Refining the Construct of Narcissistic Personality Disorder: Diagnostic Criteria and Subtypes
Abstract
OBJECTIVE: Narcissistic personality disorder has received relatively little empirical attention. This study was designed to provide an empirically valid and clinically rich portrait of narcissistic personality disorder and to identify subtypes of the disorder. METHOD: A random national sample of psychiatrists and clinical psychologists (N=1,201) described a randomly selected current patient with personality pathology. Clinicians provided detailed psychological descriptions of the patients using the Shedler-Westen Assessment Procedure-II (SWAP-II), completed a checklist of axis II diagnostic criteria, and provided construct ratings for each axis II personality disorder. Descriptions of narcissistic patients based on both raw and standardized SWAP-II item scores were aggregated to identify, respectively, the most characteristic and the most distinctive features of narcissistic personality disorder. RESULTS: A total of 255 patients met DSM-IV criteria for narcissistic personality disorder based on the checklist and 122 based on the construct ratings; 101 patients met criteria by both methods. Q-factor analysis identified three subtypes of narcissistic personality disorder, which the authors labeled grandiose/malignant, fragile, and high-functioning/exhibitionistic. Core features of the disorder included interpersonal vulnerability and underlying emotional distress, along with anger, difficulty in regulating affect, and interpersonal competitiveness, features that are absent from the DSM-IV description of narcissistic personality disorder. CONCLUSIONS: These findings suggest that DSM-IV criteria for narcissistic personality disorder are too narrow, underemphasizing aspects of personality and inner experience that are empirically central to the disorder. The richer and more differentiated view of narcissistic personality disorder suggested by this study may have treatment implications and may help bridge the gap between empirically and clinically derived concepts of the disorder.
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Results suggest potential for meaningful expansion of additional traits within the antagonism domain (e.g., manipulativeness, callousness and hostility) to indicate severity of pathology in interpersonal functioning.
“However, beyond grandiosity and attention seeking, these results suggest potential for meaningful expansion of additional traits within the antagonism domain to indicate the severity of pathology in interpersonal functioning (e.g., manipulativeness, callousness and hostility)”
From Pathological narcissism: An analysis of interpersonal dysfunction within intimate relationships (2022) · cites this paper as Russ et al., 2008
Grandiose narcissism is typically characterized by attention seeking, arrogance, and self-enhancing and exaggerated self-worth, and individuals with grandiose narcissism are interpersonally domineering, antagonistic, and vindictive.
“Grandiose narcissism is typically characterized by attention seeking, arrogance, and self-enhancing and exaggerated self-worth. These individuals have been found to be interpersonally domineering, antagonistic and vindictive [14, 74, 75, 84].”
From “It’s not you, it’s me”: identity disturbance as the main contributor to interpersonal problems in pathological narcissism (2023) · cites this paper as [74]
These features can be grouped to resemble narcissistic subtypes as described in research literature.
“These features can be grouped to resemble narcissistic subtypes as described in research literature, such as the subtypes outlined by Russ, Shedler [55] in their Q-Factor Analysis of SWAP-II Descriptions of Patients with Narcissistic Personality Disorder.”
From Living with pathological narcissism: a qualitative study (2020) · cites this paper as [55]
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“…of additional traits within the antagonism domain to indicate the severity of pathology in interpersonal functioning (e.g., manipulativeness, callousness and hostility), such as that described in the ‘malignant narcissism’ subtype (Kernberg, 2008; Lenzenweger et al., 2018; Russ et al., 2008).”
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- Authors
- Russ, E., Shedler, J., Bradley, R., & Westen, D.
- Affiliations
- Emory University (US)
- ORCID
- Russ, Eric
- Venue
- American Journal of Psychiatry
- Published
- 2008-11
- Volume
- 165
- Issue
- 11
- Pages
- 1473-1481
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2134253629
- Cited by
- 272
- References
- 32
- Citations by year
- 2026: 4 · 2025: 10 · 2024: 15 · 2023: 12 · 2022: 8 · 2021: 19 · 2020: 12 · 2019: 12 · 2018: 11 · 2017: 17 · 2016: 12 · 2015: 17 · 2014: 19 · 2013: 18 · 2012: 21
- FWCI
- 23.42
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (R01MH062378, MH-62378, MH62377, R01MH062377)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- narcissistic personality disorder, diagnostic criteria, DSM-IV, personality disorder subtypes, Axis II personality disorders, interpersonal vulnerability, anger, emotion regulation
- MeSH terms
- Adult, Diagnosis, Differential, Female, Humans, Male, Middle Aged, Personality Assessment, Personality Disorders, Psychometrics, Q-Sort, Sampling Studies, Reproducibility of Results, Diagnostic and Statistical Manual of Mental Disorders
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