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Changes in pathological narcissism

E Ronningstam1, J Gunderson, M Lyons

  • 1Psychosocial Research Program, McLean Hospital, Belmont, MA 02178-9106.

The American Journal of Psychiatry
|February 1, 1995
PubMed
Summary
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Narcissistic psychopathology can decrease over time, especially with achievements and new relationships. However, some patients with high narcissism show no change, questioning the stability of this diagnosis.

Area of Science:

  • Psychiatry
  • Clinical Psychology

Background:

  • Narcissistic personality disorder (NPD) is a complex diagnostic category.
  • Understanding the temporal dynamics of narcissistic psychopathology is crucial for clinical practice and diagnostic refinement.

Purpose of the Study:

  • To investigate the longitudinal changes in psychopathology among individuals diagnosed with narcissistic personality disorder.
  • To identify factors associated with changes or stability in pathological narcissism over a three-year period.

Main Methods:

  • A cohort of 20 patients diagnosed with NPD were assessed at baseline and after three years using the Diagnostic Interview for Narcissism.
  • Statistical analyses (t tests, chi-square) were employed to compare scores over time.
  • Patient-reported life events during the interval were analyzed in relation to psychopathology changes.

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Main Results:

  • A significant overall decrease in pathological narcissism was observed, particularly in interpersonal relations and reactiveness.
  • Sixty percent of patients showed significant improvement, while 40% remained unchanged.
  • High baseline narcissism in interpersonal relations predicted a lack of change.
  • Life events such as achievements, new relationships, and disillusionments were associated with changes in narcissism.

Conclusions:

  • The observed instability in narcissistic psychopathology challenges the construct validity of narcissistic personality disorder as a distinct diagnostic category.
  • Findings suggest that pathological narcissism may be more fluid than previously assumed, prompting re-evaluation of the core construct.