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1.1 Structure of Pathological Narcissism: what we know and what we still don't know. Since the elaboration of the Alternative Model for Personality Disorders ...
This is an Accepted Article that has been peer-reviewed and approved for publication in Personality and Individual Differences (https://www.journals.elsevier.com/personality-andindividual-differences/), but has yet to undergo copy-editing and proof correction. This paper is not the copy of record and may not exactly replicate the final, authoritative version of the article. The final article is available via its DOI: https://doi.org/10.1016/j.paid.2018.04.003

Grandiose and entitled, but still fragile: a network analysis of pathological narcissistic traits

Rossella Di Pierro, Giulio Costantini, Ilaria Maria Antonietta Benzi, Fabio Madeddu, Emanuele Preti

Department of Psychology, University of Milano-Bicocca, Milano, Italy

Corresponding author: Rossella Di Pierro Department of Psychology, University of Milano-Bicocca Piazza dell'Ateneo Nuovo, 1 20126 Milan, Italy [email protected]

Author notes: Data, analytic methods, and study materials are available upon request to other researchers by writing to the corresponding author.

Abstract There is ongoing debate about the structure of pathological narcissism. Adopting a network approach, we investigate the core features of pathological narcissism and the nature of traits interconnections in a community sample (N= 944), considering also the effect of personality structure. Results suggest that grandiose fantasies, contingent self-esteem, and entitlement rage have a central role in defining pathological narcissism. Also, differences in interconnections between traits are found when considering individuals with different levels of personality structure. Our findings shed light on the structure and nature of pathological narcissism by showing the existence of both core and peripheral features, as well as their differential role in defining narcissistic manifestations at different levels of personality functioning.

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1. Introduction

1.1 Structure of Pathological Narcissism: what we know and what we still don’t know Since the elaboration of the Alternative Model for Personality Disorders (AMPD; APA, 2013), researchers have highlighted the need of distinguishing between general and specific features of personality disorders (PDs; Wright, Hopwood, Skodol, & Morey, 2016). Indeed, the lack of a clear difference between central and peripheral symptoms, as well as the lack of clarity about the specific relations among them, might account for both the high comorbidity of PDs and the extensive heterogeneity in clinical presentations within DSM PDs diagnoses (Skodol et al., 2011). Unlike the DSM-5 official classification model, the AMPD emphasizes the presence of impairments in self and interpersonal functioning (Criterion A), and pathological traits (Criterion B) in the definition of PDs and it considers maladaptive traits as extreme variants of “normal” personality, in line with empirical evidence showing continuity between healthy and pathological personality expressions (Krueger & Markon, 2006). In this view, studying the relations among pathological personality traits might shed light on the nature of personality pathology. Inconsistencies in conceptualizations of narcissism and the predominance of the psychiatric nosology in empirical research have limited our knowledge of narcissistic functioning for a long time (Cain, Pincus, & Ansell, 2008). Recent empirical findings suggest that narcissism is a complex multidimensional construct with different phenotypic presentations like self-enhancing and exploitative attitudes (i.e., narcissistic grandiosity), but also negative affectivity and psychological distress (i.e., narcissistic vulnerability; Miller, Lynam, & Campbell, 2016; Miller, Lynam, Hyatt, & Campbell, 2017; Wright, 2016). These grandiose and vulnerable aspects of narcissism show differential patterns of associations with other features (e.g., self-esteem, Di Pierro, Mattavelli, & Gallucci, 2016; emotion regulation, 2

Di Pierro, Di Sarno, & Madeddu, 2017). Such findings have advanced our understanding of narcissism, but have also led to an accumulation of knowledge that is difficult to integrate. For instance, we still lack sufficient insight in the relations among different grandiose and vulnerable features of narcissism and we ignore which aspects of narcissism constitute the core of narcissistic pathology and which should be considered more peripheral. Reviewing recent empirical literature on narcissism, Miller et al. (2017) suggested that interpersonal antagonistic attitudes (including traits of exploitativeness, entitlement, and reactive anger) are core aspects of narcissism, while traits related to extraversion and neuroticism are peripheral features linked respectively to grandiose and vulnerable manifestations. Similarly, Krizan and Herlache (2017) identified entitled self-importance as the core aspect of narcissism that could be related to both grandiose and vulnerable manifestations, depending on temperamental dimensions (i.e. exhibitionism and vulnerability). Both models thus recognize entitlement and self-importance as core aspects of narcissism. However, such proposals are mainly theoretical in nature, and need to be empirically investigated. A focus on the structure of pathological narcissism calls to consider that pathological narcissism might manifest itself at different levels of personality structure. According to Kernberg’s model (Kernberg & Caligor, 2005), pathological personality structure can be described along some dimensions such as the capability to differentiate self from non-self, as well as intrapsychic from external stimuli (i.e. reality testing), the use of primitive defense mechanisms (e.g. splitting, projection and denial), and the presence of identity diffusion, which refers to instable and poorly integrated concepts of self and significant others. The more difficulties in these dimensions the more individuals’ personality structure is pathological. As for pathological narcissism, Kernberg (2007) suggests that such pathology spans from healthier personality structure (neurotic personality organization) to more severe 3

pathological levels of personality structure (borderline personality organization). The author suggests that individuals with neurotic personality organization might show pathological narcissistic traits, such as needs for admiration from others and attitudes of entitlement, in the context of a good psychological adjustment. Conversely, individuals with a borderline personality organization show narcissistic traits in the context of an unstable and unintegrated sense of self that leads to more drastic fluctuations in self-esteem and affect regulation, with relevant consequences in both intimate relationships and work experiences (Kernberg, 2007). In this sense, it seems important to investigate whether differences might be detected in core features of narcissism and in interconnections between narcissistic traits, whilst considering different levels of personality structure.

1.2 A network approach to personality disorders In recent years, the structure of some psychopathological conditions has been studied considering networks of symptoms and traits that interact with each other (e.g., Borsboom, 2017; Costantini et al., 2017). Each symptom plays a unique role, depending on its specific pattern of connections with the others. In psychopathology networks, symptoms are represented by nodes, and their pairwise relationships are represented by edges. Pairwise relationships among symptoms can be modeled using the Gaussian Graphical Model (GGM; Epskamp, Waldorp, Mõttus, & Borsboom, 2017; Lauritzen, 1996). Edges encode conditional dependence/independence relations among nodes, in the form of regularized partial correlations. If two symptoms are disconnected, it means that they are conditionally independent given the others, whereas if they are connected by an edge, it means that they are conditionally dependent, and the strength of the connection quantifies the amount of their dependence. GGMs are typically estimated using regularization techniques, which reduce

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overfitting and limit false-positive edges, thereby improving the replicability and the interpretability of results (Costantini et al., 2015, 2017; Epskamp, Waldorp et al., 2017). The network approach to psychopathology allows obtaining information on the centrality of symptoms, that is the importance of the role played by them in the context provided by other symptoms that characterize a specific disorder. Different centrality indices quantify different aspects of the importance of a node (Costantini et al., 2015). According to strength centrality a node is important if it has a large number of strong direct connections with other nodes. According to closeness centrality, a node is important if it is well connected, directly or indirectly, to other nodes in the network. Clustering coefficient evaluates how connected are a node’s neighbors and it can be considered a measure of the redundancy of a node, the higher the clustering coefficient, the lower the local importance of the node1. A GGM can be interpreted as a predictive model, in which the neighbors of each node are its predictors, and can reveal complex predictive patterns (Epskamp, Waldorp, et al., 2017). Haslbeck and Waldorp (2017) have recently proposed to compute, in addition to centrality, the predictability of each node by quantifying the proportion of variance of each node explained within the network model. Nodes with a zero predictability value are those that cannot be predicted, whereas nodes with a predictability value of 1 can be perfectly predicted by their neighbors. Predictability can also be seen as the upper bound estimate of the controllability of a node. If all GGM edges incident to a node indicated causal

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If a node’s neighbors are disconnected from each other (low clustering coefficient), the focal node plays an important role by providing an indirect route among them. Conversely, if a node’s neighbors are well connected (high clustering coefficient), the indirect paths provided by the focal node are redundant with the direct paths among its neighbors, and therefore the focal node is likely to play a less important role (Costantini & Perugini, 2014). We computed clustering coefficient using a generalization of Zhang’s formula of clustering coefficients (Zhang & Horvath, 2005) to networks with both positive and negative edges (Costantini & Perugini, 2014). This generalized index considers that a node is not redundant if its neighbors are connected to each other with an opposite sign to those that it would be expected if only their connections with the focal node were known. These situations, in which triplets of nodes are connected by one or three negative edges, have been called negative triangles (Costantini & Perugini, 2014).

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connections directed to that node, the predictability would be equal to the amount of variance of that node that could be controlled by acting on other nodes in the network (Haslbeck & Fried, 2017). Predictability was found to be higher in community samples than in clinical samples and higher for mood and anxiety disorders than for psychosis (Haslbeck & Fried, 2017). As stated, the network approach is a newly and suitable method to investigate the structure of pathological conditions. It has been used in studying the differential role of symptoms in mental health disorders such as psychosis (Isvoranu et al., 2017) and posttraumatic stress disorder (McNally et al., 2015), as well as in borderline personality disorder (Richetin, Preti, Costantini, & De Panfilis, 2017). To our knowledge, such method has not yet been used to study pathological narcissism.

1.3 Aims of the study In this study, we adopt the network approach to investigate the nature and structure of pathological narcissism. Our first aim is to identify the core aspects of narcissism and investigate their relations. We hypothesize that features of entitlement and self-importance might have a central role in narcissism, as recently suggested (Krizan & Herlache, 2017; Miller et al., 2017). Our second aim is to investigate whether the core features of narcissism and narcissistic traits interconnections differ when considering different levels of personality structure. We hypothesize that traits such as entitlement and self-importance might have a central role in defining pathological narcissism regardless of the level of personality structure. Indeed, manifestations of pathological personality are considered along a continuum with healthy personality expressions, rather than as discrete entities (Krueger & Markon, 2006). Thus, we expect that core features of pathological narcissism are the same in 6

both individuals with healthy and pathological personality structure. On the contrary, we hypothesize that levels of personality structure might affect the way narcissistic traits are related to each other. Indeed, pathological narcissism manifests differently in terms of severity depending on the individual’s level of personality structure (Kernberg, 2007). Thus, the nature and strength of traits interconnections might shape phenotypic manifestations with different levels of severity.

2. Method

2.1 Participants and Procedure The study involved a community sample of 944 Italian adults (697 females, 247 males), with a mean age of 27.25 (SD = 8.72; range = 18 – 64). Participants were invited to participate in this study through announcements on the University Department website. Participants were asked to spread the link to participate to the study through word of mouth and posts on social networks. All participants voluntarily participated in the study after reading and accepting the informed consent form, and they did not receive any kind of reward for participating in the study. All materials and procedures were approved by the Institutional Review Board. 2.2 Measures Pathological Narcissism Inventory (PNI; Pincus et al., 2009). The PNI is a 52-item self-report measure of pathological narcissism. Items are scored on a 6-point scale. Narcissistic grandiosity is measured by three subscales: Exploitativeness (EXP; a manipulative interpersonal orientation), Self-Sacrificing Self-Enhancement (SSSE; the use of purportedly altruistic acts in order to sustain an inflated self-image), and Grandiose Fantasy (GF; engagement in compensatory fantasies of gaining success, recognition, and admiration). 7

Narcissistic vulnerability is measured by four subscales: Contingent Self-esteem (CSE; fluctuations in self-esteem levels in the absence of external sources of admiration and recognition), Hiding the Self (HS; unwillingness to show others one’s faults and needs), Devaluing (DEV; disinterest in others who do not provide admiration, as well as shame over needing recognition from disappointing others), and Entitlement Rage (ER; proneness to experience anger when entitled expectations are not met). Overall, dimensions of the PNI reflect traits of pathological narcissism that can be usually observed in clinical setting (Pincus et al., 2009). In the present study, we considered the seven PNI subscales (range α = .74 .91). Inventory of Personality Organization (IPO; Lenzenweger, Clarkin, Kernberg & Foelsch, 2001). The IPO is a 57-item self-report measure of pathological personality structure according to the Kernberg’s model of personality pathology. Items are rated on a 5-point scale. The IPO measures 4 pathological dimensions of personality structure: Instability of sense of self/others, Instability of goals, Instability of behaviors, and Psychosis. In the present study, we computed a total score by averaging all the items to obtain an index of the level of pathological personality structure (α = .95).

2.3 Statistical Analyses We first estimated a GGM of narcissistic traits in the whole sample of 944 individuals using the graphical lasso algorithm, a state-of-the-art method for estimating a GGM network in a single group of individuals (Friedman, Hastie, & Tibshirani, 1998). We also estimated networks of narcissistic traits in two extreme groups of individuals according to the IPO. Individuals with healthy personality structure were selected whether IPO score was lower or equal to the first decile (IPO ≤ 1.351; low-IPO group; N = 107, 23 females and 84 males, Mean age = 28.3, SD = 8.7), whereas individuals with pathological personality structure were 8

selected whether IPO score was larger or equal to the ninth decile (IPO ≥ 2.614; high-IPO group; N = 101, 38 females and 63 males, Mean age = 24.6, SD = 6.4). To this aim, we employed an extension of the graphical lasso that jointly estimates networks in different groups, the Fused Graphical Lasso (FGL; Costantini et al., 2017; Danaher et al., 2014). This method has been used successfully in several studies in the field of both personality psychology (Costantini & Perugini, 2017; Costantini et al., 2017) and clinical psychology (Fried et al., in press; Richetin, Preti, Costantini, & De Panfilis, 2017). Details about the estimation methods are provided in the Supplementary Material (for an accessible introduction to FGL as well as for a step-by-step tutorial to implement FGL in the R language, see Costantini et al., 2017). Epskamp, Borsboom and Fried (2017) have recently proposed to use a bootstrapbased index to assess the stability of centrality estimates, the CS-coefficient, since such estimates can be unstable and thus lead to non-replicable results, especially in small samples. The CS-coefficient ranges between 0 (complete instability) and 1 (complete stability), a value of .25 or larger indicating sufficient stability2. Here we discuss only indices that resulted sufficiently stable. The CS-coefficient indicated that strength centrality (CS = .75), closeness centrality (CS = .75), and the clustering coefficient (CS = .72) were sufficiently stable in the whole network, but not in the low-IPO or in the large-IPO networks (all CSs-coefficients < .20). An additional centrality index, betweenness centrality, is not computed here because it resulted generally unstable (all CS < .12). We also computed the predictability of each node in the three networks (overall sample, low-IPO group, and high-IPO group), as well as the average predictability in the three networks.

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The CS-coefficient is not implemented for GGM estimated jointly with Fused Graphical Lasso. Consistently with previous contributions (e.g., Fried et al., in press), we computed the CS-coefficient for the low-IPO and for the large-IPO networks on independent estimates of the same networks.

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3. Results and discussion A series of t-test revealed that scores in all PNI subscales are larger in the high-IPO group than in the low-IPO group (all p < .01), suggesting that individuals having a pathological personality structure usually show more severe narcissistic traits than individuals having a healthy personality structure. However, there were no significant differences in variances for the two groups, indicating that the amount of variability in narcissistic traits was independent of the IPO (all p > .19; the exact values of the tests are reported in the Supplementary Table S1). Figure 1 shows the GGM networks computed in the complete sample and in the two subsamples of participants with a low versus high IPO score, the values of centrality and clustering coefficient in the network computed in the whole sample, and the predictability index in the three networks. Correlations among PNI subscales are reported in Table S2, the exact values of the edges in each network are reported in the Supplementary Table S3, whereas the centrality and predictability values are reported in the Supplementary Table S4.

3.1 Centrality and Predictability in whole network From a visual inspection of the network in the whole sample, three nodes are particularly well connected with all aspects of narcissism: Contingent Self-Esteem, Grandiose Fantasy, and Entitlement Rage. They are the three most central nodes both according to strength centrality, and to closeness centrality. The predictability index indicates that these nodes are also the ones that are most predictable in the network, with predictability values approaching 50% of their variance. Taken together, these results indicate that CSE, GF and ER may constitute core aspects of pathological narcissism. This partially supports recent models (Miller et al., 2017; Krizan & Herlache, 2017) suggesting that self-importance and entitlement attitudes are 10

core aspects of pathological narcissism. Additionally, the centrality of CSE in the network is in line with the idea that fragile self-esteem could play an important role in pathological narcissism (Kernis, 2003) in the form of extreme dependency from external sources of admiration. In line with previous findings (Miller et al., 2016; Wright et al., 2013), our results suggest that the description of narcissistic pathology provided by the AMPD is not adequate. Indeed, the AMPD describes narcissistic pathology referring mainly to its grandiose manifestations, and considering vulnerable ones as secondary. Differently, the present study suggests that core aspects of pathological narcissism include traits related to both grandiose and vulnerable narcissistic manifestations (Pincus, Cain, & Wright, 2014; Ronningstam, 2009). A large clustering coefficient, low centrality, and low predictability indicate that SSSE does not play a particularly important role in this network. SSSE reflects the use of purportedly communal and altruistic acts to sustain an inflated self-image (Pincus et al., 2009) and is the only PNI dimension related to covert expressions of narcissistic grandiosity. As stated by Wright (2016), individuals high in SSSE are “unlikely to also endorse very high levels of antagonism or dominance” (p. 13). Thus, it is not surprising that SSSE has a marginal role in the network and is less predictable by other narcissistic traits. However, the empirical investigation of narcissistic traits reflecting pseudo-altruism, as in the case of SSSE, is still limited, and further studies are necessary to clarify the role of SSSE. Finally, results show that EXP has the lowest clustering coefficient, indicating that it conveys unique information that is not implicated by the relationships of its neighbors. The pattern of connections of EXP with its neighbors (Figure 1) suggests that CSE and EXP might be alternative strategies to cope with grandiose fantasies. Individuals with fantasies of grandiosity may try to foster their inflated self-view by seeking positive feedback from others (CSE) or by showing manipulative attitudes to sustain a sense of dominance over others 11

(EXP), but seeking others’ admiration and exploiting them seem alternative strategies (i.e. negative relation). In turn, both individuals who rely on others’ approval and those who try to exploit others may be likely to fail in their attempt, experiencing feelings of anger when others, contrary to their expectations, do not satisfy their needs (ER). Although consistent with our findings and plausible, this explanation is speculative in nature and further studies should clarify such connections.

3.2 Network of pathological narcissism and personality structure Figure 1 reports also the networks computed in the low-IPO and in the high-IPO subsamples. A visual inspection reveals that in both the networks the strongest edges are those connecting HS with DEV, CSE with GF, and ER with GF. However, one of the most noticeable difference is that CSE is directly connected to HS only in the low-IPO network, whereas HS is directly connected to SSSE only in the high-IPO network. Similarities and differences between such networks might help us to better understand the structure of pathological narcissism. First, pathological narcissism includes some traits whose connections are unvaried and stable regardless the underlying personality structure. Individuals who nurture fantasies of grandiosity (GF) usually seek admiration and recognition from others to sustain their inflated self-view (CSE) and show reactive anger when their entitled expectations are disappointed (ER). Again, individuals showing disinterest toward others or feeling ashamed of their needs for admiration when others disappoint them (DEV) usually also avoid showing others such needs (HS). As showed by Wright et al. (2013), both vulnerable traits of devaluing and hiding the self have similar moderate correlations with detachment traits according to the AMPD (APA, 2013). Then, the strong connection between HS and DEV can be explained considering such traits as

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defensive detachment strategies to cope with feelings of frustration that can arise up when others do not satisfy one’s needs. According to Kernberg’s model (2007), narcissistic manifestations at a severe level of pathological personality structure lead to chronic failures and relevant negative consequences in individuals’ life. Our results suggest that only when a healthy personality structure is present individuals whose self-esteem depend heavily on external feedback (CSE) avoid showing others their needs for admiration and recognition (HS). Individuals with healthy personality structure seem to be able to protect themselves from exposure to interpersonal situations that can threaten their fragile self-esteem, whereas the lack of such connections in individuals with pathological personality structure may reflect a lower ability to protect themselves from potential threatening situations. Similarly, our results show that when individuals with an underlying pathological personality structure avoid showing others their needs for admiration and recognition (HS), they usually also engage in pseudo-altruistic acts to enhance their positive self-image (SSSE). Pathological personality structure is mainly defined by unintegrated sense of self and others that lead to affect dysregulation in narcissistic pathology (Kernberg, 2007), as in the case of difficulties in affective empathy (Di Pierro, Di Sarno, Preti, Di Mattei & Madeddu, 2017). Unlike other PDs, identity pathology manifests in narcissists through an unintegrated representation of others, and an integrated, but pathological (i.e. idealized), sense of self (Kernberg & Caligor, 2005). After all, integrated representations of self and others guarantee the capability of depending on others while maintaining a consistent sense of autonomy (Kernberg & Caligor, 2005). Thus, our findings suggest that narcissistic traits of SSSE and HS are strongly connected only in individuals with pathological personality structure, as they reflect the need of maintaining a stable and grandiose self-view while denying dependency on others.

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As regards predictability, the average predictability of the nodes was .38 in the overall network, .39 in the low-IPO network, and .35 in the high-IPO network. These values indicate that, on average, narcissistic traits are slightly less predictable by other traits included in the network for individuals with a pathological personality structure, compared to other individuals. Figure 3 shows that for most nodes predictability is higher for the low-IPO group compared to the high-IPO group. In particular, HS shows to have a much higher predictability for the low-IPO group than for the high-IPO group. Overall, results on predictability are consistent with previous findings showing that networks of mental disorders usually have a lower mean predictability in clinical samples than in community samples (Haslbeck & Fried, 2017). The network of pathological narcissism is more coherent for individuals with healthy personality structure, whereas narcissistic traits in individuals with pathological personality structure might be more influenced by external factors. This is not surprising if we consider that pathological personality structure, as measured by the IPO, includes several pathological aspects that affect personality functioning such as instability of self and other-representations, impulsiveness (i.e. instability of behaviors), difficulties in selfdirectedness (i.e. instability of goals), and mild reality distortions (Preti et al., 2015). Thus, traits reflecting avoidance of showing others one’s needs (HS) are well predicted by the need of protecting one’s fragile self-esteem (CSE) maintaining a grandiose self-image (GF) in individuals with healthy personality structure, while the narcissistic trait of HS could be influenced also by other structural aspects in individuals with pathological personality structure, as in the case of difficulties in recognizing one’s needs because of the lack of identity integration. In fact, identity integration guarantees a subjective feeling of continuity and coherence that helps to develop adequate self-reflective functioning (Kernberg, Weiner, & Bardenstein, 2000), which in turn allows to keep contact with deep aspects of the self, as in the case of needs and emotions. 14

Overall, the present study has relevant clinical and theoretical implications, and future studies could help to deepen some of our findings. Our findings show that some traits have a central role in defining pathological narcissism, regardless of the underlying level of personality structure, whereas the nature and strength of traits interconnections depend on the level of personality structure. Future studies should compare networks of pathological narcissism in healthy participants and PDs patients to test whether our results might be confirmed. As PDs patients have more severe pathological personality structure than healthy controls, we might expect that the nature and strength of narcissistic traits interconnections, but not core features of pathological narcissism, might differ between PDs patients and healthy controls. It is worth noticing that our results show which traits have a central role in defining manifestations of pathological narcissism which are relevant from a clinical point of view. However, we cannot exclude that other traits could be found as core aspects when examining narcissism in other contexts of study. In fact, the meaning of what can be considered a core aspect of a phenomenon depends on the main focus of investigation. Future studies could also extend the investigation of core and peripheral aspects of pathological narcissism in larger samples, with relevant implications in terms of generalizability of results. We did not consider gender differences in networks of pathological narcissism depending on personality structure, due to the two groups size (low- and high-IPO groups). Future studies could extend our findings testing whether the nature and structure of pathological narcissism might be affected by the level of personality structure differently in males and females. Finally, we included only one self-report measure of pathological narcissism, and this could limit the generalizability of our findings. Future studies should use multiple measures of pathological narcissistic traits including traits others than those measured by the PNI. Using multiple measures of narcissism could help to better understand which traits among the others might have a central role in defining pathological narcissism. 15

4. Conclusions The present study adopted a network approach for investigating the nature and structure of narcissism. Our findings shed light on some ongoing debates, as they show the differential role of narcissistic traits in defining pathological narcissism. The study suggests that traits of grandiose fantasies, entitlement rage and contingent self-esteem have a central role in defining pathological narcissism, regardless of the underlying individuals’ personality structure. On the contrary, the strength and the nature of interconnections between narcissistic traits seems to be affected by the underlying level of personality structure.

Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors

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Figure 1. Network analysis of narcissistic traits.

Notes: Green (full) lines represent positive edges and red (dashed) lines represent negative edges. EXP = Exploitativeness, SSSE= Self-Sacrificing Self-Enhancement, GF = Grandiose Fantasy, CSE = Contingent Self-esteem, HS = Hiding the Self, DEV = Devaluing, ER = Entitlement Rage.