Narcissistic Personality Disorder
Cluster B. Dramatic / Emotional / Erratic · Table 8.2 [1]
Pervasive grandiosity, need for admiration, and lack of empathy; self-esteem dependent on external validation.
Characteristics (Table 8.2) [1]
| Triggering Event(s) | Evaluation of self |
|---|---|
| Behavioral Style |
|
| Interpersonal Style |
|
| Cognitive Style |
|
| Affective Style |
|
| Temperament |
|
| Attachment Style | Fearful and dismissing |
| Parental Injunction | Grew up charged with becoming extraordinary to satisfy a parent's needs. |
| Self-View | Considers the self exceptional and one of a kind, deserving of extraordinary privileges regardless of whether they have been earned. |
| World-View | Treats the world as a spread laid out for the taking and assumes others owe them admiration and privilege, so expects and insists on special treatment. |
| Maladaptive Schemas |
|
| Optimal Diagnostic Criterion | Carries an inflated, grandiose sense of their own importance. |
DSM diagnostic criteria
A far-reaching pattern of grandiosity, in fantasy or in action, alongside a hunger for admiration and an absence of empathy, present from early adulthood.
- An inflated sense of self-importance, overstating accomplishments and abilities.
- Absorbed in daydreams of boundless success, power, brilliance, beauty, or perfect love.
- Holds that they are so special they can be understood only by other high-status or exceptional people.
- Craves a steady stream of admiration.
- Assumes they are entitled to favorable treatment.
- Uses others to serve their own ends.
- Shows little empathy, unwilling to notice or share in others' feelings.
- Frequently envies others or is convinced that others envy them.
- Carries themselves with arrogance and a haughty attitude.
- Antisocial PD (exploitation with criminality and impulsive aggression)
- Histrionic PD (attention for approval rather than to confirm superiority)
- Borderline PD (instability driven by abandonment rather than self-esteem)
- Hypomania (episodic grandiosity)
Treatment
- Build tolerance for ordinary self-esteem injuries without rage or collapse
- Develop empathy and more mutual relationships
- Address the depression/emptiness underlying the grandiose façade
Balance empathic attunement to the vulnerable self with tactful confrontation of grandiosity and entitlement. Anticipate and contain narcissistic rage and devaluation of the therapist; treat ruptures as central therapeutic material rather than failures.
- Psychodynamic / transference-focused psychotherapy
- Schema therapy
- Cognitive therapy targeting entitlement and unrelenting standards
- Empathic mirroring of the vulnerable self before confronting grandiosity.
- Tactful, well-timed confrontation of entitlement and exploitation.
- Repair work after narcissistic injury and devaluation in the relationship.
- Behavioral practice of perspective-taking and empathy.
- Devaluation of the therapist; narcissistic rage at perceived criticism
- Treatment often sought only after an injury (job loss, divorce), then dropped
- Difficulty acknowledging vulnerability or need
Guarded to fair; engagement and the management of ruptures are pivotal. Sustained work can soften entitlement and improve relationships.
Practise this presentation
For training only. Diagnostic criteria are summarised, consult the full sources [1,2] for the complete text; see References. Not a substitute for supervised clinical assessment.