A clinicians guide to evidence based approaches: Narcissistic Personality Disorder

A clinicians guide to evidence based approaches: Narcissistic Personality Disorder

Introduction:

Pathological narcissism has a long history dating back 2000 years, that has evolved into contemporary clinical psychology as a trait that may require clinical attention (Grenyer, 2013). Traditionally, Narcissistic personality disorder(NPD)is one of the 10 identified personality disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

An alternative trait-based model of personality disorders in DSM-5 described in Section III includes a more contemporary version of NPD. The former NPD description only describes the grandiose form characterized by a grandiose sense of self-importance, fantasies of success, power etc, a belief in one’s specialness, desire for admiration, sense of entitlement, interpersonal exploitativeness, and lack of empathy. The alternative NPD alsodescribes impairments in functioning across identity, self-direction, empathy, and intimacy and while identifying pathological personality traits of grandiosity and attention seeking (both facets of antagonism) as well as more vulnerable narcissism presentations with aspects of negative affectivity such as depressivity and anxiousness (American Psychiatric Association, 2013). (see Pincus, Dowgwillo, & Greenberg (2016) for descriptions of 3 cases of NPD using the alternative DSM-5 model).

Thus, contemporary views of pathological narcissism recognise both grandiose and vulnerable components.