What is Narcissistic Personality Disorder?

Narcissism subtypes -infographic. Narcissistic personality disorder symptoms.

Narcissism subtypes -infographic

Narcissistic Personality Disorder (NPD) is a mental disorder characterized by a lack of warmth and empathy, a constant need for admiration, exaggerated feelings of self-importance, and the use of various strategies to maintain an inflated self-view [1]. A person may recognize all or only some narcissistic personality disorder symptoms in themselves. Some individuals with narcissistic traits experience certain symptoms more intensely than others; the manifestation varies from person to person. Depending on the severity and number of symptoms present, a diagnosis of NPD may be made.

According to one study [4], there are several subtypes of narcissism:

  • The grandiose/malignant narcissist,
  • The fragile narcissist, and
  • The high-functioning/exhibitionistic narcissist.

Each subtype has a different treatment prognosis. Other studies, however, distinguish between grandiose narcissists and vulnerable narcissists [5], a distinction that better explains their symptoms.

NOTE: Possessing some narcissistic traits can actually be beneficial in maintaining a positive self-image [2]. In fact, people with certain narcissistic tendencies tend to be ambitious, satisfied, and relatively successful [3,4]. This means that not everyone with narcissistic traits needs to seek professional help.

 

Do you identify with some (or all) Narcissistic Personality Disorder Symptoms?

 

This page focuses on the symptoms and diagnostic criteria for NPD according to DSM-5 Section III, with explanations and examples to clarify each symptom. We prefer these diagnostic criteria because the DSM-IV and DSM-5 definitions have significant weaknesses (e.g., they fail to acknowledge certain NPD subtypes, such as malignant narcissism). For the official DSM-5-TR criteria for NPD, please visit: NPD diagnosis.

 


 
For more information:

 

At Barends Psychology Practice, narcissistic personality disorder treatment is offered. Contact us to schedule your first, free appointment.

 

Narcissistic Personality Disorder Symptoms

 

A. Significant impairments in personality functioning, as manifested by:

1. Impairments in self-functioning (a or b):

2. Impairments in interpersonal functioning (a or b):

a. Identity: Excessive reliance on others for self-definition and self-esteem regulation; exaggerated self-appraisal (either
inflated or deflated, or fluctuating between extremes); emotional regulation that mirrors self-esteem fluctuations.
b. Self-direction: Goal-setting is based on gaining approval from others; personal standards are either unreasonably high (to maintain a sense of superiority) or too low (due to entitlement); often unaware of personal motivations.

AND

a. Empathy: Impaired ability to recognize or identify with feelings
and needs of others; overly attuned to others’ reactions but only when perceived as relevant to oneself; overestimation or underestimation of one’s impact on others.
b. Intimacy: Relationships are largely superficial and serve to regulate self-esteem; little genuine interest in others’ experiences, with a predominant focus on personal gain.

 

Clarifications and examples of the symptoms Identity and Self-direction

a. Identity: There is a strong need to compare oneself to others who are perceived as inferior in some way in order to feel superior. Self-praise is essential for self-esteem regulation. Mood swings are tied to self-esteem: one moment, they may be generous and friendly (especially after an achievement), and the next, they may become irritable and snap at others.

  • Example 1: James constantly compares himself to others and feels superior when he outperforms them. If a colleague gets a promotion, he belittles their success, saying, “They only got it because of favoritism.”
  • Example 2: Maria’s mood shifts dramatically depending on whether she receives praise. When people admire her work, she is charming and enthusiastic; when she is ignored, she becomes irritable and dismissive.

b. Self-direction: Motivation is primarily driven by impressing others, so goals are set accordingly. In some cases, individuals may set extremely low goals due to a belief that they are too superior to put in effort.

  • Example 1: Mark sets unrealistic goals, such as becoming the CEO within a year, because he sees himself as exceptional. When he fails, he blames others rather than reassessing his expectations.
  • Example 2: Julia refuses to take on challenging tasks at work, saying, “I shouldn’t have to work this hard. People should recognize my talent without me proving it.”

 
(Advertisement. For more information, please scroll down.)


 

Clarifications and examples of the symptoms Empathy and Intimacy

a. Empathy: Their behavior is primarily focused on making themselves feel good. This may involve completely disregarding the emotions, needs, desires, norms, and values of others. Often, they do not consider other perspectives—either because they do not care or because they are incapable of doing so. This can make them appear rude, cruel, mean, or inconsiderate.

  • Example 1: Emma’s friend shares that she lost her job. Instead of showing concern, Emma responds, “Well, maybe you just weren’t good enough,” and then shifts the conversation back to her own career.
  • Example 2: When Alex’s partner is visibly upset, he doesn’t acknowledge their feelings. Instead, he becomes annoyed and says, “Why do you always have to be so sensitive?”

b. Intimacy: Forming deep emotional connections is difficult because they are uninterested in others’ experiences, thoughts, or feelings. Relationships primarily serve to maintain or boost their self-esteem. Once they no longer need someone, they are likely to discard them.

  • Example 1: John showers his new girlfriend with attention and gifts, but once she stops praising him daily, he becomes cold and distant. Eventually, he ghosts her.
  • Example 2: Sarah only stays in relationships as long as they boost her social status. When she meets someone more influential, she drops her current partner without hesitation.

 

B. Pathological personality traits in the following domain:

1. Antagonism (also known as hostility or opposition), characterized by:

a. Grandiosity:
Feelings of entitlement (either overt or covert); self-centeredness; a firm belief in being superior to others; condescending behavior. Grandiosity is one of the most well-known symptoms of NPD. Such individuals behave as if they are above the law and may openly express this belief. They often belittle others, even in public.
b. Attention seeking:
Excessive efforts to attract and maintain others’ attention; constant admiration-seeking. These individuals use various strategies to remain the center of attention. A common tactic is playing the victim and guilt-tripping others.

 
(Advertisement. For more information, please scroll down.)

 

Clarifications and examples of the symptoms Grandiosity and Attention seeking

a. Grandiosity:

  • Example 1: David tells his coworkers that he is “too intelligent to be working with ordinary people” and constantly reminds them of his past achievements, even when irrelevant.
  • Example 2: Sophie refuses to stand in line at a store, insisting, “I shouldn’t have to wait like everyone else.” She becomes aggressive when asked to follow the rules.

b. Attention-seeking:

  • Example 1: Brian interrupts conversations to redirect focus onto himself. If others talk about their successes, he quickly one-ups them: “That’s nothing! I once did twice as much in half the time.”
  • Example 2: Olivia plays the victim in every situation. If someone criticizes her, she breaks down in tears and accuses them of being cruel, ensuring the attention shifts back to her.

 

Other Narcissistic Personality Disorder Criteria

Criterion C

The impairments in personality functioning and personality trait expression are relatively stable over time and across different situations. People with NPD symptoms may initially present a carefully crafted public persona, but over time, their true nature is revealed—especially in close relationships.

  • Example 1: Mike behaves charmingly at work to impress his boss but is cruel and dismissive to his family at home. Over time, his true nature becomes apparent to everyone.
  • Example 2: Even after multiple failed relationships due to selfishness, Rachel refuses to change, insisting, “People just don’t appreciate my greatness.”

 

Criterion D

The impairments in personality functioning and personality trait expression are not better explained by normal developmental stages or cultural expectations. In some cultures, confidence and openly discussing achievements are the norm, while in others, such behaviors are discouraged. Adolescents, in particular, often exhibit narcissistic traits as part of their development, but these typically diminish with maturity.

  • Example 1: In some cultures, boasting about achievements is common, but Tom takes it to an extreme by dismissing others’ accomplishments and acting as if no one else’s success matters.
  • Example 2: Teenagers often go through self-centered phases, but unlike most, 25-year-old Lisa still believes she deserves special treatment and reacts aggressively when she doesn’t get it.

 

Criterion E

The impairments in personality functioning and personality trait expression are not solely due to the effects of substances (e.g., drugs, medication) or a medical condition (e.g., severe head trauma). Some drugs and medications can temporarily induce narcissistic behaviors. In cases of severe head trauma, damage to brain areas responsible for empathy may result in increased self-centeredness and diminished concern for others.

  • Example 1: Jack’s narcissistic traits are not linked to any medical condition—he has always lacked empathy and craved admiration.
  • Example 2: After a head injury, Laura becomes more self-centered, but this is due to brain damage, not NPD. If the injury had not occurred, she wouldn’t display these traits.

 
(Advertisement. For more information, please scroll down.)


 

Literature

  • [1] Campbell, W. K., & Baumeister, R. F. (2006). Narcissistic personality disorder. In Practitioner’s guide to evidence-based psychotherapy (pp. 423-431). Springer, Boston, MA.
  • [2] Pincus, A. L., & Lukowitsky, M. R. (2010). Pathological narcissism and narcissistic personality disorder. Annual review of clinical psychology, 6, 421-446.
  • [3] Ronningstam, E. (2005). Identifying and understanding the narcissistic personality. Oxford University Press.
  • [4] Russ, E., Shedler, J., Bradley, R., & Westen, D. (2008). Refining the construct of narcissistic personality disorder: Diagnostic criteria and subtypes. American Journal of Psychiatry, 165, 1473-1481.
  • [5] Pincus, A. L., Ansell, E. B., Pimentel, C. A., Cain, N. M., Wright, A. G., & Levy, K. N. (2009). Initial construction and validation of the Pathological Narcissism Inventory. Psychological assessment, 21, 365.