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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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.

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Can You Diagnose Your Narcissist?

Narcissistic personality disorder is a disease that can only be diagnosed by a qualified mental health diagnostician. People often compile lists of traits and behaviors that they believe constitute the essence of narcissism, but these are often misleading. Only five of the exhaustive list of criteria need to coexist in a patient for them to be diagnosed with narcissistic personality disorder. It is not proper for laymen to diagnose people, even if narcissists rarely attend therapy or subject themselves to diagnostic tests.

Narcissists and Codependents: Same Problems, Different Solutions

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Depressive Narcissist

Pathological narcissism is often considered a form of depressive illness, with the life of a typical narcissist punctuated with recurrent bouts of dysphoria, sadness, hopelessness, anhedonia, loss of the ability to feel pleasure, and clinical forms of depression. Narcissists react with depression not only to life crises but to fluctuations in narcissistic supply and to the internal dynamics that these fluctuations generate. There are several types of dysphoria and depression in pathological narcissism, including loss-induced dysphoria, deficiency-induced dysphoria, self-worth dysregulation dysphoria, grandiosity gap dysphoria, and self-punishing dysphoria. Many narcissists end up delusional, schizoid, or paranoid to avoid agonizing and knowing depression.

Collapsed Narcissist, Collapsed Histrionic

Pathological narcissism is a post-traumatic condition that is a result of severe abuse by primary caregivers, peers, or authority figures. Narcissists require a form of narcissistic supply, and when the supply is deficient, they resort to several adaptive solutions. These solutions include the delusional narrative solution, the antisocial solution, the paranoid schizoid solution, the paranoid, aggressive or explosive solution, and the masochistic avoidance solution. In extreme cases, the collapsed narcissist or collapsed histrionic falls apart in a process of disintegration known as decompensation, which is accompanied by acting out.

So, Is My Narcissist a Covert Narcissist? Nonsense vs. Scholarship

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Schizoid and Paranoid Narcissist

Narcissistic personality disorder is often diagnosed with other mental health disorders, other personality disorders such as borderline, histrionic or antisocial. This phenomenon of multiple diagnosis in the same patient is called co-morbidity. Narcissists are often paranoid and some of them are schizoid. The narcissist depends on people, but hates them and despises them. A minority of narcissists choose the schizoid solution.

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.

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