Narcissistic Personality Disorder Workup
- Author: Sheenie Ambardar, MD; Chief Editor: David Bienenfeld, MD more...
No specific laboratory studies are employed to diagnose narcissistic personality disorder (NPD). Nevertheless, in view of the high incidence of substance abuse in patients with this disorder, it is wise to obtain a toxicology screen to rule out drugs and alcohol as possible causes of narcissistic character pathology.
The diagnosis of NPD is often made after obtaining a history of narcissistic symptoms from pertinent sources (including the patient, the patient’s family and friends, and the clinician’s own observations). However, more specific personality tests can also be used to facilitate diagnosis. There is some debate regarding the usefulness and reliability of these tests, but they can be helpful in elucidating character pathology outside the strict confines of the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
These personality tests are typically either self-report questionnaires given directly to the patient or semistructured interviews conducted by the clinician. Examples are the Personality Diagnostic Questionnaire–4 (PDQ-4), the Millon Clinical Multiaxial Inventory III (MCMI-III), and the International Personality Disorder Examination (IPDE). Each test uses a series of questions to determine the presence or absence of character pathology, and all may be valuable aids to the clinician trying to establish a formal diagnosis of NPD.
American Psychiatric Association. Personality disorders. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC: American Psychiatric Publishing, Inc; 2013.
American Psychiatric Association. Alternative DSM-5 model for personality disorders. Fifth Edition. Washington, DC: American Psychiatric Publishing, Inc; 2013. 761-81.
Akhtar S, Thomson JA Jr. Overview: narcissistic personality disorder. Am J Psychiatry. 1982 Jan. 139(1):12-20. [Medline].
Torgersen, S. Epidemiology. Oldham JM, Skodol AE, Bender DS. The American Psychiatric Publishing Textbook of Personality Disorders. Washington, DC: American Psychiatric Publishing; 2005. 129-141.
de Ruiter C, Greeven PG. Personality disorders in a Dutch forensic psychiatric sample: convergence of interview and self-report measures. J Pers Disord. 2000 Summer. 14(2):162-70. [Medline].
Ronningstam E. Narcissistic Personality Disorder: Facing DSM-V. Psychiatric Annals. 2009 Mar. 39:111-121.
Crosby RM, Hall MJ. Psychiatric evaluation of self-referred and non-self-referred active duty military members. Mil Med. 1992 May. 157(5):224-9. [Medline].
Bourgeois JA, Hall MJ, Crosby RM, Drexler KG. An examination of narcissistic personality traits as seen in a military population. Mil Med. 1993 Mar. 158(3):170-4. [Medline].
Maffei C, Fossati A, Lingiardi V, Madeddu F, Borellini C, Petrachi M. Personality maladjustment, defenses and psychopathological symptoms in non-clinical subjects. J Pers Disord. 1995 Apr. 9:330-345.
Rebecca J. Frey, Ph.D. Narcissistic Personality Disorder. Encyclopedia of Mental Disorders. Available at http://www.minddisorders.com/Kau-Nu/Narcissistic-personality-disorder.html. Accessed: September 8, 2008.
Ronningstam E, Gunderson J, Lyons M. Changes in pathological narcissism. Am J Psychiatry. 1995 Feb. 152(2):253-7. [Medline].
Waller G, Sines J, Meyer C, et al. Narcissism and narcissistic defences in the eating disorders. Int J Eat Disord. 2007 Mar. 40(2):143-8. [Medline].
Ronningstam E. Pathological narcissism and narcissistic personality disorder in Axis I disorders. Harv Rev Psychiatry. 1996 Mar-Apr. 3(6):326-40. [Medline].
Ronningstam EF, Maltsberger JT. Part X: Personality Disorders. Gabbard GO. Gabbard's Treatments of Psychiatric Disorders. Fourth Edition. Washington DC: American Psychiatric Publishing; 2007. Chapter 52: Narcissistic Personality Disorder, pages 791-804.
David Bienenfeld, MD. Personality Disorders. Medscape Reference. Available at http://emedicine.medscape.com/article/294307-overview. Accessed: July 1, 2008.
Simon RI. Outpatients. Assessing and Managing Suicide Risk: Guidelines for Clinically Based Risk Management. Washington DC: American Psychiatric Publishing; 2004. 89-90.
Holdwick DJ Jr, Hilsenroth MJ, Castlebury FD, et al. Identifying the unique and common characteristics among the DSM-IV antisocial, borderline, and narcissistic personality disorders. Compr Psychiatry. 1998 Sep-Oct. 39(5):277-86. [Medline].
Gunderson JG, Ronningstam E. Differentiating narcissistic and antisocial personality disorders. J Personal Disord. 2001 Apr. 15(2):103-9. [Medline].
Stormberg D, Ronningstam E, Gunderson J, et al. Brief communication: pathological narcissism in bipolar disorder patients. J Personal Disord. 1998. 12(2):179-85. [Medline].
Clarkin JF, Howieson DB, McClough J. The Role of Psychiatric Measures in Assessment and Treatment. Hales RE, Yudofsky SC, Gabbard GO. The American Psychiatric Publishing Textbook of Psychiatry. 5th Edition. Arlington, VA: American Psychiatric Publishing; 2008. Chapter 3.
Roth BE. Narcissistic patients in group therapy: containing affects in the early group. Ronningstam E. Disorders of Narcissism: Diagnostic, Clinical, and Empirical Implications. Washington DC: American Psychiatric Press; 1998. 221-238.
Alonso A. The shattered mirror: treatment of a group of narcissistic patients. Group. 1992 Dec. 16:210-219.
Young J, Flanagan C. Schema-focused therapy for narcissistic patients. Ronningstam E. Disorders of Narcissism: Diagnostic, Clinical, and Empirical Implications. Washington DC: American Psychiatric Press; 1998. 239-268.
Young J, Klosko JS, Weishaar ME. Schema Therapy. A Practitioner's Guide. New York: Guilford; 2003.
Links PS, Gould B, Ratnayake R. Assessing suicidal youth with antisocial, borderline, or narcissistic personality disorder. Can J Psychiatry. 2003 Jun. 48(5):301-10. [Medline].
Links PS, Kolla N. Assessing and Managing Suicide Risk. Oldham JM, Skodol AE, Bender DS. The American Psychiatric Publishing Textbook Of Personality Disorders. Washington DC: American Psychiatric Publishing; 2005. 459.