Narcissistic Personality Disorder and the Structure of Common Mental Disorders
Abstract
Narcissistic personality disorder (NPD) shows high rates of comorbidity with mood, anxiety, substance use, and other personality disorders. Previous bivariate comorbidity investigations have left NPD multivariate comorbidity patterns poorly understood. Structural psychopathology research suggests that two transdiagnostic factors, internalizing (with distress and fear subfactors) and externalizing, account for comorbidity among common mental disorders. NPD has rarely been evaluated within this framework, with studies producing equivocal results. We investigated how NPD related to other mental disorders in the internalizing-externalizing model using diagnoses from a nationally representative sample (N = 34,653). NPD was best conceptualized as a distress disorder. NPD variance accounted for by transdiagnostic factors was modest, suggesting its variance is largely unique in the context of other common mental disorders. Results clarify NPD multivariate comorbidity, suggest avenues for classification and clinical endeavors, and highlight the need to understand vulnerable and grandiose narcissism subtypes' comorbidity patterns and structural relations.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Cites
Hu, L., & Bentler, P. M. (1999) · Structural Equation Modeling A Multidisciplinary Journal · doi:10.1080/10705519909540118 · Cited by 108,788 · see citing works
Wittchen, H.-U. (1994) · Journal of Psychiatric Research · doi:10.1016/0022-3956(94)90036-1 · Cited by 2,348 · see citing works
The Structure of Common Mental Disorders
Krueger, R. F. (1999) · Archives of General Psychiatry · doi:10.1001/archpsyc.56.10.921 · Cited by 1,881 · see citing works
Self-citationHasin, D. S., Goodwin, R. D., Stinson, F. S., & Grant, B. F. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.10.1097 · Cited by 1,645 · see citing works
Self-citationToward a unified treatment for emotional disorders
Barlow, D. H., Allen, L. B., & Choate, M. L. (2004) · Behavior Therapy · doi:10.1016/s0005-7894(04)80036-4 · Cited by 1,430 · see citing works
Reinterpreting comorbidity: a model-based approach to understanding and classifying psychopathology
Krueger, R. F., & Markon, K. E. (2006) · Annual Review of Clinical Psychology · doi:10.1146/annurev.clinpsy.2.022305.095213 · Cited by 1,171 · see citing works
Self-citationGrant, B. F., Dawson, D. A., Stinson, F. S., Chou, P. S., Kay, W., & Pickering, R. (2003) · Drug and Alcohol Dependence · doi:10.1016/s0376-8716(03)00070-x · Cited by 1,110 · see citing works
Self-citationWink, P. (1991) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.61.4.590 · Cited by 1,107 · see citing works
Grandiose and Vulnerable Narcissism: A Nomological Network Analysis: Variants of Narcissism
Miller, J. D., Hoffman, B. J., Gaughan, E. T., Gentile, B., Maples, J., & Keith Campbell, W. (2011) · Journal of Personality · doi:10.1111/j.1467-6494.2010.00711.x · Cited by 990 · see citing works
Self-citationThe Nature, Diagnosis, and Treatment of Neuroticism: Back to the Future
Barlow, D. H., Sauer-Zavala, S., Carl, J. R., Bullis, J. R., & Ellard, K. K. (2014) · Clinical Psychological Science · doi:10.1177/2167702613505532 · Cited by 850 · see citing works
Interpersonal Analysis of Grandiose and Vulnerable Narcissism
Dickinson, K. A., & Pincus, A. L. (2003) · Journal of Personality Disorders · doi:10.1521/pedi.17.3.188.22146 · Cited by 759 · see citing works
Eaton, N. R., Keyes, K. M., Krueger, R. F., Balsis, S., Skodol, A. E., Markon, K. E., Grant, B. F., & Hasin, D. S. (2012) · Journal of Abnormal Psychology · doi:10.1037/a0024780 · Cited by 701 · see citing works
Self-citationGrant, B., Harford, T., Dawson, D., Chou, P., & Pickering, R. (1995) · Drug and Alcohol Dependence · doi:10.1016/0376-8716(95)01134-k · Cited by 689 · see citing works
Self-citationTrull, T. J., Jahng, S., Tomko, R. L., Wood, P. K., & Sher, K. J. (2010) · Journal of Personality Disorders · doi:10.1521/pedi.2010.24.4.412 · Cited by 651 · see citing works
Ruan, W. J., Goldstein, R. B., Chou, S. P., Smith, S. M., Saha, T. D., Pickering, R. P., Dawson, D. A., Huang, B., Stinson, F. S., & Grant, B. F. (2008) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2007.06.001 · Cited by 557 · see citing works
Self-citationChildhood maltreatment and the structure of common psychiatric disorders
Keyes, K., Eaton, N., Krueger, R., McLaughlin, K., Wall, M., Grant, B., & Hasin, D. (2012) · British Journal of Psychiatry · doi:10.1192/bjp.bp.111.093062 · Cited by 425 · see citing works
Self-citationThe structure of common DSM-IV and ICD-10 mental disorders in the Australian general population
SLADE, T., & WATSON, D. (2006) · Psychological Medicine · doi:10.1017/s0033291706008452 · Cited by 419 · see citing works
Kendler, K. S., Aggen, S. H., Knudsen, G. P., Røysamb, E., Neale, M. C., & Reichborn‐Kjennerud, T. (2010) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2010.10030340 · Cited by 368 · see citing works
The structure of psychopathology: Toward an expanded quantitative empirical model.
Wright, A. G. C., Krueger, R. F., Hobbs, M. J., Markon, K. E., Eaton, N. R., & Slade, T. N. (2012) · Journal of Abnormal Psychology · doi:10.1037/a0030133 · Cited by 353 · see citing works
Self-citationStinson, F. S., Dawson, D. A., Golstein, R. B., Chou, P., Huang, B., Smith, S. M., Ruan, W. J., Pulay, A. J., Saha, T. D., Pickering, R. P., et al. (2008) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v69n0701 · Cited by 337 · see citing works
Self-citationModeling psychopathology structure: a symptom-level analysis of Axis I and II disorders
Markon, K. E. (2010) · Psychological Medicine · doi:10.1017/s0033291709990183 · Cited by 311 · see citing works
Narcissistic personality disorder: relations with distress and functional impairment
Miller, J. D., Campbell, W. K., & Pilkonis, P. A. (2007) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2006.10.003 · Cited by 278 · see citing works
Self-citationEaton, N. R., Krueger, R. F., Keyes, K. M., Skodol, A. E., Markon, K. E., Grant, B. F., & Hasin, D. S. (2011) · Psychological Medicine · doi:10.1017/s0033291710001662 · Cited by 275 · see citing works
Self-citationKrueger, R. F., & Eaton, N. R. (2010) · Personality Disorders: Theory, Research, and Treatment · doi:10.1037/a0018990 · Cited by 244 · see citing works
Self-citationThe structure and predictive validity of the internalizing disorders.
Eaton, N. R., Krueger, R. F., Markon, K. E., Keyes, K. M., Skodol, A. E., Wall, M., Hasin, D. S., & Grant, B. F. (2013) · Journal of Abnormal Psychology · doi:10.1037/a0029598 · Cited by 225 · see citing works
Self-citationMiller, J. D., McCain, J., Lynam, D. R., Few, L. R., Gentile, B., MacKillop, J. M., & Campbell, W. K. (2014) · Psychological Assessment · doi:10.1037/a0036613 · Cited by 204 · see citing works
Self-citationIntroduction to the National Epidemiologic Survey on Alcohol and Related Conditions
Grant, B. F., & Dawson, D. A. (2006) · PubMed Central · Cited by 201 · see citing works
Self-citationTransdiagnostic factors of psychopathology and substance use disorders: a review
Eaton, N. R., Rodriguez-Seijas, C. A., Carragher, N., & Krueger, R. F. (2015) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-014-1001-2 · Cited by 192 · see citing works
Self-citationDisorders without borders: current and future directions in the meta-structure of mental disorders
Carragher, N., Krueger, R. F., Eaton, N. R., & Slade, T. N. (2015) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-014-1004-z · Cited by 187 · see citing works
Self-citationThe joint structure of DSM-IV Axis I and Axis II disorders.
Røysamb, E., Kendler, K. S., Tambs, K., Ørstavik, R., Neale, M. C., Aggen, S. H., Torgersen, S. O., & Reichborn‐Kjennerud, T. (2011) · Journal of Abnormal Psychology · doi:10.1037/a0021660 · Cited by 165 · see citing works
Grandiose and Vulnerable Narcissism and the<i>DSM–5</i>Pathological Personality Trait Model
Miller, J. D., Gentile, B., Wilson, L., & Campbell, W. K. (2013) · Journal of Personality Assessment · doi:10.1080/00223891.2012.685907 · Cited by 145 · see citing works
Self-citationKim, H., & Eaton, N. R. (2015) · Journal of Abnormal Psychology · doi:10.1037/abn0000113 · Cited by 124 · see citing works
Self-citationAn MMPI-2 Portrait of Narcissism
Rathvon, N., & Holmstrom, R. W. (1996) · Journal of Personality Assessment · doi:10.1207/s15327752jpa6601_1 · Cited by 123 · see citing works
Rodriguez-Seijas, C. A., Eaton, N. R., & Krueger, R. F. (2015) · Journal of Personality Assessment · doi:10.1080/00223891.2015.1055752 · Cited by 104 · see citing works
Self-citationFossati, A., Beauchaine, T. P., Grazioli, F., Carretta, I., Cortinovis, F., & Maffei, C. (2005) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2004.11.006 · Cited by 97 · see citing works
Thought disorder in the meta-structure of psychopathology
Keyes, K. M., Eaton, N. R., Krueger, R. F., Skodol, A. E., Wall, M. M., Grant, B. F., Siever, L. J., & Hasin, D. S. (2012) · Psychological Medicine · doi:10.1017/s0033291712002292 · Cited by 95 · see citing works
Self-citationRodriguez-Seijas, C. A., Stohl, M., Hasin, D. S., & Eaton, N. R. (2015) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2015.0148 · Cited by 89 · see citing works
Self-citationEaton, N. R. (2014) · Psychology of Sexual Orientation and Gender Diversity · doi:10.1037/sgd0000048 · Cited by 89 · see citing works
Self-citationJames, L. M., & Taylor, J. E. (2008) · British Journal of Clinical Psychology · doi:10.1348/014466508x299691 · Cited by 85 · see citing works
Eaton, N. R., Keyes, K. M., Krueger, R. F., Noordhof, A., Skodol, A. E., Markon, K. E., Grant, B. F., & Hasin, D. S. (2012) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-012-0595-5 · Cited by 58 · see citing works
Self-citationHuprich, S. K. (2014) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000019 · Cited by 38 · see citing works
Huprich, S. K., & Nelson, S. M. (2013) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2013.09.017 · Cited by 27 · see citing works
Harford, T. C., Chen, C. M., Saha, T. D., Smith, S. M. R., Ruan, W. J., & Grant, B. F. (2013) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2013.07.016 · Cited by 19 · see citing works
Self-citationHudson, J. I., Zanarini, M. C., Mitchell, K. S., Choi-Kain, L. W., & Gunderson, J. G. (2014) · Psychological Medicine · doi:10.1017/s0033291713003140 · Cited by 18 · see citing works
Latack, J. A., Rodriguez-Seijas, C. A., Stohl, M., Blanco, C., Hasin, D. S., & Eaton, N. R. (2015) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2015.06.002 · Cited by 15 · see citing works
Self-citationThe Structure and Stability of Common Mental Disorders: The NEMESIS Study
Vollebergh, W. A. M., Iedema, J., Bijl, R. V., de Graaf, R., Smit, F., & Ormel, J. (2001) · Archives of General Psychiatry · doi:10.1001/archpsyc.58.6.597 · Cited by 6 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Hasin, D. S., & Grant, B. F. (2015) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-015-1088-0 · Cited by 452 · see citing works
Self-citationTravel selfies on social networks, narcissism and the “attraction-shading effect”
Christou, P., Farmaki, A., Saveriades, A., & Georgiou, M. (2020) · Journal of Hospitality and Tourism Management · doi:10.1016/j.jhtm.2020.01.014 · Cited by 67 · see citing works
Narcissistic Personality Disorder: Progress in Understanding and Treatment
Weinberg, I., & Ronningstam, E. (2022) · Focus · doi:10.1176/appi.focus.20220052 · Cited by 59 · see citing works
Ronningstam, E. (2020) · Journal of Personality Disorders · doi:10.1521/pedi.2020.34.supp.80 · Cited by 35 · see citing works
Principles of psychodynamic treatment for patients with narcissistic personality disorder
Crisp, H., & Gabbard, G. O. (2020) · Journal of Personality Disorders · doi:10.1521/pedi.2020.34.supp.143 · Cited by 32 · see citing works
Professional Practice Guidelines for Personality Assessment
Krishnamurthy, R., Hass, G. A., Natoli, A. P., Smith, B. L., Arbisi, P. A., & Gottfried, E. D. (2021) · Journal of Personality Assessment · doi:10.1080/00223891.2021.1942020 · Cited by 24 · see citing works
Alareqe, N. A., Hassan, S. A., Kamarudin, E. M. E., Aljaberi, M. A. A., Nordin, M. S., Ashureay, N. M., & Mohammed, L. A. (2022) · Mental Illness · doi:10.1155/2022/9594914 · Cited by 22 · see citing works
Alcohol and other drug use, and mental distress in the women’s universe
Júnior, F. J. G. D. S., & Monteiro, C. F. D. S. (2020) · Revista Brasileira de Enfermagem · doi:10.1590/0034-7167-2018-0268 · Cited by 19 · see citing works
Narcissistic and Histrionic Personality Disorders
Dawood, S., Wu, L. Z., Bliton, C. F., & Pincus, A. L. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108333931.049 · Cited by 14 · see citing works
Narcissistic Personality Disorder and Pathological Narcissism
Pincus, A. L. (2023) · Oxford University Press eBooks · doi:10.1093/med-psych/9780197542521.003.0027 · Cited by 13 · see citing works
Ng, T. H., Burke, T. A., Stange, J., Walshaw, P., Weiss, R., Urošević, S., Abramson, L., & Alloy, L. (2017) · Journal of Abnormal Psychology · doi:10.1037/abn0000255 · Cited by 8 · see citing works
Coleman, S. R. M., Oliver, A. C., Klemperer, E. M., DeSarno, M., Atwood, G., & Higgins, S. T. (2022) · Personality Disorders Theory Research and Treatment · doi:10.1037/per0000528 · Cited by 11 · see citing works
D’Avanzo, P. A., Barton, S. C., Kapadia, F., & Halkitis, P. N. (2017) · Behavioral Medicine · doi:10.1080/08964289.2017.1330079 · Cited by 11 · see citing works
Ideação suicida e consumo de drogas ilícitas por mulheres
Júnior, F. J. G. D. S., Monteiro, C. F. D. S., Veloso, L. U. P., Sales, J. C. E. S., Costa, A. P. C., & Gonçalves, L. D. A. (2018) · Acta Paulista de Enfermagem · doi:10.1590/1982-0194201800045 · Cited by 6 · see citing works
Fayaz, I., & Dhankar, S. (2025) · Current Psychology · doi:10.1007/s12144-025-07389-8 · Cited by 3 · see citing works
FEATURES OF THE DEMONSTRATION OF DEPRESSION IN NARCISSISTS: A WARTIME STUDY
Католик, Г. В., Zhyvko, Z. B., & Odyntsova, H. (2023) · Scientific notes of the UniversityKROK · doi:10.31732/2663-2209-2022-70-147-158 · Cited by 3 · see citing works
Carvalho, L. D. F., Sette, C. P., & Lima‐Costa, A. R. (2021) · Revista Colombiana de Psiquiatría · doi:10.1016/j.rcp.2020.11.015 · Cited by 2 · see citing works
Dias, G. N., de Sousa, A. A. S., Brasil, E. G. M., & da Silva, S. L. V. (2021) · Research Society and Development · doi:10.33448/rsd-v10i2.12160 · Cited by 2 · see citing works
Fasikh, M., Maelani, D., & Murtadho, A. M. (2024) · JELL (Journal of English Language and Literature) STIBA-IEC Jakarta · doi:10.37110/jell.v9i01.219 · Cited by 2 · see citing works
Gori, A., & Topino, E. (2025) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70179 · Cited by 1 · see citing works
A Call for Scientific Caution: Commentary on Narcissistic and Histrionic Personality Disorders
Weiss, B., & Campbell, W. K. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108333931.050 · Cited by 1 · see citing works
Self-citationBezerra, L. M. R., Melo, M. C. C., Bezerra, I. A. R., Carvalhal, A. M. A., de Oliveira, M. C. A., Ribeiro, Y. K. D. R., Ferreira, M. C. M., Miranda, L. A., & Botelho, A. P. B. (2024) · RECIMA21 - Revista Científica Multidisciplinar · doi:10.47820/recima21.v5i4.5105 · Cited by 1 · see citing works
Carvalho, L. D. F., Sette, C. P., & Lima‐Costa, A. R. (2022) · Revista Colombiana de Psiquiatría (English ed ) · doi:10.1016/j.rcpeng.2020.11.011
Yu, C.-C., & Castelli, D. M. (2026) · Acta Psychologica · doi:10.1016/j.actpsy.2026.107631
- Authors
- Eaton, N. R., Rodriguez-Seijas, C., Krueger, R. F., Campbell, W. K., Grant, B. F., & Hasin, D. S.
- Affiliations
- Stony Brook University (US)
- University of Minnesota (US)
- University of Georgia (US)
- National Institute on Alcohol Abuse and Alcoholism (US)
- Venue
- Journal of Personality Disorders
- Publisher
- Guilford Publications
- Published
- 2017-08
- Volume
- 31
- Issue
- 4
- Pages
- 449-461
- ISSN
- 0885-579X (ISSN-L)
- OpenAlex
- W2519266465
- Cited by
- 25
- References
- 46
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 2 · 2022: 4 · 2021: 4 · 2020: 6 · 2018: 1 · 2017: 2 · 2015: 1
- FWCI
- 1.34
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Personality Disorders (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Alcohol Abuse and Alcoholism (U01AA018111, K05AA014223)
- National Institute on Drug Abuse (R01DA018652)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- narcissistic personality disorder, comorbidities, transdiagnostic factors, internalizing problems, externalizing problems, common mental disorders, vulnerable narcissism, grandiose narcissism, anxiety disorders, mood disorders, substance use disorders
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Mental Disorders, Female, Humans, Male, Middle Aged, Personality Disorders, Comorbidity, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
