Narcissistic personality disorder: An integrative review of recent empirical data and current definitions

Current Psychiatry Reports

Volumn 16, Issue 5, 2014, Pages

  Roepke, Stefan ^a,b   Vater, Aline ^a,c  

^a CHARITÉ UNIVERSITÄTSMEDIZIN BERLIN   (Germany)

^b FREIE UNIVERSITÄT BERLIN   (Germany)

^c DARMSTADT UNIVERSITY OF TECHNOLOGY   (Germany)

Author keywords

Empathy; Narcissistic personality disorder; Self esteem; Shame; Stability

Indexed keywords

BRAIN REGION; BRAIN SIZE; CINGULATE GYRUS; DSM-5; EMOTION; EMPATHY; ETHNIC DIFFERENCE; GENETIC DISORDER; GRAY MATTER; HUMAN; INTERNAL CONSISTENCY; NARCISSISM; PREVALENCE; PSYCHOLOGIC ASSESSMENT; PSYCHOTHERAPY; RELIABILITY; REVIEW; SELF ESTEEM; SHAME; VALIDITY; DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS; EMPIRICAL RESEARCH; PERSONALITY DISORDER; PSYCHOLOGICAL ASPECT; SELF CONCEPT;

DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS; EMPATHY; EMPIRICAL RESEARCH; HUMANS; NARCISSISM; PERSONALITY DISORDERS; SELF CONCEPT;

EID: 84897044741     PISSN: 15233812     EISSN: 15351645     Source Type: Journal    
DOI: 10.1007/s11920-014-0445-0     Document Type: Review

References (94)

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. Washington: American Psychiatric Press; 2013.
2. Robins E, Guze SB. Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. Am J Psychiatry. 1970;126:983-7.
3. Ellis H. Autoeroticism: A psychological study. Alienist Neurol. 1989;19:260-99.
4. Freud S. On narcissism: An introduction. Standardth ed. London: Hogarth Press; 1914.
5. Kernberg O. Borderline conditions and pathological narcissism. New York: Jason Aronson; 1975.
6. Kohut H. Forms and transformations of narcissism. J Am Psychoanal Assoc. 1966;14:243-72.
7. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-III). 3rd ed. Washington: American Psychiatric Press; 1980.
8. Frances A. The DSM-III personality disorders section: a commentary. Am J Psychiatry. 1980;137:1050-4. (Pubitemid 10048881)
9. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), 3rd rev ed. Washington: American Psychiatric Press; 1987.
10. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). 4th ed. Washington: American Psychiatric Press; 1990.
11. Cain NM, Pincus AL, Ansell EB. Narcissism at the crossroads: Phenotypic description of pathological narcissism across clinical theory, social/personality psychology, and psychiatric diagnosis. Clin Psychol Rev. 2008;28:638-56. (Pubitemid 351374604)
12. Karterud S, Oien M, Pederson G. Validity Aspects of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, narcissistic personality disorder construct. Compr Psychiatry. 2011;52:517-26. A validity study of the NPD construct challenging the notion that the DSM-IV criteria for NPD capture a distinct diagnostic category.
13. Miller JD, Hoffman BJ, Campbell WK, Pilkonis PA. An examination of the factor structure of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, narcissistic personality disorder criteria: one or two factors? Compr Psychiatry. 2008;49:141-5. (Pubitemid 351163231)
14. Kubarych TS, Aggen SH, Kendler KS, Torgersen S, Reichborn-Kjennerud T, Neale MC. Measurement non-invariance of DSM-IV narcissistic personality disorder criteria across age and sex in a population-based sample of Norwegian twins. Int J Methods Psychiatr Res. 2010;19:156-66.
15. Fossati A, Beauchaine TP, Grazioli F, Carretta I, Cortinovis F, Maffei C. A Latent structure analysis of diagnostic and statisticalmanual ofmental disorders, fourth edition, narcissistic personality disorder criteria. Compr Psychiatry. 2005;46:361-7. (Pubitemid 41196862)
16. Blais MA, Hilsenroth MJ, Castlebury FD. Content validity of the DSM-IV borderline and narcissistic personality disorder criteria sets. Compr Psychiatry. 1997;38:31-7. (Pubitemid 26428167)
17. Russ E, Shedler J, Bradley R, Westen D. Refining the construct of narcissistic personality disorder: Diagnostic criteria and subtypes. Am J Psychiatry. 2008;165:1473-81.
18. Torgersen S, Kringlen E, Cramer V. The prevalence of personality disorders in a community sample. Arch Gen Psychiatry. 2001;58:590-6. (Pubitemid 32523740)
19. Lenzenweger MF, Lane MC, Loranger AW, Kessler RC. DSM-IV personality disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007;62:553-64. (Pubitemid 47314365)
20. Samuels J, Eaton WW, Bienvenu 3rd OJ, Brown CH, Costa Jr PT, Nestadt G. Prevalence and correlates of personality disorders in a community sample. Br J Psychiatry. 2002;180:536-42. (Pubitemid 34596805)
21. Coid J, Yang M, Tyrer P, Roberts A, Ullrich S. Prevalence and correlates of personality disorder in Great Britain. Br J Psychiatry. 2006;188:423-31.
22. Stinson FS, Dawson DA, Goldstein RB, Chou SP, Huang B, Smith SM, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. 2008;69:1033-45. (Pubitemid 352031585)
23. Dhawan N, Kunik ME, Oldham J, Coverdale J. Prevalence and treatment of narcissistic personality disorder in the community: a systematic review. Compr Psychiatry. 2010;51:333-9.
24. Trull TJ, Jahng S, Tomko RL, Wood PK, Sher KJ. Revised NESARC Personality Disorder Diagnoses: Gender, Prevalence, and Comorbidity with Substance Dependence Disorders. J Personal Disord. 2010;24:412-26.
25. Grilo CM. Are there gender differences in DSM-IV personality disorders? Compr Psychiatry. 2002;43:427-30. (Pubitemid 35375517)
26. Zimmerman M, Rothschild L, Chelminski I. The prevalence of DSM-IV personality disorders in psychiatric outpatients. Am J Psychiatry. 2005;162:1911-8. (Pubitemid 41428621)
27. Soeteman DI, Hakkaart-van Roijen L, Verheul R, Busschbach JJ. The economic burden of personality disorders inmental health care. J Clin Psychiatry. 2008;69:259-65. (Pubitemid 351469269)
28. Lynam DR, Widiger TA. Using a general model of personality to understand sex differences in the personality disorders. J Personal Disord. 2007;21:583-602. (Pubitemid 350255087)
29. Morf CC, Rhodewalt F. Unraveling the Paradoxes of Narcissism: A Dynamic Self-Regulatory Processing Model. Psychol Inq. 2001;12:177-96.
30. Horowitz M. Clinical phenomenology of narcissistic pathology. Psychiatr Ann. 2009;39:124-8.
31. Ronningstam E. Narcissistic personality disorder: a current review. Curr Psychiatr Rep. 2010;12:68-75.
32. Jordan CH, Spencer SJ, Zanna MP, Hoshino Browne E, Correll J. Secure and defensive high self-esteem. J Pers Soc Psychol. 2003;85:969-78. (Pubitemid 37417555)
33. Pincus AL, Ansell EB, Pimentel CA, Cain NM, Wright AGC, Levy KN. Initial construction and validation of the Pathological Narcissism Inventory. Psychol Assess. 2009;21:365-79.
34. Vater A, Ritter K, Schröder-Abé M, Schütz A, Lammers CH, Bosson J, et al. When Grandiosity and Vulnerability Collide: Implicit and Explicit Self-Esteem in Patients with Narcissistic Personality Disorder. J Behav Ther Exp Psychiatry. 2013;44:37-47. Study providing evidence for low explicit self-esteem in NPD compared to non-clinical controls.
35. Ritter K, Dziobek I, Preißler S, Rüter A, Vater A, Fydrich T, et al. Lack of empathy in patients with narcissistic personality disorder. Psychiatry Res. 2011;187:241-7. First empirical assessment of the 'Lack of empathy' criterion in NPD patients indicating deficits in emotional empathy with cognitive empathy within normal limits.
36. Davis MH. Measuring Individual-Differences in Empathy - Evidence for a Multidimensional Approach. J Pers Soc Psychol. 1983;44:113-26.
37. Blair RJ. Responding to the emotions of others: dissociating forms of empathy through the study of typical and psychiatric populations. Conscious Cogn. 2005;14:698-718. (Pubitemid 41742032)
38. Baron-Cohen S, Wheelwright S. The empathy quotient: an investigation of adults with Asperger syndrome or high functioning autism, and normal sex differences. J Autism Dev Disord. 2004;34:163-75. (Pubitemid 39023470)
39. Premack D, Woodruff G. Chimpanzee problem-solving: a test for comprehension. Science. 1978;202:532-5. (Pubitemid 9064331)
40. Frith U, Frith CD. Development and neurophysiology of mentalizing. Philosophical Transactions of the Royal Society of London. Series B. Biol Sci. 2003;358:459-73.
41. Mehrabian A, Epstein N. A measure of emotional empathy. J Pers. 1972;40:525-43.
42. Eisenberg N, Miller PA. The relation of empathy to prosocial and related behaviors. Psychol Bull. 1987;101:91-119.
43. Dziobek I, Rogers K, Fleck S, Bahnemann M, Heekeren HR, Wolf OT, et al. Dissociation of cognitive and emotional empathy in adults with Asperger syndrome using the multifaceted empathy test (MET). J Autism Dev Disord. 2008;38:464-73.
44. Dziobek I, Fleck S, Kalbe E, Rogers K, Hassenstab J, Brand M, et al. Introducing MASC: a movie for the assessment of social cognition. J Autism Dev Disord. 2006;36:623-36. (Pubitemid 44336985)
45. Marissen MAE, Deen ML, Franken IHA. Disturbed emotion recognition inpatients with narcissistic personality disorder. Psychiatry Res. 2012;198:269-73. Experimental facial emotion recognition study in NPD patients indicating deficits in fear and disgust labelling.
46. Schulze L, Dziobek I, Vater A, Heekeren HR, Bajbouj M, Renneberg B, et al. Gray Matter Abnormalities in Patients with Narcissistic Personality Disorder. J Psychiatr Res. 2013;47:1363-9. First structural brain data from patients with NPDindicating lower gray matter density in empathy-related brain regions such as the anterior insular and further fronto-limbic structures.
47. Fan Y, Duncan NW, de Greck M, Northoff G. Is there a core neural network in empathy? An fMRI based quantitative meta-analysis. Neurosci Biobehav Rev. 2011;35:903-11.
48. Fan Y, Wonneberger C, Enzi B, de Greck M, Ulrich C, Tempelmann C, et al. The narcissistic self and its psychological and neural correlates: an exploratory fMRI study. Psychol Med. 2011;41:1641-50.
49. Sterzer P, Stadler C, Poustka F, Kleinschmidt A. A structural neural deficit in adolescents with conduct disorder and its association with lack of empathy. Neuroimage. 2007;37:335-42. (Pubitemid 47068977)
50. Kernberg O. Narcissistic personality disorders: Part I. Psychiatr Ann. 2009;39:105-66.
51. Schoenleber M, Berenbaum H. Shame regulation in personality pathology. J Abnorm Psychol. 2012;121:433-46. Conceptual paper on maladaptive shame regulation strategies in NPD and other personality disorders.
52. Tracy JL, Robins RW. Putting the self into self-conscious emotions: a theoretical model. Psychol Inq. 2004;15:103-25. (Pubitemid 39129714)
53. Ritter K, Vater A, Rüsch N, Schröder-Abé M, Schütz A, Fydrich T, Lammers CH, Roepke S. Shame in patients with narcissistic personality disorder. Psychiatry Res. 2014;215(2):429-37. doi:10.1016/j. psychres.2013.11.019. First empirical assessment of implicit and explicit shame in patients with NPD indicating the relevance of this emotion.
54. Andrews B, Qian M, Valentine JD. Predicting depressive symptoms with a new measure of shame: the experience of shame scale. Br J Clin Psychol. 2002;41:29-42. (Pubitemid 35252125)
55. Turner JE. An Investigation of Shame Reactions, Motivation, and Achievement in a Difficult College Course (Unpublished Doctoral Dissertation). Austin: University of Texas; 1998.
56. Tangney JP, Dearing RL, Wagner PE, Gramzow R. The Test of Self-Conscious Affect-3 (TOSCA-3). George Mason University; 2000.
57. Rüsch N, Lieb K, Göttler I, Hermann C, Schramm E, Richter H, et al. Shame and implicit self-concept in women with borderline personality disorder. Am J Psychiatry. 2007;164:500.508.
58. Morey LC. Personality disorders in DSM-III and DSM-III-R: convergence, coverage, and internal consistency. Am J Psychiatry. 1988;145:573-7.
59. Morey LC. The categorical representation of personality disorder: a cluster analysis of DSM-III-R personality features. J Abnorm Psychol. 1988;97:314-21.
60. Blais MA, Hilsenroth MJ, Castlebury FD. Psychometric characteristics of the cluster B personality disorder under DSM-III-R and DSM-IV. J Personal Disord. 1997;11:270-8. (Pubitemid 27478021)
61. Blais MA, Norman DK. A psychometric evaluation of the DSM-IV personality disorder criteria. J Personal Disord. 1997;11:168-76. (Pubitemid 27313778)
62. Gunderson JG, Ronningstam E. Differentiating narcissistic and antisocial personality disorders. J Personal Disord. 2001;15:103-9. (Pubitemid 32378318)
63. Holdwick Jr DJ, Hilsenroth MJ, Castlebury FD, Blais MA. Identifying the unique and common characteristics among the DSM-IV antisocial, borderline, and narcissistic personality disorders. Compr Psychiatry. 1998;39:277-86. (Pubitemid 28425918)
64. Grilo CM, McGlashan TH. Convergent and discriminant validity of DSM-IV axis II personality disorder criteria in adult outpatients with binge eating disorder. Compr Psychiatry. 2000;41:163-6. (Pubitemid 30322480)
65. Grilo CM, McGlashan TH, Morey LC, Gunderson JG, Skodol AE, Shea MT, et al. Internal consistency, intercriterion overlap and diagnostic efficiency of criteria sets for DSM-IV schizotypal, borderline, avoidant and obsessive-compulsive personality disorders. Acta Psychiatr Scand. 2001;104:264-72. (Pubitemid 32906972)
66. Torgersen S, Lygren S, Oien PA, Skre I, Onstad S, Edvardsen J, et al. A twin study of personality disorders. Compr Psychiatry. 2000;41:416-25.
67. Kendler KS, Aggen SH, Czajkowski N, Røysamb E, Tambs K, Torgersen S, et al. The structure of genetic and environmental risk factors for DSM-IV personality disorders: A multivariate twin study. Arch Gen Psychiatry. 2008;65:1438-46.
68. Torgersen S, Myers J, Reichborn-Kjennerud T, Røysamb E, Kubarych TS, Kendler KS. The heritability of Cluster B personality disorders assessed both by personal interview and questionnaire. J Personal Disord. 2012;26:848-66. Twin study revealing.71 heritability of NPD when including self-report and clinical interview.
69. Coolidge FL, Thede LL, Jang KL. Heritability of personality disorders in childhood: a preliminary investigation. J Personal Disord. 2001;15:33-40. (Pubitemid 32180189)
70. Vater A, Ritter K, Strunz S, Ronningstam E, Renneberg B, Roepke S. Stability of Narcissistic Personality Disorder: Tracking Categorical and Dimensional Rating Systems Over a Two-Year Period. Personal Disord. 2014 Feb 10. [Epub ahead of print]. Follow-up study that provides evidence for moderate stability of NPD across two years.
71. Ball SA, Rounsaville BJ, Tennen H, Kranzler HR. Reliability of personality disorder symptoms and personality traits in substance-dependent inpatients. J Abnorm Psychol. 2001;110:341-52. (Pubitemid 32423039)
72. Lenzenweger MF, Johnson MD, Willett JB. Individual growth curve analysis illustrates stability and change in personality disorder features: The Longitudinal Study of Personality Disorders. Arch Gen Psychiatry. 2004;61:1015-24. (Pubitemid 39336535)
73. Samuel DB, Hopwood CJ, Ansell EB, Morey LC, Sanislow CA, Yen S, et al. Comparing the temporal stability of self-report and interview assessed personality disorder. J Abnorm Psychol. 2011;120:670-80.
74. Hopwood CJ, Morey LC, Donnellan MB, Samuel DB, Grilo CM, McGlashan TH, et al. Ten-year rank-order stability of personality traits and disorders in a clinical sample. J Pers. 2013;81:335-44.
75. Ronningstam EF, Gunderson J, Lyons M. Changes in pathological narcissism. Am J Psychiatr. 1995;152:253-7.
76. Spitzer RL. Psychiatric diagnosis: are clinicians still necessary? Compr Psychiatry. 1983;24:399-411. (Pubitemid 13004194)
77. Gunderson JG, Ronningstam E, Bodkin A. The diagnostic interview for narcissistic patients. Arch Gen Psychiatry. 1990;47:676-80. (Pubitemid 20215985)
78. McGlashan TH, Grilo CM, Ralevski E, Morey LC, Gunderson JG, Skodol AE, et al. Two-year prevalence and stability of individual DSM-IV criteria for schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders: toward a hybrid model of axis II disorders. Am J Psychiatry. 2005;162:883-9. (Pubitemid 40676200)
79. Livesley WJ, Jackson DN. Manual for the dimensional assessment of personality pathology. Port Huron: Sigma Press; 2002.
80. Morey LC, Hopwood CJ, Markowitz JC, Gunderson JG, Grilo CM, McGlashan TH, et al. Comparison of alternative models for personality disorders, II: 6-, 8- and 10-year follow-up. Psychol Med. 2012;42:1705-13. Analysing data from the CLPS study, results reveal that the DSM-IV NPD diagnosis did not predict 10-year outcome under treatment as usual conditions.
81. Morey LC. A psychometric analysis of five DSM-III categories. Personal Individ Differ. 1985;6:323-9.
82. Alarcón RD, Sarabia S. Debates on the narcissism conundrum: trait, domain, dimension, type, or disorder. J Nerv Ment Dis. 2012;200:16-25.
83. Skodol AE, Bender DS, Morey LC. Narcissistic Personality Disorder in DSM-5. Personal Disord. 2013 Jul 8. [Epub ahead of print].
84. Raskin RN, Hall CS. A narcissistic personality inventory. Psychol Rep. 1979;45:590.
85. Vater A, Schröder-Abé M, Ritter K, Schulze L, Renneberg B, Bosson J, et al. The Narcissistic Personality Inventory - a useful tool for assessing pathological narcissism? Evidence from patients with Narcissistic Personality Disorder. J Pers Assess. 2013;95:301-8. Study showing that the Narcissistic Personality Inventory is not useful for clinical research.
86. Dowson JH. DSM-III-R narcissistic personality disorder evaluated by patients' and informants' self-report questionnaires: relationships with other personality disorders and a sense of entitlement as an indicator of narcissism. Compr Psychiatry. 1992;33:397-406.
87. Cooper LD, Balsis S, Oltmanns TF. Self- and informant-reported perspectives on symptoms of narcissistic personality disorder. Personal Disord. 2012;3:140-54. Study showing low self- and informant-report agreement among DSM-IV diagnostic criteria and the categorical diagnosis of NPD.
88. Westen D. Divergences between clinical and research methods for assessing personality disorders; Implications for research and the evolution of Axis II. Am J Psychiatry. 1997;154:895-903. (Pubitemid 27274530)
89. Ritter K, Roepke S, Merkl A, Heuser I, Fydrich T, Lammers CH. Comorbidity in patients with narcissistic personality disorder in comparison to patients with borderline personality disorder. Psychother Psychosom Med Psychol. 2010;60:14-24.
90. Hopwood CJ, Malone JC, Ansell EB, Sanislow CA, Grilo CM, McGlashan TH, et al. Personality assessment in DSM-5: empirical support for rating severity, style, and traits. J Personal Disord. 2011;25:305-20.
91. Bamelis LLM, Evers SMAA, Spinhoven P, Arntz A. Results of a Multicenter Randomized Controlled Trial of the Clinical Effectiveness of Schema Therapy for Personality Disorders. Am J Psychiatry. 2014. doi:10.1176/appi.ajp.2013. 12040518.
92. Roepke S, Merkl A, Dams A, Ziegenhorn A, Anghelescu IG, Heuser I, et al. Preliminary evidence of improvement of depressive symptoms but not impulsivity in cluster B personality disorder patients treated with quetiapine: an open label trial. Pharmacopsychiatry. 2008;41:176-81.
93. Hollander E, Tracy KA, Swann AC, Coccaro EF, McElroy SL, Wozniak P, et al. Divalproex in the treatment of impulsive aggression: eff icacy in cluster B personali t y disorders. Neuropsychopharmacology. 2003;28:1186-97.
94. Ogrodniczuk JS, Piper WE, Joyce AS, Steinberg PI, Duggal S. Interpersonal problems associated with narcissism among psychiatric outpatients. J Psychiatr Res. 2009;43:837-42.