As suicide rates rise, it's important to study why some groups are at higher risk than others. People with pathological narcissism are at particularly high risk for making more frequent and lethal suicide attempts. Individuals with pathological narcissism often switch between feeling very good about themselves (grandiosity) and experiencing fragile self-esteem (vulnerability). Clinically, it has been observed that suicidal thinking increases during periods of narcissistic vulnerability for people with pathological narcissism. Interestingly, some people report that thinking about suicide can temporarily relieve intense negative feelings. This might also apply to those with narcissism, such that suicidal thoughts help lessen feelings of vulnerability. One distinguishing feature of suicidal thinking in people with pathological narcissism may be the content of the suicidal cognitions. Many assessments of suicidal cognitions examine low self-esteem when evaluating suicidal thoughts, but for those with narcissism, thoughts of suicide might be tied to their feelings of entitlement. In this study, we propose a model of suicide risk in narcissism such that risk fluctuates parallel to fluctuations in grandiosity and vulnerability. We note that assessments for suicide risk in people with pathological narcissism might need to assess for entitlement-based cognitions of suicide to more accurately capture the suicide risk level.
Aims: 1) Establish the degree to which state-level narcissistic grandiosity and vulnerability are associated with suicidal thinking in real time and 2) Examine how trait-based pathological narcissism associates with different suicidal cognitions.
Hypotheses: 1) Narcissistic grandiosity will be negatively associated with suicidal thinking whereas narcissistic vulnerability will be positively associated with suicidal thoughts in real-time; 2) Trait-based narcissistic vulnerability will be uniquely associated with all forms of suicidal cognitions, but effect sizes will be larger between narcissistic vulnerability and entitlement-based suicide cognitions.
Participants and Methods: Our sample will consist of 80 adults who have recently been hospitalized due to serious suicidal thoughts or actions. After joining the study, participants will complete baseline assessments where they answer basic demographic questions, measures of pathological narcissism, and measures related to suicidal cognitions. After discharge from the hospital, participants will engage in a 4-week ecological momentary assessment protocol where they complete surveys on their smartphones up to five times per day, answering questions related to momentary grandiosity and vulnerability and questions related to suicidal thinking.
Potential Impact & Future Directions: This study will be the first to look at how suicidal thinking fluctuates as a function of narcissistic grandiosity and narcissistic vulnerability in real time for people high in pathological narcissism. It will also help clarify the specific types of suicidal thoughts that often occur in people with high levels of pathological narcissism. Together, these insights will improve our understanding and assessment of suicide risk in this population. Future work should continue to examine how specific suicide cognitions inform our understanding of suicide in at-risk populations.
