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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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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.


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.


Narcissism: What's Left to Learn? (with Peter Kolakowski, Deutschlandfunk Kultur)

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.


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.


Asperger's Disorder Misdiagnosed as Narcissistic Personality Disorder (NPD)

Asperger's Disorder can be diagnosed in toddlers as young as three years old, while Narcissistic Personality Disorder cannot be safely diagnosed until late adolescence. However, Asperger's Disorder is often misdiagnosed as Narcissistic Personality Disorder. Both types of patients are self-centered and engrossed in a narrow range of interests and activities, with severely hampered social and occupational interactions. The gulf between Asperger's and pathological narcissism is vast, with the narcissist switching between social agility and social impairment voluntarily, while the Asperger's patient's social awkwardness is an inevitability.


Your Empathy as Narcissistic Injury: Narcissist Never Learns, No Insight

Narcissists reject empathy and intimacy because it challenges their grandiosity, and they become paranoid and aggressive when someone tries to be intimate with them. Narcissists lack empathy and access to positive emotions, leading to a truncated version of empathy called "cold empathy." Narcissists are self-aware but lack the incentive to get rid of their narcissism, and therapy is more focused on accommodating the needs of the narcissist's nearest and dearest. Cold Therapy is experimental and limited, as it removes the false self but does not develop empathy or improve the narcissist's interpersonal relationships.


Borderline Mislabels Her Emotions (as do Narcissist, Psychopath)

Empathy is inversely related to the ability to recognize emotions in others, meaning that as empathy increases, the capacity to accurately read others' emotions decreases. Individuals with cluster B personality disorders, such as narcissists and borderlines, possess distorted forms of empathy that hinder their emotional understanding and labeling, leading to significant cognitive and emotional deficits. These individuals often mislabel their emotions, rely on dysfunctional coping mechanisms, and experience emotional dysregulation, resulting in inappropriate affect and a lack of genuine emotional connection. Ultimately, their emotional experiences are characterized by a cognitive analysis rather than true emotive engagement, leaving them disconnected from the richness of human emotional experience.


Narcissists Hard to Spot

Narcissistic personality disorder is difficult to isolate with certainty, and it is important to distinguish between inherent traits and reactive patterns. Narcissism is considered pathological only when it becomes a rigid personality structure with primitive defense mechanisms and leads to dysfunctions in one or more areas of life. Pathological narcissism is the art of deception, and the narcissist projects a false self to manage social interactions. Victims of narcissists often find themselves involved before discovering the narcissist's true nature, and the narcissist emits subtle signals even on a first or casual encounter.


NPD CANCELLED in ICD-11: Narcissism=Dissociality+Anankastia+Negative Affectivity (Starts 07:54)

Narcissistic personality disorder (NPD) is recognized only in the DSM and CCMD, while the ICD, which is used globally, does not include it as a distinct diagnosis. The ICD adopts a more flexible approach, categorizing personality disorders based on severity and trait domains rather than discrete diagnoses, allowing for a more nuanced understanding of personality dysfunction. This perspective suggests that narcissistic traits can emerge from a combination of dissociality, anankastia, and negative affectivity, reflecting a spectrum of behaviors rather than a fixed condition. The ICD's model emphasizes the fluidity of personality traits and the interplay between them, contrasting with the DSM's rigid categorical system. Ultimately, the discussion highlights the need for a more integrated understanding of personality disorders that transcends traditional diagnostic boundaries.


DSM V Gets Narcissistic Personality Disorder Partly Right

The DSM-5 criteria for diagnosing narcissistic personality disorder include impairments in personality functioning, both self and interpersonal, and the presence of pathological personality traits. The impairments in self-functioning include identity and self-direction, while the impairments in interpersonal functioning include empathy and intimacy. The DSM-5 also focuses on pathological personality traits of the narcissist, which are characterized by antagonism, grandiosity, and attention-seeking. The diagnostic criteria should be stable across time, consistent across situations, and not solely due to direct physiological effects of a substance or general medical condition.

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