Narcissistic Personality Disorder: Progress in Understanding and Treatment

Summary & key facts

This paper reviews what we learned about narcissistic personality disorder over the last ten years. It explains a new way of diagnosing the disorder that treats narcissism as a scale instead of just a yes-or-no label. Researchers describe two common presentations — grandiose (showing arrogance and strong self-confidence) and vulnerable (showing sensitivity and low self-worth) — and say people often show mixtures of both. The review also summarizes likely causes and processes, notes that people can improve over time but usually slowly, and says several types of therapy share common helpful features.

Key facts:

• Researchers now use both a yes-or-no definition and a scale-based definition for narcissistic personality disorder. The scale-based approach means people can have higher or lower levels of narcissistic traits instead of just being labeled w
• Two main presentations are described: grandiose narcissism, which looks like arrogance and high self-confidence, and vulnerable narcissism, which looks like high sensitivity, shame, and insecurity. People can show features of both at the sa
• Studies have identified several linked problems that help explain the disorder. These include unstable self-esteem (quick changes in how people feel about themselves), trouble managing emotions, particular ways of thinking, strained relatio
• The review says there are likely many contributing causes, including temperamental traits and developmental experiences. In other words, the disorder probably develops from a mix of different risk factors rather than a single cause.
• Studies that followed people over time show that symptoms can get better, but improvement tends to be gradual and slow rather than quick.
• Many therapies have been created for this disorder. Most of these treatments share common elements: clear therapy goals, consistent rules for how therapy is done, attention to relationship patterns and self-esteem, building a strong relatio

Abstract

This review summarizes current knowledge about narcissistic personality disorder (NPD). Each section brings the reader up to date on advances in our knowledge during the last decade. In terms of NPD diagnosis, this review describes the addition of the dimensional model to the categorical model. The accumulating knowledge has led to the description of grandiose and vulnerable narcissism as well as their complex interrelationship. Strong support exists for co-occurrence of these presentations among people with high levels of grandiose narcissism. Studies have identified mechanisms, in domains such as self-esteem dysregulation, emotion dysregulation, cognitive style, interpersonal relations, and empathy, and possible developmental and temperamental antecedents of the disorder. Thus, it appears that NPD has a multifactorial etiology and pathogenesis, with numerous mechanisms associated with each area of dysfunction. Longitudinal studies support the view that these patients can improve, but such improvement is gradual and slow. Several treatments have been developed for the disorder, and a majority share commonalities, including clear goals, attention to treatment frame, attention to relationships and self-esteem, alliance building, and monitoring of countertransference.

Topics

Obsessive-Compulsive Spectrum Disorders Personality Disorders and Psychopathology Personality Traits and Psychology

Categories

Clinical Psychology Psychology Social Sciences

Tags

Alliance Borderline personality disorder Clinical psychology Cognition Countertransference Empathy Law Narcissism Narcissistic personality disorder Personality Personality disorders Political science Psychiatry Psychology Psychotherapist Social psychology

Conditions & symptoms

Feeling disconnected from others