Narcissistic Personality Disorder

This entry reviews how narcissistic personality disorder (NPD) came to be included and revised through the various iterations of the DSM. Features of NPD; its prevalence, stability, and comorbidity with other disorders; and its discriminant validity are summarized. These features are impacted by the narrow focus on narcissistic grandiosity in the DSM NPD diagnostic criteria, which lack content reflecting narcissistic vulnerability. Low prevalence rates and a modest body of clinical research first led to a proposed deletion of NPD in the initial DSM-5 proposal, followed by a revised NPD description in a revised NPD proposal that mentioned both grandiose and vulnerable themes. The personality disorder proposal was rejected, and the DSM-IV PD taxonomy was retained in DSM-5. The consequence of this rejection was that the PD section is the only one not to reflect any of the last two decades of scientific advancements since the DSM was updated previously in 1994. As such, this entry provides a review of narcissism as it is currently diagnosed (exactly as in DSM-IV) and a discussion on future directions to improve the validity and clinical utility of NPD.