The Ghost of Narcissus: Conceptual Inertia and Cultural Judgments in Psychiatric Classification - Elisabetta Lalumera (UNIBO)

The aim of the talk is to analyse how Narcissistic Personality Disorder (NPD) has persisted conceptually despite repeated attempts to revise or remove it from psychiatric classification, and what this reveals about the interaction between scientific evidence, moralisation, and cultural judgment in psychiatry.
Empirical research has long questioned the validity and distinctiveness of NPD. Studies show low reliability of diagnostic criteria, extensive overlap with borderline and antisocial personality disorders, and poor correspondence between categorical and dimensional models. During the preparation of the DSM-5, NPD was proposed for elimination due to these weaknesses, and the ICD-11 has since abandoned all categorical personality disorders, including NPD, in favour of a dimensional model based on severity and trait domains. Nevertheless, recent studies indicate that clinicians continue to recognise narcissistic presentations, both grandiose and vulnerable, by mapping them onto trait configurations of dissociality, negative affectivity, and identity disturbance.
Conceptual inertia and specifically diagnostic inertia can arise for various reasons - institutional, pragmatic, or epistemic. In this case, it is possible that inertia results from the deep moralisation and cultural entrenchment of the concept. NPD reflects long-standing social judgments about autonomy, empathy, and self-regulation, making it resistant to conceptual change. Philosophers who study conceptual engineering have argued that the more a concept is embedded in diverse social practices, the more it resists revision. The persistence of NPD confirms this: its endurance is not merely institutional but cultural, showing that psychiatry’s conceptual vocabulary remains intertwined with shared moral understandings of the self.