KELLIE NEWSOME: Context changes personality, but can it make someone narcissistic? Today, we explore the controversial criteria for Hubris Syndrome. Welcome to the Carlat Psychiatry Podcast, keeping psychiatry honest since 2003.

CHRIS AIKEN: I’m Chris Aiken, the editor-in-chief of The Carlat Psychiatry Report.

KELLIE NEWSOME: And I’m Kellie Newsome, a psychiatric NP and a dedicated reader of every issue.

CHRIS AIKEN: In 2008, two psychiatrists teamed up to describe a new psychiatric disorder. One was Jonathan Davidson, known for his work on anxiety and mood disorders at Duke University. The other was David Owen, who worked briefly as a psychiatrist before entering a long career as a politician and parliamentarian in England. The disorder was Hubris Syndrome, a kind of environmentally induced narcissism, and it came with its own set of DSM-style criteria:

KELLIE NEWSOME: 

1. A narcissistic propensity to see their world primarily as an arena in which to exercise power and seek glory 

2. A predisposition to take actions which seem likely to cast the individual in a good light— i.e., in order to enhance image 

3. A disproportionate concern with image and presentation 

4. A messianic manner of talking about current activities and a tendency to exaltation 

5. An identification with the nation, or organization to the extent that the individual regards his/her outlook and interests as identical to those of the larger group 

6. A tendency to speak in the third person or use the royal ‘we’ 

7. Excessive confidence in the individual’s own judgement and contempt for the advice or criticism of others 

8. Exaggerated self-belief, bordering on a sense of omnipotence, in what they personally can achieve 

9. A belief that rather than being accountable to the mundane court of colleagues or public opinion, the court to which they answer is: History or God 

10. An unshakable belief that in that court they will be vindicated 

11. Loss of contact with reality; often associated with progressive isolation 

12. Restlessness, recklessness, and impulsiveness 

13. A tendency to allow their ‘broad vision’, about the moral rectitude of a proposed course, to obviate the need to consider practicality, cost, or outcomes 

14. Hubristic incompetence, where things go wrong because too much self-confidence has led the leader not to worry about the nuts and bolts of policy 

You might recognized some of those items from the criteria for Narcissistic Personality Disorder, and half of them are, but the authors also drew from antisocial and histrionic personality criteria.

CHRIS AIKEN: Unlike other personality disorders, which begin at an early age, Hubris syndrome can come on at any age, and usually later in life. The longer a person has been in power, and the more power they have, the more likely they are to develop the problem.

KELLIE NEWSOME: So, it’s a like that famous saying by Lord Acton: “Power tends to corrupt, and absolute power corrupts absolutely.”

CHRIS AIKEN: Yes, Hubris Syndrome environmentally induced, and this is not the only personality change with a recognized environmental cause. ICD describes personality changes that can come on after trauma, chronic pain, or chronic psychiatric illness.

KELLIE NEWSOME: Hubris can happen to anyone. In fact, one of the best ways to guard against it is to assume that you are at risk. But some personality traits predispose people to it, and – unfortunately – many of these are the same traits that make people attractive as leaders. They are charismatic, charming. They inspire others with their vision. They are confident and take on risks. But if you’ve ever known anyone like that, you know there is often a dark side to these traits. They are impatient, impulsive, quick to anger. They are confident, but don’t listen well or take advice. They may see the big picture, but they also fail to pay attention to the details. Now, a preview of the CME quiz for this episode. Earn CME for each episode through the link in the show notes.  

1. Which condition can mimic the symptoms of Hubris Syndrome? 

A. Major Depressive Disorder 

B. Paranoid Personality Disorder 

C. Intermittent Explosive Disorder 

D. Hypomania

CHRIS AIKEN: We see hubris syndrome not just in politicians, but in artists, business leaders, priests, and gurus. Davidson and Owen call out the risky behavior of banking leaders that lead to the 2008 collapse as a possible example. They find hubristic traits in some US presidents and UK prime ministers, but they acknowledge that this is a difficult call to make. Theodore Roosevelt and Lyndon Johnson, for example had some hubristic trails, but they have also been thought by historians to possibly have had bipolar disorder, and bipolar may better explain the problem. Woodrow Wilson and Richard Nixon both displayed hubris – historians often count them as presidents who acted like dictators – but that could be explained by Wilson’s cerebrovascular deterioration in office and Nixon’s alcoholic abuse while in office.

KELLIE NEWSOME: Yes, small ischemic strokes do not help with cognitive flexibility, and alcohol abuse – or even just getting a little intoxicated for one night - impairs empathy in experimental studies.

CHRIS AIKEN: Among British prime ministers, they believe Margaret Thatcher developed the syndrome, but not until 1988, when she had held the office for 9 years. Winston Churchill, on the other hand, gets a pass, as any hubristic behaviors he exhibited might have been due to alcohol abuse, hypomania, or – later in life – vascular disease (common patterns that we see in many patients as well). Since Davidson and Owen’s article came out, studies have confirmed at least part of the idea – that power and status reduce empathy. At the University of California, Paul Piff and Dacher Keltner measured driving behavior at a busy intersection. Drivers of luxury cars were more likely to cut off other vehicles or to speed past a pedestrian at the crosswalk. We don’t know if their wealth and power made them act selfish, or if selfish people are just drawn to purchase luxury cars, but one of the findings was revealing enough to make it on the nightly talk shows. It wasn’t just the Lexus and BMW drivers that were misbehaving – drivers of the Prius – a high-status care in its own way at the time – as in the phrase “Prius envy” - were equally guilty of this behavior.

KELLIE NEWSOME: The researchers also brought people into the psychology lab, where they compared upper-and lower-class people in various tests and gaming scenarios. Upper-class people were more likely steal from others, cheat, lie in a negotiation, and generally act unethically. They were even more likely to take candy from a jar that was ostensibly for children, and less likely to show empathy for other people’s pain. The findings even pin it down at the neurobiological level. Mirroring neurons – the ones that underlie empathy – are less active in high-power people than low-power people.

CHRIS AIKEN: Some of these studies have tried to clarify the direction of causation here. For example, they’ll ask participants to think about a time when they had lots of power, or to think about how they are better off than other people to see if it induces these hubristic behaviors.

KELLIE NEWSOME: Yeah, that’s important to clarify. I mean, it’s possible that people who are low on empathy to begin with gravitate toward power and success, but empathy is also a skill that helps people rise to power and makes for better leaders.

CHRIS AIKEN: Not all of the studies support the idea that staying in power too long erodes empathy. It could be that staying in power makes you more secure, less reactive… as a study of vengeance found. When people were given the opportunity to take revenge upon perpetrators, those who are new to power are much more vengeful than those who’ve had power for a long time.

KELLIE NEWSOME: But David Owen did confirm one symptom of Hubris Syndrome. Remember that one about the tendency to speak in the third person or use the royal ‘we’? Well, he divided up prime ministers into those who met the other Hubris criteria and those who didn’t. Then he traced these self-centered linguistic tendencies over the years and found that – for the ones with hubris – they increased over time, but not for the more humble leaders.

CHRIS AIKEN: It reminds me of a study of songwriters. As the songwriters got more famous, they were more likely to use first-person language in their songs. Like many findings in social psychology, the relationship between high status and low empathy probably varies a lot by person, but I think the bulk of the research points to a worrisome trend. However, it is just a trend, not an absolute, and there are things you can do to keep a steady head as you get promoted and grow in status and power.

KELLIE NEWSOME: Self-control and humor are protective. Laugh at yourself and allow others to laugh at you. Being a realist – some healthy self-doubt – even if it means a touch of cynicism – can keep you grounded. Don’t let your head float into the clouds of abstract ideals – make sure your devotion and concern is focused on the needs of real people, rather than just an abstract cause. And most important, have some people around you who can call you out on your bullshit. Want to keep up with the latest in psychiatric research? We post new studies in the Daily Psych feed – Search for ChrisAikenMD on LinkedIn, Twitter, Facebook, and Blue Sky. Thanks for tuning in and helping us stay free of industry support.