Narcissistic Personality Disorder Diagnosis
How Professionals Clinically Diagnose Narcissism
Aug 29, 2007
What is Narcissistic Personality Disorder?
NPD is a type of psychological personality disorder characterized by grandiosity, need for admiration, and lack of empathy. Narcissism, formerly known as megalomania, occurs in a spectrum of severity, but the pathologically narcissistic are extremely self-absorbed, insensitive to others’ needs and indifferent to the effect of their own egocentric behavior. The range of narcissistic behavior can extend far beyond NPD to include even more serious forms of self-obsession such as malignant narcissism and psychopathy (Kernberg 2004).
How Is Narcissism Measured?
1. NPD Diagnosis Using the DSM-IV-TR
Used for clinical diagnosis of narcissism.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), is published by the American Psychiatric Association. It is the manual that mental health professionals most commonly use to diagnose mental disorders.
The DSM-IV-TR defines Narcissistic Personality Disorder (NPD) as "an all-pervasive pattern of grandiosity (in fantasy or behavior), need for admiration or adulation and lack of empathy, usually beginning by early adulthood and present in various contexts", such as family life and work.
According to the DSM-IV-TR, a patient must exhibit five or more of the following traits in order to be diagnosed with NPD:
- grandiose sense of self-importance
- preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
- belief that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
- need for excessive admiration
- sense of entitlement
- takes advantage of others to achieve his or her own ends
- lacks empathy
- often envious of others or believes that others are envious of him or her
- shows arrogant, haughty behaviors or attitudes
2. NPD Diagnosis Using the ICD-10
Used for clinical diagnosis of narcissism.
The current International Classification of Diseases is the 10th revision of a medical diagnostic manual published by the World Health Organization (WHO). The ICD has become the international standard diagnostic tool for the study of disease in human populations.
Narcissistic Personality Disorder (NPD) is not a specific diagnostic type in the ICD-10, but is relegated to the category "Other Specific Personality Disorders" together with the eccentric, haltlose, immature, passive-aggressive, and psychoneurotic personality disorders.
3. Narcissistic Personality Inventory (NPI)
A research instrument to measure differences in narcissism in nonclinical adult populations, not for clinical diagnosis of NPD.
The NPI is the most commonly used assessment tool for measuring narcissistic traits in social psychological research. Raskin and Hall (1979, 1981) developed the Narcissistic Personality Inventory, a 54-item, forced-choice questionnaire, with paired statements designed to measure individual differences in narcissism as a personality trait in nonclinical adult populations. For each paired statement, one represents narcissistic traits and the other nonnarcissistic.
Several different versions of this tool have emerged, since its invention. Currently a 40-item forced-choice adaptation of the NPI is the preferred format for assessing narcissism (Raskin & Terry 1988). There are also two assessments based on the NPI format that are used to measure narcissisms in non-adult populations.
Although based on the DSM-III definition of Narcissistic Personality Disorder, the inventory was designed to measure narcissistic traits in the general population. Thus, the NPI is often described as measuring both sub-clinical or “normal” narcissism as well as those considered to suffer from Narcissistic Personality Disorder. People who score very high on the NPI do not necessarily have Narcissistic Disorder.
Studies have found that those scoring high on the NPI are more likely to cheat in relationships; take a disproportionate amount of resources; and place high value material things. And NPI scores are increasing, with recent generations scoring much higher than previous cohorts (Campbell 2005).
4. The Millon™ Clinical Multiaxial Inventory (MCMI™)
Used for clinical diagnosis of NPD.
Developed by Theodore Millon, the MCMI is also a widely-used diagnostic test that includes a scale for assessing narcissism. The NPI and MCMI have proven to be highly correlated in their measurements of narcissistic traits. However, unlike the NPI, which is designed to measure narcissism in the general population, the MCMI measures Narcissistic Personality Disorder (NPD).
More Information on Narcissism
There are numerous on-line and in print resources with additional information on narcissism and personality disorders in general, including: Psychology Prof Online, The Mayo Clinic: Mental Health Center and the article Personality Disorders: Brief Summary of the Ten Disorders of Personality.
This article describes clinical tools used by professionals to diagnose or assess individuals for narcissistic traits and disorders. The contents of this article are not meant to be a substitute for professional help and counseling.
Additional Narcissism Resources
American Psychiatric Association APA (2000) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR).
Campbell, W. K. (2005). When you love a man who loves himself. Sourcebooks, Inc.
Kernberg, Otto (2004) Aggressivity, Narcissism, and Self-Destructiveness in the Psychotherapeutic Relationship: New Developments in the Psychopathology and Psychotherapy of Severe Personality Disorders.
Millon, T., Millon, C., Davis, R., and Grossman, S. MCMI-III™ (Millon™ Clinical Multiaxial Inventory-III), Dicandrien, Inc.
Raskin, R. N., & Hall, C. S. (1979). A narcissistic personality inventory. Psychological Reports, 45.
Raskin, R. N., & Hall, C. S. (1981). The Narcissistic Personality Inventory: Alternate formreliability and further evidence of its construct validity. Journal of Personality Assessment, 45.
Raskin, R. and Terry, H. (1988). A principal-component analysis of the narcissistic personality inventory and further evidence of its construct valididty. Journal of Personality and Social Psychology, 54, 5.
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