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Cited by 337Personality Disorders and PsychopathologyPersonality Traits and PsychologyBipolar Disorder and Treatment

Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Narcissistic Personality Disorder: Results From the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions

Stinson, Frederick S., Dawson, Deborah A., Golstein, Rise B., Chou, Patricia, Huang, Boji, Smith, Sharon M., Ruan, W. June, Pulay, Attila J. +3 more·2008·The Journal of Clinical Psychiatry
DOI 10.4088/jcp.v69n0701PMC PMC2669224
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Abstract

Article AbstractObjectives: To present nationally representative findings on prevalence, sociodemographic correlates, disability, and comorbidity of narcissistic personality disorder (NPD) among men and women. Method: Face-to-face interviews with 34,653 adults participating in the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions conducted between 2004 and 2005 in the United States. Results: Prevalence of lifetime NPD was 6.2%, with rates greater for men (7.7%) than for women (4.8%). NPD was significantly more prevalent among black men and women and Hispanic women, younger adults, and separated/divorced/widowed and never married adults. NPD was associated with mental disability among men but not women. High co-occurrence rates of substance use, mood, and anxiety disorders and other personality disorders were observed. With additional comorbidity controlled for, associations with bipolar I disorder, posttraumatic stress disorder, and schizotypal and borderline personality disorders remained significant, but weakened, among men and women. Similar associations were observed between NPD and specific phobia, generalized anxiety disorder, and bipolar II disorder among women and between NPD and alcohol abuse, alcohol dependence, drug dependence, and histrionic and obsessive-compulsive personality disorders among men. Dysthymic disorder was significantly and negatively associated with NPD. Conclusion: NPD is a prevalent personality disorder in the general U.S. population and is associated with considerable disability among men, whose rates exceed those of women. NPD may not be as stable as previously recognized or described in the DSM-IV. The results highlight the need for further research from numerous perspectives to identify the unique and common genetic and environmental factors underlying the disorder-specific associations with NPD observed in this study.

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  • Findingown data

    After controlling for additional comorbidity, NPD associations with bipolar I disorder, PTSD, and schizotypal and borderline personality disorders remained significant but weakened in both sexes.

    “With additional comorbidity controlled for, associations with bipolar I disorder, PTSD, and schizotypal and borderline PDs remained significant, but weakened, among men and women.”
    Quote in the paperSubstantial claim
  • Findingown data

    Among men, NPD had similar associations with alcohol abuse, alcohol dependence, drug dependence, and histrionic and obsessive-compulsive personality disorders.

    “Similar associations were observed between NPD and specific phobia, generalized anxiety disorder, and bipolar II disorder among women; and alcohol abuse, alcohol dependence, drug dependence, and histrionic and obsessive-compulsive PDs among men.”
    Quote in the paperNot a substantial claim
  • Findingown data

    NPD showed high co-occurrence rates with substance use, mood, anxiety, and other personality disorders.

    “High co-occurrence rates of substance use, mood, anxiety, and other personality disorders (PDs) were observed.”
    Quote in the paperSubstantial claim
  • Findingown data

    Among women, NPD had similar associations with specific phobia, generalized anxiety disorder, and bipolar II disorder.

    “Similar associations were observed between NPD and specific phobia, generalized anxiety disorder, and bipolar II disorder among women; and alcohol abuse, alcohol dependence, drug dependence, and histrionic and obsessive-compulsive PDs among men.”
    Quote in the paperNot a substantial claim
  • Findingown data

    NPD prevalence was significantly higher among Black men and women and Hispanic women.

    “The odds of NPD were also significantly (p < 0.01) greater among Black men and women and among Hispanic women.”
    • Also stated in: § Results · plain
      “NPD was significantly more prevalent among Black men and women and Hispanic women, younger adults, and separated/divorced/widowed and never married adults.”
    Quote in the paperSubstantial claim
  • May combine two claims. 42
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 12

  • May combine two claims.

    Findingown data

    NPD prevalence decreased with age in the total sample and in both sexes.

    “For the total sample, an inverse relationship of NPD with age was observed; this result generalized to both men and women.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    NPD was associated with mental disability among men but not among women.

    “NPD was associated with mental disability among men but not women.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    NPD was more common among separated/divorced/widowed or never married respondents in the total sample and among women; among men, separated/divorced/widowed respondents had higher odds.

    “Respondents who were separated/divorced/widowed or never married were more likely to have NPD in the total sample and among women. Among men, respondents who were separated/divorced/widowed also had a greater odds of NPD.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among respondents with NPD, alcohol dependence (13.1%), bipolar I (14.1%), and PTSD (19.5%) were the most prevalent disorders in their classes.

    “Alcohol dependence (13.1%), bipolar I (14.1%), and PTSD (19.5%) were the most prevalent disorders in their classes among respondents with NPD.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    NPD prevalence was significantly higher among men than women with alcohol use disorders, drug dependence, nicotine dependence, major depressive disorder, bipolar I disorder, and anxiety disorders except panic disorder with agoraphobia and social phobia.

    “The prevalence of NPD was significantly (p < 0.01) greater among men than women with alcohol use disorders, drug dependence, nicotine dependence, MDD, bipolar I disorder, and anxiety disorders except panic disorder with agoraphobia and social phobia.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among respondents with lifetime NPD, rates of any 12-month substance use, mood, and anxiety disorder were 40.6%, 28.6%, and 40.0%, respectively.

    “Rates of any 12-month substance use, mood, and anxiety disorder among respondents with lifetime NPD were 40.6%, 28.6%, and 40.0%, respectively.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Within mood, anxiety, and substance use disorder classes, the highest NPD prevalences were for bipolar I disorder (23.8%), panic disorder with agoraphobia (19.9%), and drug dependence (22.0%).

    “Bipolar I disorder (23.8%), panic disorder with agoraphobia (19.9%), and drug dependence (22.0%) were the most prevalent disorders in their classes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among respondents with mood, anxiety, and substance use disorders, NPD prevalences were 17.4%, 15.2%, and 11.8%, respectively.

    “For the total sample, the prevalences of NPD among respondents with mood, anxiety, and substance use disorders were 17.4%, 15.2%, and 11.8%, respectively.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Within broad disorder categories, NPD rates were highest among respondents with 12-month bipolar I (31.1%), panic disorder with agoraphobia (23.9%), and drug dependence (34.9%).

    “Within these broad categories, rates of NPD were greatest among respondents with 12-month bipolar I (31.1%), panic disorder with agoraphobia (23.9%), and drug dependence (34.9%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Men with NPD had significantly higher rates of most substance use disorders and antisocial personality disorder, whereas women with NPD generally had higher rates of MDD and most anxiety disorders.

    “Mirroring the distribution of psychiatric disorders in the general population, men with NPD had significantly higher rates of most substance use disorders and antisocial PD, whereas women with NPD generally had higher rates of MDD and most anxiety disorders.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Twelve-month associations of NPD with alcohol abuse, alcohol dependence, and drug dependence remained significant among men, whereas lifetime associations remained significant only for drug abuse among men.

    “Further, 12-month associations of NPD with alcohol abuse, alcohol dependence, and drug dependence remained significant among men, whereas lifetime associations remained significant only for drug abuse among men.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Twelve-month and lifetime associations of NPD with bipolar I disorder and PTSD remained significant, but were reduced, among men and women after additional comorbidity control.

    “Twelve-month and lifetime associations of NPD with bipolar I and PTSD remained significant, but were reduced, among men and women.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Twelve-month associations between NPD and GAD remained significant for both sexes, whereas the corresponding lifetime association was only significant among women.

    “Twelvemonth associations between NPD and GAD remained significant for both sexes, whereas the corresponding lifetime association was only significant among women.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Co-occurrence rates of NPD among individuals with other psychiatric disorders were lower than corresponding rates of other psychiatric disorders among individuals with NPD, but were far from trivial.

    “Further, the co-occurrence rates of NPD among individuals with other psychiatric disorders were lower than the corresponding rates of other psychiatric disorders among individuals with NPD, but were far from trivial.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among respondents with NPD, the most prevalent specific disorders were MDD (20.6%) and bipolar I disorder (20.1%) in mood disorders, specific phobia (27.4%) and PTSD (25.7%) in anxiety disorders, alcohol dependence (30.6%) in substance use disorders, and borderline PD (37.0%) in other personality disorders.

    “Within these diagnostic classes, MDD (20.6%) and bipolar I disorder (20.1%), specific phobia (27.4%) and PTSD (25.7%), alcohol dependence (30.6%), and borderline PD (37.0%) were the most prevalent among respondents with NPD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    NPD was inversely related to age, with the greatest decline occurring after age 29 years.

    “NPD was inversely related to age, with the greatest decline occurring after age 29 years.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    This study found higher rates of NPD among men than among women, contrary to one epidemiologic study that found no sex differences.

    “At variance with 1 epidemiologic study39 that found no sex differences in prevalence of NPD, this study found higher rates of NPD among men than among women.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
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    Findingown data

    New findings from NESARC showed that rates of NPD were higher among Black men and women and Hispanic men.

    “New findings from the NESARC showed that rates of NPD were higher among Black men and women and Hispanic men.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Rates of NPD were generally greater among individuals who were separated, divorced, or widowed, and this did not vary by sex.

    “The rates of NPD were generally greater among individuals who were separated, divorced, or widowed, results that did not vary by sex.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    NPD was highly comorbid with borderline and schizotypal personality disorders among both men and women, consistent with some but not all prior clinical research.

    “Further, NPD was highly comorbid with borderline and schizotypal PDs among both men and women, consistent with some,18,20,21,83 but not all,22–24 prior clinical research.22–24”
    Quote in the paperSubstantial claim0 of 7 sources checked
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  • May combine two claims.

    Findingown data

    For both time periods, NPD was significantly associated with bipolar II disorder among women, and the 12-month association between NPD and specific phobia remained significant, but reduced, only among women.

    “For both time periods, NPD was significantly associated with bipolar II among women, and the 12-month association between NPD and specific phobia remained significant, but reduced, only among women.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Although no prior study has examined sex differences in NPD comorbidity, this study found that some substance use disorders were associated with NPD among men, whereas GAD, specific phobia, and bipolar II disorder were consistently associated with NPD among women.

    “Although no prior study has examined sex differences in NPD comorbidity, the present study found that some substance use disorders were associated with NPD among men, whereas GAD, specific phobia, and bipolar II disorder were consistently associated with NPD among women.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    NPD has consistently been associated with histrionic, antisocial, obsessive-compulsive, and schizotypal personality disorders, with mixed evidence for borderline personality disorder.

    “By contrast, NPD has consistently been shown to be associated with histrionic, antisocial, obsessive-compulsive, and schizotypal PDs,18–21 with mixed evidence for a relationship with borderline PD.20–24”
    Quote in the paperNot a substantial claim0 of 7 sources checked
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    Premisecitation

    Early community surveys of NPD prevalence were geographically restricted to states and usually cities, and had small sample sizes (n=133-779).

    “Although prevalence estimates of NPD are available from several early community surveys,25–35 these surveys were geographically restricted to states and usually to cities, in addition to being limited by small sample sizes (n=133–779).”
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    Premisecitation

    Evidence linking NPD to substance use disorders was strong in earlier clinical work but remains mixed in more recent clinical studies.

    “Evidence linking NPD with substance use disorders, though strong in earlier clinical work,4 remains mixed when more recent clinical studies are considered.16,17”
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  • May combine two claims.

    Interpretationown data

    NPD is associated with considerable disability among men, and men's NPD rates exceed women's.

    “NPD is a prevalent PD in the general U.S. population and is associated with considerable disability among men, whose rates exceed those of women.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    Disability was measured with the SF-12v2, which yields three mental disability profile scores: social functioning, role emotional functioning, and mental health.

    “Disability was determined with the Short Form-12 Health survey, version 2 (SF-12v2).77 The SV-12v2 yields 3 profile scores that measure dimensions of mental disability: social functioning; role emotional functioning (measuring role impairment); and mental health.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
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    Study design and conductown data

    Weighted Wave 2 data were adjusted to be representative of the civilian population on region, age, race-ethnicity, and sex using the 2000 Decennial Census.

    “Weighted Wave 2 data were then adjusted to be representative of the civilian population on socioeconomic variables including region, age, race-ethnicity and sex, based on the 2000 Decennial Census.”
    Quote in the paperSubstantial claim

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    Study design and conductown data

    Wave 2 respondents did not differ significantly from the target population on age, race-ethnicity, sex, socioeconomic status, or presence of any lifetime substance use, mood, anxiety, or personality disorder.

    “there were no significant differences between Wave 2 respondents and the target population with respect to age, race-ethnicity, sex, socioeconomic status, or the presence of any lifetime substance use, mood, anxiety, or personality disorder (each examined separately).”
    Quote in the paperNot a substantial claim

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    Study design and conductreasoning

    A probability level of 0.01 was used for all statistical comparisons to minimize Type I error.

    “we selected a probability level of 0.01, rather than p < 0.05, for all statistical comparisons to minimize Type I statistical error.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    The Wave 2 NESARC sample size and high response rate permit reliable, precise estimation of lifetime NPD prevalence, especially in sociodemographic subgroups, and permit examination of NPD comorbidity with specific Axis I and II disorders.

    “The sample size and high response rate of the Wave 2 NESARC allow for reliable, precise estimation of lifetime prevalence of NPD, especially among important sociodemographic subgroups of the population, and allowed for the examination of comorbidity of NPD with specific Axis I and II disorders.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Multiple linear regression examined NPD's relationships with each SF-12v2 disability score, controlling first for sociodemographic characteristics and then for sociodemographic characteristics plus other psychiatric disorders.

    “Multiple linear regression analyses examined the relationships of NPD with each of the 3 SF-12v2 disability scores, controlling first for sociodemographic characteristics and then controlling for sociodemographic characteristics and other psychiatric disorders, to determine the independent contribution of NPD to disability.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    AUDADIS-IV alcohol and drug diagnoses had test-retest reliability from good to excellent (κ=0.70-0.91).

    “The reliability of AUDADIS-IV alcohol and drug diagnoses is documented in clinical and general population samples,53,54,56–59 with test-retest reliability ranging from good to excellent (κ= 0.70–0.91).”
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    Study design and conductreasoning

    Associations of NPD with other psychiatric disorders were calculated first controlling for sociodemographic characteristics and then further controlling for all other psychiatric disorders.

    “Associations of NPD with other psychiatric disorders were calculated 2 ways. The first controlled for sociodemographic characteristics. The second further controlled for all other psychiatric disorders.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductcitation

    Convergent validity was good to excellent for mood and anxiety diagnoses, and selected diagnoses showed good agreement (κ=0.64-0.68) with psychiatrist reappraisals.

    “Convergent validity was good to excellent for mood and anxiety diagnoses,71–76 and selected diagnoses showed good agreement (κ= 0.64–0.68) with psychiatrist reappraisals.56”
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    Study design and conductreasoning

    The cumulative Wave 2 response rate was 70.2%.

    “The cumulative response rate at Wave 2 is equal to the product of the Wave 2 and Wave 1 response rates, or 70.2%.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The Wave 2 NESARC response rate was 86.7%, with 34,653 completed interviews.

    “the Wave 2 response rate was 86.7%, reflecting 34,653 completed Wave 2 interviews.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    Standard errors and 99% confidence intervals were estimated with SUDAAN, which adjusts for complex survey design.

    “All standard errors and 99% confidence intervals were estimated using SUDAAN,78 which adjusts for design characteristics of complex surveys like the NESARC.”
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    Interpretationreasoning

    Differences in diagnostic criteria, assessment instruments, and survey designs and methodologies may also have contributed to discrepancies in NPD rates.

    “Differences in diagnostic criteria, assessment instruments, and survey designs and methodologies may also have contributed to the discrepancies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The decline in NPD rates from the 30- to 44-year-old age group to the 45- to 64-year-old group was small, suggesting an enduring, severe personality disorder in at least some individuals.

    “However, the decline in NPD rates from the 30- to 44-year-old age group to the group of respondents 45-to-64 years-old was small, suggesting an enduring, severe PD, at least in some individuals.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Prior studies have shown that NPD relative to other personality disorders was uniquely related to causing significant others pain and duress and that NPD is largely associated with costs experienced by others.

    “These findings are consistent with prior studies that have shown that NPD relative to other PDs was uniquely related to causing significant others pain an duress3 and that the NPD is largely associated with costs experienced by others.81, 82”
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  • May combine two claims.

    Interpretationreasoning

    The consistency of the observed age gradient in this study with the outcome of the clinical prospective study suggests that age differences observed in this study may in part be real, and cannot be attributed solely to artifacts such as longer duration of illness, selective mortality, cohort effects, or recall or other biases.

    “in the present study with the outcome of the clinical prospective study suggests that age differences observed in this study may in part be real, and cannot be attributed solely to artifacts such as longer duration of illness, selective mortality, cohort effects, or recall or other biases.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The drop in magnitude of these associations when other comorbidity was controlled is analogous to that in twin and genetic study designs and suggests that much of the association of NPD with these disorders appears due to factors common to these disorders.

    “The drop in magnitude of these associations when other comorbidity was controlled for is analogous to that in twin and genetic study designs and suggests that much of the association of NPD with these disorders appears due to factors common to these disorders.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    The findings on comorbidity in this study are consistent with most early clinical research that demonstrated the strongest relationships between NPD and bipolar I and substance use disorders, but at variance with most previous clinical research that has found no associations between NPD and specific anxiety disorders.

    “The findings on comorbidity in the present study are consistent with most early clinical research4 that demonstrated the strongest relationships between NPD and bipolar I and substance use disorders, but at variance with most previous clinical research that has found no associations between NPD and specific anxiety disorders.4,9,11,13,15”
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  • May combine two claims.

    Interpretationcitation

    NPD was associated with social and role dysfunction, consistent with the DSM-IV definition of NPD and with findings from one clinical study.

    “That NPD was associated with social and role dysfunction is consistent with the definition of NPD in the DSM-IV as well as with findings from 1 clinical study.3”
    Quote in the paperSubstantial claim0 of 1 sources checked
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  • May combine two claims.

    Interpretationown data

    In summary, NPD prevalence in this U.S. general population sample was significantly greater among men than among women and the disorder was associated with substantial mental disability among men.

    “In summary, the prevalence of NPD in this U.S. general population sample was significantly greater among men than among women and the disorder was associated with substantial mental disability among men.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The relationship between NPD and disability among men remained significant with adjustments for comorbidity, further suggesting that NPD may have a more severe expression in men relative to women.

    “That the relationship between NPD and disability among men remained significant with adjustments for comorbidity further suggests that NPD may have a more severe expression in men relative to women.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    NPD was inversely related to age, suggesting that the disorder may be less chronic than previously recognized.

    “Importantly, NPD was inversely related to age, suggesting that the disorder may be less chronic than previously recognized.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    These results suggest a propensity of men with NPD to self-medicate to maintain a sense of omnipotence and grandiosity, to protect a very fragile self-esteem, and to ameliorate feelings of depression, guilt, and worthlessness associated with dysthymia.

    “Taken together, these results suggest a propensity of men with NPD to self-medicate to maintain a sense of omnipotence and grandiosity, to protect a very fragile self esteem,1 and to ameliorate feelings of depression, guilt, and worthlessness associated with dysthymia.84”
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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The NESARC included a group quarters sampling frame, but some special populations were not included, such as individuals under age 18 and those incarcerated or hospitalized during interview periods.

    “Although the NESARC included a group quarters sampling frame, some special populations were not included in the sample, e.g., individuals under age 18 years and those incarcerated or hospitalized during the interview periods.”
    Quote in the paperNot a substantial claim
50 of 50

  • The paper relies on this without support.

    No prior epidemiologic study has examined disability in people with NPD or assessed NPD comorbidity with other Axis I and II disorders.

    “No prior epidemiologic work has examined disability among individuals with NPD or assessed comorbidity of NPD with other Axis I and II disorders.”

  • The paper relies on this without support.

    NPD differs from other DSM-IV personality disorders in its comorbidity pattern.

    “NPD also appears to differ from other DSM-IV PDs with respect to comorbidity.”

  • The paper relies on this without support.

    Little is known about sex differences in NPD.

    “Because so little is known about sex differences in NPD, information on correlates, disability, and comorbidity of NPD is presented for the total sample and by sex.”
3 of 3

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  • The relationship between trauma and narcissism has been documented and the term 'trauma-associated narcissistic symptoms' has been proposed.

    “The relationship between trauma and narcissism has been documented [58, 65–67] and the term ‘trauma-associated narcissistic symptoms’ has been proposed to identify such features [68].”

    From Living with pathological narcissism: a qualitative study (2020) · cites this paper as [65]

    The Results and Discussion report a significant association between narcissistic personality disorder and PTSD, which supports a related connection. They do not establish a relationship between trauma exposure itself and narcissism. The term ‘trauma-associated narcissistic symptoms’ is attributed to a different citation [68], not to this paper. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Participants reported their relative as engaging in various forms of substance use, consistent with prevalence data indicating high co-occurrence of narcissism and substance use.

    “Finally, participants reported their relative as engaging in various forms of substance use, consistent with prevalence data indicating high co-occurrence of narcissism and substance use [65].”

    From Living with pathological narcissism: a qualitative study (2020) · cites this paper as [65]

  • PN prevalence estimates in the U.S. general population reach up to 6.2%, with notably higher rates among men (7.7%) than women (4.8%).

    “with prevalence estimates in the U.S. general population reaching up to 6.2% (44–46), with notably higher rates among men (7.7%) than women (4.8%) (44).”

    From Psychoanalytically informed MDMA-assisted therapy for pathological narcissism: a novel theoretical approach (2025) · cites this paper as [44]

  • Personality disorders are highly co-morbid with anxiety and depression, and these disorders are known to be associated with increased risk of disability pensioning.

    “PDs are highly co-morbid with anxiety and depression [35–38], and these disorders are known to be associated with an increased risk of disability pensioning [3–6].”

    From Personality disorders are important risk factors for disability pensioning (2014) · cites this paper as [37]

  • Adjusting for mood and anxiety disorders may be overly conservative because personality disorder symptoms overlap with anxiety and depression, potentially underestimating the true effects of personality disorders.

    “The symptoms might therefore work as mediators instead of confounders, making the adjustments overly conservative and underestimating the true effects of PDs.”

    From Personality disorders are important risk factors for disability pensioning (2014) · cites this paper as [37]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Sex-specific race-ethnicity finding conflicts with another discussion statement

    Major

    One discussion passage says Hispanic men had higher NPD rates, but another passage says the higher-risk minority groups were Black men and women and Hispanic women. These statements cannot both describe the study findings as written.

  • The discussion swaps drug dependence for drug abuse

    Minor

    The lifetime-results section says the adjusted association among men remained significant for drug dependence. The discussion instead says that, among the listed substance-use disorders, only drug abuse retained a significant lifetime association.

  • Alcohol abuse is both an exception and a retained association

    Minor

    The 12-month results say alcohol abuse was not associated with NPD among men or women in the initial analysis, then say its association among men remained significant after additional adjustment.

3 of 3

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Authors
Stinson, 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., & Grant, B. F.
Affiliations
National Institutes of Health (US)
Corresponding author
Grant, Bridget F.
ORCID
Venue
The Journal of Clinical Psychiatry
Publisher
Physicians Postgraduate Press, Inc
Published
2008-07-15
Volume
69
Issue
7
Pages
1033-1045
ISSN
0160-6689 (ISSN-L)
DOI
10.4088/jcp.v69n0701
PMC
PMC2669224
OpenAlex
W4233879649
Semantic Scholar
799d3729818a4076ab108aef29b5d66945ddfd6e
Cited by
337
References
50
Citations by year
2026: 15 · 2025: 15 · 2024: 17 · 2023: 18 · 2022: 15 · 2021: 16 · 2020: 37 · 2019: 17 · 2018: 25 · 2017: 17 · 2016: 22 · 2015: 15 · 2014: 20 · 2013: 27 · 2012: 19
FWCI
15.59
Type
journal article
Language
en
Open access
closed
Locations
The Journal of Clinical Psychiatry (publishedVersion)
Funders
  • National Institutes of Health (Z99‐AA999999)
  • National Institute on Alcohol Abuse and Alcoholism (Z01AA000449)
  • National Institute on Drug Abuse
Topics
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Keywords
narcissistic personality disorder, prevalence, sociodemographic correlates, disability, comorbidities, sex differences, substance use disorders, mood disorders, anxiety disorders, bipolar disorder, post-traumatic stress disorder, borderline personality disorder, schizotypal personality disorder, histrionic personality disorder, obsessive-compulsive personality disorder, dysthymia, NESARC

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.

Claims read under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

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.

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