Specific narcissistic traits appear to heighten veteran PTSD risk

A recent study published in the Journal of Traumatic Stress has shed light on why some veterans develop posttraumatic stress disorder (PTSD) after combat deployments while others do not. The research found that certain personality traits, specifically those related to a form of narcissism, may increase a veteran’s vulnerability to PTSD, even when considering their combat experiences. The study suggests that understanding personality could be important in helping veterans who struggle after returning from war.

Researchers became interested in this topic because, for a long time, the focus of PTSD research has been on the traumatic events themselves. It is widely accepted that PTSD can develop after someone experiences or witnesses something deeply disturbing, such as combat. However, not everyone who goes through trauma develops PTSD. This suggests that other factors, beyond just the event, are at play. Scientists have started to consider that individual differences, like personality, might influence how people react to trauma.

Narcissism, often thought of as excessive self-love, actually has a darker side called pathological narcissism. This is not just about being confident; it involves a deeply troubled sense of self. Researchers have observed in civilian populations that pathological narcissism is linked to the development and continuation of PTSD after trauma.

People with this form of narcissism may have fragile self-esteem and be overly concerned with themselves, which can make them more vulnerable to the negative effects of traumatic experiences. However, it was not clear if this connection between narcissism and PTSD also existed in veterans, a group highly exposed to trauma. The new study aimed to investigate if narcissistic personality features contribute to PTSD symptoms in veterans, and if so, how much this contribution is compared to the impact of their combat experiences alone.

“I came up with this project with my co-authors because of an interest in how personality, generally, can create risks for different mental illnesses in the face of adversity,” said study author Sterling Nenninger, a PhD student at Long Island University. “Some people might become depressed during a major life change, while others might become anxious, and some might have no symptoms at all. Some call this line of research putting the ‘person’ back into psychology, because we all have unique backgrounds and characteristics that shape our reactions to situations.”

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To explore this, the researchers recruited 179 veterans who had been deployed to Afghanistan or Iraq after the September 11, 2001, terrorist attacks. These veterans were from various military branches and ranks. The participants were contacted through veteran student offices at a university in New York City, online forums, and social media. They completed questionnaires either online or using paper and pencil.

The questionnaires measured several things. First, to assess combat experience, veterans completed a questionnaire called the Combat Experiences scale. This asked about their direct experiences in combat, like witnessing deaths or being in firefights. Second, to measure narcissistic personality features, they used the Pathological Narcissism Inventory. This tool assesses different aspects of pathological narcissism, including both grandiose narcissism (characterized by arrogance and a sense of superiority) and vulnerable narcissism (characterized by insecurity and sensitivity to criticism). Finally, to gauge PTSD symptoms, the veterans completed the PTSD Checklist. This questionnaire asks about common PTSD symptoms like intrusive thoughts, avoidance behaviors, and feeling constantly on edge, specifically in relation to stressful military experiences.

After collecting the data, the researchers used a statistical method called regression analysis. This helped them determine if narcissistic personality features predicted PTSD symptoms, even after accounting for the level of combat experience each veteran reported. They first looked at whether overall pathological narcissism was linked to PTSD symptoms beyond combat exposure. Then, they examined whether the two different types of narcissism, grandiose and vulnerable, had different relationships with PTSD.

The study revealed that higher levels of pathological narcissism were indeed associated with more severe PTSD symptoms in veterans, even when considering their combat experiences. In fact, narcissistic features explained a significant additional portion of the variation in PTSD symptoms beyond what combat experience alone could explain.

“I was surprised at the strength of the relationship between narcissism and PTSD,” Nenninger told PsyPost.

When the researchers separated narcissism into its two types, they found that vulnerable narcissism was strongly linked to PTSD symptoms. Veterans with more vulnerable narcissistic features reported significantly higher levels of PTSD. However, grandiose narcissism was not related to PTSD symptoms. This suggests that the insecure, sensitive, and shame-prone aspects of narcissism, rather than the arrogant and entitled aspects, are what might increase a veteran’s risk for PTSD after combat.

“People may see narcissism and think only of grandiosity, which is a the classic egotistical presentation of narcissism,” Nenninger explained. “Our study actually found vulnerable narcissism, which is a much more insecure and self-doubting form of narcissism, was the main driver of the narcissism and PTSD relationship. This distinction between forms of narcissism needs to be researched much more thoroughly to see why this was the case.”

“The main takeaway is not narcissism specific, but that personality, that is, who you are and how you interact with the world, can interact with how you react to, and the meaning you make from, a traumatic event. The events that happen to us tend to impact us in highly personal ways and be filtered through our own way of viewing ourselves and the world.”

Like all research, the study has some limitations that should be considered.

“The major limitation of this study is that it’s cross-sectional (one time-point) instead of longitudinal (multiple-time points),” Nenninger noted. “This means that we can’t say that narcissism causes PTSD after a trauma, because we did not test for that. We can only say narcissism is correlated to PTSD in a robust way that has not been shown in research yet.”

Ultimately, a deeper understanding of the interplay between personality and trauma will be important for developing better ways to support veterans’ mental health and help prevent or treat PTSD.

“I want to continue this line of research on personality, but focus on methods beyond self-report questionnaires, which can be unreliable, to get a deeper understanding of individual personality,” Nenninger said.

The study, “Linking pathological narcissism to posttraumatic stress disorder in veterans,” was authored by Sterling Nenninger, Brian R. Van Buren, Ashley L. Greene, and Kevin B. Meehan.