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From the Diagnostic and Statistical Manual, Third edition. (DSM-3)

(The official diagnostic manual used by mental health proffessionals.)

301.81 Narcissistic Personality Disorder

The essential feature of this disorder is a pervasive pattern of grandiosity (in fantasy or behavior), hypersensitivity to the evaluation of others, and lack of empathy that begins by early adulthood and is present in a variety of contexts.

People with this disorder have a grandiose sense of self importance. They tend to exaggerate their accomplishments and talents, and expect to be noticed as "special" even without appropriate achievement. They often feel that because of their "specialness," their problems are unique, and can be understood only by other special people. Frequently this sense of self-importance alternates with feelings of special unworthiness. For example, a student who ordinarily expects an A and receives a grade A minus may, at that moment, express the view that he or she is thus revealed to all as a failure. Conversely, having gotten an A, the student may feel fraudulent, and unable to take genuine pleasure in a real achievement.

These people are preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love, and with chronic feelings of envy for those whom they perceive as being more successful than they are. Although these fantasies frequently substitute for realistic activity, when such goals are actually pursued, it is often with a driven, pleasureless quality and an ambition that cannot be satisfied.

Self-esteem is almost invariably very fragile; the person may be preoccupied with how well he or she is doing and how well he or she is regarded by others. This often takes the form of an almost exhibitionistic need for constant attention and admiration. The person may constantly fish for compliments, often with great charm. In response to criticism, he or she may react with rage, shame, or humiliation, but mask these feelings with an aura of cool indifference.

Interpersonal relationships are invariably disturbed. A lack of empathy (inability to recognize and experience how others feel) is common. For example, the person may be unable to understand why a friend whose father has just died does not want to go to a party. A sense of entitlement, an unreasonable expectation of especially favorable treatment, is usually present. For example, such a person may assume that he or she does not have to wait in line when others must. Interpersonal exploitativeness, in which others are taken advantage of in order to achieve one's ends, or for self- aggrandizement, is common. Friendships are often made only after the person consid- ers how he or she can profit from them. In romantic relationships, the partner is often treated as an object to be used to bolster the person's self-esteem.

Associated features:

Frequently, many of the features of Histrionic, Borderline, and Antisocial Personality Disorders are present; in some cases more than one diagnosis may be warranted. Depressed mood is extremely common. Often the person is painfulfy self-conscious and preoccupied with grooming and remaining youthful. Personal defcits, defeats, or irresponsible behavior may be justified by rationalization or lying. Feelings may be faked in order to impress others.


Some impairment in interpersonal relations is inevitable, Occupational functioning may be impeded by depressed mood, interpersonal difficulties, or the pursuit of unrealistic goals. In other cases, occupational functioning may be enhanced by an unquenchable thirst for success.


Dysthymia and psychotic disorders such as Brief Reactive Psychosis are possible complications. Major Depression can occur as the person appoaches middle age and becomes distressed by awareness of the physical and occupational limitations that become apparent at this stage of life.


This disorder appears to be more common recently than in the past, but this may be due only to more professional interest in it.


Predisposing factors, sex ratio, and familial pattern: No information.


Differential diagnosis:

Borderline, Histrionic, and Antisocial Personalitly Disorders are often also present; in such instances, multiple diagnoses should be given. However, in comparison with people with Antisocial Personality Disorder, people with Narcissistic Personality Disorder tend to be less impulsive, and their exploitation is more for the promotion of feelings of entitlement and power than for material gain. They display less emotional exaggeration than people with Histrionic Personaliy Disorder, and are less intensely involved with, or dependent on, others. People with Narcisissitic Personality Disorder also tend to have a more cohesive identity and to be less impulsive and emotional than people with Borderline Personality Disorder.

Diagnostic criteria for 301.81, Narcisisstic Personaliy Disorder:

A pervasive pattern of grandiosity (in fantasy or behavior) hypersensitivity to the evaluation of others, beginning by early adulthood and present in a variety of contexts, as indicated by at least five of the following:

(1) Reacts to criticism with feelings of rage, shame, or humiliation (even if not expressed)

(2) Is interpersonally exploitive: takes advantage of others to acheive his or her own ends.

(3) Has a grandiose sense of self-importance, e.g., exaggerates acheivements and talents, expects to be noticed as "special" without appropriate achievement

(4) Believes that his or her problems are unique and can be understood only by other special people.

(5) Is preoccupied with fantasies of unlimited success, power, beauty, or ideal love. (6) has a sense of entitlement: unreasonable expectations of especially favorable treatment, e.g, assumes that he or she does not have to wait in line when others must do so

(7) Requires constant attention and admiration, e.g., keeps fishing for compliments.

(8) Lack of empathy: inability to recognize and experperience how others feel, e.g, annoyance and surprise when a friend who is seriously ill cancels a date.

(9) Is preoccupied with feelings of envy.