Personality disorders, as described in the DSM-5,1 are characterized by inflexible and maladaptive patterns of behavior, thoughts, and feelings. Furthermore, personality disorders are associated with distress or impairment. But personality disorders differ from each other in a number of important ways. In a paper published in the March issue of Journal of Clinical Psychology, researchers Stanton and Zimmerman examine shared and unique features of two of these disorders: narcissistic personality disorder and antisocial personality disorder.2
What is narcissistic personality disorder?
According to the DSM-5, individuals who meet the criteria for narcissistic personality disorder have a sense of entitlement, are arrogant, consider themselves to be special, feel self-important, take advantage of others, have a great need for admiration, lack empathy, envy other people, and are obsessed with fantasies of boundless power.1
The prevalence of this disorder in community samples is 1%, with a range of 0 to 6%.3 Men are slightly more likely to be narcissistic than women.
What is antisocial personality disorder?
People with antisocial personality disorder disregard the law and violate the rights of others. They are deceitful, manipulative, impulsive, hostile, irresponsible, and remorseless. The 12-month community prevalence rates for antisocial personality disorder range from 0.2-3.3%. Antisocial personality disorder is more prevalent in alcohol and substance abuse programs, prisons and forensic settings, and among those affected by negative social factors (e.g., poverty).1
Antisocial personality disorder may remit as the person grows older. Nonetheless, older people with this disorder continue to experience serious difficulties in interpersonal relationships.4
Similarities between antisocial personality disorder and narcissistic personality disorders
Narcissistic personality disorder and antisocial personality disorder share much in common: Both people with antisocial and narcissistic personalities often lack empathy, suspect other people’s intentions, and are shallow. Furthermore, they are callous and unforgiving and tend to exploit others.1
Differences between narcissistic personality disorder and antisocial personality disorder
The DSM-5 distinguishes between antisocial and narcissistic personality, noting that narcissistic personality disorder is not typically associated with a history of criminality in adulthood or conduct disorder in childhood. And narcissistic personality is less likely to be associated with aggression, impulsiveness, and deceit—which better characterize antisocial personality disorder.
Another way to distinguish the two is to note that antisocial individuals do not require admiration (and do not envy others) to the same extent as narcissists.1
The Study and Methods
In the study reviewed here,2 the researchers hypothesized that the personality traits recklessness and impulsivity (i.e. traits associated with disinhibition) are unique to antisocial personality disorder, while the traits attention-seeking and grandiosity are specific to narcissistic personality disorder.
To test their hypothesis, they used a sample of 2,149 patients (40% male, 60% female) at a community outpatient setting. Over 90% of participants were Caucasian, and 4% were Black, 3% Hispanic, and 2% reported "other." The average age was 39 years old.
Of the 2,149 participants, 2% (40 individuals) met the criteria for narcissistic personality disorder, and 2% (41 individuals) met the criteria for antisocial personality disorder.
Narcissistic vs. Antisocial Personality Disorder
Both bi-factor and traditional factor analyses were conducted. First, the results revealed a strong overlap between traits defining each personality—traits such as impulsivity, grandiosity, and callousness.
So significant was the overlap that the authors concluded antisocial and narcissistic personality disorders may not be distinct disorders but “indicators of a broad externalizing spectrum,” sharing features such as impulsivity and antagonism with other disorders in the spectrum.
Second, regarding how to differentiate antisocial and narcissistic, the results showed that “unlawful behavior” and “outward aggression” distinguished antisocial personality, while viewing oneself as “high status” and “very special” distinguished narcissistic personality. Simply put, though both personalities tend to exploit people, an entitled and arrogant person is more likely to be narcissistic, while an aggressive individual with a criminal history is probably antisocial.
Stanton, K., & Zimmerman, M. (2019). Unique and shared features of narcissistic and antisocial personality disorders: Implications for assessing and modeling externalizing traits. Journal of Clinical Psychology, 75(3), 433-444.
2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
3. Dhawan, N., Kunik, M. E., Oldham, J., & Coverdale, J. (2010) Prevalence and treatment of narcissistic personality disorder in the community: a systematic review. Comprehensive Psychiatry, 51, 333–339.
4. Paris, J. (2003). Personality disorders over time: Precursors, course, and outcome. Journal of Personality Disorders, 17, 479-488.