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Narcissistic Personality Disorder Diagnostic Criteria (DSM IV-TR)

Uploaded 8/13/2010, approx. 3 minute read

My name is Sam Vaknin. I am the author of Malignant Self-Love, Narcissism Revisited.

The Narcissistic Personality Disorder, NPD for short, is hardly a new psychological construct. In previous centuries the same set of symptoms and problems was called egotism or megalomania.

Narcissistic personality disorder is an extreme form of pathological narcissism. It is one of four personality disorders in Cluster B, the Dramatic, Emotional or Eratic Cluster.

The Narcissistic Personality Disorder was first described in the Diagnostic and Statistical Manual, Edition 3, revised text in 1980.

By contrast, the International Classification of Diseases, Edition 10, published by the World Health Organization in Geneva in 1992, does not recognize the Narcissistic Personality Disorder at all. It regards NPD as a personality disorder that fits none of the specific rubrics and it lumps it together with other bizarre dysfunctions such as hulk loss, immature passive-aggressive and psychoneurotic personality disorders.

There is a catch-all category called other-specific personality disorders in the International Classification of Diseases in Narcissistic Personality Disorder is dumped in this trash bin.

The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, text revision, published by the American Psychiatric Association in Washington DC, the United States in the year 2000, provides a diagnostic criteria for Narcissistic Personality Disorder on page 717.

The Diagnostic and Statistical Manual, DSM for short, defines Narcissistic Personality Disorder thus, an all-convasive pattern of grandiosity in fantasy or behavior, need for admiration or adulation, a lack of empathy, usually beginning by early adulthood and present in various contexts such as family life or work.

Five or more of the DSM's nine diagnostic criteria must be met for a Diagnostic of Narcissistic Personality Disorder to be rendered.

I took the nine diagnostic criteria of the DSM and I augmented them with experience that I have accumulated over the last 15 years, interacting with narcissists and their nearest and dearest colleagues, neighbors, employers, bosses, friends and family.

So here are my diagnostic criteria based largely of course on the DSM.

Number one, the narcissist feels grandiose and self-important.

Example given, exaggerates accomplishments, talents, skills, contacts and personality traits to the point of lying, demands to be recognized as superior without commensurate achievements.

Number two, the narcissist is obsessed with fantasies of unlimited success, fame, fearsome power, omnipotence, unequal brilliance if he is a cerebral narcissist, ability of sexual performance if he is a somatic narcissist or both types ideal and everlasting all conquering love or passion.

Number three, the narcissist is firmly convinced that he or she is unique and being special can only be understood by, should only be treated by or associate with other special or unique or high status people or institutions.

Therefore, the narcissist requires excessive admiration, adulation, attention and affirmation or failing that wishes to be feared and to be notorious. This is known as narcissistic supply.

The narcissist feels entitled, demands automatic and full compliance with his or her unreasonable expectations for special and favourable priority treatment.

Number six, the narcissist is interpersonally exploitative. In other words, he uses others to achieve his or her own ends without any concern for the welfare of the people he so uses or abuses.

Number seven, the narcissist is devoid of empathy. He is unable or unwilling to identify with, acknowledge or accept the feelings, needs, preferences, priorities and choices of others.

Number eight, the narcissist is constantly envious of others. He seeks to hurt or to destroy the objects of his frustration. He suffers from persecutory, paranoid delusions as he or she believes that everyone feels the same about him or her and that everyone is likely to act similarly to the narcissist.

Finally, the narcissist behaves arrogantly and haughtily. He feels superior, omnipotent, omniscient, invincible, immune above the law and omnipresent, a collection of beliefs and fantasies known as magical thinking. The narcissist rages when frustrated, when contradicted, when confronted by people he or she considers inferior and unworthy.

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Can You Diagnose Your Narcissist?

Narcissistic Personality Disorder (NPD) can only be diagnosed by qualified mental health professionals using the criteria outlined in the Diagnostic and Statistical Manual (DSM). Many people incorrectly label others as narcissists based on personal experiences or traits, which can lead to misunderstandings about the disorder. Key characteristics of narcissists include a sense of grandiosity, a need for excessive admiration, entitlement, lack of empathy, and a tendency to exploit others. It is important to refrain from diagnosing or labeling individuals without proper qualifications, as this can perpetuate misconceptions about mental health disorders.


Narcissist: Is He or Isn't He?

Narcissism is a spectrum of behaviors, from healthy to pathological, and the Diagnostic and Statistical Manual specifies nine diagnostic criteria for narcissistic personality disorder (NPD). A malignant narcissist is someone who has NPD and wreaks havoc on themselves and their surroundings. They feel grandiose and self-important, exaggerate accomplishments, and demand recognition as superior without commensurate achievements. They require excessive admiration, adulation, attention, and affirmation, and are interpersonally exploitative, devoid of empathy, and constantly envious of others.


Covert Narcissist = Borderline+Psychopath+Passive-Aggressive

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Narcissistic Personality Disorder (NPD) is described as an all-pervasive condition that defines the individual, leaving them with a sense of emptiness and fraudulence when faced with narcissistic mortification. This mortification occurs under specific conditions, such as public humiliation, suddenness, and the presence of valued others, leading to a brief emotional dysregulation where the narcissist becomes vulnerable. However, they quickly restore their grandiosity through either internal or external narratives, reactivating their defenses and returning to their false self. While narcissism can be seen as a positive adaptation in a narcissistic society, the majority of narcissists ultimately face negative outcomes due to their inability to connect with others and their reliance on fantasy.


Simple Trick: Tell Apart Narcissist, Psychopath, Borderline

Narcissists maintain one stable aspect of their lives, referred to as an "island of stability," while the rest of their existence is chaotic and disordered, leading to misconceptions about their character. In contrast, psychopaths lack any stable elements in their lives, resulting in pervasive instability across all dimensions. There are two types of narcissists: those who create compensatory stability by stabilizing one area of their life while everything else is chaotic, and those who enhance instability by introducing chaos into all aspects of their lives when one area is disrupted. The distinction between narcissists and psychopaths lies in their emotional engagement and the presence of stability, with narcissists relying on external validation while psychopaths operate without emotional depth or continuity.


Narcissist Loves his Disorder and Narcissistic Personality

Narcissists may modify their behavior to become more socially acceptable, but they never heal or get better because they have an emotional investment in their disorder. Narcissistic personality disorder serves two critical functions: it endows the narcissist with a sense of uniqueness and provides an alibi for their misconduct. Narcissists reject the notion that they are mentally ill or disturbed, and their disorder becomes an integral and inseparable part of their inflated self-esteem and grandiose fantasies. The narcissist is emotionally attached to their narcissistic personality disorder and loves their disorder passionately.


Lonely, Schizoid Narcissist

Narcissistic personality disorder is often diagnosed with other mental health disorders, such as borderline, histrionic or antisocial psychopathic personality disorder. Narcissism is often also accompanied by substance abuse and other reckless and impulsive behaviors, and this we call dual diagnosis. There is one curious match, one logic-defying appearance or co-appearance of mental health disorders, narcissism, together with schizoid personality disorder. A minority of narcissists, therefore, choose the schizoid solution. They choose to disengage, to detach both emotionally and socially.


Idealized, Devalued, Dumped

Narcissists have a cycle of overvaluation and devaluation, which is more prevalent in borderline personality disorder than in narcissistic personality disorder. The cycle reflects the need to be protected against the whims, needs, and choices of other people, shielded from the hurt that they can inflict on the narcissist. The overvaluation and devaluation mechanism is the most efficient one available to the narcissist, as the narcissist's personality is precariously balanced and requires inordinate amounts of energy to maintain. The narcissist's energies are all focused and dedicated to the task concentrated upon the source of supply he had identified.


Narcissistic Personality Disorder Prevalence and Comorbidity

Pathological narcissism is a lifelong pattern of traits and behaviors that signify infatuation and obsession with oneself to the exclusion of all others. Healthy narcissism is adaptive, flexible, empathic, and causes elation and joy. Narcissistic Personality Disorder is diagnosed in between 2 and 16% of a population in clinical settings or between 0.5% and 1% of the general population. Narcissistic Personality Disorder is often diagnosed with other mental health disorders, and this is known as comorbidity.

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