DSM 301.81 Narcissistic Personality Disorder

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

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 feeling 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 considers- 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 painfully self-conscious and preoccupied with grooming and remaining youthful. Personal deficits,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 approaches 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 Personality 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 form material gain. They display less emotional exaggeration than people with Histrionic Personality Disorder, and are less intensely involved with, or dependent on, others. People with Narcissistic Personality Disorder also tend to have a more cohesive identity and to be less impulsive and emotional than people with Borderline Personality Disorder.

For additional links on the subject of narcissism: http://members.tripod.com/~samvak/thebook.html