Narcissistic Personality Disorder: Diagnostic and clinical challenges. 2015
“NPD sufferers may be grandiose or self-loathing; extroverted or socially isolated; captains of industry or unable to maintain steady employment; model citizens or prone to antisocial activities.
Eve Caligor, M.D., Kenneth N. Levy, Ph.D., Frank E. Yeomans, M.D., Ph.D. From the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York; the Department of Psychology, Pennsylvania State University, University Park; and the Department of Psychiatry, Weill Medical College of Cornell University, New York.
American Journal of Psychiatry 172:5, May 2015
“Individuals with Narcissistic Personality Disorder (NPD) may be grandiose or self-loathing; extroverted or socially isolated; captains of industry or unable to maintain steady employment; model citizens or prone to antisocial activities.
“…The grandiose, thick-skinned, overt subtype is characterized by overt grandiosity, attention seeking, entitlement, arrogance, and little observable anxiety. These individuals can be socially charming, despite being oblivious to the needs of others, and are interpersonally exploitative.
“In contrast, the vulnerable, “fragile” or thin-skinned, covert subtype is inhibited, manifestly distressed, hypersensitive to the evaluations of others while chronically envious and evaluating themselves in relation to others.
“ there is (also) a healthier group of individuals with Narcissistic Personality Disorder, described as “high-functioning,” “exhibitionistic,” or “autonomous.” These individuals … are grandiose, competitive, attention seeking, and sexually provocative, while demonstrating adaptive functioning and using their narcissistic traits to succeed.
“Because of their high level of functioning, at first glance individuals in this group may not appear to have a personality disorder, and the Narcissistic Personality Disorder diagnosis can be overlooked on diagnostic assessment.”
The authors provide an excellent summary of the varieties of NPD and how the DSM-5* approach to personality disorders differs from that of its predecssor, DSM-IV.
* DSM: the Diagnostic and Statistical Manual of Mental Disorders, the standard classification of mental disorders used by mental health professionals in the United States.
Access the full paper here: Narcissistic Personality Disorder: Diagnostic and clinical challenges