Narcissistic Personality - Prevalence of NPD

Prevalence of NPD

Home Contents

How prevalent is NPD in society?

The "official" estimate (under 1% of the population) by the American Psychiatric Association (APA) in its Diagnostic and Statistical Manual of Mental Disorders (DSM) is unreliable. In fact, it isn't even scientifically legitimate. Only in psychology would such an unscientific estimate be given a pass.

This estimate is arrived at by statistics on the diagnoses of people undergoing clinical treatment. One might as well think to estimate the prevalence of mental illness by hanging out a shingle that says, "Wanted, people who think they're sick in the head."

Does anyone seriously think narcissists will answer the call?

That's no way to estimate the prevalence of any psychiatric disorder, least of all the one whose fixed premise is denial of the disease. The very nature of NPD militates against a narcissist ever seeking help. A narcissist firmly believes that she is perfect and that there's nothing wrong with her at all — no matter what. She would rather die than know the truth. No exaggeration.

So, it's no wonder that the APA's estimate of NPD prevalence is so low: only a tiny fraction of narcissists get treatment, and the APA aren't sampling the general population: they're sampling clinical patients only.

Generally, mental patients end up in treatment one of two ways:

They seek it.

They are forced into it by the courts (as a consequence of trial for a crime).

Most narcissists convicted of violent crimes also meet the diagnostic criteria for psychopathy, so they are not included in these statistics. Child molesters may be somewhat of an exception, because some are diagnosed as narcissists only. Hence it is mainly only this fraction of narcissistic criminal offenders that gets forced into treatment and appears in the statistics.

As for the vast majority of other narcissists? They almost never seek treatment.

And when narcissists do present for help, it's almost always for some other disorder, like depression or alcohol or drug dependence.

This happens when a major life crisis (i.e., a Narcissistic Crisis, usually brought on by the death of the narcissistic parent, the loss of a job, or abandonment by a spouse) knocks down the house of cards that is their system of delusions. Those repressed those repressed memories of the despicable things they've done, those repressed feelings of shame, and that repressed the self-aware all come rushing to the surface of the mind, rushing to consciousness. WHAM. They are knocked off their own pedestal. This is when they become depressed, turn to drugs or alcohol, and consider suicide (though they usually blame someone else whom they then try to drive to suicide).

At these times, if they get the right doctor, he or she may notice and diagnose the NPD. So, those few that come to light this way are the only unimprisoned narcissists showing up in these statistics. They are those who incidentally get noticed when they suffer a major life crisis that forces them into treatment for access to drugs like Prozac or to save their job by drying them out.

In that case, however, they may present themselves for treatment, not because they're willing to admit there's something seriously wrong with them, but only because they are so desperate for attention that they will take it the only place they can get it. In fact, I know of one narcissist who became so desperate for attention after his second woman (read "momma") abandoned him that he kept calling an ambulance, thus forcing the County to keep taking him in and drying him out.

But if a therapist had told him that the root of his problem is NPD, he'd have walked out the door, deciding that the therapist was the crazy one.

In other words, these statistics are catching but a tiny subset of narcissists, and mainly only at the one or two windows of opportunity in their lives to show up in the statistics.

In fact, all psychopaths are narcissists and (according to the APA's own estimates) psychopaths alone comprise far more than 1% of the population. That fact alone blows the 1% estimate right out of the water. So, where is it coming from?

They must be counting only those diagnosed as narcissists only, ignoring cases of co-morbidity, which are the majority since they themselves instruct clinicians to diagnose more than one personality disorder if at all possible. (Which raises the question of why they do this. To muddy the picture?) That's how you fiddle with statistics to make the prevalence of NPD seem as low as fiddling with statistics can make it.

What's more, how can the APA pretend to estimate the prevalence of any personality disorder when the most commonly diagnosed one is 301.9, "Personality Disorder not Otherwise Specified"?

So, this official "estimate" smells fishy, because no first-year college math or science student would dare try to pass off statistics like that as the basis for a legitimate estimate of a mental illness' prevalence in the general population.

So, what's up? Is the mental-healthcare establishment a patronizing big brother that doesn't want us to know how prevalent NPD is? Are they afraid that "people would panic if they knew" and start pointing the finger all around, suspecting every other person of having NPD and stigmatizing those with the disease? Do they fear people would call for change in the law to allow forcing those suspected of having NPD to undergo evaluation and possibly be locked up? I don't know. But I can think of no other plausible explanation.

Such diagnostic sampling bias is a well-documented problem with prevalence estimates.

In 2004 the first actual population survey was conducted by one of the National Institutes of Health, giving us the first legitimate estimate of the prevalence of personality disorders in the United States. It doubled the DSM estimate of 6–9%, estimating that 15% of Americans meet the diagnostic criteria for at least one of seven personality disorders — not counting borderline, schizotypal, and narcissistic disorders.

Let's look again at how this survey showed how misleading clinical statistics can be.

Since Grant conducted the study among a randomly selected population-based sample, the prevalence rates from her study diverged from those presented in the DSM-IV-TR in some cases.

For instance, according to the DSM-IV-TR, dependent personality disorder is "among the most frequently reported personality disorders encountered in mental health clinics," the study report pointed out. However, Grant's study found it to be the least common in the population.

In addition, the DSM-IV-TR estimates that the prevalence of avoidant personality disorder in the general population is between 0.5 percent and 1 percent, yet Grant found it to be 2.36 percent.

Grant explained that prevalence estimates of various personality disorders in the DSM are based on relatively small, clinical studies of patients who are receiving mental health services on an inpatient or outpatient basis.

"You can run into problems if you rely solely on clinical samples," she said. "If you want to know the true prevalence of a certain disorder, you have to get out of the clinic."

Psychiatric News September 3, 2004

Volume 39 Number 17

That was a diplomatic way of putting it.

But, the APA's DSM estimates are still gospel.

As one might expect, these estimates are much higher (ten-to-fifteen times higher) for disorders that get many patients forced into treatment (like psychopathy). That means something. And it does NOT mean what it is so often represented as meaning = that disorders like NPD are far less common. To the contrary, it means the opposite = that the real prevalence of other disorders like NPD is probably much higher than treatment statistics would indicate.

© 2004 – 2008, Kathleen Krajco — all rights reserved worldwide.
The URL of this page is: http://www.narcissism.operationdoubles.com/prevalenceofnarcissism.htm.
It was last updated on 3/6/2008.
SITEMAP | INDEX
Email a friend about this site.