APA Citation
Vater, A., Ritter, K., Schröder-Abé, M., Schütz, A., Lammers, C., Bosson, J., & Ronningstam, E. (2014). Stability of narcissistic personality disorder: tracking categorical and dimensional rating systems over a two-year period. *Personality Disorders: Theory, Research, and Treatment*, 5(3), 305-313. https://doi.org/10.1037/per0000058
Summary
This study tracked individuals diagnosed with narcissistic personality disorder over two years to assess whether the diagnosis remained stable. Using both categorical (meets/doesn't meet criteria) and dimensional (trait severity) measures, researchers found that while the NPD diagnosis showed moderate stability, individual symptoms fluctuated considerably. Some individuals no longer met full diagnostic criteria at follow-up, though dimensional measures showed narcissistic traits remained elevated. The findings suggest that while core narcissistic personality features persist, symptom expression varies over time.
Why This Matters for Survivors
This research addresses the hope (and fear) about whether narcissists can change. The findings are sobering but nuanced: while some individuals no longer met full diagnostic criteria after two years, underlying narcissistic traits remained elevated. This means the narcissist in your life may show periods of improvement or different symptom presentation, but the core personality structure tends to persist. Understanding this helps calibrate expectations.
What This Research Establishes
NPD shows moderate diagnostic stability. About half of individuals diagnosed with NPD retained the diagnosis after two years. This is moderate stability—neither as rigid as once thought nor as fluid as some hoped.
Dimensional traits are more stable than categorical diagnosis. Even when individuals no longer met full diagnostic criteria, dimensional measures showed elevated narcissistic traits. The underlying personality features persist even as symptom counts fluctuate.
Severity predicts stability. More severe NPD was more stable over time. Milder narcissistic presentations showed more variability; severe NPD was more persistent.
Symptoms fluctuate more than structure. Individual symptoms varied considerably, but the overall personality organization showed more stability. A narcissist might show less grandiosity for a period without the underlying personality changing.
Why This Matters for Survivors
Calibrating expectations about change. If you’re hoping the narcissist will change, this research provides realistic expectations. Symptom expression may vary; underlying personality structure tends to persist.
Understanding the fluctuations you’ve seen. The narcissist may have shown periods of improvement, making you think change was possible. This research explains how symptom fluctuation differs from personality change—they may have been doing better temporarily without fundamentally changing.
Supporting your decision. If you’ve left based on recognizing the narcissist won’t change, this research supports that assessment. Two years showed modest categorical change and even less dimensional change. Waiting for transformation isn’t evidence-based.
Understanding severity matters. If you dealt with severe NPD, this research suggests particularly low likelihood of change. Severity predicts stability.
Clinical Implications
Set realistic treatment goals. Dimensional improvement may be more achievable than categorical “cure.” Focus on reducing trait severity and specific harmful behaviors rather than personality transformation.
Assess dimensionally as well as categorically. Categorical diagnosis (meets/doesn’t meet criteria) may miss important information. Dimensional assessment captures the underlying trait level more reliably.
Expect long-term treatment. Significant personality change takes years, not months. Brief interventions are unlikely to produce lasting change in NPD.
Address motivation carefully. Given NPD’s relative stability, treatment success depends heavily on patient motivation. Without genuine motivation for change, therapy is unlikely to produce meaningful results.
How This Research Is Used in the Book
Vater et al.’s stability research appears in chapters on prognosis and expectations:
“Research tracking individuals with NPD over two years found that while about half no longer met full diagnostic criteria, dimensional measures showed narcissistic traits remained elevated. Symptoms can fluctuate—the narcissist may show less grandiosity or fewer exploitative behaviors for periods—but the underlying personality structure tends to persist. This research supports calibrated expectations: hoping for change may be reasonable for specific behaviors, but expecting personality transformation isn’t evidence-based.”
Historical Context
This study appeared amid broader research showing personality disorders are less stable than previously believed—but also more stable than hoped by those seeking quick change. The Collaborative Longitudinal Personality Disorders Study (CLPS) had shown remission in many personality disorders; this research focused specifically on NPD, which had less longitudinal data.
The finding that dimensional traits are more stable than categorical diagnosis has implications for how we conceptualize personality disorders—as continuous traits rather than discrete categories. This aligns with the dimensional approach in DSM-5 Alternative Model for Personality Disorders.
Further Reading
- Gunderson, J.G., et al. (2011). Ten-year course of borderline personality disorder. Archives of General Psychiatry, 68(8), 827-837.
- Ronningstam, E. (2011). Narcissistic personality disorder in DSM-V—in support of retaining a significant diagnosis. Journal of Personality Disorders, 25(2), 248-259.
- Paris, J. (2015). A Concise Guide to Personality Disorders. American Psychological Association.
- McGlashan, T.H., et al. (2005). Two-year prevalence and stability of individual DSM-IV criteria for schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders. American Journal of Psychiatry, 162(5), 883-889.
About the Author
Aline Vater, PhD is a researcher at Charité – Universitätsmedizin Berlin specializing in narcissistic personality disorder. Elsa Ronningstam, PhD is Associate Clinical Professor at Harvard Medical School and McLean Hospital, a leading expert on NPD.
This study brought together researchers from multiple institutions with expertise in personality assessment and NPD specifically, providing rigorous longitudinal data on a disorder often studied only cross-sectionally.
Historical Context
This 2014 study appeared amid debates about personality disorder stability. Earlier research suggested personality disorders were more stable than clinical disorders; newer research (including the landmark CLPS study) showed more variability than expected. This study focused specifically on NPD, which had less longitudinal data than borderline personality disorder.
Frequently Asked Questions
Moderately. The study found about 53% retained their NPD diagnosis after two years. However, dimensional measures showed narcissistic traits remained elevated even when full diagnostic criteria weren't met. The core personality features persist even as symptom expression varies.
Categorical diagnosis requires meeting a certain number of symptoms. Some individuals dropped below the threshold—not because they changed fundamentally but because one or two symptoms decreased. Dimensional measures capturing overall narcissistic traits showed much more stability.
This research suggests symptom expression can change while underlying personality structure remains. A narcissist might show less grandiosity during a difficult period or fewer exploitative behaviors when incentivized, but the core self-organization—the fragile self-esteem, the need for validation—tends to persist.
The study found that baseline severity predicted retention—more severe NPD was more stable. This suggests that while milder narcissistic personalities might show more variability, severe NPD is particularly persistent.
Categorical: you either have NPD or you don't (meeting X of Y criteria). Dimensional: narcissism exists on a continuum, and we measure where someone falls. Dimensional measures showed more stability, suggesting the underlying trait persists even when symptom counts fluctuate.
Not quite. Two years is relatively short for personality change. Some symptoms did decrease. But genuine structural personality change is slow and difficult, requiring sustained therapeutic effort. Expecting rapid, dramatic change isn't realistic.
This research supports calibrated expectations. The narcissist may show improvement in specific behaviors, especially when motivated. But expecting the underlying personality—the self-organization, the empathy deficits, the need for admiration—to transform is not realistic based on this evidence.
Treatment for NPD should focus on gradual, incremental change rather than personality transformation. Dimensional improvement (reducing trait severity) may be more realistic than categorical 'cure.' Long-term therapy is needed, and motivation is crucial.