The Meaningfulness of Grandiose and Vulnerable Narcissism in Forensic Mental Health Rehabilitation Practice: A Systematic Review

Abstract

Narcissism is a personality construct with grandiose, and vulnerable aspects, that are interconnected through antagonistic characteristics. While antagonism is strongly related to antisocial behavior, the role of narcissism remains underexplored in offender rehabilitation practice. Research in non-forensic samples has already shown promising results in the differential associations for grandiose and vulnerable narcissism in relation to violent and antisocial behavior and treatment responsiveness that could be relevant for offender rehabilitation. To research the meaningfulness of both narcissism aspects for forensic offender rehabilitation practice, we systematically reviewed the electronic literature databases CINAHL EBSCOhost, Cochrane CENTRAL, EMBASE, Medline All Ovid, PsycINFO Ovid, and Web of Science Core Collection. Subsequently, we synthesized the outcome into meaningful data classifications related to the risk of violence in offender populations and treatment responsivity. In total, 14 publications on forensic samples were included. Overall, the findings suggest that grandiose narcissism was strongly related to proactive violence and a low treatment responsiveness. Vulnerable narcissism was associated with reactive aggression, mediated by impulsivity and negative emotions, and with a moderate responsivity level. As such, both narcissism aspects seem relevant for the development of structured and focused treatment plans in offender rehabilitation practice. The implications for offender rehabilitation practice are provided.

Keywords:

• Forensic mental health
• grandiose narcissism
• vulnerable narcissism
• risk-need-responsivity
• offender rehabilitation practice

Acknowledgments

The authors wish to thank Dr. W. M. Bramer, information specialist of Erasmus University, for his assistance during the systematic review process.

Conflict of interest

We have no known conflicts to disclose.

Notes

1 Throughout this systematic review we used neutral terms when referring to the conceptual boundaries of narcissism, i.e. grandiose / vulnerable aspects of narcissism, and the descriptors of these aspects, i.e. the descriptive characterizations of both aspects.

2 Participants who were later found to have one of these exclusionary criteria were omitted from analysis (fewer than 3% of participants). In addition, due to missing data on some of our variables of interest, the number of participants available for the different analyses varied from N = 320 to 342