Narcissism and Narcissistic Personality Disorder: Clinical and Diagnostic Aspects

Background: Narcissistic personality disorder, still poorly understood, has been associated with fantasies of grandiosity, but researchers have observed that it presents in different clinical ways. Although rare, it is a difficult personality disorder to manage and makes it unmanageable to approach other common comorbid mental illnesses.Aims: Present a more recent and comprehensive view of the clinical manifestations of narcissistic personality disorder, focusing on the grandiose and the vulnerable phenotype. Relate these two presentations to prevalence, comorbidities and treatment. Methods: Non-systematic review of the literature in PubMed/MEDLINE and PsychINFO of articles published between 2001 and 2020. Analysis of the bibliographic references previously selected in order to identify relevant bibliographic sources.Results and Conclusions: It is currently established that the narcissistic personality disorder manifests in two main ways: grandiosity and vulnerability, although in the DSM-5 the diagnosis still only considers grandiose presentations. This new paradigm requires a more comprehensive diagnostic model, changes the prevalence of the disorder and amends the understanding of comorbid pathologies. However, narcissistic personality disorder still needs some consensus within the scientific community regarding the construction, clinical manifestations and therapeutic approach.