Diagnosis of Narcissistic Personality Disorder

Written by Sam Vaknin

• Diagnosis criteria
• My proposed amended criteria for the Narcissistic Personality Disorder

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• Prevalence and age and gender features
• Treatment and Prognosis
• Comorbidity and Differential Diagnoses
• Clinical Features of the Narcissistic Personality Disorder
• Bibliography
• Watch the video on Diagnostic Criteria of Narcissistic Personality Disorder

Diagnostic Criteria

The ICD-10, the International Classification of Diseases, published by the World Health Organisation in Geneva [1992] regards the Narcissistic Personality Disorder (NPD) as "a personality disorder that fits none of the specific rubrics". It relegates it to the category "Other Specific Personality Disorders" together with the eccentric, "haltlose", immature, passive-aggressive, and psychoneurotic personality disorders and types.

The American Psychiatric Association, based in Washington D.C., USA, publishes the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Text Revision (DSM-IV-TR) [2000] where it provides the diagnostic criteria for the Narcissistic Personality Disorder (301.81, p. 717).

The DSM-IV-TR defines Narcissistic Personality Disorder (NPD) as "an all-pervasive pattern of grandiosity (in fantasy or behaviour), need for admiration or adulation and lack of empathy, usually beginning by early adulthood and present in various contexts", such as family life and work.

The DSM specifies nine diagnostic criteria. Five (or more) of these criteria must be met for a diagnosis of Narcissistic Personality Disorder (NPD) to be rendered.

[In the text below, I have proposed modifications to the language of these criteria to incorporate current knowledge about this disorder. My modifications appear in bold italics.]

[My amendments do not constitute a part of the text of the DSM-IV-TR, nor is the American Psychiatric Association (APA) associated with them in any way.]

[Click here to download a bibliography of the studies and research regarding the Narcissistic Personality Disorder (NPD) on which I based my proposed revisions.]

Proposed Amended Criteria for the Narcissistic Personality Disorder

• Feels grandiose and self-important (e.g., exaggerates accomplishments, talents, skills, contacts, and personality traits to the point of lying, demands to be recognised as superior without commensurate achievements);

• Is obsessed with fantasies of unlimited success, fame, fearsome power or omnipotence, unequalled brilliance (the cerebral narcissist), bodily beauty or sexual performance (the somatic narcissist), or ideal, everlasting, all-conquering love or passion;

• Firmly convinced that he or she is unique and, being special, can only be understood by, should only be treated by, or associate with, other special or unique, or high-status people (or institutions);

• Requires excessive admiration, adulation, attention and affirmation - or, failing that, wishes to be feared and to be notorious (Narcissistic Supply);

• Feels entitled. Demands automatic and full compliance with his or her unreasonable expectations for special and favourable priority treatment;

• Is "interpersonally exploitative", i.e., uses others to achieve his or her own ends;

• Devoid of empathy. Is unable or unwilling to identify with, acknowledge, or accept the feelings, needs, preferences, priorities, and choices of others;
  Constantly envious of others and seeks to hurt or destroy the objects of his or her frustration. Suffers from persecutory (paranoid) delusions as he or she believes that they feel the same about him or her and are likely to act similarly;

• Behaves arrogantly and haughtily. Feels superior, omnipotent, omniscient, invincible, immune, "above the law", and omnipresent (magical thinking). Rages when frustrated, contradicted, or confronted by people he or she considers inferior to him or her and unworthy.