Narcissistic Personality Disorder (F60.81) Diagnostic Criteria

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I’m sure you’ve heard the word “narcissism” lately, but did you know it can be an actual disorder? The most recent (2022) criteria of narcissistic personality disorder can be found in the DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision¹). Narcissistic personality disorder was first listed in the DSM-III in 1980. Since then, there’s actually been surprising controversy about this diagnosis, because it lacks scientific support and is mostly based on theory and clinical experience. In fact, there’s been some researchers who believe that narcissism is a core part of all personality disorders and that it should not be a separate disorder itself². I find myself in this camp the more I learn about narcissism. But…without further ado, let’s dive into the criteria of this disorder that often seems to be misused or misinterpreted!

Narcissistic Personality Disorder Criteria

Before we look at the individual criteria, the DSM-5-TR gives a framework about narcissistic personality disorder. The patterns of narcissistic personality disorder have to be pervasive, meaning spread across the person, time, and settings. This is further explained by noting that patterns of narcissistic personality disorder must begin by early adulthood (18 to 25) AND be present in a variety of settings (e.g. home, school, work). Basically, narcissistic personality disorder doesn’t just show up one day in a relationship at age 60. It’s been intertwined throughout a person’s life and encompasses all aspects of that person’s story.

Then we have the actual pattern of narcissistic personality disorder. There’s grandiosity (fantasy OR behavior), admiration needs, AND lack of empathy. Now, the grandiosity may not necessarily show up in observable behavior, instead, existing internally in thoughts and desires under the surface. This can actually make narcissistic personality disorder tricky to diagnose! Remember, all three of these have to be present. Plus, there has to be a presence of five or more of the specific criteria listed below.

Grandiosity: Narcissistic Personality Disorder (Criterion 1)

Those with narcissistic personality disorder have likely learned that their self-worth is superior despite effort (or lack of effort). They come off as pretentious, “special,” and braggadocious, overestimating their actual ability and expecting others to reflect their greatness back to them. If anyone else was involved in their successes, their contributions are often minimized or even dismissed altogether. For example, you might overhear someone with narcissistic personality disorder boast about the great paper they wrote by themself, even though you know differently because you were in their group for the project.

Fantasies: Narcissistic Personality Disorder (Criterion 2)

The tendency to fantasize about these things seems to be an overcompensation for emptiness. It’s not just daydreaming about a better life, like we all can do at times. Those with narcissistic personality disorder have a void inside composed of low self-worth and shame, but it’s rejected and presented as superiority. Their thoughts can often fixate on admiration and privilege they should be getting. They also tend to pick famous, “successful,” or influential people to compare themselves with in a positive manner…not the healthiest thing ever…🥴

Specialness: Narcissistic Personality Disorder (Criterion 3)

Sometimes it’s not just comparisons with successful people, but those with narcissistic personality disorder actually prefer to rub shoulders with others who are of high value. The thought that may go along with this is, “I’m the best, so I need the best.” They need the elite barber, accountant, surgeon, banker, etc. It’s almost like they try to absorb the “specialness” so they are “special” too. Also, they really don’t understand when others are oblivious to their greatness, because they expect and feel they deserve recognition. They may feel confused when you don’t worship the ground they walk on…eek! 🤢

Admiration: Narcissistic Personality Disorder (Criterion 4)

Because of their fragile self-esteem, deep self-doubt, and intense self-criticism that is hidden and rejected, those with narcissistic personality disorder need to be recognized and admired by others. They desperately need an audience and likely obsess about their image. It’s quite possible that they need to be treated as a famous person whenever they walk in the room. They desire fanfare and are genuinely confused if others aren’t envious of them. Those with narcissistic personality disorder can also be very charming in their attempt to obtain compliments. You might even feel the pull to give them “ego cookies” (i.e. of course you’re the greatest, best-dressed, richest!).

Entitlement: Narcissistic Personality Disorder (Criterion 5)

Those with narcissistic personality disorder expect excessive positive treatment from others because they believe they are extra important. They can be confused or even angry if not provided with what they expect, which can lead to (knowingly or unknowingly) exploiting others. For example, they might throw a fit because they’re too important to wait in line, or they might be confused about consequences when missing a deadline because they had better things to do. It can look like a toddler having a tantrum. 👶

Exploitative: Narcissistic Personality Disorder (Criterion 6)

Those with narcissistic personality disorder (knowingly or unknowingly) pursue everything for self-enhancement. Their relationships serve a purpose of increasing status, image, finances, self-esteem, etc. They might not actively try to con their grandmother out of money she needs for a surgery like an antisocial personality might, but if their grandmother offered that money to them, they’d take it with no hesitation and no reflection about how it would impact their grandmother. Another example would be the person who steps on coworkers with no regard for others’ needs/accomplishments in order to get a promotion. Yikes!

Unempathetic: Narcissistic Personality Disorder (Criterion 7)

Those with narcissistic personality disorder cannot handle any of their own flaws, imperfections, or “badness,” so they split it off (denial) and/or put it on someone else (projection). They can be completely oblivious to the hurtfulness of their comments, and they can come across as emotionally cold. Interestingly, research has found that those with narcissistic personality disorder have decreased emotional empathy, but not cognitive empathy³. In other words, they might mentally be able to understand empathy, but they don’t feel it…like an emotional blindness. When they do mentally understand a situation requiring empathy, they often view others’ needs as weak or vulnerable. Obviously, this isn’t good for connecting to others and having meaningful relationships.

Envious: Narcissistic Personality Disorder (Criterion 8)

With this condition, there is an intense desire for any status that others have like achievement, privilege, possessions, or successes, because they believe they’re special and entitled to it. Sometimes this can even be an obsession. Also, if someone else has something they envy, those with narcissistic personality disorder will tear the other person down. For example, if their coworker gets employee of the month instead of them, they might spread a rumor about their coworker. Again, this reminds me of a child who wants another child’s toy and throws a tantrum.

Arrogance: Narcissistic Personality Disorder (Criterion 9)

Those with narcissistic personality disorder often come across as patronizing or snobby. In their thoughts and interactions with others, there is likely to be high contempt, pettiness, and disdain. It’s a “me vs. them” attitude, where they view others as beneath them, much like Regina from Mean Girls: “My Name Is Regina George. I am a Big Deal. You can only wear pink on Tuesdays, because I say so.”

I personally believe any of these criteria can show up in any personality disorder, but remember, FIVE or more are needed for an actual diagnosis of narcissistic personality disorder.

If you are having a hard time navigating your relationship with someone who meets this description, seek out professional help! You can look on Psychology Today, or if you’re in Virginia or Pennsylvania, check out our private practice, Quest Psychological and Counseling Services for available services.

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