Am J Psychiatry 1995; 152:253-257
Copyright © 1995 by American Psychiatric Association
Changes in pathological narcissism
E Ronningstam, J Gunderson and M Lyons
Psychosocial Research Program, McLean Hospital, Belmont, MA 02178-9106.
OBJECTIVE: This study investigated types of change that occur over time in
the psychopathology of narcissistic patients. METHOD: Baseline scores on
the Diagnostic Interview for Narcissism of 20 patients, clinically
diagnosed as having narcissistic personality disorder, were contrasted with
their scores 3 years later by means of t tests and chi- square statistics.
The authors then compared these changes in narcissism with the patients'
accounts of their life events during the interval between the two
assessments. RESULTS: A significant decrease in the overall level of
pathological narcissism was found, particularly in the areas of
interpersonal relations and reactiveness. At follow-up, 60% of the subjects
had reached the cutoff score on the diagnostic interview that indicated
significant improvement, and 40% remained unchanged, with a high level of
pathological narcissism. A high baseline level of narcissism in
interpersonal relations was associated with absence of change at follow-up.
Examination of life events in the interval between assessments suggests
that changes in pathological narcissism are related to three kinds of
experiences: achievements, new durable relationships, and disillusionments.
CONCLUSIONS: The instability of narcissistic psychopathology found in this
study raises questions about the construct validity of narcissistic
personality disorder as a diagnostic category and about the core construct
of pathological narcissism.
