Narcissistic Personality Disorder
Basics
Description
- A personality disorder (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. Narcissistic personality disorder (NPD) is a cluster B PD, a group which includes antisocial PD, histrionic PD, and borderline PD. Patients with cluster B PDs commonly exhibit problems with impulse control and emotional regulation.
- Patients with NPD exhibit a pattern of grandiosity, need for admiration/validation, and lack of empathy. These behaviors typically present by early adulthood and persist in multiple environments (1)[C].
- 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, attention seeking, and grandiosity (may be externalized or internalized).
- Controversy over diagnostic criteria and possible subtypes of NPD continue to exist.
Epidemiology
- Onset usually in early adulthood (1)
- More common in males than females (2)
- Can still exist at older ages, although less common
Prevalence
- Point prevalence in adult population 0.0–6.2%; mean prevalence 1.1% (3)
Etiology and Pathophysiology
Commonly Associated Conditions
- Mood and/or anxiety disorders
- Substance use (especially cocaine use)
- Anorexia nervosa
- Bipolar disorder or hypomania
- Depression/dysthymia
- Obsessive-compulsive disorder
- Self-harm behaviors
- Other PDs, including histrionic, borderline, antisocial, and paranoid PDs
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Citation
Domino, Frank J., et al., editors. "Narcissistic Personality Disorder." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816053/all/Narcissistic_Personality_Disorder.
Narcissistic Personality Disorder. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816053/all/Narcissistic_Personality_Disorder. Accessed December 6, 2024.
Narcissistic Personality Disorder. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816053/all/Narcissistic_Personality_Disorder
Narcissistic Personality Disorder [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 December 06]. 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
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T1 - Narcissistic Personality Disorder
ID - 816053
ED - Domino,Frank J,
ED - Baldor,Robert A,
ED - Golding,Jeremy,
ED - Stephens,Mark B,
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 - 33
DB - Medicine Central
DP - Unbound Medicine
ER -