{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T19:43:43Z","timestamp":1785267823237,"version":"3.55.0"},"reference-count":69,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T00:00:00Z","timestamp":1743033600000},"content-version":"vor","delay-in-days":26,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001777","name":"University of Wollongong","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001777","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000779","name":"University of London","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000779","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Psychology and Psychoth"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Narcissistic personality disorder (NPD) is known to comprise two distinct but connected phenotypes related to \u2018grandiosity\u2019 and \u2018vulnerability\u2019, respectively. While evidence suggests differing countertransference responses to narcissism subtype expression, no study has examined this using a qualitative methodology and explored associations with ratings of personality disorder severity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Mental health clinicians (<jats:italic>N<\/jats:italic>\u2009=\u2009180, 67% female, age\u2009=\u200938.9), completed qualitative clinical reflections and ratings of overall personality disorder severity towards two hypothetical vignettes displaying pathological narcissism (\u2018grandiose\u2019 and \u2018vulnerable\u2019 narcissism respectively), as well as a rating of attitudes towards patients in their routine practice who resemble these vignettes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Distinct qualitative themes were identified between narcissistic subtype, with grandiose narcissism evoking anger, lack of empathy and hopelessness, compared to sympathy, sadness and discomfort in vulnerable narcissism. In terms of diagnostic category, the grandiose vignette was predominately identified as \u2018narcissistic personality disorder\u2019 (97%), whereas the vulnerable vignette was a mixture of \u2018depressive disorder\u2019 (29%), \u2018narcissistic personality disorder\u2019 (24%), \u2018trauma and stressor related disorders\u2019 (21%) and \u2018borderline personality disorder\u2019 (21%). Attitude scores differed significantly between subtypes, with more negative attitudes towards narcissistic grandiosity than narcissistic vulnerability. The grandiose vignette was also rated as displaying more overall personality impairment, with an association observed between negative clinician attitude scores and increased ratings of personality disorder severity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Two potential pathways are outlined to interpret these findings. The first is that inordinate stigma towards narcissistic grandiosity negatively biases clinicians when working with these patients due to feelings of anger and frustration. The second is that clinicians are drawn to minimise pathology of vulnerable patients due to their feelings of sadness and empathy. We propose that effective diagnosis and psychotherapy for pathological narcissism rely on clinicians' ability to balance these two dilemmas and resist either extreme.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cpp.70070","type":"journal-article","created":{"date-parts":[[2025,3,30]],"date-time":"2025-03-30T07:36:38Z","timestamp":1743320198000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Clinician Diagnostic Ratings and Countertransference Reactions Towards Grandiose and Vulnerable Narcissism"],"prefix":"10.1002","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2090-9778","authenticated-orcid":false,"given":"Nicholas\u00a0J.\u00a0S.","family":"Day","sequence":"first","affiliation":[{"name":"School of Psychology University of Wollongong  Wollongong Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marko","family":"Biberdzic","sequence":"additional","affiliation":[{"name":"Department of Psychology Bishop's University  Sherbrooke Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ava","family":"Green","sequence":"additional","affiliation":[{"name":"Department of Psychology City St George's, University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgia","family":"Denmeade","sequence":"additional","affiliation":[{"name":"School of Psychology University of Wollongong  Wollongong Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Bach","sequence":"additional","affiliation":[{"name":"Center for Personality Disorder Research Psychiatric Research Unit, Mental Health Services  Region Zealand Denmark"},{"name":"Department of Psychology University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1501-4336","authenticated-orcid":false,"given":"Brin\u00a0F.\u00a0S.","family":"Grenyer","sequence":"additional","affiliation":[{"name":"School of Psychology University of Wollongong  Wollongong Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,27]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12144\u2010022\u201003851\u2010z"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11920\u2010022\u201001364\u2010x"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/YCO.0000000000000658"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1521\/pedi.2006.20.3.281"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/capr.12360"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-981-10-5251-4_103"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2007.09.006"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2014.14060723"},{"key":"e_1_2_11_12_1","unstructured":"Caligor E. M. J.Petrini A.Skodol andR.Hermann.2018. \u201cTreatment of Narcissistic Personality Disorder.\u201d UpToDate.https:\/\/www.uptodate.com\/contents\/narcissistic\u2010personality\u2010disorder\u2010treatment\u2010overview."},{"key":"e_1_2_11_13_1","volume-title":"Statistical Power Analysis for the Behavioral Sciences","author":"Cohen J.","year":"1988"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1521\/pedi.2020.34.supp.143"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1037\/per0000347"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1521\/pedi_2019_33_413"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/jclp.23701"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/pmh.1429"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40479\u2010020\u201000132\u20108"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/pmh.1532"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12888\u2010021\u201003660\u2010x"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1521\/pedi.17.3.188.22146"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1080\/15298868.2019.1627241"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1080\/00223891.2012.742904"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1080\/13645579.2016.1144401"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2020.70"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.3928\/00485713-20090301-03"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10879\u2010022\u201009535\u2010w"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1214\/aoms\/1177705148"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1037\/per0000181"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2023.1090746"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197804202981605"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1037\/pst0000189"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0038827"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/pmh.1408"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2017.01600"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12888\u2010019\u20102185\u20105"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1037\/per0000164"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.3109\/10673229.2011.632604"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1177\/000306516501300102"},{"key":"e_1_2_11_41_1","volume-title":"Borderline Conditions and Pathological Narcissism","author":"Kernberg O. F.","year":"1985"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1177\/00030651070550020701"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/1745\u20138315.12204"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12144\u2010020\u201001296\u2010w"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.26502\/jppd.2572\u2010519X0099"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.1177\/1088868316685018"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.1002\/jclp.21893"},{"key":"e_1_2_11_48_1","volume-title":"Psychodynamic Diagnostic Manual (PDM\u20102)","author":"Lingiardi V.","year":"2017"},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejsp.2752"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.1037\/10250-000"},{"key":"e_1_2_11_51_1","doi-asserted-by":"publisher","DOI":"10.1002\/9781394266487.ch9"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.1037\/per0000510"},{"key":"e_1_2_11_53_1","doi-asserted-by":"publisher","DOI":"10.1037\/pas0000616"},{"issue":"1","key":"e_1_2_11_54_1","article-title":"Therapist Stigma Towards Narcissistic Personality Disorder: Lessons Learnt From Borderline Personality Disorder","volume":"3","author":"Penney E.","year":"2017","journal-title":"Australian Clinical Psychologist"},{"key":"e_1_2_11_55_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0016530"},{"key":"e_1_2_11_56_1","doi-asserted-by":"publisher","DOI":"10.1037\/per0000031"},{"key":"e_1_2_11_57_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.clinpsy.121208.131215"},{"key":"e_1_2_11_58_1","doi-asserted-by":"publisher","DOI":"10.5507\/bp.2010.029"},{"key":"e_1_2_11_59_1","doi-asserted-by":"publisher","DOI":"10.1097\/NNR.0000000000000686"},{"key":"e_1_2_11_60_1","doi-asserted-by":"publisher","DOI":"10.3928\/00485713\u201020090301\u201009"},{"key":"e_1_2_11_61_1","doi-asserted-by":"publisher","DOI":"10.1080\/1750984x.2017.1317357"},{"key":"e_1_2_11_62_1","doi-asserted-by":"publisher","DOI":"10.1002\/pmh.1404"},{"key":"e_1_2_11_63_1","doi-asserted-by":"publisher","DOI":"10.1037\/pap0000145"},{"key":"e_1_2_11_64_1","doi-asserted-by":"publisher","DOI":"10.1037\/per0000146"},{"key":"e_1_2_11_65_1","doi-asserted-by":"publisher","DOI":"10.1521\/pedi.2020.34.supp.42"},{"key":"e_1_2_11_66_1","doi-asserted-by":"publisher","DOI":"10.1037\/pst0000111"},{"key":"e_1_2_11_67_1","unstructured":"Vorhauer J.2024. \u201cInvestigating the use of the Term \u2018Narcissist\u2019 on Twitter: A Text Mining Approach.\u201d University of Twente.http:\/\/essay.utwente.nl\/103688\/."},{"key":"e_1_2_11_68_1","doi-asserted-by":"publisher","DOI":"10.1521\/pedi.2020.34.supp.122"},{"key":"e_1_2_11_69_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.focus.20220052"},{"key":"e_1_2_11_70_1","volume-title":"Clinical Descriptions and Diagnostic Requirements for ICD\u201011 Mental, Behavioural and Neurodevelopmental Disorders","author":"World Health Organization","year":"2024"}],"container-title":["Clinical Psychology &amp; Psychotherapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cpp.70070","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T13:10:06Z","timestamp":1753708206000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/cpp.70070"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3]]},"references-count":69,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.1002\/cpp.70070"],"URL":"https:\/\/doi.org\/10.1002\/cpp.70070","archive":["Portico"],"relation":{},"ISSN":["1063-3995","1099-0879"],"issn-type":[{"value":"1063-3995","type":"print"},{"value":"1099-0879","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3]]},"assertion":[{"value":"2024-10-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70070"}}