Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York.
Department of Medical Psychology in Psychiatry, Columbia University College of Physicians and Surgeons, New York.
J Pers Disord. 2020 Mar;34(Suppl):104-121. doi: 10.1521/pedi.2020.34.supp.104.
Narcissistic personality disorder (NPD) remains a controversial diagnosis, with lack of consensus on essential features of the disorder and its boundaries. Within the framework of object relations theory (ORT), core organizing, structural features define NPD and provide a coherent conceptual framework for understanding clinical features of the disorder. In the ORT model, both grandiose and vulnerable presentations of NPD are characterized by a specific form of self-pathology, reflecting the impact of a grandiose self-structure in the setting of borderline personality organization. The grandiose self-structure provides some stability of self-functioning but does not confer the self-regulatory capacities provided by normal identity formation and is reliant on maintaining a sense of the self as exceptional. We compare the ORT model of NPD to diagnostic criteria in the Alternative Model for Personality Disorders (AMPD) of the DSM-5, highlighting significant correspondence between the two models as well as conceptual differences.
自恋型人格障碍 (NPD) 仍然是一个有争议的诊断，对于该障碍的基本特征及其界限缺乏共识。在客体关系理论 (ORT) 的框架内，核心组织、结构特征定义了 NPD，并为理解该障碍的临床特征提供了一个连贯的概念框架。在 ORT 模型中，NPD 的夸大和脆弱表现都以特定形式的自我病理学为特征，反映了在边缘型人格组织背景下夸大的自我结构的影响。夸大的自我结构为自我功能提供了一些稳定性，但没有赋予正常身份形成所提供的自我调节能力，并且依赖于保持自我非凡的感觉。我们将 ORT 模型与 DSM-5 中的人格障碍替代模型 (AMPD) 的诊断标准进行比较，突出了两种模型之间的显著对应关系以及概念差异。
