What is the dimensional model for diagnosis of narcissistic personality disorder (NPD)?

Updated: May 16, 2018
  • Author: Sheenie Ambardar, MD; Chief Editor: David Bienenfeld, MD  more...
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Answer

These official diagnostic criteria are unchanged from the previous DSM edition. It should be noted, however, that there is currently a general inclination away from a strict criterion-based approach to diagnosis and toward a more “dimensional” model, as outlined in section III of DSM-5 (“Emerging Measures and Models”). In the subsection of section III entitled “Alternative DSM-5 Model for Personality Disorders,” NPD is newly characterized on the basis of (1) impairment in personality functioning and (2) pathologic personality traits. [2]

Specifically, in this proposed new model, NPD is characterized by moderate or greater impairment in personality functioning, manifested by characteristic difficulties in 2 or more of the following 4 areas [2] :

  • Identity - Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal inflated or deflated, or vacillating between extremes; emotional regulation mirroring fluctuations in self-esteem

  • Self-direction - Goal setting based on gaining approval from others; personal standards that are either unreasonably high (in order to see oneself as exceptional) or too low (from a sense of entitlement); frequent unawareness of one’s own motivations

  • Empathy - Impaired ability to recognize or identify with the feelings and needs of others; excessive attunement to reactions of others, but only if these are perceived as relevant to the self; over- or underestimation of one’s own effect on others

  • Intimacy - Relationships that are largely superficial and exist to serve self-esteem regulation; mutuality constrained by little genuine interest in others’ experiences and predominance of a need for personal gain


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