Narcissism: Investigation of an assessment tool and understanding its contribution to eating disorder treatment using a self psychology perspective

The framework of self psychology suggests that narcissism can play a significant role in the pervasive treatment resistance in eating disorders (EDs). The primary focus of this research program is to examine the differential roles of grandiose narcissism and vulnerable narcissism in treatment resistance in a clinical population of individuals with anorexia nervosa or bulimia nervosa. This research explored the factor structure of the Narcissistic Personality Inventory (NPI), assessed grandiose narcissism and vulnerable narcissism among ED patients including their influence on resistance, and examined whether therapists endorse eating symptomatology and narcissism (in turn, contributing to clients’ resistance). Study 1 assessed the factor structure of the NPI and examined GN in the ED population. Using a sample of the general population (N = 905), a three-factor solution of the NPI was found: 1) authority and self-sufficiency; 2) entitlement, exhibitionism and exploitativeness; and 3) superiority and vanity, highlighting the three main components of GN. Study 2 explored whether the two facets of narcissism, grandiose narcissism (including its factors as identified in Study 1) and vulnerable narcissism, are present in individuals with either anorexia nervosa or bulimia nervosa and whether these facets of narcissism predict treatment resistance in this population. Using a self-report questionnaire with a sample of adults (N = 180), findings revealed that 1) VN was elevated in individuals with anorexia nervosa and bulimia nervosa compared to a mental health control group and a healthy control group; 2) both ED groups scored significantly higher on entitlement, exhibitionism and exploitativeness; 3) both ED groups endorsed state-like resistance; 4) both ED groups endorsed one trait-like resistance measure (i.e., significantly lower expectation of benefit); 5) anorexia nervosa endorsed an additional trait-like resistance measure (i.e., significantly higher self-orientation/narcissism); 6) authority and self-sufficiency contributed to state-like resistance in the bulimia nervosa group; and 7) entitlement, exhibitionism, exploitativeness, superiority and vanity contributed to trait-like resistance in the AN group. Study 3 explored narcissism and eating disorder symptoms in treatment providers of individuals with eating disorders as the presence of these characteristics in this population may result in treatment hindering countertransference. In Study 3, ED therapists, non-ED therapists, individuals with anorexia or bulimia nervosa and a healthy control group (N = 955) completed self-report measures. Results revealed that ED therapists scored 1) higher on GN and authority and self-sufficiency compared to all groups; 2) significantly higher on entitlement, exhibitionism and exploitativeness than non-ED therapists; and 3) significantly lower on superiority and vanity than non-ED therapists and healthy controls. Study 4 aimed to clarify and obtain a deeper understanding of the findings of Study 2 and Study 3 by interviewing patients with EDs (N = 14). The data confirmed that participants identified with the characteristics of GN and VN and that these characteristics contributed to resistance. However, there was little evidence that ED-therapists were perceived as eating disordered or narcissistic. This research provides the first psychometrically sound three-factor solution of the NPI in a general population sample. Also, this research is the first to examine the two facets of narcissism (VN and GN) in a clinical eating disorder population and demonstrates the importance of including VN and aspects of GN in the conceptualisation of AN and BN as these play some role in treatment resistance.