Russ Eric, Shedler Jonathan, Bradley Rebekah, Westen Drew
Department of Psychology, Emory University, Atlanta, GA, USA.
Am J Psychiatry. 2008 Nov;165(11):1473-81. doi: 10.1176/appi.ajp.2008.07030376. Epub 2008 Aug 15.
Narcissistic personality disorder has received relatively little empirical attention. This study was designed to provide an empirically valid and clinically rich portrait of narcissistic personality disorder and to identify subtypes of the disorder.
A random national sample of psychiatrists and clinical psychologists (N=1,201) described a randomly selected current patient with personality pathology. Clinicians provided detailed psychological descriptions of the patients using the Shedler-Westen Assessment Procedure-II (SWAP-II), completed a checklist of axis II diagnostic criteria, and provided construct ratings for each axis II personality disorder. Descriptions of narcissistic patients based on both raw and standardized SWAP-II item scores were aggregated to identify, respectively, the most characteristic and the most distinctive features of narcissistic personality disorder.
A total of 255 patients met DSM-IV criteria for narcissistic personality disorder based on the checklist and 122 based on the construct ratings; 101 patients met criteria by both methods. Q-factor analysis identified three subtypes of narcissistic personality disorder, which the authors labeled grandiose/malignant, fragile, and high-functioning/exhibitionistic. Core features of the disorder included interpersonal vulnerability and underlying emotional distress, along with anger, difficulty in regulating affect, and interpersonal competitiveness, features that are absent from the DSM-IV description of narcissistic personality disorder.
These findings suggest that DSM-IV criteria for narcissistic personality disorder are too narrow, underemphasizing aspects of personality and inner experience that are empirically central to the disorder. The richer and more differentiated view of narcissistic personality disorder suggested by this study may have treatment implications and may help bridge the gap between empirically and clinically derived concepts of the disorder.
自恋型人格障碍相对较少受到实证研究的关注。本研究旨在提供一幅基于实证且临床丰富的自恋型人格障碍画像，并识别该障碍的亚型。
一个由精神病医生和临床心理学家组成的全国随机样本（N = 1201）描述了一名随机选取的当前患有个性病理学问题的患者。临床医生使用谢德勒-韦斯顿评估程序-II（SWAP-II）对患者进行了详细的心理描述，完成了轴II诊断标准清单，并为每种轴II人格障碍提供了结构评分。基于原始和标准化的SWAP-II项目得分对自恋患者的描述进行汇总，分别以识别自恋型人格障碍最具特征性和最独特的特征。
根据清单，共有255名患者符合自恋型人格障碍的DSM-IV标准，基于结构评分则有122名；101名患者通过两种方法均符合标准。Q因子分析确定了自恋型人格障碍的三种亚型，作者将其标记为夸大/恶性型、脆弱型和高功能/表现型。该障碍的核心特征包括人际脆弱性和潜在的情绪困扰，以及愤怒、情绪调节困难和人际竞争，这些特征在自恋型人格障碍的DSM-IV描述中并未提及。
这些发现表明，自恋型人格障碍的DSM-IV标准过于狭窄，没有充分强调那些在实证上对该障碍至关重要的人格和内心体验方面。本研究提出的对自恋型人格障碍更丰富、更具区分性的观点可能对治疗有启示作用，并可能有助于弥合该障碍在实证和临床衍生概念之间的差距。
