To establish whether consensus exists among 3 diagnostic systems that outline criteria for narcissistic personality disorders (NPDs) in children (Kernberg), in adolescents (Bleiberg), and in adults primarily (DSM-IV) and to identify age-related criteria for preadolescents.
Method:
A comparative analysis was used to determine the rate of concordance for the 9 DSM-IV criteria for NPD.
Results:
There is a high concordance among the 3 systems for DSM criteria, suggesting that NPD can be identified among preadolescents.
Conclusion:
Preliminary ways of adapting DSM-IV criteria for NPD in this age group are discussed.
HillJRutterM.Personality disorders. In: RutterMTaylorEHersovL, editors. Child and adolescent psychiatry. 3rd ed.Oxford: Blackwell Publications; 1995. p 688–96.
2.
BleibergE.The clinical challenge of children and adolescents with severe personality disorders. Bull Menninger Clin1990;54:107–210.
3.
RinsleyDB. The severely disturbed adolescent: Indications for hospital and residential treatment. Bull Menninger Clin1990;54:3–12.
4.
LadameF.Depressive adolescents, pathological narcissism, and therapeutic failures. Adolesc Psychiatry1987;14:301–15.
5.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed.Washington (DC): American Psychiatric Press; 1994.
6.
KernbergPF. Personality disorders. In: WienerJM, editor. Textbook of child and adolescent psychiatry. Washington (DC): American Psychiatric Press; 1991. p 515–33.
7.
CokerRRCoverstoneKLSchultzDM. DSM-III-R diagnosis and code types of the diagnostic inventory of personality and symptoms in an adolescent clinical population. J Clin Psychol1990;46:839–45.
ZoccolilloMPicklesAQuintonDRutterM.The outcome of childhood conduct disorder: Implications for defining adult personality disorder and conduct disorder. Psychol Med1992;22:971–86.
10.
MartonPKorenblumMKutcherSSteinBKennedyBPakesJ.Personality dysfunction in depressed adolescents. Can J Psychiatry1989;34:810–3.
11.
KutcherSPMartonPKorenblumM.Adolescent bipolar illness and personality disorder. J Am Acad Child Adolesc Psychiatry1990;29:355–8.
12.
McGlashanTHHeinssenRK. Narcissistic, antisocial, and noncomorbid subgroups of borderline disorder: Are they distinct entities by long-term clinical profile?Psychiatr Clin North Am1989;12:653–70.
13.
LofgrenDPBemporadJKingJLindemKO'DriscollG.A prospective follow-up study of so-called borderline children. Am J Psychiatry1991;148:1541–7.
14.
BernsteinDPCohenPVelezNSchwab-StoneMSieverLJShinstaL.Prevalence and stability of the DSM-III-R personality disorders in a community-based survey of adolescents. Am J Psychiatry1993;150:1237–43.
15.
JohnsonBABrentDAConnollyJBridgeJMattaJConstantineD, and others. Familial aggregation of adolescent personality disorders. J Am Acad Child Adolesc Psychiatry1995;34:798–804.
16.
EpprightTDKashaniJHRobisonBDReidJC. Comorbidity of conduct disorder and personality disorders in an incarcerated juvenile population. Am J Psychiatry1993;150:1233–6.
17.
GuzderJParisJZelkowitzPMarchessaultK.Risk factors for borderline pathology in children. J Am Acad Child Adolesc Psychiatry1996;35:26–33.
18.
CaronCRutterM.Comorbidity in child psychopathology: Concepts, issues and research strategies. J Child Psychol Psychiatry1991;32:1063–80.
19.
KernbergO.Borderline conditions and pathological narcissism. New York: Jason Aronson; 1975.
20.
KernbergPF. Narcissistic personality disorder in childhood. Psychiatr Clin North Am1989;12:671–94.
21.
BleibergE.Developmental pathogenesis of narcissistic disorders in children. Bull Menninger Clin1988;52:3–15.
22.
BleibergE.Normal and pathological narcissism in adolescence. Am J Psychother1994;48:30–51.
23.
BlosP.The adolescent passage. New York: International Universities Press; 1979.
24.
KernbergO.Severe personality disorders: Psychotherapeutic strategies. New Haven (CT): Yale University Press; 1984.
25.
ClarkinJFKernbergO.Developmental factors in borderline personality disorder and borderline organization. In: ParisJ, editor. Borderline personality disorder. Washington (DC): American Psychiatric Press; 1993. p 161–84.
26.
PerryJCKlermanGL. The borderline patient: A comparative analysis of four sets of diagnostic criteria. Arch Gen Psychiatry1978;35:141–50.
27.
RonningstamE.Comparing three systems for diagnosing narcissistic personality disorder. Psychiatry1988;51:300–11.
28.
AkhtarSThomsonJA. Overview: Narcissistic personality disorder. Am J Psychiatry1982;139:12–20.
29.
GundersonJRonningstamESmithLE. Narcissistic personality disorder. In: LivesleyWJ, editor. The DSM-IV personality disorders. New York: Guilford Press; 1995. p 201–12.
30.
MastersonJF. Application to the personality disorders (DSM-III-R). In: MastersonJFKleinR, editors. Psychotherapy of the disorders of the self: The Masterson approach. New York: Brunner/Mazel Publishers; 1989. p 5–8.
31.
PiagetJ.The origins of intelligence in children. New York: International Universities Press; 1952.
32.
UngererJADolbyRWatersB, and others. The early development of empathy: Self-regulation and individual differences in the first year. Motivation and Emotion1990;14:93–106.
33.
Zahn-WaxlerCRadke-YarrowM.The origins of empathic concern. Motivation and Emotion1990;14:107–30.
34.
RonningstamEGundersonJLyonsM.Changes in pathological narcissism. Am J Psychiatry1995;152:253–7.
35.
KohutH.Thoughts on narcissism and narcissistic rage. Psychoanal Study Child1972;27:360–400.
36.
RinsleyDB. Notes on the developmental pathogenesis of narcissistic personality disorder. Psychiatr Clin North Am1989;12:695–707.
37.
OrcuttC.Progressive interventions based on the developmental paradigm. In: MastersonJFKleinR, editors. Psychotherapy of the disorders of the self: The Masterson approach. New York: Brunner/Mazel Publishers; 1989. p 110–46.
38.
ParisJ.Commentary on narcissistic personality disorder. In: LivesleyWJ, editor. The DSM-IV personality disorders. New York: Guilford Press; 1995. p 213–17.
