When social anxiety and narcissism coincide

344 Pages·2016·2.37 MB·English

by  James Williams

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When social anxiety and narcissism coincide: An exploration of narcissistic social
anxiety subgroups
James S. Williams
A thesis submitted in total fulfilment of the requirements of the degree of
Doctor of Philosophy
2016
Department of Psychological Sciences
Faculty of Health, Arts and Design
Swinburne University of Technology
Melbourne, Australia
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Abstract
This thesis develops an argument for the existence of narcissistic social anxiety
subtypes. The genesis of this argument came from a review of historical and
contemporary literature on social anxiety revealing that some socially anxious
individuals exhibit narcissistic characteristics. This review supported an argument for
the existence of distinct overt and covert narcissistic social anxiety subtypes.
Two studies were conducted to explore narcissistic social anxiety subtypes.
Study one comprised 349 individuals (204 women (MAge = 32.02), 145 men (MAge =
31.69), and study two 612 individuals (380 women (MAge age = 26.27) and 232 men
(MAge = 26.92). Study one identified five subgroups, four of which were socially
anxious, and one non-socially anxious. Of the four socially anxious subgroups, three
were associated with elevations on multiple narcissism scales. Two had elevations on
covert narcissism, though differed on anger. These groups were classified as angry
covert and covert narcissistic social anxiety subgroups. The third group was
characterised by elevations on overt and covert narcissism and was classified as the
narcissistic social anxiety group. Further exploration of the subgroups revealed the
narcissistic social anxiety subgroups reported more shame, depression, anxiety and
stress and worse personality organisation than the non-narcissistic social anxiety
subgroup. The angry covert narcissistic subgroup was the most impaired.
Study two replicated study one and identified similar subgroups in a different
sample. In addition to greater social anxiety and psychological distress, the covert
narcissistic groups experienced greater Taijin-Kyofusho (TKS) related anxiety. The
narcissistic subgroup reported higher social rank than the other social anxiety
subgroups, although despite this, had poor personality organisation.
Overall, the key contribution of this thesis was the identification of four unique
social anxiety subgroups. The two covert narcissistic social anxiety subgroups represent
severely maladjusted individuals. The narcissistic social anxiety subgroup, while not as
maladjusted as the covert groups, represents a subgroup of social anxiety not captured
in the DSM-5 diagnostic criteria. These individuals reported high social anxiety,
psychological distress and shame concerning personal efficacy. Yet this occurred
alongside higher perceived social rank, and a greater likelihood of being in a
relationship relative to the covert narcissistic groups. The new subtypes identified
provide a way to bridge several theoretical models of social anxiety, including
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evolutionary, contemporary psychodynamic and cognitive theories. The results of the
two studies also have implications for the diagnosis and treatment of social anxiety.
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Acknowledgements

I am indebted to many people, without whom this PhD journey would not have been
possible. First, I would like to thank my supervisor, Professor Glen Bates for his
constant, ongoing support, encouragement and constructive continuous feedback over
the many years that I have been working on this thesis. In addition, I would like to thank
my associate supervisor, Dr Roslyn Galligan, whose advice on Kohut’s theories in
particular was very much appreciated. Thank you also to the many friends, colleagues
and students at Swinburne whom I was fortunate to meet during my candidature. In
particular, Matt Farrugia, whose support and friendship is appreciated.

I would like to thank my parents and grandparents who have been a constant source of
support and encouragement to me. Thank you for putting up with many years of this
thesis, and for encouraging my interest in research. Without your support, this thesis
would not have been possible.

Finally, I would like to thank my wife, Elizabeth, and our two children Meredith and
Julianne who have endured many, many years of me working on this thesis. Your
emotional support and endless patience and encouragement during the long process of
completing this PhD have been invaluable. I love you all very much, and this thesis
wouldn’t have been possible without you. I look forward to having weekends free!
Thank you also to our furry family members, Milly and Elsa (and Mindy and Polly
before them).
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Declaration by candidate

This thesis contains no material which has been accepted for the award of any other
degree or diploma, except where due reference is made in the text of this thesis. To the
best of my knowledge this thesis contains no material previously published or written
by another person except where due reference is made in the text. Where the work is
based on joint research or publications, the relative contributions of the respective
authors are disclosed in the text.

Signed: ________________________________

Dated: _________________________________
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Table of contents

Abstract ............................................................................................................................. ii
Acknowledgements .......................................................................................................... iv
Declaration by candidate ................................................................................................... v
Table of contents .............................................................................................................. vi
List of tables ................................................................................................................... xvi
List of Figures .............................................................................................................. xviii
Chapter 1: Introduction and Overview .............................................................................. 1
Chapter 2: Historical Review of Social Anxieties ............................................................ 4
French contributions in the late 19th and early 20th centuries ....................................... 4
Dugas. ....................................................................................................................... 4
Paul Hartenberg. ........................................................................................................ 5
Pierre Janet. ............................................................................................................... 6
Summation of early French theories of social anxiety. ............................................. 7
Freud’s Theories on Anxieties and Phobias .................................................................. 7
Anxiety (anxiety neuroses and psychoneuroses). ..................................................... 7
Phobias (anxiety-hysteria). ........................................................................................ 9
Inhibitions, Symptoms and Anxiety. ......................................................................... 9
Freud’s views of social anxiety. .............................................................................. 10
Freud’s key contribution on social anxiety. ............................................................ 11
Developments in the Understanding of Social Anxiety: 1926 – 1950 ........................ 11
Hampton. ................................................................................................................. 11
Edward Glover. ....................................................................................................... 12
Otto Fenichel. .......................................................................................................... 12
Schilder. .................................................................................................................. 13
Kaufman. ................................................................................................................. 14
Lewinsky. ................................................................................................................ 14
Myerson. ................................................................................................................. 14
Points of Convergence in the Social Anxiety Literature 1926-1950 .......................... 15
Dixon, Sandler and De Monchaux’s Contributions .................................................... 15
Overview of the contributions of Sandler et al. ...................................................... 17
The Shift Towards Behavioural Models of Anxieties and Phobias ............................ 18
Cognitive-Behavioural Theories of Social Anxiety .................................................... 20
Self-presentation model of social anxiety. .............................................................. 20
Clark and Wells’ cognitive model of social anxiety. .............................................. 21
Rapee and Heimberg’s cognitive behavioural model of social anxiety. ................. 25
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Summation of cognitive behavioural models. ......................................................... 25
Alternative Models of Social Anxiety ........................................................................ 26
Interpersonal theory of social anxiety. .................................................................... 26
An attachment theory perspective on social anxiety. .............................................. 28
Contemporary psychodynamic theories of social anxiety. ..................................... 29
Ethological/evolutionary models of social anxiety. ................................................ 31
Paul Gilbert’s ethological model of social anxiety. ............................................ 31
General ethological model. ............................................................................. 31
Evolved mental systems. ................................................................................. 31
Social rank. ...................................................................................................... 34
Gilbert’s ethological model of social anxiety. ................................................ 35
Review of Alternative Models of Social Anxiety ....................................................... 37
Chapter Summary........................................................................................................ 37
Chapter 3: Taijin-Kyofusho ............................................................................................ 39
Shoma Morita .............................................................................................................. 39
Shinkeishitsu and the development of Taijin-Kyofusho. ........................................ 40
Current Research on Taijin-Kyofusho ........................................................................ 41
Taijin-Kyofusho subtypes. ...................................................................................... 41
Offensive and neurotic subtypes of Taijin-Kyofusho. .................................... 42
TKS outside of Japan and Korea. ............................................................................ 43
Comparison of Taijin-Kyofusho with Western Accounts of Social Anxiety ............. 45
Chapter Summary........................................................................................................ 46
Chapter 4: Social anxiety in the psychiatric nomenclature ............................................. 47
Social Anxiety in the Diagnostic and Statistical Manual of Mental Disorders .......... 47
DSM I and II. .......................................................................................................... 48
DSM-III. .................................................................................................................. 48
DSM-III-R. .............................................................................................................. 51
DSM-IV and DSM-IV-TR. ..................................................................................... 52
DSM-5. .................................................................................................................... 54
Avoidant Personality Disorder in the DSM ................................................................ 56
DSM-III. .................................................................................................................. 56
DSM-III-R. .............................................................................................................. 58
DSM-IV and DSM-IV-TR. ..................................................................................... 60
DSM-5. .................................................................................................................... 61
The Relationship Between SAD and AVPD ............................................................... 62
Social Anxieties in the International Classification of Diseases (ICD) ...................... 64
Social Phobia. .......................................................................................................... 65
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Anxious (avoidant) personality disorder. ................................................................ 66
Psychodynamic Diagnostic Manual (PDM)................................................................ 66
Summation of Social Anxiety as a Diagnosis ............................................................. 67
Social Anxiety Subtypes ............................................................................................. 68
Alternatives to the DSM subtypes........................................................................... 68
Friendly-Submissive and Hostile-Dominant Subtypes. ...................................... 68
Approach-Motivated and Avoidance-Motivated Subtypes. ................................ 70
Summation of Kachin et al. and Kashdan and colleagues subgroups. ................ 72
Chapter Summary and Conclusions ............................................................................ 73
Chapter 5: The Clinical Perspective on Narcissism ........................................................ 75
Early History of the Concept of Narcissism ............................................................... 76
The Narcissus myth. ................................................................................................ 76
Early psychiatric research. ...................................................................................... 77
Ellis and Näcke: Auto-eroticism and narcissism. ................................................... 77
Freud’s theories of narcissism. ................................................................................ 78
Freud’s early work on narcissism. .................................................................. 78
Freud’s “On Narcissism”. ............................................................................... 80
Early post-Freudian contributions. .......................................................................... 81
Karen Horney. ..................................................................................................... 81
Annie Reich ......................................................................................................... 82
Contemporary post-Freudian contributions. ........................................................... 82
The contributions of Otto Kernberg and Heinz Kohut............................................ 83
Otto Kernberg’s theory of narcissism. ................................................................ 83
Normal Narcissism. ......................................................................................... 84
Pathological Narcissism. ................................................................................. 85
Pathological narcissism and Borderline Personality Organisation. ................ 87
Heinz Kohut: Self Psychology and the theory of narcissism. ............................. 87
Clinical presentation........................................................................................ 90
Compatibility of Kernberg and Kohut’s theories with the theory of a relationship
between social anxiety and narcissism. ................................................................... 91
Post Kernberg/Kohut theoretical contributions to clinical narcissism. ................... 93
James Masterson’s theory of closet narcissistic disorder of the self. .................. 93
Masterson and the relationship between narcissism and social anxiety. ........ 97
Cooper’s theory of the relationship between narcissism and masochism. .......... 98
Masochism. ..................................................................................................... 98
The Narcissistic-Masochistic Character. ......................................................... 98
Compatibility of Cooper’s theory of narcissism with the theory of a
relationship between narcissism and social anxiety. ....................................... 99
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Cognitive theory of narcissism.......................................................................... 100
Similarity between the cognitive model and the psychodynamic models. ... 101
Compatibility of the cognitive theory of narcissism and the theory of a
relationship between narcissism and social anxiety. ..................................... 102
Narcissism in the Psychiatric Nomenclature......................................................... 102
Narcissism in the DSM. .................................................................................... 103
Compatibility of the DSM conceptualization of narcissism and the theory of a
relationship between narcissism and social anxiety. ..................................... 106
Narcissism in the Psychodynamic Diagnostic Manual ..................................... 106
Compatibility of the PDM conceptualization of narcissism and the theory of a
relationship between narcissism and social anxiety. ..................................... 107
Chapter Summary...................................................................................................... 108
Chapter 6: The social-personality perspective and covert narcissism .......................... 109
The Social-Personality Perspective ........................................................................... 109
The Narcissistic Personality Inventory. ............................................................ 110
Factor structure of the NPI. ................................................................................... 111
Empirical research using the NPI. ......................................................................... 111
The NPI and psychological health. ................................................................... 112
Narcissism and self-esteem instability. ............................................................. 113
The NPI and interpersonal maladjustment. ....................................................... 114
A proposal to revise the NPI. ................................................................................ 115
Review of the Social-Personality Perspective .......................................................... 117
Overt and Covert Narcissism .................................................................................... 118
Historical development of the concept of covert narcissism. ............................... 119
Theoretical developments. ................................................................................ 119
Kohut and covert narcissism. ........................................................................ 119
Bach’s extension of Kohut’s work. ............................................................... 119
Bursten’s narcissistic types. .......................................................................... 120
Miller’s perspective on narcissistic disturbance. .......................................... 121
Covert narcissism and DSM. ............................................................................ 122
Post DSM-III work on covert narcissism. ......................................................... 123
Empirical research on covert narcissism. .............................................................. 124
Early empirical research on covert narcissism. ................................................. 124
Later empirical research on covert narcissism. ................................................. 128
Development of the Hypersensitive Narcissism Scale.................................. 128
Overt narcissism, covert narcissism and approach-avoidance motivation.... 129
Overt Narcissism, covert narcissism and aggression. ................................... 131
Development of the Pathological Narcissism Inventory. .............................. 132
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Overview of Overt and Covert narcissism ................................................................ 133
Attempting to Bridge Clinical, Social Personality and Overt/Covert Narcissism .... 133
Current Work on Social Anxiety and Narcissism ..................................................... 135
Summary of the Narcissism Chapters ....................................................................... 136
Chapter 7: Study 1 Exploration of Narcissistic Social Anxiety Subgroups .................. 137
Study 1 Part A ........................................................................................................... 137
Aims and hypotheses. ........................................................................................... 137
Method .................................................................................................................. 137
Participants ........................................................................................................ 137
Rationale for sample selection strategy. ....................................................... 137
Recruitment. .................................................................................................. 138
Characteristics of the final Sample ................................................................... 139
Description of the sample.................................................................................. 139
Country of residence. .................................................................................... 139
Relationship status. ....................................................................................... 139
Education status. ........................................................................................... 140
Self-reported clinical history. ........................................................................ 141
Self-report measures of Social Anxiety and Narcissism ................................... 141
Measures of Social Anxiety. ......................................................................... 141
Measures of Narcissism. ............................................................................... 144
Narcissistic Personality Inventory................................................................. 144
Narcissistic Personality Disorder Scale (NPDS). ......................................... 145
The Hypersensitive Narcissism Scale (HSNS). ............................................ 146
Results ................................................................................................................... 147
Preliminary analyses of the scales..................................................................... 147
Preliminary analyses of social anxiety scales. .............................................. 147
Univariate normality of the Social Anxiety Scales. ...................................... 148
Preliminary analyses of the narcissism scales. .............................................. 149
Univariate normality of the narcissism scales. .............................................. 149
Overview of univariate normality. ................................................................ 150
Overview of multivariate normality. ............................................................. 150
Overview of scale reliability. ........................................................................ 150
Age and gender differences in the scales. ......................................................... 151
Age differences. ............................................................................................ 151
Gender differences. ....................................................................................... 151
Cluster Analysis. ............................................................................................... 152
Choice and justification of cluster analytic method. ..................................... 152