Some comments on nomology, diagnostic process, and narcissistic personality disorder in the DSM-5 proposal for personality and personality disorders.

Narcissistic Personality Disorder is the new borderline personality disorder of our current era. There have been recent developments on narcissism that are certainly worthwhile examining. Firstly, relational and intersubjective psychoanalysts have been rethinking the underlying concepts of narcissism, focusing on the development of self and relations to others. Secondly, in the DSM-5, the Alternative DSM-5 Model for Personality Disorders (AMPD) was presented for a dimensional evaluation of the severity of personality disorder pathology. The combined dimensional and trait conceptualization of NPD opened the door to new integrated diagnostic perspectives, including both internal and interpersonal functioning. Finally, Pincus and Lukowitsky encourage clinicians to use a hierarchical model of pathological narcissism, as it opens up opportunities for shared points of interest in empirical research from different scholarly perspectives. As for most non-psychodynamic clinicians and researchers the DSM-5 clearly bears dominant weight in their work, we will take the AMPD model for NPD as our point of reference. We will discuss the narcissist's unique pattern of self-impairments in identity and self-direction, and of interpersonal disfunctioning (evaluated by assessing empathy and intimacy). Subsequently, we will examine how contemporary psychodynamic theories and the hierarchical model of Pincus and Lukowitsky additionally inform or contradict the AMPD. For us, one of the big advantages of the AMPD is the use of structured clinical evaluations of disturbances of the self and interpersonal functioning and the dimensional evaluation of severity. As psychodynamically oriented therapists, we are enthusiastic about the opportunities for inclusion of psychodynamic concepts, but we also discuss a number of sticking points.

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Narcissistic Personality Disorder: The Diagnostic Process

The Oxford Handbook of Personality Disorders ◽

10.1093/oxfordhb/9780199735013.013.0024 ◽

2012 ◽

pp. 526-548

Author(s):

Elsa Ronningstam

Keyword(s):

Personality Disorder ◽

Diagnosis And Treatment ◽

Narcissistic Personality Disorder ◽

Diagnostic Process ◽

Pathological Narcissism ◽

Dsm 5 ◽

The Past ◽

Narcissistic Personality ◽

Specific Focus ◽

Alliance Building

The diagnosis of narcissistic personality disorder (NPD) evolving over the past 40 years within several fields of inquiry—clinical and psychoanalytic as well as psychiatric and empirical—is discussed in this chapter. The inclusion of NPD as a separate personality disorder in the latest proposal of DSM-5 has warranted continuing studies and development of the diagnosis and treatment of pathological narcissism and NPD. Specific focus is on capturing the complexity of narcissistic pathology, identifying narcissistic core traits in the context of regulatory and dynamic variability, and incorporating the functional and phenotypic range of NPD. The diagnostic process, that is, identifying narcissistic traits in a collaborative alliance-building context between patient and clinician, aims at establishing a meaningful diagnosis that can inform patient and relatives and serve to guide treatment. Concluding guidelines for enhancing accuracy and meaningfulness of the NPD diagnosis are proposed.

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Narcissistic Pathology as Core Personality Dysfunction: Comparing the DSM-IV and the DSM-5 Proposal for Narcissistic Personality Disorder

Journal of Clinical Psychology ◽

10.1002/jclp.21895 ◽

2012 ◽

Vol 68 (8) ◽

pp. 908-921 ◽

Cited By ~ 21

Author(s):

Leslie C. Morey ◽

Brian H. Stagner

Keyword(s):

Personality Disorder ◽

Narcissistic Personality Disorder ◽

Dsm 5 ◽

Narcissistic Personality ◽

Personality Dysfunction ◽

Dsm Iv

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Examining the Incremental Utility of DSM-5 Section III Traits and Impairment in Relation to Traditional Personality Disorder Scores in a Female Correctional Sample

Journal of Personality Disorders ◽

10.1521/pedi_2017_31_320 ◽

2018 ◽

Vol 32 (6) ◽

pp. 738-752 ◽

Cited By ~ 4

Author(s):

Chelsea E. Sleep ◽

Dustin B. Wygant ◽

Joshua D. Miller

Keyword(s):

Personality Disorder ◽

Personality Disorders ◽

Alternative Model ◽

Female Inmates ◽

Societal Costs ◽

Dsm 5 ◽

Narcissistic Personality ◽

Categorical Models ◽

Personality Psychopathology ◽

Personality Disordered

Personality disorders (PDs) are challenging to assess and are associated with great individual and societal costs. In response to the limitations of categorical models, the DSM-5 included an alternative model (i.e., Section III), which uses impairment (Criterion A) and pathological traits (Criterion B) to diagnose PDs. Although numerous studies have illustrated dimensional trait models' ability to capture personality psychopathology, less attention has been paid to personality impairment. The present investigation sought to examine Criterion A's ability to contribute incrementally to the prediction of antisocial (ASPD), borderline (BPD), and narcissistic personality disorders (NPD), and Interpersonal-Affective (F1) and Impulsive-Antisocial (F2) features of psychopathy. The current study used 200 female inmates and found that impairment contributed to the prediction of BPD, NPD, and psychopathy F1 scores and did not add to the prediction of ASPD and psychopathy F2 scores. Difficulties in distinguishing between personality impairment and personality disordered traits are discussed.

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Female Narcissism: Assessment, Aetiology, and Behavioural Manifestations

Psychological Reports ◽

10.1177/00332941211027322 ◽

2021 ◽

pp. 003329412110273

Author(s):

Ava Green ◽

Rory MacLean ◽

Kathy Charles

Keyword(s):

Personality Disorder ◽

Partner Violence ◽

Narcissistic Personality Disorder ◽

Empirical Literature ◽

Statistical Manual ◽

Masculine Norms ◽

Diagnostic And Statistical Manual ◽

Dsm 5 ◽

Narcissistic Personality

Despite putative gender differences in the expression of narcissism, prominent theories have virtually dismissed the role of females in the development and manifestation of narcissism. The contention that narcissism is a pathology of the self that may partly differ in males and females is further evident in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 reports that up to 75% of those diagnosed with Narcissistic Personality Disorder (NPD) are men. Such figures suggest that the representation of narcissism as codified in the DSM-5 may only be marginally applicable to females, given its prominent focus and nature on capturing grandiose themes which closely resemble commonly masculine norms. The overemphasis on grandiose features extends to the empirical literature which defines narcissism as a normative personality trait and is widely assessed using the Narcissistic Personality Inventory (NPI), on which males obtain significantly higher scores than females. As this review will demonstrate, one limitation frequently occurring in the literature is the attempt to comprehend narcissistic manifestations in females through the lens of what has commonly been defined as narcissism (DSM/NPI). In this review, the literature concerning the diagnostic assessment and conceptualization of narcissistic personality disorder, etiological factors, aggression, and partner violence perpetration will be discussed in relation to the importance of gender. This is followed by a review of existing gaps in theory and research, and suggestions for fruitful directions that can aid a richer and more meaningful literature on narcissism inclusive of gender issues.

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Analysing Joker: an attempt to establish diagnosis for a film icon

BJPsych Bulletin ◽

10.1192/bjb.2020.146 ◽

2021 ◽

pp. 1-4

Author(s):

Valentin Yurievich Skryabin

Keyword(s):

Traumatic Brain Injury ◽

Mental Illness ◽

Brain Injury ◽

Personality Disorder ◽

Mental Disorder ◽

Psychotic Disorder ◽

Narcissistic Personality Disorder ◽

Dsm 5 ◽

Narcissistic Personality ◽

Unusual Combination

Summary Todd Phillips's film Joker, a 2019 psychological thriller, has stirred up strong reactions to the portrayal of the lead character's mental disorder, which is never specified. I used DSM-5 criteria to study whether Joker/Arthur Fleck showed signs of a real mental disorder. The psychopathology Arthur exhibits is unclear, preventing diagnosis of psychotic disorder or schizophrenia; the unusual combination of symptoms suggests a complex mix of features of certain personality traits, namely psychopathy and narcissism (he meets DSM-5 criteria for narcissistic personality disorder). He also shows the symptoms of pseudobulbar affect due to traumatic brain injury. This apparent co-occurrence of both mental disorder and a neurological condition may be confusing for audiences trying to understand mental illness.

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