Narcissistic Personality Disorder: Diagnostic Foundations, Psychodynamic Constructs, and Contemporary Perspectives.

Abstract

Narcissistic Personality Disorder (NPD) is currently understood through the concept of the narcissistic spectrum, which ranges from explicit grandiosity to hidden vulnerability. This duality challenges diagnosis based exclusively on categorical criteria. Historically, the definition of NPD has oscillated between operational psychiatric models and formulations from the psychology of the self and object relations. With the DSM-5-TR and ICD-11, an integration between phenomenological description and dimensional assessment of severity and pathological traits is observed. NPD is configured as a multifactorial condition, marked by entitlement, exhibitionism, apparent self-sufficiency, and a paradoxical search for external validation, with associated social and occupational impairments and comorbidities. The articulation between current diagnostic models and psychodynamic constructs, such as grandiose self, splitting, entitlement, and mentalization deficits, proves essential for case formulation and psychotherapeutic guidance. This is a systematic literature review of a bibliographic nature, guided by the following question: What are the theoretical and clinical contributions of psychodynamic constructs, particularly self psychology and object relations theory, to the understanding of Narcissistic Personality Disorder (NPD) in the context of contemporary diagnostic models (DSM-5-TR and ICD-11)? It concludes that the integration between descriptive and explanatory levels represents the most promising advance for clinical practice and research in severe personality disorders.