Various forms of narcissism have differing implications for therapy.
It is not unusual today for individuals to be labeled as narcissistic by family members, friends, or co-workers. It has become a popular concept and, according to some experts, a more common problem among today’s Generation Y than among prior generations (Twenge, 2006). Other experts disagree about the change in prevalence. Most notably, Dr. Craig Malkin has written comprehensively on the subject of narcissism (Malkin, 2015) and has concluded that the prevalence of Narcissistic Personality Disorder (a specific diagnosable form) remains unchanged at 1% of the population. The contradictions are head-spinning, especially when you take into account all of the various forms of this personality style and all of the labels given to these forms.
It is somewhat helpful to know that most of the experts at least agree that there are different forms of narcissism. The most basic difference is that between what most have called “grandiose narcissism” versus “vulnerable narcissism” (Wink, 1991; Dickinson and Pincus, 2003). The grandiose narcissist is described as arrogant, entitled, exploitative, and envious. He maintains his own self-esteem by self-enhancement, denial of weaknesses and demands of entitlement. He may become angry and aggressive (at least verbally) when his needs are not met. In contrast, the vulnerable narcissist is overly self-inhibited and appears modest, but actually has grandiose expectations for himself and others. The failure to meet his own high expectations as well as the failure of others to meet his expectations often leads to anger, disappointment, shame, and social withdrawal. Both types feel entitled, lack empathy, and exploit others to meet their own needs.
A further distinction is that the grandiose narcissist is more social, more aggressive and tends to be dominant in relationships. He is usually characterized by a high level of self-acceptance, although here is another example of disagreement in the literature. Some have argued that the grandiose narcissist actually has low self-esteem and covers up for those feelings with arrogance. For a discussion of those differing views, see “http://psychologytoday.com/blog/the-narcissism-epidemic/narcissism-and-the-myths-that-just-won-t-die.” There seems to be less controversy about whether or not the vulnerable narcissist has low self-esteem. These individuals exhibit more distress, decreased sociability, and lower levels of self-acceptance. An interesting contrast was noted when the spouses of narcissists were asked to describe the behaviors of concern to them. Grandiose narcissists were described as aggressive, exhibitionistic, and lacking awareness of how their behavior affects others. Vulnerable narcissists were described by spouses as dissatisfied, anxious, and bitter. (Wink, 1991).
Contrary to the standard grandiose vs. vulnerable distinction, Malkin disputes the idea that any narcissist is vulnerable. He prefers the terms “extroverted narcissist” and “introverted narcissist” (Malkin, 2015). This re-labeling emphasizes that the narcissistic person is less often the victim/vulnerable one than those with whom s/he lives or works. Malkin adds a third sub-type to his description of narcissistic personality styles: the “communal narcissist”. This is the person who promotes himself as committed to the general well-being of others. This is the do-gooder who appears to be invested in helping others but eventually is found out to be acting in his own self-interest and disregarding the negative consequence for others.