Two dimensions of narcissism were related to psychophysiological responses to stress in 50 young women. Cardiovascular, electrodermal, task performance, and stress appraisal measures were recorded during rest, mental arithmetic, and a computerized Thematic Apperception Test (Murray, 1943). The Egocentricity and Alienation scales of the Bell Object Relations and Reality Testing Inventory (Bell, 1995) served as measures of overt/inflated and covert/deflated narcissism. Egocentricity correlated consistently with heightened preejection period reactivity, whereas Alienation correlated consistently with diminished electrodermal reactivity (all p < .05). Multivariate analyses supported specific relationships between Egocentricity and preejection period hyperreactivity, and between Alienation and electrodermal hyporeactivity. These results have implications for narcissism, cardiovascular disease risk, and a variety of psychiatric disorders.