Narcissistic personality disorder (NPD) shows high rates of comorbidity with mood, anxiety, substance use, and other personality disorders. Previous bivariate comorbidity investigations have left NPD multivariate comorbidity patterns poorly understood. Structural psychopathology research suggests that two transdiagnostic factors, internalizing (with distress and fear subfactors) and externalizing, account for comorbidity among common mental disorders. NPD has rarely been evaluated within this framework, with studies producing equivocal results. We investigated how NPD related to other mental disorders in the internalizing-externalizing model using diagnoses from a nationally representative sample (N = 34,653). NPD was best conceptualized as a distress disorder. NPD variance accounted for by transdiagnostic factors was modest, suggesting its variance is largely unique in the context of other common mental disorders. Results clarify NPD multivariate comorbidity, suggest avenues for classification and clinical endeavors, and highlight the need to understand vulnerable and grandiose narcissism subtypes’ comorbidity patterns and structural relations.
Bibliographical noteFunding Information:
From Stony Brook University, Stony Brook, New York (N. R. E., C. R.-S.); University of Minnesota, Minneapolis (R. F. K.); University of Georgia, Athens (W. K. C.); National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland (B. F. G.); and Columbia University and the New York State Psychiatric Institute, New York, New York (D. S. H.). Grant funding includes nos. U01AA018111 and K05AA014223, from the National Institute on Alcohol Abuse and Alcoholism, and R01DA018652, from the National Institute on Drug Abuse (Hasin). The National Epidemiologic Survey on Alcohol and Related Conditions was sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and funded in part by the Intramural Program, NIAAA, National Institutes of Health, with additional support from the National Institute on Drug Abuse. The views and opinions expressed in this report are those of the authors and do not necessarily represent the views of the sponsoring agencies or the United States government. Address correspondence to Nicholas R. Eaton, Ph.D., Department of Psychology, Stony Brook University, Stony Brook, NY 11794-2500. E-mail: email@example.com