Personality Disorders: Theory, Research, and Treatment 2014, Vol. 5, No. 2, 234
© 2014 American Psychological Association 1949-2715/14/$12.00 DOI: 10.1037/per0000010
AUTHOR’S RESPONSE
Response to Commentaries: Modernity and Narcissistic Personality Disorder Joel Paris
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
McGill University
is probably a naturalistic developmental process. Whereas I support the overall thrust of their argument, we do not know enough to quantify increases in narcissism. Twenge, Miller, and Campbell (2014) disagree with my suggestion that psychotherapy has the potential to increase narcissism. I did not claim, of course, that therapy is a cause of cohort changes. I also acknowledged that I cannot prove that such effects are consistent. Even so, anyone who has spent years living in a psychotherapy culture will have seen examples in patients—a point that Wright (2014) readily acknowledges, recommending that it be examined in future research. For those interested in a more extended argument about why psychotherapy can be a doubled-edged tool in an age of cultural narcissism, see Paris (in press).
I would like to thank all three commentators for focusing on points in my article that need clarification. Wright (2014, pp. 232–233) underlines the problem of precisely defining narcissism, arguing that research cannot progress until we agree on the meaning of the construct. Certainly, narcissism and narcissistic personality disorder (NPD) need reliable definitions, preferably based on observable phenomena. However, this problem cannot be resolved by psychometrics or theory alone, as narcissism requires external validators, which could be epidemiological, neurobiological, or psychosocial. As has happened with other categories in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM–IV–TR; American Psychiatric Association, 2000) system, new research findings can be used to further refine and determine the boundaries of a diagnosis. Trull (2014, pp. 230 –231) makes the useful point that cohort changes in narcissism do not translate into changes in the prevalence of NPD. He also points out that, given the limitations of self-report measures of traits, they should be supplemented by ratings from peers or family members, as well as by naturalistic observation. I strongly agree with these recommendations, which are in accord with the views of Kagan (2012) that the study of personality cannot be based entirely on self-report. Twenge, Miller, and Campbell (2014, pp. 227–229) are leaders in the empirical study of narcissism and NPD. I am therefore pleased that they agree with some of my conclusions. However, they should not consider the case for dramatic increases in trait narcissism to be settled. They support this conclusion with data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) study (Stinson et al., 2008), but this survey had serious problems with overdiagnosis, finding that 7% of the sample met criteria for obsessive– compulsive personality disorder and that 4% could be diagnosed with borderline personality disorder (Grant et al., 2004)— high numbers that no other survey has confirmed. Moreover, the NESARC study did not measure trait narcissism, but the DSM–IV criteria for NPD, rated by research assistants. One also cannot conclude that differences in the frequency of NPD symptoms that vary with age prove a cohort effect. Most people are more narcissistic when younger, but become less so as they grow older (Foster, Campbell, & Twenge, 2003). This
References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author. Foster, J. D., Campbell, W. K., & Twenge, J. M. (2003). Individual differences in narcissism: Inflated self-views across the lifespan and around the world. Journal of Research in Personality, 37, 469 – 486. Grant, B. F., Hasin, D. S., Stinson, F. S., Dawson, D. A., Chou, S. P., & Ruan, W. J. (2004). Prevalence, correlates, and disability of personality disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 65, 948 –958. Kagan, J. (2012): Psychology’s ghosts. New Haven, CT: Yale University Press. Paris, J. (in press). Psychotherapy in an age of narcissism. Basingstroke, UK: Palgrave Macmillan. Stinson, F. S., Dawson, D. A., Goldstein, R. B., Chou, S. P., Huang, B., & Smith, S. M. (2008). Prevalence, correlates, disability, and comorbidity of personality disorder diagnoses in a DSM–IV narcissistic personality disordered non-patient sample. Results from the wave 2 national epidemiologic survey on alcohol and related conditions. Journal of Clinical Psychiatry, 69, 1033–1045. Trull, T. J. (2014). Ruminations on narcissistic personality disorder. Personality Disorders: Theory, Research, and Treatment, 5, 230 –231. doi: 10.1037/per0000009 Twenge, J. M., Miller, J. D., & Campbell, W. K. (2014). The narcissism epidemic: Commentary on modernity and narcissistic personality disorder. Personality Disorders: Theory, Research, and Treatment, 5, 227– 229. doi:10.1037/per0000008 Wright, A. G. C. (2014). Narcissism and its discontents. Personality Disorders: Theory, Research, and Treatment, 5, 232–233. doi:10.1037/ per0000007
Correspondence concerning this article should be addressed to Joel Paris, 4333 cote Ste. catherine, Montreal, Quebec, H3T1E4, Canada. E-mail: [email protected]
234
© 2014 American Psychological Association 1949-2715/14/$12.00 DOI: 10.1037/per0000010
AUTHOR’S RESPONSE
Response to Commentaries: Modernity and Narcissistic Personality Disorder Joel Paris
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
McGill University
is probably a naturalistic developmental process. Whereas I support the overall thrust of their argument, we do not know enough to quantify increases in narcissism. Twenge, Miller, and Campbell (2014) disagree with my suggestion that psychotherapy has the potential to increase narcissism. I did not claim, of course, that therapy is a cause of cohort changes. I also acknowledged that I cannot prove that such effects are consistent. Even so, anyone who has spent years living in a psychotherapy culture will have seen examples in patients—a point that Wright (2014) readily acknowledges, recommending that it be examined in future research. For those interested in a more extended argument about why psychotherapy can be a doubled-edged tool in an age of cultural narcissism, see Paris (in press).
I would like to thank all three commentators for focusing on points in my article that need clarification. Wright (2014, pp. 232–233) underlines the problem of precisely defining narcissism, arguing that research cannot progress until we agree on the meaning of the construct. Certainly, narcissism and narcissistic personality disorder (NPD) need reliable definitions, preferably based on observable phenomena. However, this problem cannot be resolved by psychometrics or theory alone, as narcissism requires external validators, which could be epidemiological, neurobiological, or psychosocial. As has happened with other categories in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM–IV–TR; American Psychiatric Association, 2000) system, new research findings can be used to further refine and determine the boundaries of a diagnosis. Trull (2014, pp. 230 –231) makes the useful point that cohort changes in narcissism do not translate into changes in the prevalence of NPD. He also points out that, given the limitations of self-report measures of traits, they should be supplemented by ratings from peers or family members, as well as by naturalistic observation. I strongly agree with these recommendations, which are in accord with the views of Kagan (2012) that the study of personality cannot be based entirely on self-report. Twenge, Miller, and Campbell (2014, pp. 227–229) are leaders in the empirical study of narcissism and NPD. I am therefore pleased that they agree with some of my conclusions. However, they should not consider the case for dramatic increases in trait narcissism to be settled. They support this conclusion with data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) study (Stinson et al., 2008), but this survey had serious problems with overdiagnosis, finding that 7% of the sample met criteria for obsessive– compulsive personality disorder and that 4% could be diagnosed with borderline personality disorder (Grant et al., 2004)— high numbers that no other survey has confirmed. Moreover, the NESARC study did not measure trait narcissism, but the DSM–IV criteria for NPD, rated by research assistants. One also cannot conclude that differences in the frequency of NPD symptoms that vary with age prove a cohort effect. Most people are more narcissistic when younger, but become less so as they grow older (Foster, Campbell, & Twenge, 2003). This
References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author. Foster, J. D., Campbell, W. K., & Twenge, J. M. (2003). Individual differences in narcissism: Inflated self-views across the lifespan and around the world. Journal of Research in Personality, 37, 469 – 486. Grant, B. F., Hasin, D. S., Stinson, F. S., Dawson, D. A., Chou, S. P., & Ruan, W. J. (2004). Prevalence, correlates, and disability of personality disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 65, 948 –958. Kagan, J. (2012): Psychology’s ghosts. New Haven, CT: Yale University Press. Paris, J. (in press). Psychotherapy in an age of narcissism. Basingstroke, UK: Palgrave Macmillan. Stinson, F. S., Dawson, D. A., Goldstein, R. B., Chou, S. P., Huang, B., & Smith, S. M. (2008). Prevalence, correlates, disability, and comorbidity of personality disorder diagnoses in a DSM–IV narcissistic personality disordered non-patient sample. Results from the wave 2 national epidemiologic survey on alcohol and related conditions. Journal of Clinical Psychiatry, 69, 1033–1045. Trull, T. J. (2014). Ruminations on narcissistic personality disorder. Personality Disorders: Theory, Research, and Treatment, 5, 230 –231. doi: 10.1037/per0000009 Twenge, J. M., Miller, J. D., & Campbell, W. K. (2014). The narcissism epidemic: Commentary on modernity and narcissistic personality disorder. Personality Disorders: Theory, Research, and Treatment, 5, 227– 229. doi:10.1037/per0000008 Wright, A. G. C. (2014). Narcissism and its discontents. Personality Disorders: Theory, Research, and Treatment, 5, 232–233. doi:10.1037/ per0000007
Correspondence concerning this article should be addressed to Joel Paris, 4333 cote Ste. catherine, Montreal, Quebec, H3T1E4, Canada. E-mail: [email protected]
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