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Narcissistic Personality Disorder Introduction

Narcissism has stood at the center of the last 30 years of psychoanalytic exploration and controversy. Investigations into both healthy and pathological narcissism have occasioned significant developments and debates in psychoanalytic theory and psychotherapeutic technique. As Narcissus has assumed a place alongside Oedipus in the pantheon of developmental and pathogenic myths, the domain of practice has expanded to include disorders once believed to be untreatable. The therapist has been confronted with a rich, if at times contradictory and confusing, variety of phenomenological descriptions, etiological explanations, transference and countertransference phenomena, and technical recommendations for treating primary disturbances of the self. The treatment in such patients is widely recognized to be highly challenging as well as potentially highly rewarding.

As the domain of narcissism and its pathologies has expanded, nosologists have sought to define narcissistic personality disorder clearly with a set of agreed-on phenomenological criteria. These efforts to define and empirically test criteria that would diminish the overlap between narcissistic personality disorder and other personality disorders, while improving the fit between the phenomenological diagnosis and the entity described in the clinical literature, have led to the evolving DSM terms for narcissistic personality disorder. The DSM-IV (American Psychiatric Association 1994) criteria represent one consensus in the ongoing attempt to sharpen the specificity and improve the sensitivity of the diagnosis and meaning of narcissistic personality disorder.