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Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Narcissistic Personality Disorder: Results From the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions

Frederick S. Stinson, Ph.D.; Deborah A. Dawson, Ph.D.; Risë B. Goldstein, Ph.D., M.P.H.; S. Patricia Chou, Ph.D.; Boji Huang, M.D., Ph.D.; Sharon M. Smith, Ph.D.; W. June Ruan, M.A.; Attila J. Pulay, M.D.; Tulshi D. Saha, Ph.D.; Roger P. Pickering, M.S.; and Bridget F. Grant, Ph.D., Ph.D.


Objectives: To present nationally representative findings on prevalence, sociodemographic correlates, disability, and comorbidity of narcissistic personality disorder (NPD) among men and women.

Method: Face-to-face interviews with 34,653 adults participating in the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions conducted between 2004 and 2005 in the United States.

Results: Prevalence of lifetime NPD was 6.2%, with rates greater for men (7.7%) than for women (4.8%). NPD was significantly more prevalent among black men and women and Hispanic women, younger adults, and separated/divorced/widowed and never married adults. NPD was associated with mental disability among men but not women. High co-occurrence rates of substance use, mood, and anxiety disorders and other personality disorders were observed. With additional comorbidity controlled for, associations with bipolar I disorder, posttraumatic stress disorder, and schizotypal and borderline personality disorders remained significant, but weakened, among men and women. Similar associations were observed between NPD and specific phobia, generalized anxiety disorder, and bipolar II disorder among women and between NPD and alcohol abuse, alcohol dependence, drug dependence, and histrionic and obsessive-compulsive personality disorders among men. Dysthymic disorder was significantly and negatively associated with NPD.

Conclusion: NPD is a prevalent personality disorder in the general U.S. population and is associated with considerable disability among men, whose rates exceed those of women. NPD may not be as stable as previously recognized or described in the DSM-IV. The results highlight the need for further research from numerous perspectives to identify the unique and common genetic and environmental factors underlying the disorder-specific associations with NPD observed in this study.

(J Clin Psychiatry 2008;69:1033-1045. Online Ahead of Print June 10, 2008.)


Received Mar. 4, 2008; accepted Apr. 4, 2008. From the Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Md.

The National Epidemiologic Survey on Alcohol and Related Conditions is funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) with supplemental support from the National Institute on Drug Abuse. This research was supported in part by the Intramural Program of the National Institutes of Health, NIAAA.

Dr. Grant had full access to all of the data in this study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

The views and opinions expressed in this report are those of the authors and should not be construed to represent the views of sponsoring organizations, agencies, or the U.S. government.

The authors report no additional financial or other relationships relevant to the subject of this article.

Corresponding author and reprints: Bridget F. Grant, Ph.D., Ph.D., Laboratory of Epidemiology and Biometry, Room 3077, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, M.S. 9304, 5635 Fishers Lane, Bethesda, MD 20892-9304 (e-mail: bgrant@willco.niaaa.nih.gov).