Narcissistic Personality Disorder Workup

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

Approach Considerations

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). [1]

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. [20]