The interplay among narcissistic vulnerability, interpersonal sensitivity, and metacognitive integration: A network analysis approach

Background Narcissistic Personality Disorder (NPD) involves disturbances in self-regulation, interpersonal functioning, and personality organization. Although traditionally characterized by grandiosity, contemporary models suggest that grandiose self-states coexist with vulnerable features such as shame, emotional dysregulation, and hypersensitivity to rejection. Recent evidence indicates that metacognitive impairments may underlie both grandiose and vulnerable narcissistic presentations; however, no study has examined how metacognition interacts with personality traits and interpersonal difficulties within an integrated system. Methods A cross-sectional network analysis was conducted on 287 patients with NPD. Measures included the Metacognition Assessment Interview, the Pathological Narcissism Inventory, the Personality Inventory for DSM-5 (PID-5), the Inventory of Interpersonal Problems, and SCL-90-R Depression. A Gaussian graphical model with LASSO regularization was estimated, and expected influence was used as the primary index of node centrality. Network accuracy and stability were assessed through bootstrapping procedures. Results Narcissistic vulnerability was the most central node, followed by interpersonal sensitivity and metacognitive integration. Narcissistic vulnerability showed strong associations with PID-5 Negative Affectivity and Detachment, whereas narcissistic grandiosity was related to PID-5 Antagonism. Metacognitive integration occupied a central position, linking maladaptive traits and interpersonal distress. Network stability indices indicated good reliability. Conclusions Findings suggest that narcissistic vulnerability and interpersonal hypersensitivity are central aspects of dysfunction in NPD, whereas metacognitive integration appears closely associated with the organization of psychological processes within the network. Although causal inferences cannot be drawn, the results are consistent with theoretical models underlying Metacognitive Interpersonal Therapy (MIT), supporting the potential relevance of targeting integrative metacognitive capacities in NPD treatment.