Medically reviewed by
Jill E. Daino, LCSW-R

Reviewed On: February 21, 2023

Narcissistic personality disorder (NPD) is a mental health condition that can wreak havoc on relationships, impede career paths, and make it incredibly difficult to have a healthy, productive sense of self. 

Hallmarks of the condition are having an inability to show empathy, being self-absorbed or boastful, coming across as arrogant, and feeling a persistent need for praise and admiration. 

You might be thinking that these narcissistic personality disorder symptoms describe a lot of people you know, and that’s probably true. It’s one of the reasons that getting an accurate NPD diagnosis can be difficult. Add to this the fact that several other mental health conditions share similar symptoms with NPD, and it becomes clear that you must get a diagnosis from a trained and licensed mental health professional. 

If you’re looking for more information on how to diagnose someone with narcissistic personality disorder, we’ll help you sort through everything you should know, and figure out the next steps to take.

How is Narcissistic Personality Disorder Diagnosed?

There are multiple diagnostic techniques used by the mental health community to diagnose NPD.  

DSM-5 criteria

The most commonly used method of arriving at an NPD diagnosis is by using the criteria set in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). 

The DSM-5 requires that someone meet at least 5 of the following 9 criteria to get a narcissistic personality disorder diagnosis. Someone with NPD might:

  • Have a grandiose view of oneself
  • Be preoccupied with things such as success, beauty, or power 
  • Believe they’re so unique and special that they could only be understood by or associated with very high-status individuals or institutions
  • Have an intense need for admiration
  • Maintain a sense of entitlement
  • Exhibit behavior that’s interpersonally exploitative  
  • Show almost no empathy for others
  • Feel envious of people they encounter, or believe others are envious of them
  • Seem arrogant   

An alternative in the DSM-5 supports a diagnosis of NPD if someone is impaired in at least 2 of these 4 areas of their life:

  • Identity
  • Self-direction
  • Empathy
  • Intimacy

“It may not be common for a person with a narcissistic personality to seek a diagnosis on their own. Many of the symptoms of this disorder might not allow them to seek counseling voluntarily. Grandiosity and self-importance, along with a lack of self-reflection, are a few of the attributes of NPD that hinder someone from seeking treatment.”

Talkspace therapist Karmen Smith, LCSW, DD

Tests for narcissistic traits

There are also several written tests that can be used to make a narcissistic personality disorder diagnosis. These are not “black and white” tests and are subject to interpretation only by a trained mental health professional. These tests include:

  • Personality diagnostic questionnaire – 4 (PDQ-4)
  • Millon clinical multiaxial inventory III (MCMI-III)
  • International personality disorder examination (IPDE)

Each of these tests is made up of simple, easy-to-answer questions. You only need to respond honestly for them to offer accurate insight. 

Conditions That Share Similar Symptoms

One of the major challenges when learning how to diagnose someone with narcissistic personality disorder is the fact that other mental health conditions share similar symptoms. NPD is also commonly misdiagnosed as several other conditions, including:

To make things even more complex, it’s incredibly common for people to also have one or more other mental health conditions. In fact, it’s actually somewhat rare for someone diagnosed with NPD to not have a comorbid condition (when two conditions co-exist). 

Some of the conditions and comorbidities that share symptoms with NPD follow.

Histrionic personality disorder

It’s estimated by some research that up to 53% of people diagnosed with NPD might also have histrionic personality disorder. This mental health condition is hallmarked by: 

  • Attention-seeking behavior
  • Unstable emotions 
  • A distorted self-image

Although genetics may play a role in histrionic personality disorder, it’s believed to be largely the result of childhood abuse and neglect.

Borderline personality disorder

Borderline personality disorder (BPD) co-exists in up to 47% of people diagnosed with NPD. 

Key symptoms of BPD can include: 

  • A poor self-image
  • Fear of being abandoned 
  • Impaired social relationships

BPD is also believed to stem from childhood experiences and is especially common in adults who were abandoned physically or emotionally during childhood.

Paranoid personality disorder

Paranoid personality disorder is a chronic personality disorder that co-exists in approximately 36% of people with NPD. Paranoid personality disorder can be characterized by: 

  • Being afraid or mistrustful of others without good reason
  • Feeling on guard all the time
  • Thinking that others are going to hurt them

Avoidant personality disorder

People with avoidant personality disorder feel inadequate and believe they’re always being judged by others. It’s estimated that 36% of people diagnosed with NPD might also have avoidant personality disorder. Symptoms can include:

  • Difficulty making friendships
  • Extreme shyness and avoiding social situations
  • Feeling like everyone hates you

Anxiety and depressive disorders

It’s also common for people with NPD to have anxiety and depressive disorders. Additionally, in cases where this is true, symptoms are typically more severe than when these conditions occur on their own.

What to Do if You Get Diagnosed With NPD

Being diagnosed with NPD, or having someone you love receive this diagnosis, is not the end of the world. The good news is there are many ways for treating narcissistic personality disorder that can be effective in helping both the person living with narcissism, as well as those around them, increase their quality of life and form stronger, healthier relationships.

  • For people with NPD, it’s important to stay committed to your narcissistic personality disorder medication and treatment, both for you and for the people who care about you. This becomes increasingly important as you begin to feel better and see success in your treatment. Long-term treatment is essential to living the best quality of life possible with NPD.  
  • For those who care about someone with NPD, you might be questioning “how to help a narcissist.” You can help by encouraging your friend, partner, or spouse to keep their appointments, even if that means offering to drive or go with them. 

You can also educate yourself about NPD. If you want to know more about how to diagnose someone with narcissistic personality disorder, it’s important to ignore the large volume of “pop” information you might encounter on social media or casual websites. Instead, dig deeper, reading articles from reputable medical journals and studies. There are also a number of support groups for people in a relationship with someone who has NPD. Through your own therapy and support, you can learn to cope better and support your loved one.

You don’t have to just put up with the symptoms of NPD — whether you’re the person diagnosed with it, or you’re someone close to them. Treatment, which usually involves therapy for narcissistic personality disorder and possibly medication, can be effective if you stay with it and are committed to success. 

“The therapist’s relationship to the person with NPD is key in any form of treatment provided. There needs to be trust and an ability to identify manipulations and inconsistent verbal and behavioral communications.”

Talkspace therapist Karmen Smith, LCSW, DD

Talkspace is an online therapy platform that can provide you with the help and support you or your loved one needs. 

See references