What is the criterion for NPD?
Not everyone who has narcissistic tendencies has NPD. It is not easy for an ordinary person to tell the difference between someone who has strong narcissistic traits and a person with full blown NPD. It is a condition that can only be diagnosed by a mental health professional and even they can make errors in their diagnosis.
The European diagnostic criterion for NPD in the International Classification of Diseases is not clearly laid out in section 6D10 Personality disorder but it offers a scale of mild, moderate and severe. Most Clinical Psychologists use the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-V). NPD is one of the Cluster B personality disorders which are known for the display of dramatic, emotional, and erratic behaviour. The diagnostic criteria for NPD is in section 301.81(F60.81) on page 669 of the DSM-V.
A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
- Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
- Is preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love.
- Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
- Requires excessive admiration.
- Has a sense of entitlement (i.e., unreasonable expectations of especially favourable treatment or automatic compliance with his or her expecations)
- Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).
- Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
- Is often envious of others or believes that others are envious of him or her.
- Shows arrogant, haughty behaviors or attitudes.
Children can display narcissistic behaviours but they cannot be diagnosed with personality disorders. Children do go through narcissistic phases as part of normal development and they can pick up behaviours from a narcissistic parent but a child’s neural networks are still developing. It takes time for patterns of behaviour to become set in adulthood.
Narcissism exists on a scale, all of us have some levels of narcissism but those with personality disorders are higher up the narcissistic scale (Figure 1 – ). Narcissists (those diagnosed with NPD) and those who do not meet the criteria for NPD but are still higher up on the narcissistic scale can be found in all areas of life, at home, at work and in any profession.
The following diagram has been adapted from Dr Alexander Lowen’s narcissistic scale in his book Narcissism: Denial of the True Self [1985].
Suffers of NPD may suffer from elements of other personality disorders. This is due mainly to the fact that it is not possible to define an exact set of criteria for each personality disorder which will apply to all cases. Personality disorders are a relatively new field of research and it is likely the criteria used to define specific disorders will change over time.
Why are men more likely to develop NPD than women?
In America it is estimated that up to 5% of the population has NPD. The actual percentage of people in UK with NPD is unknown but Consultant psychiatrist Dr. Tharaka Gunarathne suggested in 2024 that at least 1 in 20 or 5% of the UK population had NPD.
Dr Ramani Durvasula Clinical Psychologists suggest that the figure may be as high as 1 in 6 people. It is true that most people who suffer with NPD are men (approximately 75%), however, Dr Durvasula indicates modern research is highlighting that the number of narcissistic women is being underestimated because whereas men are more likely to be grandiose Narcissists, the split between genders is almost equal when it comes to vulnerable narcissism.
Vulnerable narcissism is often referred to as “covert narcissism”. Instead of the more obvious grandiose and arrogant signs of grandiose narcissism the vulnerable narcissist displays victimhood and more subtle forms of manipulation and control. Recent research from the University of Southampton has also shown that “Grandiose narcissism was a significant predictor of psychological IPV in men, whereas vulnerable narcissism significantly predicted physical/sexual and psychological IPV in women.“
Children can have strong reactions to constant perceived criticism.
Boys and girls usually have different ways of dealing with criticism. Girls tend to internalise the criticism they receive whereas boys tend to cast it out. This may be explained by the fact that the female brain functions in a different way to that of a male brain. It could also be due to the manner in which girls are primarily socialised as nurturers who shoulder the burden when things go wrong within the family. This role of the female nurturer is also encouraged through the mass media. For these reasons it is possible that women will more readily give up their narcissism in favour of another persons need and are therefore less likely to develop NPD than a man.
Women who have experienced an unempathic upbringing similar (sometimes more abusive) to that of men who suffer from NPD are more susceptible to developing Borderline Personality Disorder (BPD) as opposed to NPD. They tend to have a poor self-image seeing themselves as “worthless” as opposed to the grandiose image that sufferers of NPD have of themselves.
From an early age, the casting out of criticism on to other sources starts the pattern that leads to denial of faults. The child clings to the idea of themselves as “omnipresent” and “good” and projects these faults on to others who are “weak” or “bad”. This behaviour is evident in sufferers of NPD and because boys tend to do this more than girls it may be an explanation as to why more men suffer from NPD than women.
Some Psychologist have also sought to demonstrate that the reason there are more men diagnosed with NPD than women is that the Psychologist making the diagnosis has their own bias and stereotypes of relating to the sexes.