Personality Disorder Support Community

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Narcissistic Personality Disorder

Narcissistic personality disorder is a personality disorder which usually occurs in early adulthood, and is found more frequently in males than females. It belongs to a group of conditions labeled “dramatic, emotional or erratic personality disorders”.

People with narcissistic personality disorder have an inflated sense of self importance. They see themselves as superior to others, and expect others to see this and treat them differently.

To be diagnosed with narcissistic personality disorder, a person must fulfil certain criteria laid out by the DSM-IV. The ICD-10, which is the European diagnostic manual for mental disorders, does not give a list of criteria for narcissistic personality disorder, although it is mentioned under the section “other specific personality disorders”.

The DSM-IV criteria are as follows:

A pervasive pattern of grandiosity (in fantasy or behaviour), 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 favourable treatment or automatic compliance with his or her expectations.

  6. Is inter-personally 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 that others are envious of him or her.

  9. Shows arrogant, haughty behaviours or attitudes.

Cause of NPD

There is no known cause for NPD, although some research suggests it may be caused either by severe emotional abuse in childhood or being undeservedly praised as a child.

Diagnosing NPD

NPD is usually diagnosed by a mental health professional. It may take several sessions before a diagnosis is confirmed.

If you suspect you have NPD, you will need to speak to your GP and ask for a referral to a mental health professional who is trained to diagnose and treat this disorder.


There is no medication used to treat NPD, although some doctors may prescribe medication to help with associated depression or anxiety.

Therapy is the recommended treatment for NPD. Short term therapy may be enough to resolve an immediate crisis, although long term therapy is often needed to make any real difference. Couples therapy or family therapy may be useful if the disorder is causing a lot of difficulty with specific interpersonal relationships.

Millon’s Subtypes

Unprincipled - This involves antisocial features. Those who fall under this subtype tend to be deceptive and disloyal, and have an impaired sense of empathy.

Elitist - This is often called a variant of “pure” narcissistic. Those who fall under this subtype consider themselves privileged and empowered without any real evidence to support this, and seek out those who reinforce this belief.

Amorous - This involves histrionic features. Those who fall under this subtype tend to be seductive and avoid real intimacy. They usually come across as incredibly charming.

Compensatory - This involves negativistic and avoidant features. Those who fall under this subtype seek to counteract feelings of inferiority by creating illusions of being special and superior.

Author: Rachael Baker

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