Diagnostic Criteria For NPD and Narcissistic Abuse

NPD is a cluster B personality disorder with symptoms that cause the NPDer distress and affects their lives and relationships. A simple google search of NPD can make a person who suspects they have this personality disorder feel hopeless and reject seeking help. With articles such as “How to Recognize a Malignant Narcissist” or “How to identify a narcissist- and cope with their toxic behavior” how can one not want to keep the fact they might be a “narcissist” secret.

The issue is a misunderstanding of the disorder. In forums you can see people saying, “To be diagnosed with NPD they must be abusive,” or “being abusive is pretty much built into this disorder’s criteria.” NPD Or Narcissistic personality disorder as according to the DSM -V is diagnosed under these criteria in the DSM-V:

“The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose narcissistic personality disorder, the following criteria must be met:

A. Significant impairments in personality functioning manifest by:
1. Impairments in self functioning (a or b):
a. Identity: Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal may be inflated or deflated or vacillate between extremes; emotional regulation mirrors fluctuations in self-esteem.
b. Self-direction: Goal-setting is based on gaining approval from others; personal standards are unreasonably high in order to see oneself as exceptional, or too low based on a sense of entitlement; often unaware of own motivations.


2. Impairments in interpersonal functioning (a or b):
a. Empathy: Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimate of own effect on others.
b. Intimacy: Relationships largely superficial and exist to serve self-esteem regulation; mutuality constrained by little genuine interest in others‟ experiences and predominance of a need for personal gain

B. Pathological personality traits in the following domain:

1. Antagonism, characterized by:
a. Grandiosity: Feelings of entitlement, either overt or covert; self-centeredness; firmly holding to the belief that one is better than others; condescending toward others.
b. Attention seeking: Excessive attempts to attract and be the focus of the attention of others; admiration seeking.

C. The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations.

D. The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or socio-cultural environment.

E. The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma)” (DSM-V)

Notice this diagnostic sheet does not say “must be abusive.” Those with NPD often suffer from extreme trauma in childhood. Many also suffer C-PTSD and have low self-esteem. NPD is not a disorder that requires abuse for diagnosis.

The other thing to notice is that this symptom sheet isn’t like what you see online. That’s because websites such as mayo clinic list criteria in this sort manner:

• Have an exaggerated sense of self-importance
• Have a sense of entitlement and require constant, excessive admiration
• Expect to be recognized as superior even without achievements that warrant it
• Exaggerate achievements and talents
• Be preoccupied with fantasies about success, power, brilliance, beauty or the perfect mate
• Believe they are superior and can only associate with equally special people
• Monopolize conversations and belittle or look down on people they perceive as inferior
• Expect special favors and unquestioning compliance with their expectations
• Take advantage of others to get what they want
• Have an inability or unwillingness to recognize the needs and feelings of others
• Be envious of others and believe others envy them
• Behave in an arrogant or haughty manner, coming across as conceited, boastful and pretentious
• Insist on having the best of everything — for instance, the best car or office”
(Mayo Clinic, 2020)

Not only does this list seem to demonize NPD it seems vastly different from the actual criteria. This is because most articles are using the DSM IV for their diagnostic criteria. It reads:

“A. 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:

1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).

2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.

3. 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).

4. Requires excessive admiration.

5. Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations.

6. Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends.

7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.

8. Is often envious of others or believes that others are envious of him or her.

9. Shows arrogant, haughty behaviors or attitudes.” (DSM-IV)

Even in the more demonizing DSM-IV criteria it does not say “is abusive,” as criteria for NPD. When people say, “NPD means you are inherently abusive,” they are saying that being “exploitive, entitled, having lack of empathy, and envious” are abusive and seeing as this is a personality disorder that claim is ableist. None of those behaviours are inherently abusive. Just because you know someone with NPD that was abusive does not mean it is required for diagnosis. If someone tells you must be abusive feel free to link here.

  • I do need to edit and update this article with some new acquired information.


Association, A. P. (2012). DSM-IV and DSM-5 Criteria for the Personality Disorders. Retrieved January 23, 2020, from https://www.nyu.edu/gsas/dept/philo/courses/materials/Narc.Pers.DSM.pdf
Staff, M. C. (2017, November 18). Narcissistic personality disorder. Retrieved January 23, 2020, from https://www.mayoclinic.org/diseases-conditions/narcissistic-personality-disorder/symptoms-causes/syc-20366662?fbclid=IwAR1kVF76IODMbR6hJ2EL5vv1DUAzlI8Xv41khnZHvYqBRehTdvnwCOp4tqE