Narcissistic personality disorder (NPD) is 1 of 10 clinically recognized personality disorders. Though NPD is only one official diagnosis, doctors further classify the condition into 2 types.

Healthcare professionals use the term “narcissism” to describe a focus or preoccupation with oneself or one’s own needs or wants. Someone who has narcissism may have an inflated sense of their own importance and may have a lack of empathy for others.

Narcissistic personality disorder (NPD) is 1 of the 10 types of personality disorders defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR). Read on for more information about the 2 types of NDP.

The DSM-5-TR, published by the American Psychiatric Association (APA), lists NPD as a single disorder. However, experts generally accept that two subtypes of narcissism exist: grandiose and vulnerable. Both types may be present in one individual.

These types share many core features, including:

  • self-centeredness
  • entitlement
  • lack of empathy for others

These traits can appear in different ways depending on the type of narcissism.

Grandiose narcissism is also referred to as overt narcissism. It’s generally what comes to mind for many people when they think about narcissism.

Some of the characteristics of grandiose narcissism may include:

  • extroversion
  • high self-esteem
  • a bold or dominant personality
  • arrogance, pretension, or charm
  • an overestimation of capabilities
  • thoughts of being perfect or superior
  • attention-seeking or exhibitionist behaviors
  • aggressiveness
  • a tendency toward exploitative behavior

Individuals with grandiose narcissism generally enjoy being admired and seek to reinforce positive perceptions of themselves and their abilities.

They may deny or reject information that conflicts with their perception of themselves. They may also aggressively seek to assert dominance or superiority in settings like work or school or in their relationships. This may especially happen when they feel there is a threat to their status or image.

Vulnerable narcissism, also called covert narcissism, may include the following characteristics:

Vulnerable narcissism is more internalized than grandiose narcissism. An individual may appear shy or reserved, yet they may have internal feelings of superiority or entitlement.

They may seek admiration in less obvious ways, such as being negative or putting themselves down to solicit admiration from others to bolster their own feelings of self-worth.

Individuals with vulnerable narcissism can also be very sensitive to any perceived slights or criticisms. They may frequently compare themselves with others. As a result, they may display envy or schadenfreude (feeling secretly happy at other’s misfortune).

People with vulnerable narcissism may be more likely to lash out in a narcissistic rage. This can be due to the fact that they may have lower self-esteem than people with grandiose narcissism, resulting in anger or aggression.

Diagnosis of NPD involves both a physical and psychological evaluation. No specific laboratory tests can diagnose personality disorders.

It’s important to note that the features of NPD are similar to those of other personality disorders. Because of this, it’s possible to receive a diagnosis of more than one personality disorder.

A physical examination can help rule out physical causes of your symptoms. A psychological evaluation can also help. This is when a professional will perform a comprehensive exploration of your personality through your history, questionnaires, and performance-based instruments.

Assessing narcissistic traits or NPD is a complex diagnostic process that a licensed psychologist or psychiatrist can perform for you.

The mental health professional will also use the DSM-5-TR to make a diagnosis. It includes a set of standardized criteria for diagnosing mental disorders.

What are the DSM-5 criteria for NPD?

In order to receive a diagnosis of NPD, an individual must have:

  • Significant impairment of both self and interpersonal functioning: This can include things such as issues with identity, personal motivations, displaying empathy, or maintaining intimacy.
  • Pathological personality traits: These traits may include things like covert or overt entitlement or self-centeredness, as well as attention or admiration-seeking behavior.
  • Consistency: The level of functioning and expression of pathological personality traits must be consistent across different times and situations.
  • No other explanation for their behavior: For example, factors like age, culture, or socioeconomic status cannot explain a person’s behavior. Additionally, other medical conditions or substance use cannot explain the condition.

People with NPD have an inflated sense of themselves and may perceive the causes of their problems to be external rather than internal and may not seek treatment.

Psychotherapy, also called talk therapy, is used to treat NPD. The goals of treatment are to:

  • help you to understand the causes of your emotions, feelings, and attitudes
  • develop improved interpersonal relationships in which you can better accept and relate to others
  • cultivate a less inflated opinion of yourself, more attainable goals, and more realistic expectations of those around you

No medications can specifically treat NPD. However, if you have other conditions like anxiety or depression, you may be prescribed medications, such as anti-anxiety medications or antidepressant drugs, to manage them.

The outlook for people with NPD depends on several factors. These may include things like the severity of the condition as well as an individual’s commitment to their treatment goals.

Overall, seeking out treatment is very important for managing NPD. Those who seek out and commit to a treatment plan can help to improve their quality of life and level of functioning.

In a relationship with someone who has NPD?

Changing narcissistic thoughts and behaviors may be a slow process. Managing expectations is very important for people who are in a relationship with an individual who has NDP. Some suggestions include:

  • Acknowledge who they are and remember that the sense of entitlement and superiority that you may perceive in an individual with NDP may cover deep feelings of insecurity.
  • Avoid trying to live up to unrealistic expectations and instead work on being the best version of yourself, for yourself.
  • Build a support network. Surround yourself with people who are good listeners and can be your cheerleaders.

It’s very important to remember that some relationships with people with NPD may be emotionally exhausting and even abusive. If you’re experiencing things like constant criticism, disparaging remarks, or gaslighting, don’t be afraid to leave.

NPD is characterized by an elevated sense of one’s self and a disregard or lack of empathy for others. While the APA defines NPD as one narcissistic disorder, it has two subtypes.

Grandiose narcissism is associated with extroversion, high self-esteem, and exaggeration of abilities or achievements. Meanwhile, vulnerable narcissism is associated with introversion, lower self-esteem, and insecurity or avoidance.

People with NPD and those in relationships with them may benefit from treatment and adherence to a treatment plan. Both can help to improve the quality of life for an individual with NDP and friends, family, and loved ones.