Skodol Andrew E, Bender Donna S, Morey Leslie C
Department of Psychiatry, University of Arizona College of Medicine.
Department of Psychology, Texas A&M University.
Personal Disord. 2014 Oct;5(4):422-7. doi: 10.1037/per0000023. Epub 2013 Jul 8.
The criteria for personality disorders in Section II of DSM-5 have not changed from those in DSM-IV. Therefore, the diagnosis of Section II narcissistic personality disorder (NPD) will perpetuate all of the well-enumerated shortcomings associated with the diagnosis since DSM-III. In this article, we will briefly review problems associated with Section II NPD and then discuss the evolution of a new model of personality disorder and the place in the model of pathological narcissism and NPD. The new model was intended to be the official approach to the diagnosis of personality pathology in DSM-5, but was ultimately placed as an alternative in Section III for further study. The new model is a categorical-dimensional hybrid based on the assessment of core elements of personality functioning and of pathological personality traits. The specific criteria for NPD were intended to rectify some of the shortcomings of the DSM-IV representation by acknowledging both grandiose and vulnerable aspects, overt and covert presentations, and the dimensionality of narcissism. In addition, criteria were assigned and diagnostic thresholds set based on empirical data. The Section III representation of narcissistic phenomena using dimensions of self and interpersonal functioning and relevant traits offers a significant improvement over Section II NPD.
《精神疾病诊断与统计手册》（DSM）-5第二部分中人格障碍的标准与DSM-IV中的标准并无变化。因此，自DSM-III以来，对第二部分中自恋型人格障碍（NPD）的诊断将使所有与该诊断相关的、已详尽列举的缺陷持续存在。在本文中，我们将简要回顾与第二部分NPD相关的问题，然后讨论一种新的人格障碍模型的演变以及病理性自恋和NPD在该模型中的位置。新模型原本打算作为DSM-5中人格病理学诊断的官方方法，但最终被置于第三部分作为供进一步研究的替代方案。新模型是一种基于人格功能核心要素和病理性人格特质评估的分类-维度混合模型。NPD的具体标准旨在通过承认夸大和脆弱方面、公开和隐蔽表现以及自恋的维度性来纠正DSM-IV表述中的一些缺陷。此外，基于实证数据分配了标准并设定了诊断阈值。使用自我和人际功能维度以及相关特质对自恋现象进行的第三部分表述，相较于第二部分的NPD有了显著改进。
