Assessment of narcissistic personality disorder: A multi-method review

This review examines the available empirical data for the diagnosis of narcissistic personality disorder (NPD) for three methods of assessment: semi-structured interviews, self-report inventories, and projective techniques. Issues of reliability, validity, and clinical utility are examined for each instrument (or scale). An overview of the relative advantages, disadvantages, and empirical support for each method of assessment in the diagnosis of NPD is presented in a discussion after the review of the salient literature. In general, it was found that semi-structured interviews are a fairly reliable and valid method of diagnosis for Axis II disorders but, for the most part, these studies have used woefully small samples of NPDs. In general, self-report instruments were best at screening for the presence or absence of personality disorder, identifying members of personality disorder clusters, and identifying negative instances of specific personality disorders or clusters. Self-report inventories and the structured interviews are often in disagreement concerning presence of specific personality pathology. In general, previous studies have found the tendency for self-report measures to diagnose personality disorders at much higher frequencies than do clinicians. Moreover, self-report measures frequently attributed two or more personality disorders to a particular individual. Additionally, research with projective methods over the last decade has shown this mode of assessment to be useful in the differential diagnosis of NPD from both related and unrelated personality disorders. It seems prudent that the clinician and researcher alike should employ multiple methods of measurement and utilize information in a systematic and theoretical fashion when evaluating a patient for NPD diagnosis.