When Is Narcissism a Disorder?

Narcissistic Personality as Category or Continuum

© Tami Port

Narcissism:Disease or dimension of personality? , Bencur's Narcissus Public Domain

When is narcissism a mental illness? New research indicates that it is all a matter of degree.

What’s the distinction between “normal” narcissism and psychological disorder? In a new study appearing in the May issue of Personality and Individual Differences, two American psychologists examined the contrasting perspectives on narcissism held by social psychologists and clinical psychologists.

Social Psychology and Clinical Psychology

Social psychologists are scientists who study people in their relationship to others and to society as a whole; the discipline where mental state meets social situation.

Clinical psychology focuses on diagnosis and treatment of emotional and behavioral disorders. These mental health clinicians usually have a PhD and work in a medical setting with psychiatrists and other physicians.

Different Perspectives on Narcissism

There are many similarities to how clinical and social psychologists view narcissism, but there is one very important difference. Clinical psychologists classify narcissism as a personality disorder. So, according to their diagnostic criteria, you either have Narcissistic Personality Disorder (NPD) or you don’t.

Unlike clinicians, social psychologists generally view narcissism as a spectrum or dimension of personality, not as a category. They do not believe that there is a specific point within the continuum of narcissism where ‘normal’ suddenly becomes ‘narcissism’.

New Research on Narcissism

In their recently published study, Foster and Campbell (2007) measured narcissism using the Narcissistic Personality Inventory (NPI), an assessment tool often employed for evaluating narcissistic traits in social psychological research.

What Is the NPI?

The Narcissistic Personality Inventory is a forced-choice questionnaire that uses paired statements to assess narcissism in nonclinical, adult populations. In other words, the NPI is used for research on the general public, not necessarily mental health patients.

Although designed to measure narcissistic traits in the general population, the NPI was designed based on the clinical definition of narcissism found in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This diagnostic reference is published by the American Psychiatric Association (APA), and is the manual that mental health professionals most commonly use to diagnose narcissism and other mental disorders.

Because the purpose of the DSM is to diagnose mental illness, the various disorders are presented as specific, discrete categories. However, in the creation of the NPI, this clinical definition of narcissism was used with the assumption that people who don’t have the psychological disorder of narcissism can still display narcissistic traits.

What’s the Difference between Narcissism and Normal?

So is narcissism a distinct disorder, or is it a dimension of personality that can range from mild to extreme? Since the DSM outlines the specific criteria necessary to diagnose a person as having the psychological disorder of NPD, one might expect there to be an abrupt shift or jump in NPI narcissism scores as a point of demarcation between what is considered “normal” and what is mental illness. This is essentially what Foster and Campbell set out to explore.

Narcissism Study Method

The researchers examined 3895 participants from the general population using an on-line version of the NPI. Subjects were presented with 40 paired statements and instructed to choose the one that best described them. For each statement pair, one choice reflected a more narcissistic perspective. For example, “I am much like everybody else” versus “I am an extraordinary person.”

Narcissism Research Results

Analysis of the scores revealed no point at which there was a distinct shift from “normal” to “narcissist.” Rather the scores ranged across a continuum, a finding more in agreement with the social psychological view of narcissism.

This suggests that narcissism is structured similarly to other aspects of general personality, as a range or dimension. For example, considering the characteristic of sociability, one might see it as ranging from shy and socially withdrawn to gregarious and socially outgoing. Foster and Campbell’s research suggests that narcissism also shows a continuum of individuals who do not strongly display narcissistic traits of self-absorption to those who are extremely or pathologically narcissistic.

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 What Is a Personality Disorder?: Overview of the Ten Psychological Disorders of Personality.

This Suite 101 article summarizes one study investigating the nature of narcissism. The content of this article is not meant to be used for diagnosis and is not a substitute for professional help and counseling.

Additional Narcissism Sources

Grey, P. (2006). Psychology, 5th Edition. Worth Publishers.

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 form reliability and further evidence of its construct validity. Journal of Personality Assessment, 45.

Foster, J. D. and Campbell, W. K. (2007). Are there such things as “Narcissists” in social psychology? A taxometric analysis of the Narcissistic Personality Inventory. Personality and Individual Differences, 43, 6.


The copyright of the article When Is Narcissism a Disorder? in Narcissistic Personality is owned by Tami Port. Permission to republish When Is Narcissism a Disorder? must be granted by the author in writing.


Narcissism:Disease or dimension of personality? , Bencur's Narcissus Public Domain
       

Comments
Sep 8, 2007 8:07 PM
redback :
Very helpful article. :)


I've been reminded, after reading your articles there is 'Statistical' in the DSM 1V title...and why it got there.
And re-reading the 'cautions' and 'criticism' sections in the link I posted here, the history and broader purpose of the DSM 1V...I see there's still some way to go for its consistent use by diagnosticians and researchers.

So, I found it interesting to read in your article that the social and clinical psychologist may rely on different criteria when the ICD-10 has been brought more in line with the DSM 1V ie a need for uniformity. But the clinical psych is surely uninterested in "normal" narcissism as treatment is not sought no needed for it. The scoial psychologist may be more interested in prevention and early intervention as well as trying to find the elusive cut-off point of "normal".

Untreated "normal" vs treated "normal? A normal "narcissist" who develops an undiagnosed mental disorder, say schizophrenia? Does the narcissistic trai impact on how schizophrenia will present itself?

Research in this area is fascinating. And maybe there is scope within the human genome project to examine the whole idea of personality traits or disorders...on mental health.

I'm in the camp that believes personality traits are like healthy limbs. It don't need to be fixed if it aint broke. When it causes a defined 'impairment' (ADL) is the time to question if its a temporary problem or risks a chronic disorder. Tis a transitional shade of grey, not a decimal point threshold..
Sep 12, 2007 9:26 PM
Tami Port :
Redback -

Thanks for your postings. I am always interested in others experience and perspectives on PDs (and on most everything else as well). The many questions, conflicts and subtopics that you present in your postings could certainly give rise to numerous new articles and discussions.

With respect to your closing in the message preceding this one...I couldn't agree more. Mental illnesses have been categorized for the purposes of study, treatment, and of course billing always factors into the mix. Nonetheless, these categories that we have created are...well...categories that we have created! We have defined boundaries of mental health and mental illness when it seems rather apparent that few psychological states are black and white, sick or healthy. Like you, I agree with the social psychologists. Mental health/illness exists in a continuum.
Sep 13, 2007 1:07 AM
redback :
It has been estimated that approx 70% of the psychoses are completely untreatable:
http://www.aprn.net.au/APRN%20Final%20Report_web%20version.pdf

The Australian Psychosis Research Network (APRN) 54-page Final Report per the above hotlink makes interesting reading. The APRN is a claimed world-first uniting of more than 50 separate leading Aussie centres into the one national research unit.

I am an unpaid mental health advocate in an federal election year :) :) so will be pushing for the APRN to receive partnership funding from government to supplement private funding. I'm focusing on preventative measures and see underlying, undiagnosed, under-treated, un-mentioned PDs as problematic, not just end-stage crisis management.

A lifetime ago, in the 80s, we had many staff "diagnosed" with 'adjustment disorder' when they had difficulty coming to terms with "rationalisation" of staff (mass redundancies) that was truly mismanaged. 'Adjustment disorder' had a stigma attached to it for fighting to keep the job or get references for other jobs. This, like 'phobia' seems to be a PD subset?

Our social welfare system has been dragged screaming into the 21st century. But not without pain to system and citizen alike. Everyone deserves a fair go without having to self-identify self incriminating facts...or do they if its at taxpayers' expense? :)
Sep 14, 2007 7:14 PM
redback :
Apologies again. The link I offered is a tad "side-tracked" on the local funding issue which is of less interest internationally, probably.

But it's interesting how relatively inefficient treatment options are in the grand scheme of things and there are scientific techniques going begging. For PDs where tis a treat the symptom focus, maybe there is a greater divide.

I ponder what genetics has to offer for PDs.
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