Narcissistic Personality Disorder may not make it into the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), due out in 2013. A proposed revision of the DSM would replace the disorder with a measure of impairment in personality functioning and a list of pathological personality traits that clinicians could choose from when diagnosing a client with a personality disorder.

The change would allow clinicians to put a finer point on diagnosis and may allow researchers to get closer to the underpinnings of personality dysfunction, says Andrew E. Skodol, MD, chair of the DSM-5’s personality disorder work group and a psychiatry professor at the University of Arizona College of Medicine.

“There is a fair amount of literature suggesting that narcissism is a dimension varying amongst people and across disorders,” he says, “not necessarily a disorder in and of itself.”

But not all psychologists agree with that assessment. One dissenter is Thomas Arthur Widiger, PhD, a University of Kentucky psychology professor who served on the DSM-5’s research planning committee who says the decision wasn’t based on a systematic or objective review of the data and, if implemented, would have a chilling effect on personality disorder research.

“By turning narcissistic personality disorder into a list of traits that will lack official coding within a medical record, you are essentially relegating it to a sidebar that will unlikely draw much research or diagnostic interest,” Widiger says.

The change could also stymie the development of new treatments, says Lynn F. Bufka, PhD, assistant executive director for practice research and policy in APA’s Practice Directorate.

“If narcissistic personality disorder is no longer considered to be a diagnosis, we may not see as many interventions put forward for treating it,” she says.

The verdict on NPD is far from final, Skodol says. “The proposed changes are currently being tested in field trials around the country, and nothing is set in stone,” he says.

—S. Dingfelder