Clinical Narcissism: Narcissistic Personality Disorder

Although most of us exhibit some “narcissistic” behaviors at times, a specific set of personality traits must be habitual and consistent across time and situations for someone to be clinically diagnosed with narcissistic personality disorder, or NPD.

Mental health practitioners throughout the world use either the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD) for diagnosis. DSM, produced by the American Psychiatric Association, covers only mental-health issues, while ICD, produced by the World Health Organization, covers diseases of the body as well.

According to DSM-5, the edition released in 2013, a diagnosis of NPD requires first that certain criteria common to all personality disorders be satisfied. NPD further requires “a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
  2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
  3. Believes that he or she is ‘special’ and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
  4. Requires excessive admiration.
  5. Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).
  6. Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).
  7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
  8. Is often envious of others or believes others are envious of him or her.
  9. Shows arrogant, haughty behaviors or attitudes.”

Studies of narcissistic traits tend to focus on nonclinical narcissism, often assessed using common personality inventories such as the Narcissistic Personality Inventory (NCI), and do not necessarily suggest that the study subjects have been clinically diagnosed.