BACKGROUND: There is a presumption that pathological narcissism, or narcissistic personality disorder per se, can be considered a precursor to addiction. Although the ICD-11 model does not distinguish specific personality disorders, narcissistic psychopathology should be captured through personality trait qualifiers. OBJECTIVES: To verify the capacity of the ICD-11 model in the detection of narcissistic psychopathology in patients with addiction; to test its discrimination capacity, convergent validity, and specificity toward the gender and the type of addiction. MATERIALS AND METHODS: Two samples were employed in the study. Sample 1 (n = 421) consisted of patients with addiction; Sample 2 (n = 567) consisted of general population volunteers. Age range was 18-75 years and a battery of self-assessment questionnaires containing Personality Inventory for DSM-5-Brief Form Plus Modified; Triarchic Psychopathy Measure; Hypersensitive Narcissism Scale; and Level of Personality Functioning Scale-Self-Report was administered by pencil-and-paper method. RESULTS: The following was confirmed: (1) capacity of the ICD-11 model in relation to capture narcissistic pathology; (2) the differentiation capacity between the clinical and non-clinical population; (3) gender specificity in relation to grandiose and vulnerable narcissism; (4) the connection between the overall degree of impairment in personality functioning and most of trait qualifiers; (5) certain specifics of patients with addiction in relation to the type of addiction. CONCLUSION: Results support the empirical and clinical relevance of the ICD-11 model in capturing narcissistic pathology in addicted patients. Clinical implications concerning assessment and treatment in addiction settings, and certain limits regarding the Anankastia domain are discussed.

Department of Addictology 1st Faculty of Medicine Charles University and General University Hospital Prague Prague Czechia

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Wurmser L. The role of superego conflicts in substance abuse and their treatment. Int J Psychoanal Psychother. (1984/1985) 10:227–58. PubMed

Ronningstam E. Pathological narcissism and narcissistic personality disorder in Axis I disorders. Harv Rev Psychiatry. (1996) 3:326–40. 10.3109/10673229609017201 PubMed DOI

Stinson FS, Dawson DA, Goldstein RB, Chou SP, Huang B, Smith SM, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. (2008) 69:1033–45. 10.4088/jcp.v69n0701 PubMed DOI PMC

Levy KN, Reynoso JS, Wasserman RH, Clarkin JF. Narcissistic personality disorder. In: O’Donohue W, Fowler KA, Lilienfeld SO. editors. Personality Disorders: Toward the DSM-V. Thousand Oaks, CA: Sage Publications, Inc; (2007). p. 233–77. 10.4135/9781483328980.n9 DOI

Cain NM, Pincus AL, Ansell EB. Narcissism at the crossroads: phenotypic description of pathological narcissism across clinical theory, social/personality psychology, and psychiatric diagnosis. Clin Psychol Rev. (2008) 28:638–56. 10.1016/j.cpr.2007.09.006 PubMed DOI

Ronningstam E. Narcissistic personality disorder: facing DSM-V. Psychiatr Ann. (2009) 39:111–21. 10.3928/00485713-20090301-09 DOI

Alarcón RD, Sarabia S. Debates on the narcissism conundrum: trait, domain, dimension, type, or disorder? J Nerv Ment Dis. (2012) 200:16–25. 10.1097/NMD.0b013e31823e6795 PubMed DOI

Pincus AL, Lukowitsky MR. Pathological narcissism and narcissistic personality disorder. Annu Rev Clin Psychol. (2010) 6:421–46. 10.1146/annurev.clinpsy.121208.131215 PubMed DOI

Zimmerman M, Coryell W. DSM-III personality disorder diagnoses in a nonpatient sample. Demographic correlates and comorbidity. Arch Gen Psychiatry. (1989) 46:682–9. 10.1001/archpsyc.1989.01810080012002 PubMed DOI

Krueger RF, Hicks BM, Patrick CJ, Carlson SR, Iacono WG, McGue M. Etiologic connections among substance dependence, antisocial behavior, and personality: modeling the externalizing spectrum. J Abnorm Psychol. (2002) 111:411–24. 10.1037/0021-843X.111.3.411 PubMed DOI

Patrick CJ, Hicks BM, Krueger RF, Lang AR. Relations between psychopathy facets and externalizing in a criminal offender sample. J Pers Disord. (2005) 19:339–56. 10.1521/pedi.2005.19.4.339 PubMed DOI PMC

Kernberg OF. Factors in the psychoanalytic treatment of narcissistic personalities. J Am Psychoanal Assoc. (1970) 18:51–85. 10.1177/000306517001800103 PubMed DOI

Hare RD. A research scale for the assessment of psychopathy in criminal populations. Pers Individ Differ. (1980) 1:111–9. 10.1016/0191-8869(80)90028-8 DOI

Weiss B, Campbell WK, Lynam DR, Miller JD. A trifurcated model of narcissism: on the pivotal role of trait antagonism. In: Miller JD, Lynam DR. editors. The Handbook of Antagonism: Conceptualizations, Assessment, Consequences, and Treatment of the Low End of Agreeableness. Cambridge, MA: Elsevier Academic Press; (2019). p. 221–35. 10.1016/B978-0-12-814627-9.00015-3 DOI

Weiss B, Sleep CE, Lynam DR, Miller JD. Evaluating the instantiation of narcissism components in contemporary measures of psychopathy. Assessment. (2021) 28:15–28. 10.1177/1073191120916797 PubMed DOI

Hyatt CS, Crowe ML, Lynam DR, Miller JD. Components of the triarchic model of psychopathy and the five-factor model domains share largely overlapping nomological networks. Assessment. (2020) 27:72–88. 10.1177/1073191119860903 PubMed DOI

Bach B, First MB. Application of the ICD-11 classification of personality disorders. BMC Psychiatry. (2018) 18:351. 10.1186/s12888-018-1908-3 PubMed DOI PMC

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; (2013). 10.1176/appi.books.9780890425596 DOI

World Health Organisation. ICD-11 Clinical Descriptions and Diagnostic Guidelines for Mental and Behavioural Disorders. Geneva: World Health Organisation; (2022).

Miller JD, Gentile B, Wilson L, Campbell WK. Grandiose and vulnerable narcissism and the DSM-5 pathological personality trait model. J Pers Assess. (2013) 95:284–90. 10.1080/00223891.2012.685907 PubMed DOI

Wright AG, Pincus AL, Thomas KM, Hopwood CJ, Markon KE, Krueger RF. Conceptions of narcissism and the DSM-5 pathological personality traits. Assessment. (2013) 20:339–52. 10.1177/1073191113486692 PubMed DOI

Bach B, Sellbom M, Skjernov M, Simonsen E. ICD-11 and DSM-5 personality trait domains capture categorical personality disorders: finding a common ground. Aust N Z J Psychiatry. (2018) 52:425–34. 10.1177/0004867417727867 PubMed DOI

Bach B, Kramer U, Doering S, di Giacomo E, Hutsebaut J, Kaera A, et al. The ICD-11 classification of personality disorders: a European perspective on challenges and opportunities. Borderline Personal Disord Emot Dysregul. (2022) 9:12. 10.1186/s40479-022-00182-0 PubMed DOI PMC

Verheul R. Co-morbidity of personality disorders in individuals with substance use disorders. Eur Psychiatry. (2001) 16:274–82. 10.1016/s0924-9338(01)00578-8 PubMed DOI

Verheul R, van den Brink W. Causal pathways between substance use disorders and personality pathology. Aust Psychol. (2005) 40:127–36. 10.1080/00050060500094613 DOI

Salazar J, Page B, Ripoll C. Features, state and context of narcissism in drug misuse. Subst Use Misuse. (2021) 56:11–24. 10.1080/10826084.2020.1833923 PubMed DOI

Gerstley L, McLellan AT, Alterman AI, Woody GE, Luborsky L, Prout M. Ability to form an alliance with the therapist: a possible marker of prognosis for patients with antisocial personality disorder. Am J Psychiatry. (1989) 146:508–12. 10.1176/ajp.146.4.508 PubMed DOI

Verheul R, van den Brink W, Hartgers C. Personality disorders predict relapse in alcoholic patients. Addict Behav. (1998) 23:869–82. 10.1016/s0306-4603(98)00065-3 PubMed DOI

Ross S, Dermatis H, Levounis P, Galanter M. A comparison between dually diagnosed inpatients with and without Axis II comorbidity and the relationship to treatment outcome. Am J Drug Alcohol Abuse. (2003) 29:263–79. 10.1081/ada-120020511 PubMed DOI

Widiger TA, Livesley WJ, Clark LA. An integrative dimensional classification of personality disorder. Psychol Assess. (2009) 21:243–55. 10.1037/a0016606 PubMed DOI

Jahng S, Trull TJ, Wood PK, Tragesser SL, Tomko R, Grant JD, et al. Distinguishing general and specific personality disorder features and implications for substance dependence comorbidity. J Abnorm Psychol. (2011) 120:656–69. 10.1037/a0023539 PubMed DOI PMC

Creswell KG, Bachrach RL, Wright AG, Pinto A, Ansell E. Predicting problematic alcohol use with the DSM-5 alternative model of personality pathology. Personal Disord. (2016) 7:103–11. 10.1037/per0000131 PubMed DOI PMC

Krueger RF, Derringer J, Markon KE, Watson D, Skodol AE. Initial construction of a maladaptive personality trait model and inventory for DSM-5. Psychol Med. (2012) 42:1879–90. 10.1017/S0033291711002674 PubMed DOI PMC

Papamalis FE. Examining the relationship of personality functioning and treatment completion in substance misuse treatment. Subst Abuse. (2020) 14:1178221820951777. 10.1177/1178221820951777 PubMed DOI PMC

Widiger TA, Presnall JR. Clinical application of the five-factor model. J Pers. (2013) 81:515–27. 10.1111/jopy.12004 PubMed DOI

Green A, MacLean R, Charles K. Female narcissism: assessment, aetiology, and behavioural manifestations. Psychol Rep. (2022) 125:2833–64. 10.1177/00332941211027322 PubMed DOI PMC

Pincus AL. Some comments on nomology, diagnostic process, and narcissistic personality disorder in the DSM-5 proposal for personality and personality disorders. Personal Disord. (2011) 2:41–53. 10.1037/a0021191 PubMed DOI

Bach B, Sellbom M, Kongerslev M, Simonsen E, Krueger RF, Mulder R. Deriving ICD-11 personality disorder domains from DSM-5 traits: initial attempt to harmonize two diagnostic systems. Acta Psychiatr Scand. (2017) 136:108–17. 10.1111/acps.12748 PubMed DOI

Sellbom M, Solomon-Krakus S, Bach B, Bagby RM. Validation of personality inventory for DSM-5 (PID-5) algorithms to assess ICD-11 personality trait domains in a psychiatric sample. Psychol Assess. (2020) 32:40–9. 10.1037/pas0000746 PubMed DOI

Bach B, Kerber A, Aluja A, Bastiaens T, Keeley JW, Claes L, et al. International assessment of DSM-5 and ICD-11 personality disorder traits: toward a common nosology in DSM-5.1. Psychopathology. (2020) 53:179–88. 10.1159/000507589 PubMed DOI

Riegel KD, Ksinan AJ, Schlosserova L. Psychometric properties of the independent 36-item PID5BF+M for ICD-11 in the Czech-speaking community sample. Front Psychiatry. (2021) 12:643270. 10.3389/fpsyt.2021.643270 PubMed DOI PMC

Morey LC. Development and initial evaluation of a self-report form of the DSM-5 level of personality functioning scale. Psychol Assess. (2017) 29:1302–8. 10.1037/pas0000450 PubMed DOI

Nazari A, Huprich SK, Hemmati A, Rezaei F. The construct validity of the ICD-11 severity of personality dysfunction under scrutiny of object-relations theory. Front Psychiatry. (2021) 12:648427. 10.3389/fpsyt.2021.648427 PubMed DOI PMC

Riegel KD, Konecna J, Matoulek M, Rosova L. Implementation of the DSM-5 and ICD-11 dimensional models of maladaptive personality traits into pre-bariatric assessment. Front Psychol. (2022) 12:814421. 10.3389/fpsyg.2021.814421 PubMed DOI PMC

Bach B, Maples-Keller JL, Bo S, Simonsen E. The alternative DSM-5 personality disorder traits criterion: a comparative examination of three self-report forms in a Danish population. Personal Disord. (2016) 7:124–35. 10.1037/per0000162 PubMed DOI

Watters CA, Bagby RM. A meta-analysis of the five-factor internal structure of the personality inventory for DSM-5. Psychol Assess. (2018) 30:1255–60. 10.1037/pas0000605 PubMed DOI

Kerber A, Schultze M, Müller S, Rühling RM, Wright AGC, Spitzer C, et al. Development of a short and ICD-11 compatible measure for DSM-5 maladaptive personality traits using ant colony optimization algorithms. Assessment. (2022) 29:467–87. 10.1177/1073191120971848 PubMed DOI PMC

Patrick CJ, Fowles DC, Krueger RF. Triarchic conceptualization of psychopathy: developmental origins of disinhibition, boldness, and meanness. Dev Psychopathol. (2009) 21:913–38. 10.1017/S0954579409000492 PubMed DOI

Blagov PS, Patrick CJ, Oost KM, Goodman JA, Pugh AT. Triarchic psychopathy measure: validity in relation to normal-range traits, personality pathology, and psychological adjustment. J Pers Disord. (2016) 30:71–81. 10.1521/pedi_2015_29_182 PubMed DOI

Hendin HM, Cheek JM. Assessing hypersensitive narcissism: a reexamination of Murray’s narcism scale. J Res Pers. (1997) 31:588–99. 10.1006/jrpe.1997.2204 DOI

Keeley JW, Webb C, Peterson D, Roussin L, Flanagan EH. Development of a response inconsistency scale for the personality inventory for DSM-5. J Pers Assess. (2016) 98:351–9. 10.1080/00223891.2016.1158719 PubMed DOI

Somma A, Borroni S, Kelley SE, Edens JF, Fossati A. Further evidence for the validity of a response inconsistency scale for the personality inventory for DSM-5 in Italian community-dwelling adolescents, community-dwelling adults, and clinical adults. Psychol Assess. (2018) 30:929–40. 10.1037/pas0000547 PubMed DOI

Bagby RM, Sellbom M. The validity and clinical utility of the personality inventory for DSM-5 response inconsistency scale. J Pers Assess. (2018) 100:398–405. 10.1080/00223891.2017.1420659 PubMed DOI

Lowmaster SE, Hartman MJ, Zimmermann J, Baldock ZC, Kurtz JE. Further validation of the response inconsistency scale for the personality inventory for DSM-5. J Pers Assess. (2020) 102:743–50. 10.1080/00223891.2019.1674320 PubMed DOI

IBM Corp. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp; (2017).

Blüml V, Doering S. ICD-11 personality disorders: a psychodynamic perspective on personality functioning. Front Psychiatry. (2021) 12:654026. 10.3389/fpsyt.2021.654026 PubMed DOI PMC

Clarkin JF, Lenzenweger MF, Yeomans F, Levy KN, Kernberg OF. An object relations model of borderline pathology. J Pers Disord. (2007) 21:474–99. 10.1521/pedi.2007.21.5.474 PubMed DOI

Fjermestad-Noll J, Ronningstam E, Bach BS, Rosenbaum B, Simonsen E. Perfectionism, shame, and aggression in depressive patients with narcissistic personality disorder. J Pers Disord. (2020) 34:25–41. 10.1521/pedi.2020.34.supp.25 PubMed DOI

Koenigsberg HW, Kernberg OF, Stone MH, Appelbaum AH, Yeomans FE, Diamond D. Borderline Patients: Extending the Limits of Treatability. New York, NY: Basic Books; (2000).

Kernberg OF. Severe Personality Disorders: Psychotherapeutic Strategies. New Haven, CT: Yale University Press; (1984).

Riegel KD, Preiss M, Ksinan AJ, Michalec J, Samankova D, Harsa P. Psychometric properties of the Czech version of the personality inventory for DSM-5: internal consistency, validity, and discrimination capacity of the measure. Czechoslovak Psychol. (2017) 61:128–43.

Hemmati A, Rahmani F, Bach B. The ICD-11 personality disorder trait model fits the Kurdish population better than the DSM-5 trait model. Front Psychiatry. (2021) 12:635813. 10.3389/fpsyt.2021.635813 PubMed DOI PMC

Grijalva E, Newman DA, Tay L, Donnellan MB, Harms PD, Robins RW, et al. Gender differences in narcissism: a meta-analytic review. Psychol Bull. (2015) 141:261–310. 10.1037/a0038231 PubMed DOI

De Fruyt F, De Clercq B, De Bolle M, Wille B, Markon K, Krueger RF. General and maladaptive traits in a five-factor framework for DSM-5 in a university student sample. Assessment. (2013) 20:295–307. 10.1177/1073191113475808 PubMed DOI

Pincus AL, Ansell EB, Pimentel CA, Cain NM, Wright AGC, Levy KN. Initial construction and validation of the pathological narcissism inventory. Psychol Assess. (2009) 21:365–79. 10.1037/a0016530 PubMed DOI

Schmitt DP, Realo A, Voracek M, Allik J. Why can’t a man be more like a woman? Sex differences in big five personality traits across 55 cultures. J Pers Soc Psychol. (2008) 94:168–82. 10.1037/0022-3514.94.1.168 PubMed DOI

Zimmermann J, Müller S, Bach B, Hutsebaut J, Hummelen B, Fischer F. A common metric for self-reported severity of personality disorder. Psychopathology. (2020) 53:168–78. 10.1159/000507377 DOI

Skodol AE, Gunderson JG, McGlashan TH, Dyck IR, Stout RL, Bender DS, et al. Functional impairment in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder. Am J Psychiatry. (2002) 159:276–83. 10.1176/appi.ajp.159.2.276 PubMed DOI

Bach B, Simonsen S. How does level of personality functioning inform clinical management and treatment? Implications for ICD-11 classification of personality disorder severity. Curr Opin Psychiatry. (2021) 34:54–63. 10.1097/YCO.0000000000000658 PubMed DOI

Sleep CE, Hyatt CS, Lamkin J, Maples-Keller JL, Miller JD. Examining the relations among the DSM-5 alternative model of personality, the five-factor model, and externalizing and internalizing behavior. Personal Disord. (2018) 9:379–84. 10.1037/per0000240 PubMed DOI

Few LR, Miller JD, Rothbaum AO, Meller S, Maples J, Terry DP, et al. Examination of the section III DSM-5 diagnostic system for personality disorders in an outpatient clinical sample. J Abnorm Psychol. (2013) 122:1057–69. 10.1037/a0034878 PubMed DOI PMC

Clarkin JF, Caligor E, Sowislo JF. An object relations model perspective on the alternative model for personality disorders (DSM-5). Psychopathology. (2020) 53:141–8. 10.1159/000508353 PubMed DOI PMC

Leeman RF, Potenza MN. Similarities and differences between pathological gambling and substance use disorders: a focus on impulsivity and compulsivity. Psychopharmacology (Berl). (2012) 219:469–90. 10.1007/s00213-011-2550-7 PubMed DOI PMC

Sedgwick P. Questionnaire surveys. BMJ. (2011) 343:d4449. 10.1136/bmj.d4449 DOI

Clarkin J, Caligor E, Stern B, Kernberg O. The Structured Interview of Personality Organization-Revised (STIPO-R). New York, NY: Personality Disorders Institute, Weill Cornell Medical College; (2016).