Narcissistic Personality Disorder is one of the Cluster B personality disorders, also known as ‘dramatic, emotional or erratic’. The others are Borderline, Histrionic and Antisocial. Narcissistic Personality Disorder is commonly defined as ‘a pervasive pattern of grandiosity, need for admiration, and a lack of empathy’. It is important to note that individuals usually show symptoms across the range of Cluster B personality disorders which makes diagnosis challenging.

Narcissistic Personality Disorder seems to occur more with men (about 75% men 25% women), though this may be an issue of reporting rather than reality.

DSM-IV-TR specifies nine diagnostic criteria for Narcissistic Personality Disorder. For the clinician to make the diagnosis, an individual must fit five or more of the following descriptions:

• They have a grandiose sense of self-importance (exaggerates accomplishments and demands to be considered superior without real evidence of achievement).
• They live in a dream world of exceptional success, power, beauty, genius, or “perfect” love.
• They think of themselves as “special” or privileged, and that they can only be understood by other special or high-status people.
• They demand excessive amounts of praise or admiration from others.
• They feel entitled to automatic deference, compliance , or favorable treatment from others.
• They are exploitative towards others and take advantage of them.
• They lack empathy and do not recognize or identify with others’ feelings.
• They are frequently envious of others or think that they are envious of them.
• They “have an attitude” or frequently act in haughty or arrogant ways.

Symptoms of Narcissistic Personality Disorder are often combined with the other Cluster B personality disorders. Some of the symptoms include:

• history of intense but short-term relationships with others; inability to make or sustain genuinely intimate relationships
• tendency to be attracted to leadership or high-profile positions or occupations
• patterns of alternating between unrealistic idealization of others and equally unrealistic devaluation of them
• assessment of others in terms of usefulness
• need to be the center of attention or admiration in a working group or social situation
• hypersensitivity to criticism, however mild, or rejection from others
• unstable view of the self that fluctuates between extremes of self-praise and self-contempt
• preoccupation with outward appearance, “image,” or public opinion rather than inner reality
• painful emotions based on shame (dislike of who one is) rather than guilt (regret for what one has done)

Living with Narcissistic Personality Disorder

Dealing with the Narcissist