Personality traits are patterns of thoughts, feelings, and behaviors that remain relatively stable over a person’s life and strongly influence how people interact with and perceive the world. Personality disorders are personality traits that cluster in recognizable patterns and produce dysfunction in multiple areas of life. They do not respond well to pharmacologic interventions but are often accompanied by other psychiatric comorbidities. Recognizing personality disorders can help a provider avoid misdiagnosing psychiatric conditions, anticipate future care challenges, and counsel family and caregivers.

This chapter presents the transcript of an interview with a patient with narcissistic personality disorder, alcohol use disorder, and bipolar disorder, who completed a rehabilitation program (individual and group psychotherapy as well as psychopharmacological treatment). He revealed extensive use of many image- and performance-enhancing drugs (IPEDs) and fitness supplements to boost his physical performance in gym training routines. The interviewer specifically asked about the effects of these compounds on the patient’s mental state, and the ‘information’ that he gave to his clients in his capacity as personal trainer in his gyms. He had no specific expertise in the field, and the various products and combinations of supplements that he recommended were not used under medical supervision. The chapter highlights the problem of supplement and IPED consumption among gym users, the need to provide reliable information about these compounds in order to prevent psychopathological problems, and the importance of medical supervision.

Defines the main features of personality disorders. Describes the three clusters of personality disorders. Describes the 10 personality disorders categorized in DSM-5tr. Identifies models of, and effective treatments for, personality disorders

This chapter reviews Narcissistic and Histrionic Personality Disorders (NPD, HPD) from three current perspectives. The categorical approach is exemplified in the DSM-5 Section II chapter on personality disorders. The categorical/dimensional hybrid approach is characterized by the DSM-5 Section III Alternative Model for Personality Disorders. Finally, both personality disorders are also conceptualized by purely dimensional and multidimensional models (e.g., pathological narcissism, histrionism). Integrative, interdisciplinary research and theory on NPD and pathological narcissism is expanding rapidly, providing novel clinical insights into classification, etiology, maintenance, patient presentation, and treatment. The clinical science of narcissism is robust, and its future appears quite promising. In contrast, contemporary research and theory on HPD and histrionism is scant and declining. Some have called for its elimination as a diagnostic entity. If the current trend of waning empirical and clinical interest persists, it is unlikely that HPD will be retained in future revisions of the DSM and other personality disorder classification systems.

Although Dawood, Wu, Bliton, and Pincus (this volume) generally describe narcissistic personality pathology, and NPD in particular, in a reasonable and thoughtful way that aligns with our own perspective, the authors’ treatment of narcissism as a largely monolithic and unified construct contributes towards obscuring three important and longstanding methodological issues in the literature. First, variability in the measurement of NPD makes conclusions about the functioning of NPD, broadly defined, vulnerable to error. Second, variability in vulnerable content contained in measures of NPD is likely to be exerting a biasing effect on the strength of internalizing correlates of NPD (e.g., suicidality). Third, the prevalence of small samples containing high levels of vulnerable features may bias researchers toward stronger relations between NPD and internalizing correlates. Overall, the authors urge researchers to empirically resolve disagreements about the structure and process of narcissistic personality pathology in order to move the field towards more precise definition and measurement, and greater scientific confidence in conclusions related to narcissism’s nomological network.

Narcissistic personality function is influenced by several different factors beyond the nucleus diagnostic conceptualization of NPD. A dimensional approach as outlined in DSM 5 Section III AMPD can demonstrate the clinical complexity of NPD, in particular the co-occurrence and fluctuations between grandiose and vulnerable core features, and the stability versus oscillation between high competent and low impaired functioning. There is also a significant value in the integration of different modalities of research on narcissism and NPD across multiple areas in psychology and psychiatry with longstanding clinical and psychoanalytic accounts. This commentary also addresses some additional factors that affect narcissistic personality functioning, i.e., sense of agency and control, aggression and violence, fear and trauma, and suicide.