Understanding Narcissistic Personality Disorder: Clinical Features and Neurobiological Underpinnings.

This thesis investigates the construct of narcissistic personality disorder (NPD) by synthesizing multidisciplinary research from historical, clinical, and neurobiological perspectives. NPD is a complex and often misunderstood condition characterized by a pervasive pattern of grandiosity, an excessive need for admiration, and a notable lack of empathy. The first chapter explores the conceptual evolution of narcissism, from its mythological roots to its formal inclusion in the Diagnostic and Statistical Manual of Mental Disorders (DSM). It also examines the relationship between NPD and the dark triad traits (narcissism, Machiavellianism, and psychopathy) as well as the epidemiology and etiology of the disorder, with particular attention to potential gender biases in diagnosis and prevalence. Furthermore, this section reviews commonly used methods of assessment, such as the Narcissistic Personality Inventory (NPI) and the Pathological Narcissism Inventory (PNI), evaluating their validity, reliability, and limitations. The second chapter addresses the clinical presentation of NPD, including its phenotypic expressions (grandiosity vs. vulnerability) and different manifestations (overt vs. covert), as well as the frequent comorbidity with other psychiatric disorders. Current therapeutic approaches are reviewed, with particular emphasis on the psychotherapeutic interventions that show promising results. The third chapter focuses on recent advances in neuroimaging research, offering important insights into the neurobiological underpinnings of NPD. Despite its clinical significance, narcissistic personality disorder remains under-researched compared to other personality disorders, particularly in terms of its psychobiological mechanisms and evidence-based treatment modalities. ​