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Narcissistic Personality Disorder

Narcissistic Personality Disorder is a topic covered in the 5-Minute Clinical Consult.

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  • Narcissistic personality disorder (NPD) is a cluster B personality disorder (PD), which is rooted in problems with impulse control and emotional regulation. This group also includes antisocial PD, histrionic PD, and borderline PD. A PD is defined as an enduring pattern of inner experience and behavior that causes dysfunction, is inflexible, persists across multiple situations, and leads to clinically significant distress or impairment in functioning.
  • NPD is defined as a pervasive pattern of grandiosity, need for admiration, and lack of empathy. These behaviors must be inflexible, maladaptive, and persistent; typically begins by early adulthood and persists in a variety of contexts
  • Diagnostic criteria according to section II of the DSM-5 (must meet five or more of the following):
    • Grandiose sense of self-importance
    • Obsessed with fantasies of unlimited achievement or success, beauty, love
    • Believes they are “special” and should only associate with other high-status people or institutions
    • Requires excessive admiration
    • Has a sense of entitlement or has unreasonable expectations for favorable treatment
    • Is interpersonally exploitative, often takes advantage of others to achieve personal success
    • Lacks empathy toward others
    • Is often envious of others or believes others are envious of him or her
    • Shows arrogant, haughty behaviors or attitudes
  • Alternative DSM-5 model for PDs (section III) defines PD by specific criteria of impairments of personality functioning and pathologic personality traits. Specific PDs may then be diagnosed based on traits.
    • Typical features of NPD in this model include vulnerable and variable self-esteem and attempts to regulate self-esteem, thought approval and attention-seeking, and grandiosity (may be externalized or internalized).
    • Controversy over diagnostic criteria and possible subtypes of NPD continue to exist.


  • Onset usually in early adulthood
  • More common in males than females
  • Can still exist at older ages, although less common

  • Point prevalence in adult population 0.0–6.2%; mean prevalence 1.1% (1)
  • Most prevalence statistics are obtained via self-reported inventories, which may underestimate true prevalence (2).

Etiology and Pathophysiology

  • Current DSM-5 definition supports pathologic central grandiosity, with core dysfunction rooted in managing needs for validation and admiration (3).
  • Multiple twin studies show a relatively high heritability rate among PDs of 25–71% (4).

Commonly Associated Conditions

  • Mood and/or anxiety disorders
  • Substance abuse (especially cocaine abuse)
  • Anorexia nervosa
  • Bipolar disorder or hypomania
  • Depression/dysthymia
  • Obsessive-compulsive disorder
  • Substance abuse
  • Self-harm behaviors
  • Other PDs, including histrionic, borderline, antisocial, and paranoid PDs

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Stephens, Mark B., et al., editors. "Narcissistic Personality Disorder." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816053/all/Narcissistic_Personality_Disorder.
Narcissistic Personality Disorder. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816053/all/Narcissistic_Personality_Disorder. Accessed April 25, 2019.
Narcissistic Personality Disorder. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816053/all/Narcissistic_Personality_Disorder
Narcissistic Personality Disorder [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 25]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816053/all/Narcissistic_Personality_Disorder.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Narcissistic Personality Disorder ID - 816053 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816053/all/Narcissistic_Personality_Disorder PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -