Miller, J., Lynam, D., Hyatt, C., & Campbell, W. (2018) | References

Core Concept

The Research Question

What exactly is vulnerable narcissism? While clinicians and researchers have long recognised that narcissism comes in different flavours—the confident, grandiose type and the insecure, hypersensitive type—the fundamental nature of vulnerable narcissism remained unclear. Miller and colleagues set out to answer a critical question: When we strip vulnerable narcissism down to its basic personality components, what do we find? Is it essentially narcissism expressed through insecurity, or is it something else entirely that happens to share some narcissistic features?

The Key Finding

The study's central discovery is striking in its clarity: neuroticism—the tendency toward negative emotions, anxiety, self-consciousness, and emotional instability—explains approximately 65% of the variance in vulnerable narcissism. This means that nearly two-thirds of what we measure as vulnerable narcissism can be accounted for by emotional instability alone. The remaining variance includes genuinely narcissistic elements (entitlement, exploitativeness, grandiose fantasy), but the foundation is emotional dysregulation. Grandiose narcissism, by contrast, shows a completely different profile: high extraversion, low agreeableness, and relatively normal levels of neuroticism.

The Implications

This finding fundamentally challenges the assumption that grandiose and vulnerable narcissism are simply two expressions of the same underlying condition. They may share surface features—entitlement, lack of empathy, need for validation—but they appear to have entirely different personality foundations. Grandiose narcissism is built on self-enhancement and dominance; vulnerable narcissism is built on emotional pain and dysregulation. This has profound implications for how we diagnose, treat, and understand narcissistic presentations.

The Method

Miller and colleagues analysed data from multiple samples using the Five Factor Model (FFM) of personality—the most widely validated framework for understanding basic personality structure. They examined how vulnerable narcissism scores related to the Big Five traits (neuroticism, extraversion, agreeableness, conscientiousness, openness) and found that neuroticism dominated the profile. They then compared this to grandiose narcissism profiles and found strikingly different patterns, supporting the conclusion that these are fundamentally different personality configurations.

Original Context

The Two-Narcissism Problem

Since Wink's seminal 1991 paper identified two distinct types of narcissism, the field has grappled with how to understand their relationship. Early theories suggested they were simply different expressions of the same underlying pathology—one overt, one covert. Kernberg's object relations approach saw both as compensations for the same underlying emptiness. Kohut's self psychology understood both as different responses to the same developmental failures. But accumulating evidence suggested the relationship was more complex than "same condition, different presentation."

Personality Structure Approach

Miller's research team approached this question through the lens of the Five Factor Model, asking: if we measure the basic personality traits that underlie each type of narcissism, what do we find? This approach had proven powerful in understanding other personality disorders—revealing, for example, that borderline personality disorder is largely characterised by high neuroticism and low agreeableness. Applying the same methodology to narcissism subtypes promised to clarify their fundamental nature.

The 65% Finding

The discovery that neuroticism accounts for 65% of vulnerable narcissism variance was more dramatic than expected. While researchers anticipated some role for negative emotionality, the magnitude of this finding surprised the field. It suggested that vulnerable narcissism might be better conceptualised as a high-neuroticism condition with narcissistic features rather than a narcissistic condition with emotional dysregulation. The practical implications were significant: treatments targeting emotional instability might be more relevant than treatments targeting narcissistic defences.

Reception and Impact

The study has been widely cited and debated since publication. Some researchers embraced the findings as finally explaining the distinctiveness of vulnerable narcissism. Others argued that despite the high neuroticism loading, the narcissistic elements remain clinically significant and should not be minimised. The debate continues, but Miller's research has fundamentally shaped how the field thinks about narcissism's internal structure and the relationship between its subtypes.

For Survivors

Understanding Their Emotional Storms

If you've been in a relationship with a vulnerable narcissist, you know the exhausting reality of their emotional volatility. The constant crises, the overwhelming neediness, the way their emotions could dominate every interaction—Miller's research explains this: their core is emotional instability. The suffering you witnessed wasn't performance; it was genuine neuroticism-based distress. What made it damaging was how they used that suffering: to manipulate, to demand attention, to avoid accountability, to keep you focused on their needs while yours disappeared.

Why Their Pain Felt So Real

Many survivors of vulnerable narcissist relationships struggle with confusion because their partner's suffering seemed genuine—how could someone in so much pain also be abusing them? Miller's findings clarify this: the pain is real. High neuroticism means genuine anxiety, depression, shame, and emotional instability. The vulnerable narcissist isn't pretending to suffer; they're genuinely drowning in negative emotions. But their narcissistic traits—entitlement, lack of empathy, exploitativeness—shape how they handle that pain. They feel entitled to have their suffering prioritised; they lack empathy for yours; they exploit your caretaking instincts. Real suffering weaponised.

The Differences from Grandiose Narcissism

If you've experienced both types, you know they feel different. The grandiose narcissist makes you feel small through their arrogance and contempt. The vulnerable narcissist makes you disappear through their endless needs and emotional demands. Miller's research explains why: these are fundamentally different personality structures. With a grandiose narcissist, you're dealing with someone who genuinely feels superior. With a vulnerable narcissist, you're dealing with someone in genuine emotional turmoil who believes their suffering entitles them to special treatment. Both leave you drained and diminished, but through different mechanisms.

Implications for Your Healing

Understanding that your vulnerable narcissist partner was fundamentally driven by emotional instability can help your healing in several ways. First, it explains why you couldn't fix them—their core issue was deep-seated affective dysregulation, not something your love or patience could address. Second, it helps you understand why they seemed so different from the "classic" narcissist profile, reducing self-doubt about whether you were really dealing with narcissism. Third, it explains why they may have had some capacity for apparent self-awareness during calm periods—lower neuroticism moments allowed glimpses of insight that vanished when emotional storms resumed. Your experience was real, even if it didn't match the textbook descriptions.

For Clinicians

Diagnostic Considerations

Miller's findings have significant implications for differential diagnosis. The high neuroticism loading means vulnerable narcissism can be easily confused with other conditions characterised by emotional instability: borderline personality disorder, dependent personality disorder, avoidant personality disorder, or major depression with narcissistic features. Accurate diagnosis requires careful assessment of specifically narcissistic elements—not just emotional distress but entitlement, exploitativeness, grandiose fantasies (even if expressed as victimhood or "unrecognised genius"), and empathy deficits. The emotional instability is the substrate; the narcissism is what's built on that substrate.

Treatment Implications

If vulnerable narcissism is "mostly neuroticism," treatment should prioritise interventions that address emotional dysregulation. Dialectical Behaviour Therapy (DBT), developed for high-neuroticism conditions like borderline personality disorder, may be particularly relevant. Skills in distress tolerance, emotion regulation, and interpersonal effectiveness address the core affective instability. However, the narcissistic elements—entitlement, exploitativeness, empathy deficits—also require attention, perhaps through modified Transference-Focused Psychotherapy or schema-focused approaches. Treatment may need to sequence or integrate these foci based on patient presentation.

The Neuroticism-Narcissism Interface

Clinicians working with vulnerable narcissistic patients should understand how neuroticism and narcissism interact. Negative emotions trigger narcissistic defences: shame activates grandiose fantasies of being special; anxiety activates entitlement ("I shouldn't have to feel this way"); depression activates exploitative help-seeking ("You must rescue me"). In turn, narcissistic relating patterns generate more negative emotions: entitlement leads to interpersonal conflict; exploitativeness drives away supports; empathy deficits prevent genuine connection. This creates a self-perpetuating cycle that treatment must address at both levels.

Working with Survivors

Clinicians treating survivors of vulnerable narcissist relationships should understand Miller's findings. These survivors often present with significant confusion—their partner seemed so different from the "narcissist" stereotype that they question whether the label applies. Explaining that vulnerable narcissism has a different personality foundation than grandiose narcissism, while still causing harm through narcissistic mechanisms, can validate their experience. The survivor's experience of being consumed by their partner's emotional needs, of feeling invisible beneath waves of crisis, of encountering entitlement masked as suffering—this makes sense given what we now know about vulnerable narcissism's structure.

Broader Implications

Reconceptualising the Narcissism Spectrum

Miller's findings contribute to an ongoing reconceptualisation of how we understand the narcissism spectrum. Rather than viewing grandiose and vulnerable narcissism as two ends of a single spectrum or two expressions of the same condition, we may need to understand them as overlapping but distinct phenomena. They share some features (entitlement, low empathy, need for supply) but have different core personality structures. This has implications for research, clinical practice, and how we talk about narcissism publicly. The "narcissism" umbrella may cover conditions that, while sharing surface features, have fundamentally different aetiologies and require different interventions.

Personality Disorder Classification

The study contributes to broader debates about personality disorder classification. The dimensional approach to personality pathology—understanding disorders as extreme variants of normal personality traits—gains support from findings like Miller's. If vulnerable narcissism is essentially extreme neuroticism with narcissistic features, this supports a dimensional model where conditions are understood through their trait profiles rather than categorical diagnoses. The alternative model for personality disorders in DSM-5 Section III reflects this dimensional thinking, and research like Miller's provides empirical support.

Understanding Comorbidity

The high neuroticism finding helps explain the substantial comorbidity observed between vulnerable narcissism and other conditions. Vulnerable narcissism frequently co-occurs with depression, anxiety disorders, and borderline personality disorder—all conditions characterised by high neuroticism. If they share a common personality foundation (emotional instability), comorbidity is expected. This has treatment implications: addressing the underlying neuroticism may simultaneously improve multiple conditions. It also has diagnostic implications: clinicians should carefully parse which symptoms reflect neuroticism generally versus specifically narcissistic pathology.

The Role of Shame

Miller's findings illuminate the central role of shame in vulnerable narcissism. Shame is a core component of neuroticism—a painful self-conscious emotion involving feelings of inadequacy, worthlessness, and defectiveness. If vulnerable narcissism is fundamentally a high-neuroticism condition, shame may be its driving affect. The grandiose fantasies, the victimhood, the entitled demands—these may all represent attempts to manage unbearable shame. This shame-based understanding aligns with clinical theories emphasising shame's role in narcissistic development (Kohut, Kernberg) while grounding them in personality science.

Social and Cultural Considerations

Understanding vulnerable narcissism as primarily emotional instability has implications for how we discuss narcissism culturally. Public discourse about narcissism often focuses on the grandiose type—the arrogant, confident, dominating individual. Vulnerable narcissists don't fit this stereotype, yet they cause substantial harm to those around them. Miller's research helps explain why vulnerable narcissists seem so different while still being considered narcissistic: they share some narcissistic features but have an entirely different personality foundation. This nuance is important for public education about narcissistic abuse and for survivors whose experiences don't match the stereotypical narrative.

Future Research Directions

Miller's findings generate important research questions. What developmental pathways lead to high-neuroticism narcissism versus low-neuroticism narcissism? Are there different genetic, neurobiological, or environmental risk factors? Do they respond to different treatments? Can interventions targeting neuroticism (medication, therapy) reduce vulnerable narcissistic features? Should treatment protocols distinguish between "neuroticism-based" and "extraversion-based" narcissism? The field needs longitudinal research tracking how these different personality profiles develop and respond to intervention over time.

FAQs

What is the Five Factor Model that this study uses?

The Five Factor Model (FFM), also called the Big Five, is the most widely validated framework for understanding personality structure. It identifies five basic dimensions of personality: neuroticism (tendency toward negative emotions), extraversion (tendency toward positive emotions and social engagement), agreeableness (tendency toward cooperation and concern for others), conscientiousness (tendency toward self-discipline and organisation), and openness (tendency toward intellectual curiosity and creativity). Research consistently shows that personality disorders can be understood as extreme variants of these normal traits. Miller's study applied this framework to understand what basic personality traits underlie vulnerable narcissism.

How is neuroticism different from being neurotic in the colloquial sense?

In personality psychology, neuroticism refers specifically to the tendency to experience negative emotions—anxiety, depression, anger, self-consciousness, vulnerability to stress. It's a dimension of personality, not a diagnosis or insult. Everyone falls somewhere on the neuroticism spectrum; high neuroticism simply means more prone to negative emotions. It doesn't mean "crazy" or "unstable" in the pejorative sense. Miller's finding that vulnerable narcissism is "mostly neuroticism" means that vulnerable narcissists score very high on measures of negative emotionality, emotional instability, and proneness to psychological distress. This is their core personality feature, with narcissistic elements (entitlement, low empathy) added on top.

Does this mean medication could help vulnerable narcissists?

Potentially, yes—though this remains an area requiring more research. If vulnerable narcissism is fundamentally a high-neuroticism condition, medications that reduce neuroticism might help. SSRIs, for example, have been shown to reduce neuroticism-related symptoms and might reduce the emotional instability driving vulnerable narcissistic behaviour. However, medication wouldn't address the specifically narcissistic features—the entitlement, the exploitativeness, the empathy deficits. These would still require psychotherapeutic intervention. A combined approach addressing both the affective and narcissistic components might be most effective, but research specifically on this population is limited.

Why do vulnerable narcissists feel so entitled if they're so insecure?

This apparent paradox makes sense when you understand that emotional instability and entitlement can coexist. The vulnerable narcissist experiences genuine distress—anxiety, shame, depression. But they also believe, at some level, that they shouldn't have to feel this way, that they deserve better, that others should rescue them from their suffering. This entitlement doesn't come from confidence; it comes from a sense that life has been unfair, that they've been victimised, that they deserve compensation for their pain. The suffering is real; the entitlement is how they cope with it. Miller's research shows these two features—high neuroticism (suffering) and narcissistic entitlement (demanding special treatment)—coexist in vulnerable narcissism.

How can I tell if someone is a vulnerable narcissist versus having borderline personality disorder?

This is a challenging differential diagnosis precisely because both conditions involve high neuroticism. Key distinguishing features include: vulnerable narcissists have more persistent feelings of grandiosity or being "special" (even if unrecognised), while people with BPD have more unstable self-image without the grandiose core. Vulnerable narcissists are more focused on feeling entitled to admiration or special treatment; BPD is more characterised by fear of abandonment. Vulnerable narcissists tend toward consistent exploitative patterns; BPD shows more chaotic relationships without the same calculating quality. However, the conditions frequently co-occur, and some individuals meet criteria for both. Careful assessment over time, ideally with structured interviews, is essential.

What does this mean for the relationship between vulnerable and grandiose narcissism?

Miller's research supports the view that vulnerable and grandiose narcissism, while sharing some features, may be fundamentally different conditions. They share narcissistic elements—entitlement, low empathy, need for supply. But their personality foundations differ dramatically: grandiose narcissism is built on high extraversion and low agreeableness; vulnerable narcissism is built on high neuroticism. They may be better understood as overlapping syndromes rather than subtypes of a single condition. Some researchers now question whether they should share the "narcissism" label at all, or whether vulnerable narcissism is better conceptualised as a high-neuroticism condition with narcissistic features.

How should this change how we talk about narcissism in popular discourse?

Public understanding of narcissism typically focuses on the grandiose type—the arrogant, confident, dominating figure. Miller's research reminds us that narcissistic harm also comes from the vulnerable type, who looks entirely different: insecure, hypersensitive, perpetually victimised. Survivors of vulnerable narcissist relationships may not recognise their experience in typical narcissism discussions. We need more nuanced public education acknowledging that narcissism has multiple presentations, that the vulnerable type can be equally damaging despite appearing sympathetic, and that its foundation in emotional instability doesn't make it less harmful. The suffering is real; the harm it causes is also real.

Can someone's narcissism flip between vulnerable and grandiose presentations?

Yes, and research suggests this is relatively common. The same individual may present as grandiose when their narcissistic supply is stable and their self-esteem is bolstered, then collapse into vulnerable presentation when they experience narcissistic injury or supply disruption. This oscillation, sometimes called "narcissistic flip," represents shifts in which personality features are most activated at a given time. During vulnerable phases, the high neuroticism dominates; during grandiose phases, the extraversion and self-enhancement dominate. For survivors, this can be especially confusing—you may have witnessed both presentations and wondered which is the "real" person. Both are real; they're different modes of the same disordered personality system.

Limitations and Considerations

While Miller's research provides important insights, several limitations warrant acknowledgment.

Cross-sectional design limits causal inference. The study demonstrates that vulnerable narcissism correlates highly with neuroticism but cannot establish that neuroticism causes vulnerable narcissism or that treating neuroticism would reduce narcissistic features. Longitudinal research is needed to understand developmental trajectories.

Measurement limitations. The study relies on self-report measures of both personality and narcissism. Self-report of narcissistic traits is inherently problematic; narcissists may lack insight into their own characteristics or respond in self-enhancing ways. Observer reports or structured interviews might yield different findings.

Sample characteristics. The samples studied were primarily undergraduate students and online community participants. Whether findings generalise to clinical populations with more severe pathology remains to be established. Clinical samples might show different personality profiles.

Dimensional versus categorical interpretation. While the dimensional Five Factor Model illuminates personality structure, clinical practice often requires categorical decisions (diagnosis or not, treatment X or Y). How to translate dimensional findings into clinical practice remains an ongoing challenge.

Cultural specificity. Personality structure and narcissism expression may vary across cultures. Research conducted primarily in Western samples may not fully generalise to other cultural contexts where self-construal, emotional expression, and personality organisation may differ.

Historical Context

Miller's 2018 paper appeared during an active period of reconceptualisation in narcissism research. Several historical developments set the stage for this work.

The distinction between grandiose and vulnerable narcissism was formally established by Paul Wink's 1991 paper, which factor-analysed narcissism measures and found two independent dimensions. This finding challenged the assumption that narcissism was a unitary construct and initiated decades of research on how the subtypes differ.

The Five Factor Model approach to personality disorders, developed through the 1990s and 2000s, provided a framework for understanding disorders through their basic trait components. This approach had proven valuable for understanding borderline, antisocial, and other personality pathology, establishing the methodology Miller would apply to narcissism subtypes.

Growing clinical attention to the distinction between grandiose and vulnerable presentations reflected practitioners' observations that these patients differed in important ways. Therapists noted that vulnerable narcissists presented more like depressed or anxious patients, responded differently to interventions, and evoked different countertransference reactions than grandiose narcissists. Miller's research provided empirical grounding for these clinical observations.

The alternative model for personality disorders in DSM-5 Section III (2013) reflected the field's move toward dimensional understanding of personality pathology. By demonstrating that vulnerable narcissism is "mostly neuroticism," Miller's research supported this dimensional approach and suggested that current categorical diagnoses might obscure important within-category differences.

Vulnerable narcissism is (mostly) a disorder of neuroticism

APA Citation