Narcissistic Personality Disorder Phenomenology and Diagnosis

The challenge of understanding and treating narcissistic personality disorder has been compounded by the multiple, wide-ranging, and often ambiguous meanings of the terms narcissism and narcissistic pathology. As Cooper has written, "The fuzziness of the term reflects the complexity of the concepts, while the persistence of the term reflects their central importance". At the same time, he continues, "[W]e remain with more ambiguity than is desirable or useful".

The history of the concept of narcissism has been reviewed elsewhere. Recent literature recognizes that narcissism is a healthy, normal, and necessary component of psychological development and psychic life, thereby avoiding the pejorative connotation that the term narcissistic has often assumed. Narcissistic traits, moreover, appear in all forms of character pathology. A constellation of certain pathological traits that dominate the life history and the transference relationship distinguishes narcissistic personality disorder from other forms of personality disturbance.

Narcissistic pathology assumes a wide range of clinical and functional forms. Clinically, these forms range from the arrogant, boastful individual who steals the spotlight to the shy, easily slighted person who avoids center stage. Functionally, they may range from the prominent businessperson and political leader to the malignant narcissist and premeditating murderer.