How to Diagnose Narcissistic Personality Disorder

Who Can Diagnose Narcissistic Personality Disorder?

Typically, psychiatrists and clinical psychologists are the professionals qualified to diagnose NPD. These experts assess behavioral patterns and emotional functioning. They conduct thorough evaluations, including clinical interviews and psychological testing, to distinguish NPD from other personality disorders. Their assessment adheres to the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It’s essential to seek a diagnosis from these mental health professionals, as they have the necessary skills to accurately identify NPD.

At Talkspace, our mental health providers can help you or someone you know find a diagnosis for NPD. Our platform provides an accessible way for you to connect with a mental health professional for evaluation and work with them to understand and manage your condition with a treatment plan.

How is Narcissistic Personality Disorder Diagnosed?

There are multiple diagnostic techniques used by mental health professionals 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:

• Exhibit grandiosity in self-perception and behavior
• 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

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 narcissistic personality disorder test listed above is made up of simple, easy-to-answer questions. You only need to respond honestly for them to offer accurate insight into each narcissistic trait exhibited.

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:

• Bipolar disorder (manic phases)
• Generalized anxiety disorder (GAD)
• Asperger’s disorder

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 NPDto nothave 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.

How to Get a NPD Diagnosis with Talkspace

If you’re wondering whether you have narcissistic personality disorder (NPD) or someone close to you has suggested that you might, a Talkspace provider can provide guidance. You can quickly and conveniently connect with a licensed provider who will evaluate your symptoms, listen to your concerns, and, if appropriate, diagnose you with NPD or another condition. 

Here’s how it works:

1. Get started any time by answering a few questions on the Talkspace website or app. You don’t need a referral for either therapy or psychiatric care.
2. You’ll be connected with a therapist within about two days or a psychiatric provider within about a week. 
3. If you choose to start with therapy you can message with your therapist as much as you like and also schedule live sessions. If you choose psychiatry you’ll schedule a live video session with your psychiatric provider.

Online therapy helps you manage symptoms and develop coping skills, while online psychiatry addresses the physiological basis or your symptoms, usually with a prescription for medication and ongoing medication management.

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 who are married to or are dating a narcissist.

Through your own therapy and support, you can learn to cope better and support your loved one exhibiting narcissism. Additionally, it’s crucial for those in relationships with individuals who have NPD to remain vigilant about the signs of narcissistic abuse and understand how to set boundaries with a narcissist. Recognizing and addressing these dynamics is key to maintaining a healthy relationship and personal well-being.

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

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