Over the last several decades there has been significant growth in the understanding of the neurobiological basis of fear. At the center of the fear circuitry is the amygdala. The amygdala mediates processes such as the detection of emotionally arousing and/or salient stimuli.47 Additional regions (eg, nucleus accumbens, hippocampus, some prefrontal regions, etc) form a neural network involved in the perception of threat, fear learning, and fear expression.48 These areas individually mediate symptoms of fear and collectively act to produce an integrated fear response. Our nuanced understanding of this complex neural network results from imaging (eg, during fear conditioning studies), physiological (eg, skin conductance, eye-blink response), and psychopharmacological studies that not only enhance the mechanistic understanding of fear but also highlight the role of fearrelated dysfunction in the generation and maintenance of various forms of psychopathology.
Failure to properly regulate fear responses is central to specific phobia, post-traumatic stress disorder, generalized anxiety, and some Axis II disorders (ie, fear of separation and loss of support in dependent personality disorder (DPD) of abandonment in borderline personality disorder (BPD), and of criticism, disapproval, and rejection in avoidant personality disorder (APD).6 While some disorders are largely associated with hyperviglance and an over-reactive fear response (eg, anxiety disorders and BPD), others are related to deficient fear reactivity (eg, psychopathy). Studies on the relationship between fear and narcissism have been sparse, both at a phenotypic and mechanism level. One study of individuals with narcissistic traits, as measured by the Narcissism Personality Inventory (NPI)49 reported that they display diminished electrodermal reactivity to aversive stimuli,50 indicating weak responses to punishment or aversive cues.
Despite the limited research directly examining fear and narcissism, there are studies of other related conditions with relevance to pathological narcissism that highlight the importance of fear in the expression of psychopathology. Specifically, the role of fear in psychopathy-related disinhibition has been the focus of studies for decades. NPD and psychopathy are considered to be overlapping constructs, both expressing symptoms of grandiosity, compromised empathic functioning, and callousness. In fact, Kernberg2 suggested that narcissism might be the core of psychopathy.51–53 Psychopathic individuals generally display an inability to form genuine relationships; limited (ie, grandiose) affective processing, especially with respect to anticipatory anxiety and remorse; an impulsive behavioral style involving a general failure to evaluate anticipated actions and inhibit the inappropriate ones; and a chronic antisocial lifestyle that entails great costs to society as well as for the affected individual.54 While both affective and behavioral characteristics are important elements of psychopathy, the affective deficits have traditionally been considered to be the root cause of the psychopath’s problems.