There is a lot of debate and discussion in society about narcissism, and confusion about when it is a personality trait versus when it is a psychiatric disorder. Knowing the diagnostic criteria for narcissistic personality disorder can help you make sense of discourse about narcissism, and help you know when to encourage someone you care about (who may have the disorder) to seek help from a therapist.
The Diagnostic and Statistical Manual-V (DSM-V) of mental disorders by the American Psychiatric Association defines someone with narcissistic personality disorder as exhibiting a pattern of grandiose, admiration-seeking and low empathy attitudes and behaviours. That is in a variety of contexts with other people and can include how they think and what they daydream about. The disorder is said to begin in early adulthood and defined by the DSM-V as when a person has five or more symptoms from the following list.
Symptom 1: A person with narcissistic personality disorder has a sense of grandiose self-importance. They tend to exaggerate their accomplishments and expect that other people think of them and treat them as a superior human being.
Symptom 2: A person with narcissistic personality disorder tends to be preoccupied with fantasies of being a brilliant, powerful, successful, highly attractive or worthy of perfect romantic love. They may spend a lot of time talking about it, behaving like it, or daydreaming about it.
Symptom 3: A person with narcissistic personality disorder tends to believe that they are special and unique. They believe they can only be friends with, date or associate with people who are special and have a high social status. They might discard people who they feel are not “worthy” of their time because of arbitrary reasons like how someone speaks, dresses, or where they went to school.
Symptom 4: A person with narcissistic personality disorder tends to require an excessive amount of admiration from other people. They might get angry, upset or spiteful if they feel ignored or if they feel that someone is not recognising their “grandeur.”
Symptom 5: A person with narcissistic personality disorder has a sense of entitlement in life. For example, they tend to have unrealistic expectations in social situations by expecting that other people will show favouritism towards them or be compliant with their expectations.
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Symptom 6: A person with narcissistic personality disorder tends to be exploitative of other people, such as taking advantage of them to meet their own goals. They might take advantage of other people’s time, money, ideas, or feelings without regret.
Symptom 7: A person with narcissistic personality disorder tends to lack empathy and is unwilling to acknowledge other people’s feelings or needs. They tend not to see their attitudes or behaviours as a problem, and they tend to be oblivious to other people’s distress.
Symptom 8: A person with narcissistic personality disorder tends to think that other people envy them and they are also usually quite envious about who other people are or what they have. They might treat the objects of their envy quite viciously or try and destroy their reputation in the hope of bettering their own.
Symptom 9: A person with narcissistic personality disorder tends to be quite arrogant in their behaviour and attitude towards other people. They might lack etiquette (decorum) in being impolite or obnoxious in what they say or how they act.
The DSM-V does not list these symptoms in a specific order which means that someone with narcissistic personality disorder can exhibit any five or more of the above symptoms in any order of prominence or occurrence. It is a very difficult disorder to diagnose and treat because people with psychopathological narcissism often lack the insight needed to recognise that their personality is causing problems.
The disorder is classified by the DSM-V as a cluster B disorder together with disorders such as antisocial personality disorder, borderline personality disorder and histrionic personality disorder but this does not mean that someone with narcissistic personality disorder has these other disorders.
In understanding what is a narcissistic personality trait versus what is a narcissistic personality disorder, it is important to consider the extent to which a person’s attitudes or behaviours are mirrored in most areas of their life. They will be narcissistic in most areas of their life. For example, a person with narcissistic personality disorder will experience significant impairments in their relationships with different kinds of people be they romantic partners, friends, workmates, strangers or family members. The disorder can often cause problems in relationships because people with it can tend to get angry, confrontational, vengeful or spiteful if they feel that other people are not giving them the admiration they feel entitled to. They might turn against a romantic partner who does not revere them or agree that they brilliant, powerful or successful.
In workplaces, people with narcissistic personality disorder can be bullies who tend to take credit for other people’s work, boast about themselves at every opportunity, exploit work colleagues’ ideas or efforts for their own benefit, and do things that upset and distress other people. They may lack empathy for work colleagues who are ill or suffering and be people
A person with narcissistic personality disorder is likely to show a lack of empathy in different domains in life – from lacking empathy with romantic partners, family, friends or strangers to lacking empathy with animals or nature. They may be someone who enjoys hurting people or show little sympathy or understanding when other people are upset.
Additionally, the extent to which narcissism significantly impairs a person’s ability to function healthily in life is an important consideration in determining whether it is a personality trait or a personality disorder.
For example, if narcissistic personality traits persistently prevent someone from having normal, healthy relationships with other people because of arguments, conflicts or drama related to narcissism, then their personality is psychopathological in that it is severely dysfunctional. It is something that is significantly impairing their functioning in social settings and is a clinical concern.
A person’s insight is also important. Someone who easily recognises that their personality traits are causing conflict and is willing to seek help might have a narcissistic personality but not necessarily a disorder.
Diagnosing any psychiatric disorder requires clinical training and it is not appropriate for someone who is not clinically trained to try and use the DSM-V to diagnose themselves or other people with narcissistic personality disorder. However, knowing what it is can be useful in helping you know when to seek help or when to encourage someone you care about (who might have the disorder) to seek help from a therapist.
