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Class 6: Narcissistic PD
Models of Narcissism and Narcissistic PD
Cain – Narcissism at the Crossroads: Phenotypic description of pathological narcissism
across clinical theory, social/personality psychology, and psychiatric diagnosis.
This review documents two themes of emphasis found in phenotypic descriptions of pathological
narcissism across clinical theory, social/personality psychology, and psychiatric diagnosis.
Clinical theories of narcissism spanning 35 years consistently describe variations in the
expression of pathological narcissism that emphasize either grandiosity or vulnerable
affects and self-states.
Recent research in social/personality psychology examining the structure of narcissistic
personality traits consistently finds two broad factors representing Grandiosity–
Exhibitionism and Vulnerability–Sensitivity–Depletion respectively.
However, the majority of psychiatric criteria for narcissistic personality disorder (NPD) in the
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric
Association, 1994) emphasize expressions of grandiosity.
By placing most of the diagnostic emphasis on overt grandiosity, DSM NPD has been limited by
poor discriminant validity, modest levels of temporal stability, and the lowest prevalence
rate on Axis II.
Despite converging support for two phenotypic themes associated with pathological narcissism,
psychiatric diagnosis and social/personality psychology research often focus only on
grandiosity in the assessment of narcissism.
In contrast, clinical theory struggles with a proliferation of labels describing these broad
phenotypic variations.
We conclude that the construct of pathological narcissism is at a crossroads and provide
recommendations for diagnostic assessment, clinical conceptualization, and future research that
could lead to a more integrated understanding of narcissistic personality and narcissistic
personality pathology.
Introduction
Narcissistic personality disorder (NPD) is added on Axis II of the DSM.
Current fields of research regarding NPD have internal problems with conceptualization
and assessment.
Overall, two themes of emphasis in the phenotypic descriptions of pathological
narcissism across clinical theory, social/personality psychology and DSM criteria were
found, namely narcissistic grandiosity and narcissistic vulnerability.
Problems
The lack of coordination between clinical conceptualizations of pathological narcissism,
research on narcissistic personality traits, and psychiatric diagnosis of NPD puts the
study of narcissism at a crossroads.
The current situation is unfortunate in light of the links reported between narcissism
and related areas of psychopathology ad dysfunction: DSM Axis I disorders, psychopathy,
interpersonal problems and relational dysfunction, substance use and abuse, aggression
and sexual aggression, impulsivity, and suicidal behaviour.
Action must be taken to resolve disjunctions and integrate findings in future
conceptualizations of pathological narcissism or these efforts will impede their own
progress towards a more sophisticated understanding of narcissism.
Class 6: Narcissistic PD
Models of Narcissism and Narcissistic PD
Cain – Narcissism at the Crossroads: Phenotypic description of pathological narcissism
across clinical theory, social/personality psychology, and psychiatric diagnosis.
This review documents two themes of emphasis found in phenotypic descriptions of pathological
narcissism across clinical theory, social/personality psychology, and psychiatric diagnosis.
Clinical theories of narcissism spanning 35 years consistently describe variations in the
expression of pathological narcissism that emphasize either grandiosity or vulnerable
affects and self-states.
Recent research in social/personality psychology examining the structure of narcissistic
personality traits consistently finds two broad factors representing Grandiosity–
Exhibitionism and Vulnerability–Sensitivity–Depletion respectively.
However, the majority of psychiatric criteria for narcissistic personality disorder (NPD) in the
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric
Association, 1994) emphasize expressions of grandiosity.
By placing most of the diagnostic emphasis on overt grandiosity, DSM NPD has been limited by
poor discriminant validity, modest levels of temporal stability, and the lowest prevalence
rate on Axis II.
Despite converging support for two phenotypic themes associated with pathological narcissism,
psychiatric diagnosis and social/personality psychology research often focus only on
grandiosity in the assessment of narcissism.
In contrast, clinical theory struggles with a proliferation of labels describing these broad
phenotypic variations.
We conclude that the construct of pathological narcissism is at a crossroads and provide
recommendations for diagnostic assessment, clinical conceptualization, and future research that
could lead to a more integrated understanding of narcissistic personality and narcissistic
personality pathology.
Introduction
Narcissistic personality disorder (NPD) is added on Axis II of the DSM.
Current fields of research regarding NPD have internal problems with conceptualization
and assessment.
Overall, two themes of emphasis in the phenotypic descriptions of pathological
narcissism across clinical theory, social/personality psychology and DSM criteria were
found, namely narcissistic grandiosity and narcissistic vulnerability.
Problems
The lack of coordination between clinical conceptualizations of pathological narcissism,
research on narcissistic personality traits, and psychiatric diagnosis of NPD puts the
study of narcissism at a crossroads.
The current situation is unfortunate in light of the links reported between narcissism
and related areas of psychopathology ad dysfunction: DSM Axis I disorders, psychopathy,
interpersonal problems and relational dysfunction, substance use and abuse, aggression
and sexual aggression, impulsivity, and suicidal behaviour.
Action must be taken to resolve disjunctions and integrate findings in future
conceptualizations of pathological narcissism or these efforts will impede their own
progress towards a more sophisticated understanding of narcissism.
