Risk Factors
 
Age Features
 
Although narcissistic traits may be common among adolescents, this does not necessarily mean that the person will develop Narcissistic Personality Disorder (NPD).

Recently published results of an eighteen-year longitudinal study of adolescents seems to indicate that personality traits associated with the personality disorders decline in prevalence over the course of adolescence.  However, the study also found that adolescents with personality disorders also are found to have elevated PD traits as young adults and that those traits’ stability during adolescence and early adulthood seems to be similar.1

Another recent study of adolescent criminal offenders indicates that those who had Narcissistic Personality Disorder symptoms showed an increased risk for committing arson, vandalism, and acts of violence which include threatening others with physical injury, starting physical fights, and committing assault that injured others.2

Persons with Narcissistic Personality Disorder may have adjustment difficulties associated with the physical or occupational limitations associated with the aging process.
 
 
Gender Features
 
Controversy exists over distribution of Narcissistic Personality Disorder by gender.  Studies conducted by Ronningstam and Gunderson3 and Millon4 have found that more males than females are diagnosed with Narcissistic Personality Disorder.  However, Plankun5 says the distribution is 1:1.  Finally, the DSM-IV-R reports that between fifty and seventy-five percent of those diagnosed with NPD are male.6

Reichman and Flaherty “found that men and women express narcissistic issues in different ways, and . . . [claim] that the present conceptualization of narcissism reflects predominantly male expressions of the disorder.  Men manifest a greater sense of uniqueness, more interpersonal exploitativeness, entitlement, and lack of empathy, while women show more intense reactiveness to slights from others.”7
 
 
Socio-Economic Features
 
In the developed world, individuality, personal achievement, and autonomy are attainments that are thought to contribute to the development of a narcissistic personality.  In more traditional cultures, the opposite are affirmed:  attachment, dependency, cohesions, and loyalty to the community.  Ronningstam posits that since Narcissistic Personality Disorder is both excluded from the ICD’s classification system and considered to occur infrequently in some countries that it may well be a culturally bound disorder reflecting “social and cultural differences.”8
 
 
Cultural Features
 
Some cultural critics have observed that there has been a change in America to a greater focus on the self.9  There appears to be an erosion in the sense of allegiance to a community as well as an increase in consumerism.  Moreover, popular media (TV, music, movies) have glorified violence, glamour and sex, all of which put the individual/the self above the community.  However, until the correlation between these phenomenological cultural markers can be evaluated, their relationship to the perception that pathological narcissism is on the rise remains speculative.  Ronningstam observes, “that [because] NPD is not included in the ICD, and . . . some countries actually consider it to be a disorder with very low prevalence  . . . [it] might reflect . . . social and cultural differences.”10
 



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1Johnson, et al, 2000
2Johnson, et al, 2000
3Ronningstam & Gunderson, 1990a
4Millon, 1990
5Plankun, 1990
6APA, 2000
7Ronningstam, 1999, p. 679
8Ronningstam, 1999, p. 680
9Lasch, 1991
10Ronningstam, 1999, p. 680