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Narcissistic Personality Disorder Symptoms, Diagnosis

In-depth info on narcissistic personality disorder symptoms and traits. Plus the narcissistic personality disorder criteria for a diagnosis of NPD.

Narcissistic personality disorder (NPD) symptoms manifest as long-standing, inflexible, and pervasive maladaptive behaviors that occur across a broad range of contexts and circumstances. Regular, as well as famous people with narcissistic personality disorder, frequently display haughty, arrogant, and patronizing attitudes and have a grandiose self-perception.

They have a tumultuous inner experience that alternates between feeling excessively superior and unfairly devalued. You'll notice people with NPD (narcissists) are highly sensitive to even the slightest rejection or criticism. Consequently, they frequently avoid any setting where they feel people might criticize them or make them feel inferior. Individuals with narcissistic personality disorder either lash out angrily or withdraw into a prison of hate when criticized. Experts believe both of these responses arise from an extremely low self-esteem and feeling of inferiority.

Specific Symptoms of Narcissistic Personality Disorder

Symptoms of narcissistic personality disorder appear in adolescence or no later than early adulthood. These symptoms make up a large part of the narcissist's inner experience. To receive a diagnosis of NPD, a person must meet five or more of the nine criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5).

Narcissistic personality disorder criteria as outlined in the DSM 5:

  • Grandiose sense of self-importance
  • Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
  • Belief that he or she is special and unique and can only be understood by, or should associate with, other special or high-status people and institutions
  • Need for excessive admiration
  • Sense of entitlement
  • Interpersonally exploitive behavior (manipulates others)
  • Lack of empathy
  • Envy of others or belief that others envy him or her
  • Demonstration of arrogant and haughty behaviors

Many people may act out in these ways to a point, but a diagnosis of narcissistic personality disorder is only appropriate when these symptoms pervade all areas of an individual's life, having a significant negative social and personal impact on him or her.

Signs of Narcissistic Personality Disorder

Signs of narcissistic personality disorder are behaviors that you can see in someone through simple observation. Consider, for example, the symptom of grandiosity. You can't readily observe a person's inner feeling of grandiosity. But you can observe the behaviors that arise from it.

Grandiosity scenario: When Robert first met his wife, Amber, she told him she had attended Brown University and became the creative director of a best-selling fashion magazine soon after graduating with honors. Their relationship moved rapidly and they married less than a year after their first date. Amber quit her job to stay at home, so they could start a family. She often mentioned that she had superior breeding, culture, and background compared to people they knew.

After only a few months of marriage, Robert discovered that Amber had only worked as a paid intern at the magazine. And she didn't quit her job; she was fired because a random drug screening revealed heavy use of cocaine and amphetamines. She never attended the prestigious Brown University. Instead, she dropped out of classes at a local community college during the first year.

Interpersonally exploitive scenario: Tom, an influential medical doctor, befriended and pursued, Rachel, owner of a genetic testing company. Young, brilliant, and highly successful, Rachel felt drawn to the charming, well-known physician, especially after he poured his heart out about his cold, emotionally unavailable wife and his loneliness. When Rachel told Tom she was pregnant, he became furious, demanding that she terminate the pregnancy and threatening to ruin her reputation in the medical community.

Devastated, she went through with the pregnancy and Tom proceeded to spread vicious lies about her. He claimed she tried to seduce him and she has stalked him ever since he spurned her. He even accused her of skimming from the medical facilities who purchased her products. Essentially, Tom used Rachel to meet his physical and emotional needs and discarded her when she was no longer useful.

Sense of entitlement scenario: Michael feels entitled to unreasonably favorable treatment from others due to his exceedingly good looks, professional success, and privileged upbringing in Greenwich, Connecticut. When he doesn't get his way, he lashes out in dramatically stunning episodes of anger, abuse, and paranoia. People often give in to him just so they can avoid a scene. He also uses charm and emotional seduction on both men and women to get them to cater to his outrageous requests.

These three stories touch only on a few of the endless ways in which narcissistic personalities act out in response to their distorted thought patterns and beliefs. People with narcissistic personality traits may have:

  • A scale in which they rate others in terms of usefulness
  • An overwhelming need to be the focus of admiration and attention at work or social situations
  • A pattern of rapidly alternating between idealization and devaluation of others
  • A history of intense, but short relationships with others, showing an inability to form and maintain truly intimate bonds
  • An attraction to leadership positions or high-profile careers
  • An unstable self-perception that vacillates between excessive self-praise and excessive self-hate
  • An excessive sensitivity to rejection or even very mild criticism from others

Diagnosis of Narcissistic Personality Disorder

Only a mental health professional, such as a psychiatrist or psychologist, can give an official diagnosis of narcissistic personality disorder. The clinician will conduct a comprehensive psychological evaluation and ask the client a number questions about mental health history and that of immediate family members.

The doctor will compare the client's symptoms, their severity, and other mental health information to criteria in the DSM 5. The client may meet criteria for a co-occurring personality disorder or other mental illnesses, such as depression or anxiety. Since people with NPD often abuse drugs or alcohol, the clinician may also order a toxicology report.

After carefully assessing all of this information, the doctor will determine the diagnosis and begin developing an individualized treatment plan.

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next: Narcissistic Personality Disorder Treatment
~ all articles on Narcissistic Personality Disorder
~ all Personality Disorder articles

Last Updated: 20 July 2016
Reviewed by Harry Croft, MD

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