This is very interesting, pathologically rather than medically. Perhaps the milder or socially aware subjects find that grandiosity is enough to counteract their feelings of shame- the commonly understood cause of narcissism. It may very well be that depending on the level of shame, some narcissists might need to employ the more destructive strategies. While grandiose narcissists find that egoism is adequate to counteract their shame, vulnerable narcissists might need more aggressive strategies.

Grandiosity does not result in the more socially destructive effects, among all the known strategies. Many narcissists devalue those in their surroundings, to suggest a favorable comparison of themselves to others. That along with domineering control, like gaslighting, deceptions, manipulations, are the more socially destructive strategies. Understanding the strategic differences through measurable stress response could help psychiatry better understand the spectrum of the disorder and resulting strategies more completely.