Narcissistic personality disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis
- Eve Caligor, MD
Eve Caligor, MD
- Clinical Professor of Psychiatry
- Columbia University College of Physicians and Surgeons
- Mark J Petrini, MD
Mark J Petrini, MD
- Assistant Clinical Professor of Medicine and Psychiatry
- Columbia University Medical Center
Grandiosity, which may be overt or covert, need for attention and admiration, superficial interpersonal relationships, and a lack of empathy are central features of narcissistic personality disorder (NPD) . Additional features of the disorder have a variable presentation, contributing to disagreement over the disorder’s boundaries and diagnostic criteria.
DSM-5 focuses on a more aggressive, grandiose subtype of NPD, while an alternative model, which we favor, describes additional subtypes – a healthier, high-functioning type and a vulnerable, introverted type – and places greater emphasis on problems with self-definition, self-esteem regulation, and affective reactivity.
NPD is one of the least studied personality disorders. It appears to be prevalent, highly comorbid with other psychiatric disorders, and associated with significant psychosocial disability. NPD is difficult to treat, and can complicate the treatment of co-occurring disorders.
The epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis of NPD are reviewed here. Treatment of narcissistic personality disorder is described separately. The epidemiology, clinical manifestations, assessment, and diagnosis of other personality disorders are also described separately. (See "Treatment of narcissistic personality disorder" and "Personality disorders" and "Borderline personality disorder: Epidemiology, clinical features, course, assessment, and diagnosis" and "Antisocial personality disorder: Epidemiology, clinical manifestations, course and diagnosis".)
The prevalence and sociodemographic features of narcissistic personality disorder (NPD) are poorly defined, in part because of evolving diagnostic criteria.
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- CLINICAL MANIFESTATIONS
- Core features
- - Grandiosity
- - Excessive need for admiration
- - Superficial and exploitative relationships
- - Lack of empathy
- - Identity disturbance
- - Attachment and dependence difficulties
- - Chronic emptiness and boredom
- - Life transition vulnerabilities
- - High-functioning subtype
- - Grandiose/overt subtype
- - Vulnerable/covert subtype
- Assessment instruments
- Diagnostic criteria
- - DSM-5
- - Alternative-model diagnostic criteria
- - ICD-10
- Differential diagnosis
- SUMMARY AND RECOMMENDATIONS