An examination of the factor structure of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, narcissistic personality disorder criteria: one or two factors?

Abstract

A growing body of research has suggested that narcissistic personality disorder (NPD) contains two factors or types: overt/grandiose and covert/vulnerable. A recent factor analysis of DSM-IV NPD symptoms supported a similar two-factor model. The present research tested this proposed two-factor solution against a one-factor solution (N = 298; 72% patients) using both confirmatory factor analysis (CFA) and an examination of associations between the resultant factors and theoretically relevant criteria (other PDs; depression, anxiety). The results of the CFA supported a one-factor solution. Likewise, the two factors each yielded a similar pattern of correlations with relevant criteria. Together, these results argue against a two-factor structure for the current DSM-IV NPD symptoms. Given the broader research literature suggesting a two-factor structure of narcissism, strategies for assessing both overt/grandiose and covert/vulnerable forms of narcissism in DSM-V are discussed. Narcissistic personality disorder (NPD) is characterized by a "pervasive pattern of grandiosity, need for admiration, and lack of empathy" (1; p.714). While narcissism and NPD have attracted the attention of prominent personality theorists such as Freud (2), Kernberg (3), Kohut (4), and Millon (5), NPD has received little empirical attention. This is at odds with the sizable body of research that exists on the study of narcissism as a "normal" trait (e.g., 6-7). Unfortunately, the degree of concordance between these conceptually similar constructs (e.g., trait narcissism as measure by the Narcissistic Personality Inventory [NPI,8] vs. NPD, as assessed by the DSM-IV) is unclear (9). As a result, it is difficult to be certain that the substantial body of empirical work from the social-personality literature generalizes directly to the study of NPD.One specific area of interest with regard to NPD is its underlying factor structure. Research using alternative measures of narcissism has suggested that there may be two forms of narcissism, which have been labeled "overt" vs. "covert" or "grandiose" vs. "vulnerable" (9-12), that may primarily "share a cognitive orientation to pathological Correspondence: Address correspondence to: Joshua D. Miller, Department of Psychology, University of Georgia, Athens, 542-1173; Fax: (706) 542-8048; e-mail: jdmiller@uga.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. (12, p. 205). However, the two variants are thought to differ with regard to their relation to self-esteem, negative emotionality, and extraversion/dominance (9-12), with the overt/grandiose "t...

A comparison of the criterion validity of popular measures of narcissism and narcissistic personality disorder via the use of expert ratings.

“…Although the DSM-IV-TR and DSM-5 NPD criteria mostly reflect grandiosity (Fossati et al, 2005;Miller, Hoffman, Campbell, & Pilkonis, 2008), the corresponding DSM-IV-TR and DSM-5 text also emphasizes narcissistic vulnerability. In addition, the wording of items on these self-report DSM-TV-TR NPD mea sures often emphasizes vulnerability to a greater degree than is specified in the actual criteria.…”

Experts’ Views Regarding the Conceptualization of Narcissism

“…In contrast, clinical psychologists/psychiatrists are more likely to focus on both grandiosity and vulnerability Miller et al, 2016). Nevertheless, because the DSM criteria for NPD primarily describe pathological grandiosity (Miller, Hoffman, Campbell, & Pilkonis, 2008), experts who rely on such criteria and/or use measures based on them may believe that vulnerability is less central (e.g., Lynam & Widiger, 2001).…”

The Impact of Pathological Narcissism on Psychotherapy Utilization, Initial Symptom Severity, and Early-Treatment Symptom Change: A Naturalistic Investigation

“…However, this proposal led to a welter of responses from theorists and researchers alike arguing for the clinical utility and validity of the broader construct of pathological narcissism (e.g., Miller, Widiger, & Campbell, 2010;Pincus, 2011;Ronningstam, 2011;Shedler et al 2010). Central to many of these critiques was the idea that pathological narcissism involves two facets: narcissistic grandiosity, characterized by feelings of entitlement, interpersonal manipulativeness, and arrogance, and narcissistic vulnerability, involving shyness, shame, and avoidance of relationships, whereas the construct of NPD in the DSM seemed to focus exclusively on a grandiose presentation (Miller, Hoffman, Campbell, & Pilkonis, 2008;Pincus & Roche, 2011). Some researchers have contended that this narrow focus on grandiosity leads to the low prevalence of DSM-IV NPD, because the construct as written might not capture the typical presentation in clinical settings (Levy et al, 2007;Miller et al, 2010;.…”