What Is Narcissistic Personality Disorder?

Narcissistic Personality Disorder (NPD) is a condition marked by a pattern of grandiosity, fixation on power fantasies, desire for admiration, arrogance, lack of empathy, and envy. Individuals with NPD may be overly sensitive to criticism, though they may hide their fragile self-esteem behind a self-important exterior.

NPD is the second most prevalent personality disorder, affecting about 6.2% of the population1. It is one of ten personality disorders listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Along with histrionic, antisocial, and borderline personality disorders, NPD is a Cluster B disorder, which causes affected individuals to appear erratic, emotional, or dramatic.

Narcissistic Personality Disorder: Symptoms

Though symptoms may manifest in different ways, people with NPD experience at least five of the following:

• Inflated sense of self-importance
• Preoccupation with fantasies of power, beauty, or ideal love
• The belief that they are unique and should only associate with other special or high-status people and institutions
• Requires admiration
• Unreasonable entitlement
• Takes advantage of others
• Lacks empathy
• Envious of others, or believing that others are envious of them
• Arrogant behaviours or attitudes

Narcissistic Personality Disorder: Other Signs

Though the DSM symptoms are used to diagnose NPD, the following associated features may help clinicians support a diagnosis. These can include:

• Low self-esteem. Despite their outwardly arrogant presentation, people with NPD often have low self-esteem. They are vulnerable to injuries to their egos and may become angry or humiliated.
• Unwillingness to engage in potentially humiliating tasks. Because of their low self-esteem, people with NPD are hesitant to struggle publicly.
• Eating disorders. Because some people with NPD rely on external validation, they are susceptible to developing eating disorders to increase their perceived self-worth.
• Substance abuse. Though there is an established link between substance use disorder and NPD, there is no consensus on a specific cause. There are likely varied reasons that people with NPD develop substance use disorders.

Grandiose vs Vulnerable Narcissism

Though both the DSM-5 and popular ideas of narcissism centre on open arrogance, NPD researchers identify two different subgroups: grandiose and vulnerable.

Grandiose narcissism is the familiar self-important expression of narcissism. Grandiose narcissists will be more likely to display narcissistic traits such as:

• Entitlement
• Manipulation of others
• Overt arrogance
• Aggression
• Anger/Rage

Vulnerable narcissism is a less understood aspect of narcissism, but one that research is beginning to consider. Vulnerable narcissism is covert narcissism, as many symptoms are not readily visible to outside observers. Vulnerable narcissists do not have grandiose self-esteem and are sensitive to rejection or criticism. Though vulnerable narcissists do still have grandiose fantasies and believe they are somehow “special,” they display different symptoms, such as:

• Shyness
• Shame
• Few meaningful relationships due to fear of rejection
• Hyper-vigilance
• Need for outside approval
• Low self-esteem