Fast Five Quiz: Narcissistic Personality Disorder Key Aspects

Stephen Soreff, MD


June 24, 2022

The diagnosis of NPD is typically made on the basis of a history of narcissistic symptoms from pertinent sources (such as the patient, their friends, family, and co-workers, and the observations of the clinician).

In the psychiatric interview, the person with NPD will display a lack of concern for others, a sense of superiority, and an egocentric view of the world. No signs of psychosis (eg, hallucinations, delusions) are present. They have full orientation to time, place, and person and memory is intact. More specific personality tests, such as the Personality Diagnostic Questionnaire-4, can also be used to facilitate diagnosis; however, this is not required, and debate surrounds their reliability and usefulness.

Although there are no specific laboratory studies that diagnose NPD, a toxicology screen may be advisable in view of the high incidence of substance abuse in patients with this disorder, to rule out alcohol and drugs as possible causes of narcissistic character pathology. However, this is not a requirement for the diagnosis.

Two basic subtypes have been identified: grandiose NPD and vulnerable NPD. The grandiose subtype is associated with aggression and boldness. The vulnerable subtype involves hypersensitivity and defensiveness, and it is often overlooked. Some persons with NPD may exhibit parts of both subtypes.

Learn more about the workup for NPD.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.