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Narcissistic Personality Disorder

Updated: Mar 31

The hallmarks of Narcissistic Personality Disorder (NPD) are a profound lack of empathy, sense of grandiosity or self-importance, and a need to be admired. While everyone displays these characteristics at some point in their lives, for people with NPD these traits are pervasive, enduring, inflexible, stable over time. and leads to distress or impairment (American Psychiatric Association, 2013).

According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5, American Psychiatric Association, 2013, p. 669), a person who exhibits five or more of the following qualities meets the diagnostic criteria for NPD:

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.

Development of Narcissistic Personality Disorder

Aronson et al. (2016) describes John Bowlby’s attachment theory succintly as “the expectations people develop about relationships with others based on the relationship they had with their primary caregiver when they were infants” (p. 329). As noted in my post Attachment Styles, “In a nutshell, Avoidants are self-possessed individuals who avoid emotions and intimate connections...The Disorganized are overwhelmed by the intensity of emotion and intimacy and vacillate between seeking and fleeing from it...” (Clinton & Sibcy, 2006).

Childress (2015) makes a compelling argument that NPD is the result of disorganized attachment with avoidant overtones. (Read more about disorganized attachment here.) Avoidants supress and dismiss their need for connection with others due to the belief that others will refuse or reject them. The combination of disorganized attachment style and avoidant tendancies results in “a stable narcissistic-style personality structure in which intimacy is avoided and relationships are shallow and easily discarded once the other person ceases to provide narcissistic supply” (Childress, 2015).

Narcissistic supply refers to the benefits the narcissist receives from those with whom they are in “relationship.” Childress (2015) likens it to the relationship between a vampire and its victim – the relationship lasts as long as the blood flows; in other words as long as the admiration, the submission to the narcissists supremacy, and the relationship partner does not require true intimacy. Once the narcissist ceases to receive what they believe they are entitled to, the person is discarded.

If the narcissist’s partner is the one to leave, this action constitues a narcissistic wound, reactivating the original attachment trauma of rejection and abandonment (Childress, 2015). In this case, the narcissist retaliates with vengance seeking to displace their pain and shame onto their former partner through public rejection and shaming. Truth and reality are malleable constructs for the narcissist. They excel in twisting the truth to suit their purposes and recruit others to reject their former partner.

For the most part, the narcissist is unaware of their motivations and the impact of their words and actions. They create for themselves a self-serving world, yet possess an outstanding lack of self-awareness. While they may not be consciously and purposefully destructive, intent does not equal impact. The most profound “distress and impairment” is experienced by those who love a narcissist.

Angela W Startz, MAHSC, CCLC

Mental Health Coach

Recommended Reading: Understanding and Loving a Person With Narcissistic Personality Disorder by Stephen Arterburn and Patricia Kuhlman.

(Please Note: As an Amazon Associate, I earn from qualifying purchases.)


American Psychiatric Association. (2013). Personality disorders. In Diagnostic and statistical manual of mental disorders (5th ed.).

Aronson, E., Wilson, T. D., Akert, R. M., & Sommers, S. R. (2016). Social psychology (9th ed.). Pearson.

Childress, C. A. (2015). An attachment-based model of parental alienation: Foundations. Oaksong Press.

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