Narcissism in the Rorschach revisited: Some reflections on empirical data.

Abstract

This study investigates the extent to which the Rorschach was able to identify accurately pathological expressions of narcissism according to the methodological recommendations offered by T. Nezworski and J. Wood (1995). Ninety-one patients who were found to meet DSM-IV criteria for an Axis II disorder (Cluster A personality disorders = 10; antisocial = 20, borderline = 25, histrionic = 5, narcissistic [NPD] =15; Cluster C personality disorders = 16) and 50 nonclinical participants were compared on 5 Rorschach variables: reflection, pair, personalization, idealization, and the egocentricity index. The results of this study indicate that selected Rorschach variables can be used effectively to differentiate NPD patients from a nonclinical sample and from Cluster A, Cluster C, and other Cluster B personality disorders. Also, the reflection and idealization variables were found to be empirically related to DSM-IV diagnostic criteria for NPD and a self-report measure of NPD. Finally, these two variables could be used for classification purposes in ways that were clinically meaningful in the diagnosis of NPD. Narcissistic personality disorder (NPD) was included as a diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed.; DSM-III; American Psychiatric Association, 1980) in large part because of widespread interest in the theoretical and clinical concept of narcissism by psychodynamic psychotherapists (Kernberg, 1970, 1975, 1984; Kohut, 1971, 1977; Pulver, 1970; Stolorow, 1975; Teicholz, 1978). However, the justification for regarding NPD as an independent diagnostic entity having distinguishable features from other personality disorders has been the matter of some controversy