Aidan G. C. Wright

Initial Construction and Validation of the Pathological Narcissism Inventory

The construct of narcissism is inconsistently defined across clinical theory, social-personality psychology, and psychiatric diagnosis. Two problems were identified that impede integration of research and clinical findings regarding narcissistic personality pathology: (a) ambiguity regarding the assessment of pathological narcissism vs. normal narcissism and (b) insufficient scope of existing narcissism measures. Four studies are presented documenting the initial derivation and validation of the Pathological Narcissism Inventory (PNI). The PNI is a 52-item self-report measure assessing 7 dimensions of pathological narcissism spanning problems with narcissistic grandiosity (Entitlement Rage, Exploitativeness, Grandiose Fantasy, Self-sacrificing Self-enhancement) and narcissistic vulnerability (Contingent Self-esteem, Hiding the Self, Devaluing). The PNI structure was validated via confirmatory factor analysis. The PNI correlated negatively with self-esteem and empathy, and positively with shame, interpersonal distress, aggression, and borderline personality organization. Grandiose PNI scales were associated with vindictive, domineering, intrusive, and overly-nurturant interpersonal problems, and vulnerable PNI scales were associated with cold, socially avoidant, and exploitable interpersonal problems. In a small clinical sample, PNI scales exhibited significant associations with parasuicidal behavior, suicide attempts, homicidal ideation, and several aspects of psychotherapy utilization.

The Hierarchical Structure of DSM-5 Pathological Personality Traits

A multidimensional trait system has been proposed for representing personality disorder (PD) features in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to address problematic classification issues such as comorbidity. In this model, which may also assist in providing scaffolding for the underlying structure of major forms of psychopathology more generally, 25 primary traits are organized by 5 higher order dimensions: Negative Affect, Detachment, Antagonism, Disinhibition, and Psychoticism. We examined (a) the generalizability of the structure proposed for DSM-5 PD traits, and (b) the potential for an integrative hierarchy based upon DSM-5 PD traits to represent the dimensions scaffolding psychopathology more generally. A large sample of student participants (N = 2,461) completed the Personality Inventory for DSM-5, which operationalizes the DSM-5 traits. Exploratory factor analysis replicated the initially reported 5-factor structure, as indicated by high factor congruencies. The 2-, 3-, and 4-factor solutions estimated in the hierarchy of the DSM-5 traits bear close resemblance to existing models of common mental disorders, temperament, and personality pathology. Thus, beyond the description of individual differences in personality disorder, the trait dimensions might provide a framework for the metastructure of psychopathology in the DSM-5 and the integration of a number of ostensibly competing models of personality trait covariation.

The Convergent Structure of DSM-5 Personality Trait Facets and Five-Factor Model Trait Domains

The DSM-5 Personality and Personality Disorder Work Group have proposed diagnosing personality disorder based in part on 25 pathological traits. Initial research suggests that five factors explain the covariance among these traits and that these factors reflect the domains of the well-validated Five-Factor Model (FFM) of normative personality. This finding is important because it signifies the potential to apply normative trait research to personality disorder classification in the DSM-5. In this study, trait scale scores on the Personality Inventory for DSM-5 (PID-5) and domain scores from the FFM Rating Form (FFMRF) were subjected to a conjoint exploratory factor analysis (EFA) to test the higher-order convergence of the DSM-5 pathological trait model and the FFM in a nonclinical sample (N = 808). Results indicate that the five higher-order factors of the conjoint EFA reflect the domains of the FFM. The authors briefly discuss implications of this correspondence between the normative FFM and the pathological PID-5.

The Hierarchical Taxonomy of Psychopathology (HiTOP) : A Dimensional Alternative to Traditional Nosologies

The reliability and validity of traditional taxonomies are limited by arbitrary boundaries between psychopathology and normality, often unclear boundaries between disorders, frequent disorder co-occurrence, heterogeneity within disorders, and diagnostic instability. These taxonomies went beyond evidence available on the structure of psychopathology and were shaped by a variety of other considerations, which may explain the aforementioned shortcomings. The Hierarchical Taxonomy Of Psychopathology (HiTOP) model has emerged as a research effort to address these problems. It constructs psychopathological syndromes and their components/subtypes based on the observed covariation of symptoms, grouping related symptoms together and thus reducing heterogeneity. It also combines co-occurring syndromes into spectra, thereby mapping out comorbidity. Moreover, it characterizes these phenomena dimensionally, which addresses boundary problems and diagnostic instability. Here, we review the development of the HiTOP and the relevant evidence. The new classification already covers most forms of psychopathology. Dimensional measures have been developed to assess many of the identified components, syndromes, and spectra. Several domains of this model are ready for clinical and research applications. The HiTOP promises to improve research and clinical practice by addressing the aforementioned shortcomings of traditional nosologies. It also provides an effective way to summarize and convey information on risk factors, etiology, pathophysiology, phenomenology, illness course, and treatment response. This can greatly improve the utility of the diagnosis of mental disorders. The new classification remains a work in progress. However, it is developing rapidly and is poised to advance mental health research and care significantly as the relevant science matures.

DSM-5 Personality Traits and DSM-IV Personality Disorders

Two issues pertinent to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) proposal for personality pathology, the recovery of DSM-IV personality disorders (PDs) by proposed DSM-5 traits and the validity of the proposed DSM-5 hybrid model, which incorporates both personality pathology symptoms and maladaptive traits, were evaluated in a large undergraduate sample (N = 808). Proposed DSM-5 traits as assessed with the Personality Inventory for DSM-5 explained a substantial proportion of variance in DSM-IV PDs as assessed with the Personality Diagnostic Questionnaire-4+, and trait indicators of the 6 proposed DSM-5 PDs were mostly specific to those disorders with some exceptions. Regression analyses support the DSM-5 hybrid model in that pathological traits, and an indicator of general personality pathology severity provided incremental information about PDs. Findings are discussed in the context of broader issues around the proposed DSM-5 model of personality disorders.

The Higher Order Factor Structure and Gender Invariance of the Pathological Narcissism Inventory.

The Pathological Narcissism Inventory (PNI) is a recently developed multidimensional inventory for the assessment of pathological narcissism. The authors describe and report the results of two studies that investigate the higher order factor structure and gender invariance of the PNI. The results of the first study indicate that the PNI has a higher order factor structure that conforms to the theoretical structure of pathological narcissism with one factor representing narcissistic grandiosity and the other capturing narcissistic vulnerability. These results uniquely place the PNI as the only measure to broadly assess the two phenotypic themes of pathological narcissism. In the second study, results from tests of measurement invariance indicate that the PNI performs similarly in large samples of men (n = 488) and women (n = 495). These results further establish the psychometric properties of the PNI and suggest that it is well suited for the assessment of pathological narcissism.

On the Structure of Personality Disorder Traits: Conjoint Analyses of the CAT-PD, PID-5, and NEO-PI-3 Trait Models

The current study examines the relations among contemporary models of pathological and normal range personality traits. Specifically, we report on (a) conjoint exploratory factor analyses of the Computerized Adaptive Test of Personality Disorder static form (CAT-PD-SF) with the Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition and NEO Personality Inventory-3 First Half, and (b) unfolding hierarchical analyses of the three measures in a large general psychiatric outpatient sample (n = 628; 64% Female). A five-factor solution provided conceptually coherent alignment among the CAT-PD-SF, PID-5, and NEO-PI-3FH scales. Hierarchical solutions suggested that higher-order factors bear strong resemblance to dimensions that emerge from structural models of psychopathology (e.g., Internalizing and Externalizing spectra). These results demonstrate that the CAT-PD-SF adheres to the consensual structure of broad trait domains at the five-factor level. Additionally, patterns of scale loadings further inform questions of structure and bipolarity of facet and domain level constructs. Finally, hierarchical analyses strengthen the argument for using broad dimensions that span normative and pathological functioning to scaffold a quantitatively derived phenotypic structure of psychopathology to orient future research on explanatory, etiological, and maintenance mechanisms.

An Interpersonal Analysis of Pathological Personality Traits in DSM-5

The proposed changes to the personality disorder section of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) places an increased focus on interpersonal impairment as one of the defining features of personality psychopathology. In addition, a proposed trait model has been offered to provide a means of capturing phenotypic variation on the expression of personality disorder. In this study, the authors subject the proposed DSM-5 traits to interpersonal analysis using the Inventory of Interpersonal Problems–Circumplex scales via the structural summary method for circumplex data. DSM-5 traits were consistently associated with generalized interpersonal dysfunction suggesting that they are maladaptive in nature, the majority of traits demonstrated discriminant validity with prototypical and differentiated interpersonal problem profiles, and conformed well to a priori hypothesized associations. These results are discussed in the context of the DSM-5 proposal and contemporary interpersonal theory, with a particular focus on potential areas for expansion of the DSM-5 trait model.

DSM-5 Pathological Personality Traits and the Personality Assessment Inventory

Section 3 of the DSM-5 will include a pathological personality trait system rooted in the quantitative epistemology of personality and clinical psychology. This system has the potential to enhance the clinical utility of the diagnostic nosology by providing a means for the dimensional assessment of individuals with psychopathology. However, there is limited research on the associations of DSM-5 traits with common mental disorders and related clinical phenomena as measured by currently popular assessment instruments. The purpose of this article was to evaluate the convergence of the DSM-5 trait system with a well-validated broadband clinical instrument, the Personality Assessment Inventory (PAI). Bivariate correlations were examined and factor analytic methods were used to examine the degree to which the DSM-5 traits and PAI capture common variance in personality and mental health. In a student sample (N = 1,001), we found broad convergence between the DSM-5 traits and PAI, which could be organized effectively using five factors. The implications of these findings for using traits to address issues related to diagnostic co-occurrence and heterogeneity in routine clinical assessment are discussed.

Evidence for the Criterion Validity and Clinical Utility of the Pathological Narcissism Inventory.

In this study, the authors evaluated aspects of criterion validity and clinical utility of the grandiosity and vulnerability components of the Pathological Narcissism Inventory (PNI) using two undergraduate samples (N = 299 and 500). Criterion validity was assessed by evaluating the correlations of narcissistic grandiosity and narcissistic vulnerability with established indices of normal personality traits, psychopathology and clinical concerns, and pathological personality traits. Overall, the pattern of correlations supported the convergent and discriminant validity of grandiose and vulnerable conceptualizations of pathological narcissism as measured by the PNI. Clinical utility was assessed by evaluating the extent to which clinicians without specific training in pathological narcissism as well as clinicians with expertise in pathological narcissism could accurately predict the correlates of PNI grandiosity and vulnerability with normal and pathological personality traits and psychopathology. The rcontrast-cv coefficient provided a global index of accuracy in clinicians’ predictions that was more fully elaborated by examining systematic discrepancies across groups. Overall, novice and expert clinicians were generally able to predict criterion correlations, with some exceptions (e.g., counter to predictions, pathological narcissism was negatively associated with treatment resistance). These results provide further evidence regarding the validity and utility of the narcissistic grandiosity and narcissistic vulnerability constructs as measured by the PNI.