The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) provides the criteria for diagnosing NPD. According to the DSM-5, a person must meet at least five of the following nine criteria for a diagnosis of NPD:
- Grandiosity with expectations of superior treatment: Individuals with NPD often display an exaggerated sense of self-importance and expect others to recognize their superiority without evidence.
- Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love: They often fantasize about achieving greatness, success, or perfection, and may believe they deserve special treatment.
- Believing they are “special” and unique: Narcissistic individuals often perceive themselves as exceptional, and they may feel they can only be understood by other extraordinary or high-status people.
- Requiring excessive admiration: A strong need for attention and admiration is characteristic. They seek out constant validation and praise to maintain their self-esteem.
- Sense of entitlement: Individuals with NPD often have unreasonable expectations of favorable treatment or automatic compliance with their desires, believing that they are entitled to special privileges.
- Exploiting others: Narcissistic individuals may take advantage of others to achieve their own goals or maintain their self-image, showing a lack of concern for the feelings or needs of others.
- Lack of empathy: One of the hallmark features of NPD is a lack of empathy, which means they struggle to understand or care about the emotions and needs of others.
- Being frequently envious of others or believing others are envious of them: Those with NPD may exhibit envy towards others’ successes or believe that others are jealous of them.
- Arrogant, haughty behaviors or attitudes: Narcissistic individuals may display arrogance and a sense of superiority, often belittling others to elevate their own status.
Individuals with NPD typically have a fragile self-esteem that requires constant reinforcement. While they may appear confident and self-assured, they often feel deep insecurity and vulnerability. They may react with rage or withdrawal if their self-image is threatened or challenged.