NPD is a cluster B personality disorder, alongside borderline (BPD), antisocial (ASPD) and histrionic personality disorders (HPD). The common thread uniting these conditions: Tendencies that lead to inappropriate ways of thinking, feeling and interacting with others.

The nine criteria of narcissistic personality disorder

“We use a set of criteria from the fifth edition of The Diagnostic and Statistical Manual of Mental Health Disorders, which we call ‘the DSM-5,’ to determine if somebody has NPD,” Dr. Markley explains.

“To be diagnosed with a personality disorder of any kind, an individual has to meet with a behavioral health specialist and complete a comprehensive clinical evaluation.”

According to the DSM-5, a person with NPD needs to demonstrate at least five of nine qualities in a wide range of situations. During the evaluation process, the mental health provider assesses and differentiates the criteria to ensure the diagnosis is accurate.

1. A grandiose sense of self-importance

We all know people who — despite having a list of accomplishments as long as your arm — have managed to stay humble. That isn’t the case for people with NPD. They’re often inclined to brag about who they are, what they have and the things they’ve done.

The DSM-5 is quick to note that this sense of superiority doesn’t have to be earned. In other words, a person with NPD might make up or exaggerate their achievements. They may even expect to be regarded as special without doing anything (personally or professionally) to distinguish themselves.

A lesser-known quality of NPD is holding oneself to unreasonably high standards. Dr. Markley says that happens, in part, because people with NPD tend to overestimate their abilities. In other words, a person with NPD often doesn’t realize their goals are unrealistic because they think they’re better than other people.

2. Fantasies about having or deserving

To use the DSM-5’s exact words, people with NPD often have, “A preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love.” Most of us have probably daydreamed about being rich, famous, powerful, loved or talented. But in the case of NPD, these flights of fancy are defense mechanisms.

According to Dr. Markley, there are two sides of the NPD coin: The grandiose side and the vulnerable side. And one can’t really exist without the other. Behind all the bravado, people with NPD tend to have very low self-esteem. Fantasies of having and deserving act like a shield. Keeping their head in the clouds makes it easier to square the person they believe they are with the person they actually are.

3. A sense of self-superiority

From the time we’re little, we all learn that each of us is unique and special in our own way. And it’s true! But for people with NPD, that idea becomes a bit distorted.

According to the DSM-5, people with NPD tend to believe that they are so unique and special that most people can’t understand them. That impacts their personal and professional lives because they feel that only very distinguished people or institutions are worthy of associating with them. In other words, they’re “high status,” and only want to interact with people they consider to be their social equals (or betters).

4. A need for excessive admiration

While it may make us blush, most of us want or need the occasional compliment or recognition to feel valued. For people with NPD, Dr. Markley clarifies that the need for positive reinforcement is much greater.

While people with NPD might not show it, they often experience intense feelings of inadequacy, self-doubt, emptiness and anxiety about how they’re perceived. That anxiety motivates them to seek the approval and praise of others. As part of their efforts to protect their self-image, they may fish for compliments, be hostile to constructive criticism and engage in attention-seeking behaviors.

5. A sense of entitlement

Another common feature of NPD is a sense of entitlement. The DSM-5 describes entitled behavior as unreasonably expecting special treatment or compliance — a sense that the rules don’t apply. The key word here is “unreasonable.”

There are certain circumstances where you can reasonably anticipate special treatment. It’s reasonable to expect a DJ to play your favorite song at your birthday party, even if it’s really unpopular. It’s not reasonable to expect that stinker to ring out at the club or over the airwaves of your local radio station.

When a person has an entitlement mindset, they spend a lot of time feeling disappointed, wronged and even angry. That, Dr. Markley says, can take a big toll on a person’s mental health. It’s sort of like seeing the world through a funhouse mirror. Each unmet expectation or perceived injustice is a new curve in the mirror, adding to their distorted understanding of themselves and the world they live in.

6. Exploitative behavior

According to the DSM-5, it’s common for people with NPD to take advantage of other people for selfish reasons. Sometimes, they use people on purpose, but it can also be an unconscious thing.

“That can be a really hard interpersonal tendency to manage,” Dr. Markley notes.

For example, many people with NPD are driven by a need for external validation. As a result, they might pursue friendships or relationships based on what a person can give them — like wealth or status — as opposed to who they are. They don’t necessarily know that’s how they’re choosing their friends, but it’s what’s happening.

7. A lack of empathy

Empathy is the ability to understand how other people feel and share in those feelings. Many individuals with NPD struggle with active listening because they aren’t naturally inclined to be interested in the people around them, Dr. Markley explains. Some either can’t or won’t recognize, understand and respond appropriately to other people’s emotions.

Lacking empathy can cause a person with NPD to say and do things that are extremely hurtful, without anticipating (or in some cases, caring) about how their actions are affecting others. They may even see being upset or highly sensitive as a sign of weakness.

8. Frequent envy

Everybody struggles with “the green-eyed monster” from time to time, especially in the age of social media. But for people with NPD, envy looms a bit larger. They spend a lot of time wanting what other people have. Because they believe they deserve more than everybody else, they may play down or belittle other people’s successes.

At the same time, people with NPD often assume other people envy them and their successes — whether those successes are real or imagined. And, Dr. Markley adds, they believe they should be envied.

9. Arrogance

The ninth and final diagnostic criteria the DSM-5 assigns to NPD is demonstrating “arrogant and haughty behaviors or attitudes.” A person with NPD may act condescending, snobby or even disdainful of the people around them.

Dr. Markley says that it’s important to keep in mind that the person who has NPD may not realize that they’re making the people around them feel inferior. After all, the line between healthy self-confidence and arrogance can be difficult for anybody to tread. It’s even tougher if your perception of yourself and the people around you is warped by a personality disorder.

Why you shouldn’t call people ‘narcissists’

There are two reasons why labeling somebody a “narcissist” is bad form:

Unless you know they’ve been diagnosed with the condition, you’re making a big assumption. Having narcissistic tendencies isn’t the same thing as having NPD.

The word “narcissist” stigmatizes people who actually have NPD. And the stigma around mental health is bad enough already. When you feel the urge to call somebody a narcissist, what are you really trying to say? Chances are, it’s not a compliment. The word’s become a kind of cultural catch-all. Narcissists are “bad people,” the script goes. And you should avoid them.

“Because narcissistic personality disorder is part of that cluster B category of personality disorders, it’s normal to experience difficulties in relationships with folks with this diagnosis,” Dr. Markley concedes. “But no one ever deserves to be demonized for their mental health struggles. People with NPD deserve compassion and empathy, even if they struggle to show it themselves because of their diagnosis.”