The increasing prevalence of psychological disorders raises more questions about the development of these disorders. Among the many to raise controversy in the “nature vs nurture” dispute is narcissistic personality disorder (NPD). Otto Rank’s 1911 paper was the first to psychoanalyze the concept of narcissism, a notion based on the Greek legend of “Narcissus” (Akhtar and Thompson, 1982). His work paved the way for later research that discovered NPD, which is now categorized as a cluster B personality disorder by the DSM 5.
The two types of NPD
Before getting into the root-causes of NPD, it is important to remember the fact that this disorder is distinguished in the DSM-5 under two different types.; grandiose and vulnerable narcissism. Grandiose narcissism is characterized by an exaggerated sense of self-importance, a preoccupation with fantasies of unlimited success, power, and brilliance, and a belief in one’s inherent superiority over others. Individuals with grandiose NPD often exhibit arrogance, a lack of empathy, and a tendency to exploit others for personal gain. On the other hand, vulnerable narcissism involves an underlying sense of inadequacy and hypersensitivity to perceived criticism or rejection. Those with this subtype may appear shy or reserved, but their self-absorption and need for constant validation can lead to interpersonal difficulties. Both subtypes share a core feature of self-centeredness but manifest in distinct ways. (Gabbard, 1989)
Distinguishing Features of NPD
Weinberg and Ronningstam (2022) attribute the diverse manifestations of pathological narcissism to the complex interplay of psychological dynamics underlying the disorder. Lack of empathy has always been a central component of the diagnostic criteria defining NPD, but the causes responsible for this deficit have been consistently updated with each new edition of the DSM. Recent studies have also identified temperamental characteristics as precursors to the formation of NPD. Cramer (2017) found that childhood impulsivity and unstable self-esteem were positively correlated to (and even predictive of) vulnerable narcissism, a subtype of NPD. Temperamental antecedents of grandiose narcissism, another subtype of NPD, include low playfulness, histrionic tendencies, and attention seeking (Carlson and Gjerde, 2009).
In the pop-psychology world, personality disorders are commonly attributed to the early stages of a person’s life. However, evidence suggests a strong biological root for the disorder.
Genetic influence on the development of NPD
The genetic predisposition to NPD is increasingly recognized through studies examining the heritability of narcissistic traits. Twin, family, and adoption studies have provided evidence supporting a substantial genetic influence on narcissistic personality features, with heritability up to 24% (Cloninger, 2020). Specific genes related to neurotransmitter systems, such as serotonin and dopamine, have been implicated, suggesting a biological basis for certain personality traits associated with NPD (Ma et al., 2016).
While genetic factors lay the groundwork, they interact dynamically with environmental influences. Individuals with a genetic predisposition may exhibit varying degrees of vulnerability or resilience to narcissistic traits based on their life experiences and upbringing. Heritable factors serve as a foundation, shaping the potential for NPD, but does not determine the outcome independently.
Parental Engagement
Studies from the past two decades have linked and categorized the developmental factors behind the formation of both subtypes of NPD. Physical neglect (Hengartner et al., 2013) parental hostility (Wetzel and Robins, 2016), and emotional abuse (Clemens et al., 2022) were among the childhood adversities deemed precursors of grandiose narcissism. Physical abuse (Keene and Epps, 2016) and
maltreatment (Bertele et al., 2022) were among the childhood adversities linked to the development of both subtypes of NPD. Other environmental factors include parenting styles. For instance, paternal overvaluation (Brummelman et al., 2015) and paternal control (Winner and Nicholson, 2018) were listed as precursors leading to the formation of grandiose narcissism. Furthermore, invalidation (Huxley and Bizumic, 2017) and coldness/rejection (Horton and Tritch, 2014) were parental factors linked to the formation of both subtypes of NPD. Hong et al. (2017) studied the developmental trajectories of maladaptive perfectionism and found NPD to be an adaptation to neglectful parenting and emotional injury in childhood, caused by parental criticism and humiliation.
Genetic and environmental interplay
The hereditary and environmental mechanisms behind NPD are also relevant when assessing the prognosis of the disorder. Hallquist and Lenzenweger (2013) found the presence of comorbid disorders to be a setback when treating persistent impaired functioning. Age was also listed as a moderator of a patient’s prognostic trajectory, with younger samples recorded as more likely to improve (Durbin & Klein, 2006). Lastly, evaluation of life events, such as new relationships, employment status, and family relations are influential moderators when assessing prognosis. Processing life events in a sympathetic environment increases chances of improvement (Ronningstam, Gunderson, Lyons, 1995), whereas paranoid thinking and antisocial traits hinder the recovery process (Lenzenweger et al., 2018).
Conclusion
In conclusion, the etiology of Narcissistic Personality Disorder (NPD) is a multifaceted interplay between genetic predispositions and environmental factors, offering a nuanced perspective on the “nature vs nurture” debate. While evidence suggests a strong genetic influence on the development of narcissistic traits, environmental factors, particularly adverse childhood experiences such as physical abuse, maltreatment, and emotional abuse, play a crucial role in shaping the trajectory of NPD. Parental engagement, including overvaluation, control, invalidation, and rejection, contributes significantly to the formation of both subtypes previously mentioned. Understanding the complex origins of NPD is essential for developing effective therapeutic interventions that consider both the biological and environmental aspects of this challenging personality disorder. Further research and clinical advancements will contribute to refining our comprehension and treatment strategies for individuals grappling with Narcissistic Personality Disorder.
