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Clinician perception of pathological narcissism in females: a vignette-based study

Green, Ava; MacLean, Rory; Charles, Kathy


Ava Green

Kathy Charles


The DSM-5 reports that up to 75% of those diagnosed with Narcissistic Personality Disorder (NPD) are males, which denotes that narcissism is a clinical phenomenon that operates differently in men and women. Vulnerable narcissism, which tends to be more prevalent in females and is currently under-appreciated in the DSM-5, may be diagnosed as other “vulnerable” disorders (e.g., Borderline Personality Disorder; BPD). The current study investigated gender differences in clinicians’ perceptions of narcissistic pathology. Adopting an online vignette-based study, clinicians (N = 108; 79 females) read clinical case vignettes of hypothetical patients and provided diagnostic ratings of existing personality disorders. Clinicians’ diagnostic ratings of NPD were concurrent with the vignette containing grandiose narcissism symptoms, irrespective of patient gender. However, when presented with a vulnerable narcissism vignette, clinicians were significantly more likely to attribute a BPD diagnosis in female patients, compared to male patients. Clinicians with a psychodynamic approach and more experience in practice were also more likely to label vulnerable narcissism symptoms as NPD, compared to those with a CBT approach and less experience in practice. The clinical implications of these results support the shift toward assessing personality dysfunction based on dimensional trait domains.

Journal Article Type Article
Acceptance Date Apr 4, 2023
Online Publication Date Apr 20, 2023
Publication Date Apr 20, 2023
Deposit Date Apr 21, 2023
Publicly Available Date Apr 21, 2023
Journal Frontiers in Psychology
Publisher Frontiers Media
Peer Reviewed Peer Reviewed
Volume 14
Article Number 1090746
Keywords female narcissism, pathological narcissism, vulnerable narcissism, gender differences, gender bias, diagnosis, treatment
Publisher URL


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