Narcissistic personality disorder (NPD) remains a controversial diagnosis, with lack of consensus on essential features of the disorder and its boundaries. Within the framework of object relations theory (ORT), core organizing, structural features define NPD and provide a coherent conceptual framework for understanding clinical features of the disorder. In the ORT model, both grandiose and vulnerable presentations of NPD are characterized by a specific form of self-pathology, reflecting the impact of a grandiose self-structure in the setting of borderline personality organization. The grandiose self-structure provides some stability of self-functioning but does not confer the self-regulatory capacities provided by normal identity formation and is reliant on maintaining a sense of the self as exceptional. We compare the ORT model of NPD to diagnostic criteria in the Alternative Model for Personality Disorders (AMPD) of the DSM-5, highlighting significant correspondence between the two models as well as conceptual differences.

中文翻译：

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客体关系理论框架内自恋型人格障碍的诊断、分类和评估

自恋型人格障碍 (NPD) 仍然是一个有争议的诊断，对该障碍的基本特征及其界限缺乏共识。在对象关系理论 (ORT) 的框架内，核心组织、结构特征定义了 NPD，并为理解该疾病的临床特征提供了一个连贯的概念框架。在 ORT 模型中，NPD 的夸大和脆弱表现都以特定形式的自我病理为特征，反映了夸大自我结构在边缘人格组织环境中的影响。宏大的自我结构提供了一些自我功能的稳定性，但不赋予正常身份形成提供的自我调节能力，并且依赖于保持对自我的特殊感。