The Handbook of Narcissism and Narcissistic Personality Disorder by Miller Joshua D. Campbell W. Keith & Joshua D. Miller

Author:Miller, Joshua D., Campbell, W. Keith & Joshua D. Miller
Language: eng
Format: epub, mobi
Publisher: John Wiley & Sons
Published: 2011-06-27T04:00:00+00:00

Chapter 22

THE COMORBIDITY OF NARCISSISTIC PERSONALITY DISORDER WITH OTHER DSM-IV PERSONALITY DISORDERS

Thomas A. Widiger

The purpose of this chapter is to summarize and discuss the comorbidity of narcissistic personality disorder (NPD) as it has been diagnosed within the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) with other officially recognized personality disorders. Much of the time spent by the authors of the diagnostic criterion sets included within the recent editions of the DSM has been given to deleting, adding, or revising items to improve differential diagnosis so that they lead clinicians and researchers to the presence of a distinct disorder (Gunderson, 1992; Gunderson, Ronningstam, & Smith, 1991; Widiger, Frances, Spitzer, & Williams, 1988). Much of the time spent by some psychopathology researchers is given to the search for the specific pathology that would explain the symptoms of a particular mental disorder, such as NPD (Cooper, 1998; Kernberg, 1970; Levy, Reynoso, Wasserman, & Clarkin, 2007; Pincus & Lukowitsky, 2010; Ronningstam, 2005). The assumption in both instances is that mental disorders are distinct clinical entities. The task of the clinician is to identify which specific mental disorder optimally explains a particular patient’s problems, the identification of which would then suggest a specific pathology and a specific treatment (Frances, First, & Pincus, 1995).

Fundamentally problematic to this effort is a patient meeting diagnostic criteria for more than one disorder. The clinician must then decide which disorder provides the correct diagnosis or, alternatively, conclude that the person is suffering from two comorbid disorders. The term comorbidity was first coined by Feinstein (1970) to mean, “any distinct additional clinical entity that has existed or that may occur during the clinical course of a patient who has the index disease under study” (pp. 456–467). In psychiatric epidemiology, the term has typically meant the relative risk of having another disorder given the presence of the index condition (Maser & Cloninger, 1990).

Comorbidity among mental disorders has been heavily researched and discussed (Aragona, 2009; Krueger & Markon, 2006; Meehl, 2001; Widiger & Sankis, 2000), but comorbidity studies are not generally conducted to identify the risk of one disorder given the presence of another. Comorbidity findings are often understood as indicating the extent to which conditions are not clearly distinct from one another, as diagnostic co-occurrence often reflects a common etiology, pathology, and/or overlap in symptomatology rather than the comorbid presence of two distinct disorders. It is for this reason that some researchers prefer the more neutral term co-occurrence over comorbidity (Lilienfeld, Waldman, & Israel, 1994; Widiger & Clark, 2000). In this chapter, the term comorbidity is often used, but it is understood simply as a matter of co-occurrence.

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