Narcissistic Personality Disorder: Facing DSM-V Elsa Ronningstam, PhD sychoanalytic theories and clini- cal case studies of patients with Pnarcissistic character pathology were most infl uential in outlining the conceptualization and description of the narcissistic personality disorder (NPD) when it was fi rst included as a diagnostic category in the Diagnostic and Statistic Manual of Mental Disorders, third edi- tion, (DSM-III) in 1980. This was elo- quently summarized by Salman Akhtar.1 Infl uences from other disciplines, (ie, psychiatric and psychosocial research on epidemiology and prototypical features), as well as academic social psychological inventory and laboratory studies of hu- man behavior, have contributed additional perspectives on pathological narcissism and NPD. More recently, cognitive neu- ropsychology and studies of infant and child development have also added valu- able information to our understanding of the origins of pathological narcissism and specifi c areas of narcissistic personality functioning. Three recent reviews2-4 have Elsa Ronningstam, PhD, is Associate Clinical Professor, Harvard Medical School, and Psychol- ogist, McLean Hospital. Address correspondence to: Elsa Ron- ningstam, PhD, McLean Hospital, 115 Mill Street, Belmont MA 02478; or e-mail ron-
[email protected]. Dr. Ronningstam has disclosed no relevant fi nancial relationships. © Medusa Lemieux / Pennsylvania College of Art & Design PSYCHIATRIC ANNALS 39:3 | MARCH 2009 PsychiatricAnnalsOnline.com | 111 33903Ronningstam.indd903Ronningstam.indd 111111 33/11/2009/11/2009 33:27:47:27:47 PPMM men and 4.8% for women) in the general TABLE 1. population, with considerable psycho- Prevalence of NPD social disability, especially among men, and co-occurring mood disorders (de- General population 0%-5.3%86-90 pression, bipolar I disorder), anxiety Wave 2, NESARC lifetime prevalence 4.8%-7.7%13 Clinical population 1.3%-17%53,91-94 disorder, personality disorders, and sub- Forensic population 6%95 stance use disorder.