12c
Aaron L. Pincus, Sindes Dawood, Leila Z. Wu, and Chloe F. Bliton
Twenty-five years ago, Benjamin (1994a) presented an extended view of how her Structural Analysis of Social Behavior (SASB) model and theory could bridge personality theory and clinical psychology. This was followed by commentaries from a range of eminent scholars. Benjamin (1994b) divided the commentaries into those whose authors believed it necessary for clinical personality science to reciprocally inform and be informed by the clinical enterprise and those whose authors were dismissive of clinical complexity and promoted their preferred trait models. A quarter century later, a similar dichotomy is evident here.
Clinical Complexity of Narcissism
Like Benjamin, Ronningstam is a clinical scientist and master clinician who has been treating patients with personality disorders continuously for decades. Her work consistently provides a bridge between clinical personality science and practice (e.g., Ronningstam, 2005, 2016). Her current commentary with Russell expands the clinical portrait of narcissism beyond what was presented in our chapter. We are reminded that the clinical presentation and treatment of narcissism is complex and serious, including risks for aggression, violence, and suicide, as well as complications due to fear and trauma, and related dark personality traits. We completely agree with these observations and concerns and recognize the list of risks and complications is even longer (Dowgwillo, Dawood, & Pincus, 2016). The portrait of narcissism Ronningstam and Russell paint here is clinically informed, dynamic, and complex. All Ronningstam’s work articulating the complexity of narcissism suggests that to successfully build a bridge to the clinic, clinical personality science needs to integrate narcissistic structure (i.e., its fundamental traits) with narcissistic patients’ dynamic intra- and interpersonal processes and maintenance mechanisms (Ackerman, Donnellan, & Wright, 2019; Pincus & Wright, in press). This is because personality processes and mechanisms are the key targets of psychotherapeutic intervention.
Quit Making Calls and Join the Field of Contemporary Clinical Personality Science
Faced with the complexity of narcissistic phenomena observed in the clinic and the need to integrate structure and dynamics in advancing the utility of clinical science, Weiss and Campbell call for scientific caution. Notably, in response to Hopwood’s (2018) target article making the same assertions for the clinical science of personality disorders more generally, Campbell’s frequent collaborators made a similar call for “parsimony, proof, and prudence” (Miller & Lynam, 2018, p. 568). We would encourage these academic researchers to stop avoiding clinical complexity, and instead, take advantage of the advances in research methods, analytics, and technology to build a truly meaningful bridge between clinical personality science and practice. Their corpus of work to date has generally failed in this regard because profiles of trait elevations, correlations between trait and personality disorder scales, and expert trait ratings of prototypical personality disorders are not the clinical entities seen in the consulting room (Pincus, 2018).
Weiss and Campbell make three broad critiques of our chapter. First, they criticize us for synthesizing research on narcissism across related but not identical conceptualizations and measures. This is a straw man argument applicable to research on virtually all clinical (e.g., depression) and personality (e.g., impulsivity) constructs. The field certainly must reduce the heterogeneity in conceptualizing and assessing narcissism. Until then caution is needed, but without synthesis there is no cumulative science. Second, they critique the view that grandiosity and vulnerability may oscillate in narcissistic personalities. At its core, this is an anti-clinical stance. Those who regularly provide treatment and supervision for personality disordered patients have little argument with this perspective (e.g., Gore & Widiger, 2016), and longitudinal research on narcissistic states is emerging (Dowgwillo, Dawood, Bliton, & Pincus, 2018; Edershile & Wright, in press). The authors also misunderstand our position on oscillation. We assert that narcissistic patients may be chronically grandiose, chronically vulnerable, or oscillating (Pincus, Dowgwillo, & Greenberg, 2016). Perhaps certain presentations are more prominent in certain contexts. Third, they criticize us for examining narcissism in clinical contexts. Although we agree that expressions of narcissism may differ in treatment seeking outpatients compared to individuals in forensic or community contexts, we aim to develop a clinical personality science of narcissism that actually bridges to the clinic, not just another corner of the academy (Benjamin, 1994b).
References
Ackerman, R. A., Donnellan, M. B., & Wright, A. G. C. (2019). Current conceptualizations of narcissism. Current Opinion in Psychiatry, 32, 32–37.
Benjamin, L. S. (1994a). SASB: A bridge between personality theory and clinical psychology. Psychological Inquiry, 5, 273–316.
Benjamin, L. S. (1994b). The bridge is supposed to reach the clinic, not just another corner of the academy. Psychological Inquiry, 5, 336–343.
Dowgwillo, E. A., Dawood, S., Bliton, C. F., & Pincus, A. L. (2018). Within-person covariation of narcissistic grandiosity and vulnerability in daily life. Paper presented at the Society for Personality Assessment annual meeting, Washington, DC, March.
Dowgwillo, E. A., Dawood, S., & Pincus, A. L. (2016). The dark side of narcissism. In V. Zeigler-Hill & D. Marcus (Eds.), The Dark Side of Personality: Science and Practice in Social, Personality, and Clinical Psychology (pp. 25–44). Washington, DC: American Psychological Association.
Edershile, E. A., & Wright, A. G. C. (in press). Grandiose and vulnerable narcissistic states in interpersonal situations. Self and Identity.
Gore, W. L., & Widiger, T. A. (2016). Fluctuation between grandiose and vulnerable narcissism. Personality Disorders: Theory, Research, and Treatment, 7, 363–371.
Hopwood, C. J. (2018). Interpersonal dynamics in personality and personality disorders. European Journal of Personality, 32, 499–524.
Miller, J. D., & Lynam, D. R. (2018). A call for parsimony, proof, and prudence: A response to Hopwood. European Journal of Personality, 32, 568–569.
Pincus, A. L. (2018). Bringing personality traits from bench to bedside. European Journal of Personality, 32, 572–573.
Pincus, A. L., Dowgwillo, E. A., & Greenberg, L. (2016). Three cases of narcissistic personality disorder through the lens of the DSM-5 alternative model for personality disorders. Practice Innovations, 1, 164–177.
Pincus, A. L., & Wright, A. G. C. (in press). Narcissism as the dynamics of grandiosity and vulnerability. In S. Doering, H.-P. Hartmann, & O. F. Kernberg (Eds.), Narzissmus: Grundlagen – Störungsbilder – Therapie (2nd ed.). Stuttgart: Schattauer Publishers.
Ronningstam, E. (2005). Identifying and Understanding the Narcissistic Personality. New York: Oxford University Press.
Ronningstam, E. (2016). Pathological narcissism and narcissistic personality disorder: Recent research and clinical implications. Current Behavioral Neuroscience Reports, 3, 34–42.