Decode The Narcissistic Personality Disorder Diagnostic Criteria

— Researched and written by Dr. Sandip Roy.

Understanding Narcissistic Personality Disorder (NPD) is much like deciphering an intricate code.

Note these three intrigues:

  1. Narcissists are quite likable at first, but eventually tend to alienate others.
  2. A charming narcissist can become highly aggressive in retaliation for wounded pride.
  3. Narcissists fantasize about their brilliance or beauty and believe they are entitled to praise and privileges, but deep inside, they realize they are average and even inadequate achievers.

The Diagnostic and Statistical Manual (DSM-5), a trusted manual among mental health professionals, provides a blueprint for understanding this complex disorder.

A narcissistic person isn’t too hard to spot. They constantly boast and humblebrag about themselves. They hate to see someone else given preference in their presence.

That said, narcissistic features alone do not make a Narcissistic Personality Disorder — only a psychological expert can diagnose someone as NPD.

Can You Fix A Narcissist

The DSM-5 Narcissistic Personality Disorder Diagnostic Criteria

Narcissistic Personality Disorder (NPD) is characterized by:

  • a pervasive pattern of grandiosity,
  • a constant need for admiration, and
  • a distinct lack of empathy, beginning in early adulthood and present in a variety of contexts.

NPD is indicated by 5 or more of the following:

1. Grandiose sense of self-importance

A narcissist exaggerates their achievements, expecting recognition far beyond their actual merit.

This is like the Emperor parading in his ‘new clothes,’ unable to perceive the stark reality of his situation.

2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

Narcissists live in a bubble of illusion, a fantasy world of their own making, driven by delusions of grandeur and a desperate need for validation.

They are always seeking the spotlight to validate their exaggerated characteristics.

They tend to pursue an idealistic concept of success, power, brilliance, beauty, or love, but are remarkably inconsistent in following through on efforts to achieve that ideal.

3. Believes he or she is special and unique as can only be understood by, or should associate with, other special or high-status people

Narcissists perceive themselves as unique and extraordinary, worthy of the company of high-status individuals.

This social snobbery of associating only with those who reflect or enhance their inflated self-image makes them arrogant and obnoxious. This also makes narcissists admire narcissistic dictators.

4. Requires excessive admiration

The need for constant affirmation is a common trait among narcissists. They crave and even demand to be validated for their qualities, decisions, ideas, possessions, and achievements.

If they see the spotlight shift away from them, they often resort to emotional drama and psychological manipulation to regain their focus.

5. Has a sense of entitlement and unreasonable expectations or especially favorable treatment

Narcissists demand preferential treatment wherever they go. This shows up as unreasonable expectations of favorable treatment from others. They demand center stage in your life, avoiding any confrontation with their own flaws, an encounter that could trigger unbearable shame. When they do not get the importance they believe they deserve, it often leads them to get into conflicts and rage.

6. Is interpersonally exploitative (takes advantage of others)

Most narcissists keep few true friends. They prefer an entourage of people they can exploit. They are also reluctant to reveal their vulnerabilities to others, since they fear being exploited themselves.

They lack genuine empathy, which makes their friendships one-sided. Sooner or later, their friends understand their tendency to use others for personal gain, and keep away from them.

7. Lacks empathy and is unwilling to identify or recognize the feelings and needs of others

Empathy and compassion are the lifeblood of human connection, and both are absent in narcissists. The empathy deficit makes it difficult for narcissists to recognize or respond appropriately to others’ feelings and needs, often leaving those close to them emotionally marooned.

8. Is envious of others or believes others are envious of him or her

Narcissists believe others are envious of them. Actually, they are themselves envious of other people’s success and status, and often project these feelings of envy onto others. Worse, when they blame others for their shortcomings and failures, they fail to look into the psychological mirror and recognize themselves.

9. Shows arrogant, haughty behaviors or attitudes

This is an overt display of their grandiosity, often used as a defense mechanism. This haughtiness is common among overt narcissists but can show up in covert narcissists when their self-image is threatened. They wield their arrogance as a shield, deflecting perceived threats to their grandiose self-image.

Narcissistic Personality Disorder Diagnostic Criteria
Photo by Miriam Alonso, Pexels

The Invisible Narcissist: A DSM-5 Blind Spot

“The Devil’s greatest trick was convincing the world he didn’t exist.”

One flaw in the DSM-5’s approach is that it largely focuses on the grandiose or overt subtype of narcissism, leaving the vulnerable or covert narcissist less recognized.

This omission gives the covert narcissist a cloak of diagnostic invisibility. And misses the opportunity to fully understand and address the complex spectrum of NPD.

There have been debates over the years about the classification, subtyping, and criteria of NPD, and how well these capture the various presentations of narcissism.

However, these debates are a normal part of the ongoing scientific discourse aimed at improving our understanding and treatment of mental health disorders.

Can a narcissist change?

Transactional Relationships: The Narcissist’s Modus Operandi

On interpreting the DSM-5’s criteria, it becomes evident that a narcissist’s relationships are typically transactional.

For narcissists, relationships are like deals. They forge their friendships after making sure they will get something more out of it, such as more attention or to move up in the world.

You stop being useful to the narcissist when they see you’re questioning their actions or demanding more than you are giving. They will discard you at this point, without much of a hint or explanation.

Only then that you realize how coldhearted they have been since the start of your relationship. They really never cared about your feelings or needs.

Did you know that you can undo their twisted tangle of talks called Narcissistic Word Salad?

Early Intervention: A Controversial Counterpoint

When does narcissism first show up in a person? A debate exists around the onset of NPD.

A consensus in clinical psychology suggests that a diagnosis of a personality disorder should be deferred until at least 18 years of age. This age boundary is considered the last opportunity to reverse the damage inflicted by a traumatic or invalidating childhood.

However, there exists the counterargument that early diagnosis and intervention, when a youth starts showing the first signs of narcissism, may serve as a powerful preventative measure.

A diagnosis not only informs the patient, but it also serves as a guide for future medical and mental health providers, steering the therapeutic course.

The DSM helpfully standardized the NPD diagnostic criteria, so that all over the world, clinicians reach the same diagnosis.

Narcissism & Self-esteem

In normal populations, the results from the Narcissistic Personality Inventory test (Emmons, 1984; Raskin & Hall, 1981) often correlate with self-esteem (Rhodewalt & Morf, 1995; Sinha & Krueger, 1998).

Narcissistic people usually think very highly of themselves, but in a way that’s not stable or real; they can quickly feel threatened or insecure.

In studies, being narcissistic (but not just having high self-esteem) made people more likely to act aggressively, especially if someone had upset them before. This shows that having a high opinion of yourself that’s narcissistic can lead to negative behaviors.


  1. Why was “narcissism” removed from the DSM?

    The term “narcissism” has been used in various psychological contexts, but was never officially a diagnostic category in the DSM.

    The DSM-III (1980) officially introduced and recognized “Narcissistic Personality Disorder” as a specific diagnosis with its set of criteria for clinicians to use in their practice. This was “not a case of replacing” the term narcissism, but rather a formalization that allowed for a more precise diagnosis of this personality disorder.

    Historically, in 1967-68, psychoanalysts Otto Kernberg and Heinz Kohut presented two early theories on narcissism.

    Kernberg described a “narcissistic personality structure,” proposing three types of narcissism: normal adult narcissism, normal infantile narcissism, and pathological narcissism.

    Kohut presented the concept of “narcissistic personality disorder,” arguing that narcissism is an essential aspect of normal development.

  2. What are the 9 criteria for narcissistic personality disorder?

    1. Grandiose sense of self-importance.
    2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
    3. Believes he or she is special and unique as can only be understood by, or should associate with, other special or high-status people.
    4. Requires excessive admiration.
    5. Has a sense of entitlement and unreasonable expectation or especially favorable treatment.
    6. Is interpersonally exploitative (takes advantage of others).
    7. Lacks empathy and is unwilling to identify or recognize the feelings and needs of others.
    8. Is envious of others or believes others are envious of him or her.
    9. Shows arrogant, haughty behaviors or attitudes.

Final Words

Narcissistic Personality Disorder, hidden within the complex language of the DSM-5, is a narrative of grandiosity, entitlement, and exploitation. Decoding this language helps us get a clearer view of the narcissist’s inner world, and helps us better navigate a narcissistic relationship.

In my practice, I have increasingly seen people consult me because they have been sidelined from groups and “hush-hush” labeled as narcissists. They cannot decide if they genuinely deserve social ostracization.

Remember that mental well-being is a complex roller coaster. If you feel you’re struggling with people criticizing your selfishness and narcissistic bent, please reach out to a psychologist.

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√ Also Read: Narcissistic Projection: Learn How To Handle It (With Examples)

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