542 - Development and validation of the narcissistic personality screening questionnaire (NPSQ) among Thai older adults

BackgroundA screening tool for narcissistic personality disorder (NPD) in older adults is lacking.ObjectiveThe study aimed to develop a screening tool for detecting symptoms of the NPD and to validate its psychometric properties in older adults.MethodsThis Narcissistic Personality Screening Questionnaire (NPSQ) was developed by constructing items based on DSM-5 criteria of the narcissistic personality disorder (NPD). A literature review regarding the signs and symptoms of NPD was conducted. Interview with NPD patients, the patients’ key informants, and a focus group discussion among psychiatrists, psychiatric nurses and psychiatry residents who have experience in working with patients with NPD were performed. After the items were created, the content validity index (CVI) by 1 psychologist and 1 psychiatrist was analyzed. A field trial was conducted among older adult patients visiting the psychiatry and the cardiology departments at Maharaj Nakorn Chiang Mai hospital between March and April 2021. The internal consistency using Cronbach alpha was analyzed.Item hierarchy, item difficulty, and item fit was also calculated usingRasch analysis. Qualitative information was analyzed regarding language use and time to complete the test.ResultsOriginally, a total of 80 NPSQ items with 4-Likert scales i.e., strongly agree, moderately agree, slightly agree, and disagree were generated. The CVI was 0.75-1 for item-CVI and 0.89 for scale-CVI. The NPSQ was examined among 30 Thai older adults with a mean age of 70.76 ± 6.23 years. The percent of missing items of all 80 items ranged from 2.9% to 8.9%. Cronbach’s alpha for the 80-item NPSQ wasTo determine the correlation of hippocampal volume with Mini-Mental State Examination 0.96. Rasch analysis identified 37 misfitting with a mean square > 1.50, therefore 43 items remained. Person-item map showed a good target between items and sample, even though some items may be redundant. Cronbach’s alpha for the 43-item NPSQ was 0.96. Some participants were confused about who the questions referred to, which were then revised before including it in the final draft version. Only one participant did not complete the questionnaire.ConclusionThe 43 item NPSQ shows good content validity and an excellent internal consistency among older adults. A study with a larger sample size is warranted.

Narcissistic Personality Disorder: Are Psychodynamic Theories and the Alternative DSM-5 Model for Personality Disorders Finally Going to Meet?

Narcissistic Personality Disorder is the new borderline personality disorder of our current era. There have been recent developments on narcissism that are certainly worthwhile examining. Firstly, relational and intersubjective psychoanalysts have been rethinking the underlying concepts of narcissism, focusing on the development of self and relations to others. Secondly, in the DSM-5, the Alternative DSM-5 Model for Personality Disorders (AMPD) was presented for a dimensional evaluation of the severity of personality disorder pathology. The combined dimensional and trait conceptualization of NPD opened the door to new integrated diagnostic perspectives, including both internal and interpersonal functioning. Finally, Pincus and Lukowitsky encourage clinicians to use a hierarchical model of pathological narcissism, as it opens up opportunities for shared points of interest in empirical research from different scholarly perspectives. As for most non-psychodynamic clinicians and researchers the DSM-5 clearly bears dominant weight in their work, we will take the AMPD model for NPD as our point of reference. We will discuss the narcissist's unique pattern of self-impairments in identity and self-direction, and of interpersonal disfunctioning (evaluated by assessing empathy and intimacy). Subsequently, we will examine how contemporary psychodynamic theories and the hierarchical model of Pincus and Lukowitsky additionally inform or contradict the AMPD. For us, one of the big advantages of the AMPD is the use of structured clinical evaluations of disturbances of the self and interpersonal functioning and the dimensional evaluation of severity. As psychodynamically oriented therapists, we are enthusiastic about the opportunities for inclusion of psychodynamic concepts, but we also discuss a number of sticking points.