Pathological Narcissism and Suicidal Tendencies in Psychiatric Outpatients: Mediating Role of Shame Experiences

Abstract

Introduction Pathological narcissism, described by two dysfunctional phenotypic forms – grandiosity and vulnerability – has often been connected to suicidal tendencies in theoretical and clinical literatures. Furthermore, shame-proneness has been implicated as a key mechanism that links these two constructs. However, empirical evidence for the presumed relationship between narcissism and suicidal tendencies is sparse, and no prior research has investigated the role of shame experiences in this relationship. Objectives The goal of the present research was to investigate the relations between pathological narcissism (grandiose and vulnerable narcissism) and suicidal ideation in psychiatric outpatients. The potential mediating role of shame experiences in the pathological narcissism – suicidality relationship was examined. Methods A sample of 190 adult psychiatric outpatients (64% female; mean age 40.34 years), heterogeneous in terms of psychiatric diagnoses, was gathered between January and April 2014. The participants filled out the Pathological Narcissism Inventory (PNI), the Experience of Shame Scale (ESS), and the Suicide Assessment Scale – self-rating (SUAS-S). Results Narcissistic vulnerability was found to have unique positive association with acute suicidal ideation, whereas narcissistic grandiosity exhibited no relation with the same construct. Moreover, two dimensions of shame – characterological and bodily shame – mediated the relationship between narcissistic vulnerability and suicidality. Conclusions Narcissistic vulnerability seems to be more strongly related to suicidal ideation than narcissistic grandiosity, while experience of shame represents one of the underlying mechanisms of this relationship among psychiatric outpatients. These findings have relevant implications for the diagnostic classification of pathological narcissism as well as its treatment.