How to Diagnose Narcissistic Personality Disorder

Co-authored by Trudi Griffin, LPC, MS

Last Updated: December 31, 2022 References

Narcissistic personality disorder is a mental disorder that is characterized by an excessive sense of self-worth and a lack of empathy for others. Many people who have the disorder actually have very low self-esteem, but hide this behind their inflated egos.^{[1]
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Mayo Clinic
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Go to source} You may be able to recognize many of the symptoms of narcissistic personality disorder on your own, although it can be challenging to distinguish this condition from other personality disorders. If you believe that you or someone you know has narcissistic personality disorder, it's best to see a professional for a diagnosis and treatment.

Part 1

Part 1 of 3:

Recognizing Symptoms of Narcissistic Personality Disorder

1
Look for extreme self-importance. People with narcissistic personality disorder think very highly of themselves in a way that crosses over the line of normal self-confidence. If you suspect that someone you know has this disorder, pay attention to how the person seems to think about themselves and whether these feelings are grounded in reality.^{[2]
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- The person may have obsessive fantasies about their own greatness.
- The person may lie about or exaggerate achievements in order to seem more accomplished.
- The person may believe that they are superior to others, even if no facts or accomplishments back this up.
- The person may also assume that others are jealous of this superiority, and may exhibit extreme jealousy when other people experience success.
2
Watch for entitlement. Because people with narcissistic personality disorder tend to think they are superior to other people, they also tend to believe that they deserve the best of everything. Pay attention to whether the person seems to believe they are entitled to special treatment for no apparent reason. ^{[3]
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Mayo Clinic
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- The person may also believe that they deserve to be in the company of other "elite" individuals.
- The person may also make frequent demands and expect other people to respond without question.
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3
Observe the need for admiration. Many people with narcissistic personality disorder are very needy. They feel the need to be recognized and praised for their superiority constantly.^{[4]
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- You may notice that the person constantly points out achievements.
- The person may also fish for compliments.
4
Take note of hyper-critical tendencies. People with narcissistic personality disorder may seem hyper-critical of everyone around them. They may often insult or critique people who they come in contact with, whether that person is a waiter at a restaurant or the person's doctor.^{[5]
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- The person may criticize even competent people, especially if they disagree with or challenge the person.
5
Observe interactions with other people. People with narcissistic personality disorder do not interact with other people in a normal way, so pay careful attention to the person's behavior in social settings. The person may often come across as arrogant and lacking in empathy.^{[6]
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- The person may frequently manipulate or take advantage of others for personal benefit.
- The person may seem completely oblivious of other people's needs and feelings.
6
Notice reactions to criticism. People who have narcissistic personality disorder do not handle criticism well because it challenges their feelings of superiority. Take note of whether the person seems to react in an extreme manner to even the most minor criticism.^{[7]
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Mayo Clinic
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- The person may lash out at people who offer criticism.
- Alternatively, the person may become very depressed when faced with criticism.
- For some people, this may extend to an inability to handle anything that might be perceived as a challenge, even something as simple as a differing opinion.^{[8]
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Part 2

Part 2 of 3:

Understanding Other Possible Causes of Narcissistic Characteristics

1
Distinguish narcissistic tendencies from a personality disorder. Not everyone who displays narcissistic traits has narcissistic personality disorder. Some people are simply selfish and have big egos, so be careful about over-diagnosing.
- In order for a person to be diagnosed with narcissistic personality disorder, symptoms must interfere with basic functioning in at least two of the following areas: cognition, affect, interpersonal functioning, or impulse control.^{[9]
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- A professional diagnosis is needed to confirm whether a person has narcissistic personality disorder or just narcissistic traits.
2
Consider the possibility of borderline personality disorder. Borderline personality disorder is often confused with narcissistic personality disorder. The two share many of the same symptoms, so it's important to understand the subtle differences.^{[10]
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- People with both disorders may display anger, but people with narcissistic personality disorder tend to display anger towards others, while people with borderline personality disorder tend to express anger towards themselves.
- People with borderline personality disorder may care more about other people's concerns and opinions than people with narcissistic personality disorder, although they are still unlikely to interact with others in a normal and healthy way.
- It is possible for one individual to have both narcissistic personality disorder and borderline personality disorder, which may further complicate the diagnosis.
3
Recognize the possibility of antisocial personality disorder. Antisocial personality disorder, also known as sociopathic personality disorder, is also commonly confused with narcissistic personality disorder because people with both disorders tend to display a general disregard for other people. There are, however, some symptoms that distinguish the two disorders from one another.^{[11]
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- People with antisocial personality disorder tend to have a harder time controlling impulses than people with narcissistic personality disorder. As a result, they are often more aggressive and/or self-destructive.
- People with antisocial personality disorder also tend to be more intentionally manipulative and deceitful than people with narcissistic personality disorder.

Part 3

Part 3 of 3:

Getting a Professional Diagnosis

1
Understand who is affected. Narcissistic personality disorder affects approximately 6% of the population. Anyone can be affected, but symptoms of the disorder are more common in certain individuals.^{[12]
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- Males are more likely to have narcissistic personality disorder than females.
- Because the symptoms of personality disorders tend to decrease as a person ages, narcissistic personality disorder is typically more noticeable in younger people.
2
Get a physical examination. If you suspect that you might have a personality disorder, it's a good idea to see your doctor for a complete physical exam. This can help rule out the possibility of any physical illnesses that may be contributing to your symptoms.^{[13]
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- Your doctor will probably want to do blood tests as well.
3
See a mental health professional. In order to confirm a diagnosis of narcissistic personality disorder, the individual must be seen by a mental health professional, such as a psychiatrist or psychologist. A general practitioner can refer you to a mental health specialist, but will not be able to make the diagnosis.^{[14]
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- The diagnosis process will involve a complete psychological evaluation. Questionnaires are sometimes used to understand the person's state-of-mind.^{[15]
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- As with many mental health disorders, there is no laboratory test that can be used to diagnose narcissistic personality disorder. A trained mental health professional must analyze the person's symptoms and history in order to make a diagnosis.
4
Get treatment. Once a person has been officially diagnosed with narcissistic personality disorder, they can receive treatment. Most often, this is psychotherapy, which helps to teach the person how to interact with people in a healthy way and how to manage their expectations.^{[16]
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Mayo Clinic
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- Treatment for narcissistic personality disorder is a lengthy process. The person may require years of therapy.
- In some cases, medications may also be prescribed to help the person combat symptoms such as anxiety or depression.