding abilities in targets of positive valence. Results: Both hypotheses were not supported; however, a statistically significant quadratic relationship was found between the PNI and the RME, such that higher and lower levels of narcissism were associated with decreases in mental state decoding abilities, with moderate levels of narcissism associated with higher RME scores. Mirror, Mirror, In the Eyes: Mental State Decoding Abilities in Pathological Narcissism Our modern interpretation of narcissism can be traced back to Narcissus of Greek mythology—a man who fell in love with his own reflection, disregarding all others, until his untimely death. As a construct, narcissism can be defined dimensionally (e.g., low to high levels of narcissism) and categorically (e.g., as a person who is narcissistic). The inability to empathize with other people—whether by choice, skill, or any combination of the two—is a hallmark of Narcissistic Personality Disorder (NPD) (for a review, see Carlson, Vazire, & Oltmanns, 2011). In the absence of empathy, the quality of a one’s personal, professional, and familial lives, tend to suffer (Byron, 2007). According to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM–IV–TR; APA, 2000), symptoms of the disorder include pervasive thoughts or fantasies of an idealized self, an unreasonable sense of entitlement over others, and haughty or arrogant behavior. Narcissists also tend to share the belief that their lives, opinions, 85 and thoughts are in a category all their own. People who suffer from NPD are also often willing to use or manipulate other people in a way that is advantageous to their own pursuits, disregarding the wellbeing of others. Across NPD symptomatology, interpersonal functioning deficits in particular are most severe (e.g., Magidson et al., 2012; Miller, Campbell, & Pilkonis, 2007; Ogrodniczuk et al., 2009), often resulting in many failed relationships (Kernberg, 1976; Kohut, 1984), with some citing concerns for increased risk of suicide (e.g., Kernberg, 1984; Magidson et al., 2012; Links, Gould, & Ratnayake, 2003; Ronningstam & Maltsberger, 1998; Ronningstam, Weinberg, & Maltsberger, 2008). Reports on the prevalence of narcissism as a personality disorder range from 0% to 6% in communities (APA, 2000; Ritter, 2011; Stinson et al., 2008), with higher rates of clinical prevalence, estimated to range from 2% to 16% (APA, 2000). Additionally, patients diagnosed with NPD accounted for 84% of those disciplined in the military, while narcissism in CEOs was found to be related to unstable performance (Chatterjee & Hambrick, 2007). Historically, narcissism as a personality disorder was not a viable diagnosis for practicing clinicians until 1980, when a portrait of NPD was articulated within the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). At present, much discussion exists within the literature about the future of narcissism. Some have argued that since the publication of the DSM-III, clinicians have faced diagnostic challenges, particularly when dealing with the disparities between the characteristics of their clinically distressed narcissistic patients and an inadequate match of their symptomatology to DSM criteria (Cain, Pincus, & Ansell, 2008; Gabbard, 1989; Gunderson, Ronningstam, & Smith, 1991; Levy, Reynoso, Wasserman, & Clarkin, 2007). Some have also argued that the elimination of certain criteria in subsequent editions of the DSM were due in large part to concerns over comorbidity with other personality disorders (Levy, Ellison, & Reynoso, 2011). Amid growing concerns regarding the dramatic changes posed by the DSM-5 committee, including the recently discarded plan to remove NPD from the latest edition of the manual (Pies, 2011), the results of one study (Zimmerman, Chelminski, Young, Dalrymple, & Martinez, 2012) argued that such an omission could have wrongfully resulted in the absence of diagnoses for a small but significant subset of patients (i.e., false-negative diagnoses). To better articulate narcissism, clinical scholars have posed two subtypes. Like two sides of a mirror, the two sides of narcissism are known as narcissistic grandiosity and narcissistic vulnerability (e.g., Akhtar & Thomson, 1982; Cain et al., 2008; Gabbard, 1989; 1998; Gersten, 1991; Kernberg, 1967; 1984; Kohut & Wolf, 1978; Levy et al., 2007; 2011; 2012; Pincus & Lukowitsky, 2010). Grandiose narcissism can be characterized by arrogance, exploitativeness, lack of empathy, having minimal anxiety, and being envious of others (or believing that others are envious of you) (Levy, 2012). Although the grandiose narcissistic symptomatology is better in sync with current DSM-IV-TR criteria, someone in a state of grandiose narcissism tends to appear less frequently in the clinical setting. In contrast, the vulnerable manifestation of narcissism is largely absent from the DSM-IV, but prevalent in the clinical setting (Pincus et al., 2009). The vulnerable state of narcissism can both endure and inflict suffering; this is often implemented by provoking others to react to their psychological pain. They experience bouts of rage, can be quite irritating to others, and can be verbally abusive (Pies, 2011). As such, their levels of distress are significantly more visible to clinicians than that of a grandiose narcissist (Pincus et al., 2009). 86 Pincus et al., (2009) argued that the clinic to research disparity of NPD was a direct result of measures that failed to account for its multi-dimensional characteristics. They further argued that, despite the large research body on the two-sided nature of narcissism, the majority of researchers have continued to use measures derived from the DSM’s one-dimensional grandiosethemed NPD criteria. This statement is highly congruent with the clinical literature when examining the populous Narcissistic Personality Inventory (NPI). For over 30 years, the NPI has been one of few industry standard measures for narcissism; in fact, since 1985, in 77% of research conducted on narcissism in social or personality psychology, the NPI was used as the only or a primary measure for narcissism (Cain, Pincus, & Ansell, 2008). Ultimately, the inadequacy of these measures necessitated the development of the Pathological Narcissism Inventory (PNI) (Pincus et al., 2009), which is used in the current study. Despite the large and diverse literature on narcissism as a construct—as a personality disorder, it has the least empirical support of the other 9 personality disorders in the DSM-IV (Stinson et al. 2008). Similarly, empathic deficits in narcissism have also received little empirical attention in research (South, Eaton, & Krueger, 2011). From a perspective based in theory, clinical scholars have published many writings hypothesizing why narcissistic individuals exhibit deficits in empathy (Dimaggio et al. 2002; Gabbard, 1989; Kernberg, 1967; Kohut, 1966; Moeller, Robinson, Wilkowski, & Hanson, 2012). To briefly define the construct, empathy can be described as the ability to decode and experience the cognitive and emotional states of others, while simultaneously reflecting on one’s internalized response to them (Decety & Moriguchi, 2007). Most research examining empathy in narcissism has used self-report measures for empathy; however, social desirability bias (Fisher, 1993)—defined as the tendency for participants to answer questions in favorable ways—may result when using these measures. This effect may become compounded within the narcissistic individual’s personality, as clinical theory would suggest that they might exaggerate, overestimate, or otherwise inflate their empathic abilities, more so than someone who is not pathologically distressed. In contrast to the social desirability bias, other internal biases may also be at work, leading the narcissistic individual to downplay their empathic abilities for any number of reasons, including the belief that they are uninterested or bored by the minutia of interpersonal structures. Interestingly, a new thread of research suggests that narcissists are not as out of touch with interpersonal structures as once thought (Carlson, Vazire, & Furr, 2011); however, many clinical theorists suggest otherwise (Benjamin, 1993; Dimaggio et al. 2002; Gabbard, 1989; Kernberg, 1967; Kohut, 1966; Moeller, Robinson, Wilkowski, & Hanson, 2012). Thus, additional empirical research on empathy is needed, as well as a tool of measurement with greater precision. The Reading the Mind in the Eyes (RME) task (Baron-Cohen et al., 2001) attempts to measure components of empathy, by gauging one’s ability to decode the mental states of others. It is also a task that can be evaluated empirically. In it, participants are presented with photographs of faces that are cropped from the nose to the eyebrow region, along with four words, all of similar valence (to reduce ceiling effects). The task has proven to be valid across several studies, with significant differences being reported across samples of clinically distressed patients. In women with major depressive disorder, significant deficits in RME accuracy were found (Lee, Harkness, Sabbagh, & Jacobson, 2005), and in people with borderline personality disorder (BPD), increases in both overall RME accuracy (Fertuck et al., 2009) and negative RME accuracy were reported (Scott, Levy, Adams Jr. & Stevenson, 2011). 87 In the current study, the relationship between pathological narcissism and mental state decoding is evaluated, using the PNI as a measure for components of narcissism, and the Reading the Mind in the Eyes task as a measure for mental state decoding. The first research hypothesis is that a negative correlation will be observed in the relationship between overall PNI scores and the overall RME accuracy, such higher levels of narcissism narcissistic traits will be associated with lower levels of mental state decoding accuracy. The second research hypothesis is that a positive correlation will be observed in overall PNI scores and RME targets of positive valence, such that an higher levels of narcissism will associate with higher accuracy in decoding mental states from photos of positive valence.