Infatuation Rules
Infatuation Rules
Photo: Laura Tancredi
Narcissistic traits have been linked to structural and functional brain networks, including the insular cortex, however, with inconsistent findings. In this study, we tested the hypothesis that subclinical narcissism is associated with variations in regional brain volumes in insular and prefrontal areas.
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Read More »The present study set out to test the hypothesis that subclinical narcissistic traits in a nonclinical population would be associated with brain structural variation of grey matter, esp. in prefrontal systems. And indeed, our findings provide evidence of a correlation of prefrontal cortical grey matter with NPI narcissism. Our interpretation of results is directed at the three main aspects of the study: first, the implication of insular and prefrontal cortical regions (including orbitofrontal, ventromedial/medial prefrontal, and dorsolateral prefrontal areas) towards a neurobiological model of narcissistic traits; second, the relation of our findings to the (limited) imaging studies in clinical narcissistic personality disorder (NaPD); and thirdly, an overlap of our findings with studies of related behavioural traits, such as social dominance or self-enhancement, which map to some of the identified regions. Our findings extend the previous structural association studies of narcissism (measured with the PNI) and reduced right dorsolateral prefrontal thickness34 by showing a (positive) correlation with a more widespread network of prefrontal areas including the medial/ventromedial and orbitofrontal cortices, subgenual anterior cingular as well as insular cortices. It is therefore the first to suggest multiple widespread prefrontal networks to be involved in the narcissistic phenotype. This is of relevance, esp. given a previous VBM study failing to demonstrate such an association35. This seems plausible, also given the multiple facets of narcissism on the phenotype level1,50, which do not make convergence on a single neuroanatomical region/network plausible. In fact, the insular finding potentially links our finding to both studies of cognitive empathy27,51,52 as well as to studies in patients with clinical narcissistic personality disorder52. However, the latter study, similar to another pilot study in NaPD42, only had small sample sizes, and rather hinted to a lateral prefrontal deficit. It is worthwhile noting that, unlike the clinical studies, our findings showed a positive, rather than negative, correlation of the narcissistic phenotype with brain volumes. It is interesting to note that comparable VBM studies of nonclinical population assessing subclinical phenotypes, for example irritability/hostility53 or impulsivity54 have shown such positive correlations and it has been suggested that this might be due to a non-linear association across a broader continuum (from nonclinical to pathology), of which only a small proportion would be assessed in a nonclinical study; hence, if narcissism, like irritability or hostility would show an inverted-U-shape relation across the whole nonclinical-to-clinical spectrum, a study in the lower to mid nonclinical range might show positive correlations (see, e.g.53). An additional interpretation might be that some aspects of narcissistic traits in a low expression, might be beneficial or even desirable in a particular (e.g. competitive) social context, but our lack of relevant social or other personality data in this sample does not allow for further testing in this particular cohort. In comparing our findings to the literature, we also need to consider differences across narcissism inventories: in contrast to the NPI, the PNI focuses more on pathological narcissism, with a more thorough focus on vulnerable facets, which might be more closely associated with clinically relevant phenotypes (for discussion, see3,8,55).
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Read More »The discrepancies to the two previous nonclinical association studies using the PNI34 and NPI35, respectively, might additionally be explained by data analysis methodology as well as culturally different expressions (e.g., see56). While our study only assessed brain structure, there are several links to functional imaging studies pertinent to aspects of the narcissistic phenotype, which link our findings to prefrontal and insular networks to the expression of relevant behaviours. One of these is social rejection, which has been related to networks including the anterior insula, dorsal ACC and subgenual ACC29—part of which also featured prominently in our findings. Similarly, a recent study on cognitive emotion regulation training demonstrated that vmPFC activity exerts a modulated emotional response in regulating emotions to aversive images57, which connects our study to previous hypotheses of deficient emotion regulation in narcissism and prefrontal brain networks. The mPFC, also identified in our study, has previously been linked to self-enhancement in a series of brain stimulation studies58,59,60. Given the relative paucity of imaging studies of narcissistic traits in the narrow sense, we should like to point out that several previous studies have linked medial PFC structure and activity to social functions, especially pertaining to social dominance and self-enhancement. The “dominance behavioral system”, which has been linked to narcissistic and manic temperament phenotypes61,62 provides such a framework. In fact, at least two recent fMRI studies of social dominance and hierarchies show brain activation foci in location similar to findings of our study: one showed social hierarchy processing in an anterior dorsolateral prefrontal cluster, slightly dorsal in localisation to our anterior prefrontal clusters63, while another showed modulation of dominance and subordination to a medial prefrontal/bilateral caudate network64. While the latter in particular are consistent with more general conceptualisations of biological dominance, it should be pointed out that this inference is indirect at best, and that this interpretation should be considered with caution. It should, however, be noted that networks involving mPFC activity have consistently been linked to socially dominant behaviours even across a more general biological conceptualisation of this phenotype across species27,65,66,67,68, which warrants further studies of its overlap with the narcissistic phenotype studied in our sample. Our study only found minor interactions of sex and narcissism in its relation to brain structure. While we need to consider that our sample showed only minor differences in narcissism (sub)scales between females and males, it might lack generalisability in that respect (as gender differences have been shown in large meta-analyses21). The few findings of a sexually dimorphic effect were, however identified in the lateral prefrontal cortex and thus no effects or trends were observed in medial prefrontal, orbitofrontal, or insular cortices. Finally, we need to consider a few limitations of our study, including the moderate sample size, which is also a potentially limiting factor in identifying sex interactions and correlations to those subscores, which are based on a smaller number of NPI items, as well as the lack of functional MRI analyses. While our choice of the NPI was guided based on its wide-spread application in the past, it might not cover some aspects of narcissism as well as other inventories, and further studies are needed to differentiate the contribution of, for example, entitlement vs. vulnerability to the different prefrontal network nodes. Despite our support for prefrontal involvement in narcissism, the current evidence across the few available studies is not unequivocal, and additional studies using more fine-grained phenotyping as well as possibly additional imaging modalities are needed to further corroborate the available evidence, which is non unequivocal.
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Read More »One major limitation is specificity: as our phenotyping only included the NPI, which defines a complex, multi-faceted narcissism phenotype, we cannot exclude the possibility that other, less-specific factors or even traits unrelated to narcissism (e.g. neuroticism) might similarly have explained variance in the identified brain structure. Further studies with more in-depth phenotyping would be necessary to ascertain specificity and better characterise which singular facets of narcissism or related traits might drive the associations to different brain areas, esp. across the prefrontal cortex. Nevertheless, our study is a potentially important advance over previous studies, as it shows for the first time, using a robust imaging and statistical approach, that multiple prefrontal and insular cortical areas are correlated with the expression of narcissistic traits, even in the absence of manifest pathology.
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