Abstract：
Modern diagnostic and classification frameworks such as the ICD-11 and DSM-5-AMPD have adopted a dimensional approach to diagnosing personality disorder using a dual \"severity\" and \"trait\" model. As narcissistic personality has historically struggled to be adequately captured in dominant diagnostic systems, this study investigated the utility of the new ICD-11 framework in capturing diverse narcissistic expressions. Participants were mental health clinicians (N = 180, 67% female, age = 38.9), who completed ratings of ICD-11 personality severity, trait domains and a clinical reflection for two hypothetical case vignettes reflecting either prototypical \"grandiose\" or \"vulnerable\" narcissism. The majority of clinicians (82%) endorsed a diagnosis of personality disorder for both grandiose and vulnerable vignettes. Discriminant elements of personality impairment included rigid, unrealistically positive self-view, low empathy and high conflict with others for grandiosity, and incoherent identity, low self-esteem and hypervigilant, avoidant relations with others for vulnerability. Regarding trait profile, grandiose narcissism was predominately dissocial whereas vulnerable narcissism was primarily associated with negative affectivity and detachment. Qualitative responses highlight distinct clinical themes for each presentation. These findings suggest that clinicians using the ICD-11 framework are able to identify common core elements of personality dysfunction in grandiose and vulnerable narcissism while also recognizing their distinctive differences.
摘要：
ICD-11和DSM-5-AMPD等现代诊断和分类框架已采用维度方法，使用双重“严重程度”和“特质”模型诊断人格障碍。由于自恋型人格历来难以在占主导地位的诊断系统中被充分捕获，这项研究调查了新的ICD-11框架在捕获各种自恋表达中的实用性。参与者是心理健康临床医生(N=180，67%为女性，年龄=38.9)，完成ICD-11人格严重程度评级的人，特征域和两个假设的案例插图的临床反映，反映了原型的“宏伟”或“脆弱的”自恋。大多数临床医生（82％）都认可人格障碍的诊断，包括浮夸和脆弱的小插曲。人格障碍的判别要素包括僵化，不切实际的积极的自我观点，低同理心和与他人的高度冲突，和不连贯的身份，自卑和过度警惕,为了脆弱而避免与他人的关系。关于特质档案，浮夸的自恋主要是非社会的，而脆弱的自恋主要与消极的情感和超然有关。定性反应突出了每个演示文稿的不同临床主题。这些发现表明，使用ICD-11框架的临床医生能够识别浮夸和脆弱自恋中人格障碍的共同核心要素，同时也认识到它们的独特差异。
