Narcissistic Personality Disorder: DSM-5 Criteria And Treatment Options

Reviewed by Whitney White, MS CMHC, NCC., LPC

Published 12/10/2020

A narcissistic personality disorder is one of several personality disorders that people can be diagnosed with, and it involves some features such as arrogance, lack of empathy, and self-centeredness. This article will cover the DSM-5 criteria that are used to diagnose people with narcissistic personality disorder and what can be done to help people with the condition.

What Is Narcissistic Personality Disorder DSM 5 Criteria?

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You may have heard of the word narcissistic more than once in your life, and perhaps it was used to describe an individual that seemed that they frequently wanted to be the center of attention or were boastful at times.

Narcissistic personality disorder can involve these types of traits; however, they tend to be much more severe and, importantly, negatively affect their ability to function properly.

An individual with this personality disorder will typically have an extremely high or exaggerated sense of self-importance, a strong desire to be admired virtually at all times, and struggle to have empathy for others.

However, behind the grandiose feelings, sense of superiority, and excessive confidence is a fragile ego that can be easily damaged by criticism. Individuals can also become very envious if others receive praise and validation.

As a rebuttal, it’s common for people with a narcissistic personality disorder to try to belittle and put down others to inflate their own self-esteem. These individuals also tend to put their thoughts, feelings, and needs above all other people and completely disregard what others might say or feel.

Because of these issues, people who have narcissistic personality disorder will struggle in many life areas, especially interpersonal relationships.

The Narcissistic Personality Disorder DSM-5 Criteria

Below, you will find the criteria found in the Diagnostic and Statistical Manual 5th edition that issued to diagnose narcissistic personality disorder: [1]

The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and pathological personality traits.

To diagnose a narcissistic personality disorder, the following criteria must be met:

A. Significant impairments in personality functioning manifest by:

  1. Impairments in self-functioning (a or b):

a. Identity: Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal may be inflated or deflated, or vacillate between extremes; emotional regulation mirrors fluctuations in self-esteem.

b. Self-direction: Goal-setting is based on gaining approval from others; personal standards are unreasonably high to see oneself as exceptional or too low based on a sense of entitlement, often unaware of their own motivations.

  1. Impairments in interpersonal functioning (a or b):

a. Empathy: Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimate of own effect on others.

b. Intimacy: Relationships largely superficial and exist to serve self-esteem regulation; mutuality constrained by little genuine interest in others‟ experiences and predominance of a need for personal gain

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B. Pathological personality traits in the following domain:

  1. Antagonism, characterized by:

a. Grandiosity: Feelings of entitlement, either overt or covert self-centeredness; firmly holding to the belief that one is better than others, condescending toward others.

b. Attention seeking: Excessive attempts to attract and be the focus of the attention of others; admiration seeking.

C. The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations.

D. The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or socio-cultural environment.

E. The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

What Are The 9 Narcissistic Personality Disorder DSM 5 Criteria or Traits?

In addition to the criteria mentioned above, the DSM-5 narcissism guidelines also point out nine different features of narcissistic personality disorder that professionals should look for when diagnosing the condition: [2]

  1. Inflated self-esteem or a grandiose sense of self-importance or superiority
  2. Craving admiration
  3. Exploitative relationships (i.e., manipulation)
  4. Little to no empathy
  5. Identity is easily disturbed (i.e., can’t handle criticism)
  6. Lack of attachment and intimacy
  7. Feelings of depression or emptiness when not validated
  8. A sense of entitlement
  9. Can feel like others are envious of them, or may envy others

An individual must have at least five out of nine of these traits, many of which can start appearing at a young age. In the next section, you will learn more about some of the possible causes of narcissistic personality disorder.

What Causes Narcissistic Personality Disorder?

Like most mental health conditions, the exact causes are unknown, and personality disorders are especially complex, and their development can be influenced by various factors.

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Environmental ones, especially a person’s upbringing, can play a role in narcissistic personality disorder; for example, being excessively praised or overvalued by parents, peers, or teachers can lead to an inflated sense of self-importance and arrogance seen in the disorder.

On the other hand, abuse, neglect, and criticism can also be a contributor too, and this may lead to the attention-seeking behaviors that are characteristic of narcissistic personality disorder.

Like manipulation and a lack of empathy for others, certain behaviors can also be learned from those around them early on in life. Unfortunately, it can reinforce the personality disorder because it can result in the individual getting what they want.

Genetics and neurobiology can also be important when it comes to the development of narcissistic personality disorder. Some characteristics can be inherited, and changes or differences in brain chemistry can lead to the condition's formation.

Treating Narcissistic Personality Disorder DSM 5 Criteria

A narcissistic personality disorder is one of the most difficult mental health conditions to treat because many people with the disorder feel that they don’t have a problem, even though it causes them distress and impairs their ability to function.

Therefore, most NPD people don’t seek out help, and the condition will continue to persist.

However, if someone does try to find assistance, it’s often due to coexisting issues often seen alongside narcissistic personality disorder, such as depression, anxiety, bipolar disorder, or substance abuse. [3]

Medication will often be prescribed to help manage the symptoms of these other conditions. Still, there aren’t any medications recommended to treat NPD, and instead, psychotherapy is the primary treatment for NPD.

With narcissistic personality disorder, individuals have a distorted sense of themselves, and their actions and motivations are often contradictory.

While people will have traits such as a grandiose or inflated sense of self-importance, a belief that they are special, and display other arrogant behaviors, it’s a coping mechanism for their insecurities. They are used to try to mask their self-doubt. [4]

To try to satisfy this, it’s also why they will crave attention and validation from others, and if they don’t receive it, they may become hostile or vindictive.

Therapy will attempt to replace the distorted thinking patterns and behaviors with more positive and realistic ones and teach individuals with narcissistic personality disorder more productive and effective ways of coping instead of resorting to attention-seeking and other damaging behaviors for relief.

Therapists who work with people with narcissistic personality disorder must be extra careful not to criticize the individual since people with the condition are often resistant to treatment at first.

Over time, trust and rapport must be built for progress to be made, and eventually, they can realize that they can make significant progress if they cooperate with their therapist and what advice they have to offer.

How To Get Diagnosed With Narcissistic Personality Disorder DSM 5 Criteria

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Personality disorders require a careful diagnosis from a mental health professional by following the narcissistic personality disorder criteria.

However, as mentioned in the previous section, it’s challenging for people with a narcissistic personality disorder to reach out for help because they don’t believe there is an issue or don’t recognize that their symptoms are what is causing problems in their lives.

If you or a loved you show the signs and symptoms of NPD, it is recommended that you find a licensed mental health professional as soon as possible who can diagnose you and help you get on track to recovery.

Additionally, you can take this narcissistic personality disorder test to see where you stand. This brief test is completely free, and the results may be able to give you the confidence you need to get started with treatment. This test isn’t diagnostic, but can shed light on symptoms and help you discuss things with your mental health professional.

Conclusion: Narcissistic Personality Disorder DSM 5 Criteria

Despite the challenges that narcissistic personality disorder creates, it can be addressed. With the right resources, people can learn how to cope, mend their relationships with others, and have happy, healthy, and successful lives.

References

  1. DSM-IV and DSM-5 Criteria for Personality Disorders. American Psychiatric Association. (2012.). [PDF]. American Psychiatric Association. Retrieved from http://www.nyu.edu/gsas/dept/philo/courses/materials/Narc.Pers.DSM.pdf
  2. Cunha, J. P. (2020, August 10). What Are the Nine Traits of a Narcissist? Retrieved from https://www.emedicinehealth.com/what_are_the_nine_traits_of_a_narcissist/article_em.htm
  3. Mayo Clinic Staff. (2017, November 18). Narcissistic personality disorder. Retrieved from https://www.mayoclinic.org/diseases-conditions/narcissistic-personality-disorder/symptoms-causes/syc-20366662