Narcissistic Personality Disorder in DSM-V—In Support of Retaining a Significant Diagnosis
Abstract
Narcissistic personality disorder, NPD, has been excluded as a diagnostic category and independent personality disorder type in the Personality and Personality Disorder Work Group's recent proposal for DSM-5 Personality and Personality Disorders. The aim of this paper is to present supporting evidence in favor of keeping NPD as a personality type with a set of separate diagnostic criteria in DSM-5. These include: the prevalence rate, extensive clinical and empirical reports and facts, its psychiatric, social and societal significance especially when associated to functional vocational and interpersonal impairment, social and moral adaptation, and acute suicidality. Proposals for a clinically relevant and empirically based definition of narcissism, a description of the narcissistic personality disorder type, and a set of diagnostic criteria for NPD are outlined.
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Most narcissistic patients present with some degree of fluctuation between grandiose and vulnerable self-esteem states.
“There is however growing consensus, that most narcissistic patients present with some degree of fluctuation between grandiose and vulnerable self-esteem states [23, 35, 66, 35, 73].”
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 [73]
Grandiose and vulnerable narcissism may reflect both sides of a narcissistic 'coin' that may be regularly oscillating, inter-related and state dependent.
“While the differences in presentation between grandiose and vulnerable narcissism appear manifest, it has been argued that they reflect both sides of a narcissistic ‘coin’ [9] that may be regularly oscillating, inter-related and state dependent [6, 18–22].”
From Living with pathological narcissism: a qualitative study (2020) · cites this paper as [18]
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Self-citation
- Authors
- Ronningstam, E.
- Affiliations
- Harvard University (US)
- Corresponding author
- Ronningstam, Elsa
- ORCID
- Ronningstam, Elsa
- Venue
- Journal of Personality Disorders
- Publisher
- Guilford Publications
- Published
- 2011-04
- Volume
- 25
- Issue
- 2
- Pages
- 248-259
- ISSN
- 0885-579X (ISSN-L)
- OpenAlex
- W2108349403
- Cited by
- 122
- References
- 59
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 4 · 2023: 7 · 2022: 4 · 2021: 7 · 2020: 10 · 2019: 4 · 2018: 5 · 2017: 11 · 2016: 6 · 2015: 8 · 2014: 10 · 2013: 10 · 2012: 18
- FWCI
- 16.87
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Personality Disorders (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
- Social Sciences › Political Science and International Relations › History, Medicine, and Leadership
- Keywords
- narcissistic personality disorder, DSM-5, personality disorder classification, diagnostic criteria, prevalence, functional disability, suicidality
- MeSH terms
- Humans, Narcissism, Personality, Personality Disorders, Diagnostic and Statistical Manual of Mental Disorders
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