Narcissism at the crossroads: Phenotypic description of pathological narcissism across clinical theory, social/personality psychology, and psychiatric diagnosis

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Abstract

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.

Section snippets

Clinical theories of narcissism

In the last 35 years, the expanding clinical literature on narcissism and narcissistic personality pathology has led to a marked proliferation of labels implying variations in the phenotypic expression of narcissism. We identified over 50 distinct labels describing variability in the expression of pathological narcissism. While each individual conceptualization has unique clinical value, neither future classification systems (e.g., DSM-V), nor intervention models, are likely to sustain such a

Narcissism in social/personality psychology

The publication of NPD on DSM-III Axis II also stimulated research on narcissistic personality traits in social and personality psychology. The publication of the Narcissistic Personality Inventory (NPI; Raskin and Hall, 1979, Raskin and Hall, 1981) followed on the heels of DSM-III and provided a self-report measure derived from criteria presented in DSM-III. For over two decades, the NPI has dominated social/personality research on narcissistic personality traits. We conducted PsychInfo

DSM narcissistic personality disorder

Narcissistic personality disorder (NPD) was first included in DSM-III due to its use by psychodynamically informed clinicians. However, despite two major revisions since its inclusion, the clinical utility of the NPD diagnosis remains questionable. It is unclear whether the DSM NPD diagnosis serves its original purpose, i.e., to facilitate the accurate diagnosis of patients with pathological forms of narcissism. This problem is not unique to the NPD diagnosis. Livesley (2001) noted that many of

Narcissism at the crossroads

In our review, we found two broad themes of dysfunction in the phenotypic descriptions of pathological narcissism across clinical theory, social/personality psychology, and psychiatric diagnosis. One theme reflects an emphasis on grandiose aspects of narcissism and a second theme reflects an emphasis on vulnerable aspects of narcissism. As noted in our review, support for the two descriptive themes of emphasis has been found in clinical theory and social/personality psychology. Clinical

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