“…In an attempt to further understand the formidable challenges these patients pose, clinicians and, increasingly, clinical researchers have focused on the diverse and often contradictory clinical presentations, internal complexity, and subjective distress of individuals with narcissistic personality disorder (NPD; Levy, Reynoso, Wasserman, & Clarkin, 2007;Ronningstam, 2010Ronningstam, , 2011Levy, 2012). The plethora of theories and treatment approaches to narcissistic pathology (Kohut, 1971(Kohut, , 1977Kernberg, 1975Kernberg, , 1984Kernberg, , 1997Kernberg, , 2007Bach, 1985) that reflect the diverse presentations of NPD have been downplayed in the current DSM-IV criteria, which privileges overt grandiosity without taking into account the ways this symptom may be expressed covertly in fantasy or may mask internal distress and suffering.…”