What Happens When Narcissism Turns Malignant

In a recent New York Times op-ed, renowned psychiatrist Richard Friedman discounted the idea that we can assign a mental health diagnosis to President Donald Trump. Friedman was discussing the wave of speculation disseminating through the mental health community, and the news, that President Trump suffers from one or another psychological disorder. As pointed out by Friedman, the “Goldwater Rule,” instituted by the American Psychiatric Association in 1973, makes it unethical for anyone, even a mental health professional, to provide a diagnosis without a face-to-face assessment. As Friedman states: “This is all to say that when mental health professionals label public figures with mental illnesses, it is not just unethical — it’s intellectually suspect. We don’t have the requisite clinical data to know what we are talking about.”

One of the targets of Friedman’s opinion piece was a U.S. News and World Report article entitled “Temperament Tantrum,” in which Senior Writer Susan Milligan claimed that Trump’s narcissism went beyond simple, everyday narcissism, but takes a malignant form. Quoting John Gartner, a Johns Hopkins psychotherapist who wrote a biography of Bill Clinton, Trump has “malignant narcissism,” an incurable disorder that includes “anti-social behavior, sadism, aggressiveness, paranoia and grandiosity.”

The three things wrong with this “diagnosis” are that (a) Gartner violates the Goldwater Rule, (b) there is no such diagnosis as “malignant narcissism,” and (c) since there’s no such diagnosis, it’s not clear how it can be “incurable.” In fact, the term “malignant narcissism” is a colorful but unsubstantiated construct coined by psychoanalyst Otto Kernberg, whose specialty was the psychology of narcissism long before it was in popular usage.

This discussion raises the interesting question, nevertheless, of what we know about the constellation of personality traits that make up narcissism’s malignant variety and whether progress has been made since in the ensuing decades since Kernberg's writing. Although you won’t find the term “malignant” applied to narcissism, there are an increasing number of studies examining the “Dark Triad” in personality that adds psychopathy and Machiavellianism (extreme deviousness) to the portrait of narcissism. The Dark Triad, though, does not quite fit the bill of being “malignant” because, as we saw from Gartner’s quote, you need to add sadism as a fourth trait.

The Dark Triad becomes malevolent, then, when you add the true desire to inflict pain onto others in order to exact your own pleasure. Mitch van Geel of Leiden University (the Netherlands) and his collaborators (2017) believed that the Dark Triad plus sadism provides the perfect breeding ground for bullies. The Dark Triad plus sadism then becomes the “Dark Tetrad.” van Geel et al. proposed that this combination of four traits would predict the behavior of bullies—both of the physical and cyber varieties.

The main question of the Dutch study was whether the Dark Tetrad would uniquely predict bullying behavior, defining bullying as “a subtype of aggressive behavior wherein a relatively powerful perpetrator repeatedly harasses a weaker victim, in a physical, relational, or verbal manner” (p. 231). Because cyberbullying has become, unfortunately, a common variant of physical bullying, the van Geel and team study examined predictors of both traditional and virtual bullying behaviors.

Relying on self-reported instances of in-person and cyberbullying, the researchers asked participants to complete, in addition, a series of personality questionnaires. These included the Five Factor Model measure of what we might consider “normal” personality traits of openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism as well as measures of the Dark Triad and sadism. For this latter trait, participants completed the Varieties of Sadistic Tendencies Scale (VAST) in which they endorsed items reflecting enjoyment from hurting or humiliating others (direct sadism) and enjoyment from watching other people suffer (indirect sadism). As we tend to associate bullying with adolescence, the participants were an age-appropriate sample of high school students in the Netherlands. Obviously, bullying isn’t restricted to this age group, but it is certainly a prevalent feature of teenage life.

The good news from the Leiden University study is that when you expand your definition of personality to include more than the Dark Tetrad, you find out who is least likely to be a bully. This would be the highly agreeable individual. All other things being equal, a “nice” person is unlikely to engage in bullying of any form. Agreeableness implies not only the ability to be nice, but also to be altruistic and tender-minded. Feeling sympathy with the target of bullying, we might even imagine that such highly agreeable individuals would step in and try to prevail on bullies to stop targeting their weaker victims.

This finding on agreeableness was predicted and, in fact, makes sense. Surprisingly, though, narcissism had no relationship to bullying. The authors reasoned that narcissism alone, defined as extreme self-love, grandiosity, and superiority, alone wouldn’t lead an individual with these traits to seek out ways to torment others. Furthermore, the ordinary Dark Triad traits weren’t enough to predict levels of bullying. The authors conclude that it's sadism that becomes the key to understanding what makes bullies bully: “bullies may simply like to see their victims suffer” (p. 234). Bullying comes not from some sort of desire to manipulate others, but from the “pernicious pleasure” (p. 235) it provides.

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The van Geel study demonstrates, then, from an empirical perspective, why it’s so difficult—and inappropriate—to provide diagnoses of public figures using terms that have a broad if not sloppy meaning. Teasing apart the components of the Dark Tetrad led these researchers to be able to predict a very harmful interpersonal set of behaviors from one, but not all four, traits. This doesn’t mean that the Dark Tetrad doesn’t exist as a constellation of traits, but it does mean that they can each have independent relationships with particular behaviors.

We don’t know whether adolescents who enjoy bullying will spend their lives involved in tormenting others, but it would be unwise to argue that any aspects of personality are “incurable.” Traits and situations interact in countless complex ways throughout life. Even those whose personalities live in the darkest of shadows may find new pathways to fulfillment as their experiences shape their development.

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Copyright Susan Krauss Whitbourne 2017