Narcissistic Personality Disorder (NPD) is a complex mental health condition characterized by a pervasive pattern of grandiosity, need for admiration, and a lack of empathy, as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (American Psychiatric Association, 2013). Though no blood tests or MRIs can confirm it, diagnosis is based on observed behavior and a combination of traits—only five out of nine DSM-5 criteria are required for a diagnosis.
1. Superiority and Entitlement
A key trait of NPD is a belief in one’s superiority. Narcissists often see the world through a rigid hierarchy, placing themselves at the top. This mindset leads to controlling behaviors and unrealistic expectations of others. Interestingly, those with covert narcissism may seek superiority by portraying themselves as the most wronged or most ill, expecting constant sympathy and special treatment (Pincus & Lukowitsky, 2010).
2. Need for Admiration and Attention
Narcissists crave constant attention and validation, often engaging in behaviors to keep the spotlight on themselves. However, this validation is never enough due to underlying insecurity. Praise may be temporarily uplifting but quickly loses value, leading to a constant cycle of seeking more affirmation (Miller et al., 2017).
3. Perfectionism
People with NPD often exhibit perfectionistic tendencies. They expect themselves and others to be flawless, creating unrealistic standards that leave them chronically dissatisfied. This perfectionism is often used as a mechanism to mask their inner vulnerability and maintain control (Ronningstam, 2005).
4. Control Issues
Narcissists have a strong need to control situations and people. They may manipulate or micromanage others to align reality with their internal narrative. When others deviate from their expectations, narcissists may react with anger, confusion, or contempt (Campbell & Foster, 2007).
5. Blaming and Lack of Responsibility
Despite their desire for control, narcissists deflect responsibility when things go wrong. Blame is often assigned to others, especially those closest to them. This helps preserve their self-image and avoid feelings of failure or shame (Cain et al., 2008).
6. Lack of Boundaries
Those with NPD struggle to respect others’ boundaries. They may see others as extensions of themselves, frequently violating emotional, physical, or conversational limits. This sense of entitlement can lead to manipulative behavior aimed at fulfilling their own needs (Gabbard, 1989).
7. Lack of Empathy
A hallmark trait of NPD is an impaired ability to empathize. Narcissists often disregard or minimize others’ emotions, believing everyone feels and thinks as they do. They may appear cold or unremorseful, even when their actions cause harm (American Psychiatric Association, 2013).
8. Perceiving Threats and Emotional Misreading
Narcissists are often hypervigilant to perceived threats or slights. They misread facial expressions and tones, frequently interpreting neutral or supportive cues as criticism or rejection. This emotional misreading leads to defensive or aggressive responses (Domes et al., 2014).
9. Emotional Reasoning
Rather than relying on logic, narcissists make decisions based on emotional impulses. Their feelings—especially negative ones—are externalized, often blaming others for their emotional states. They also look to external solutions (e.g., new relationships or purchases) to resolve inner discomfort (Miller et al., 2017).
10. Splitting
Narcissists view people and situations in extremes: all good or all bad. They deny personal faults while attributing blame to others, making balanced, nuanced understanding nearly impossible. This black-and-white thinking makes genuine emotional connection difficult (Linehan, 1993).
11. Fear of Rejection
Beneath their grandiosity lies a deep fear of rejection or exposure. Narcissists are often driven by anxiety about being “found out” or abandoned. Intimacy threatens their carefully curated self-image, leading them to test loved ones’ loyalty through escalating behaviors (Ronningstam, 2005).
12. Chronic Anxiety
Narcissists often struggle with free-floating anxiety, though they may hide or project it onto others. By blaming or criticizing close loved ones, they deflect internal tension and regain a sense of superiority or control (Miller et al., 2010).
New Dimensions Can Help
If you or someone you know is struggling with narcissistic personality disorder, New Dimensions can help. New Dimensions offers programs for adolescents and adults and has locations in The Woodlands, Katy, and the Clear Lake areas of Houston. We also offer online treatment programs for adults who reside within the State of Texas. To learn more about our Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs (IOP), contact us at 800-685-9796 or go to our website: www.nddtreatment.com.
References:
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
- Cain, N. M., Pincus, A. L., & Ansell, E. B. (2008). Narcissism at the crossroads: Phenotypic description of pathological narcissism across clinical theory, social/personality psychology, and psychiatric diagnosis. Clinical Psychology Review, 28(4), 638-656.
- Campbell, W. K., & Foster, C. A. (2007). The narcissistic self: Background, an extended agency model, and ongoing controversies. Self and Identity, 6(2-3), 219–232.
- Domes, G., Schulze, L., & Herpertz, S. C. (2014). Emotion recognition in borderline personality disorder—a review of the literature. Journal of Personality Disorders, 28(1), 91–110.
- Gabbard, G. O. (1989). Two subtypes of narcissistic personality disorder. Bulletin of the Menninger Clinic, 53(6), 527-532.
- Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder.
- Miller, J. D., Campbell, W. K., & Pilkonis, P. A. (2007). Narcissistic personality disorder: Relations with distress and functional impairment. Comprehensive Psychiatry, 48(2), 170–177.
- Pincus, A. L., & Lukowitsky, M. R. (2010). Pathological narcissism and narcissistic personality disorder. Annual Review of Clinical Psychology, 6, 421–446.
- Ronningstam, E. (2005). Identifying and understanding the narcissistic personality. Oxford University Press.