The Narcissist Versus the Narcissistic Personality Disorder

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Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More

What’s the Difference Between Narcissistic Personality Disorder and Narcissism? 

Narcissistic personality disorder (NPD) is a complex mental health condition characterized by a pervasive pattern of grandiosity, a need for admiration, and a lack of empathy. Key criteria in the DSM-5 include an exaggerated sense of self-importance, fantasies of unlimited success, a sense of entitlement, and exploitation of others for personal gain.[1]
NPD differs from narcissistic behaviors or the trait of narcissism. While narcissistic traits may be present in many individuals to some degree, NPD involves a more extreme and inflexible pattern of behavior that significantly impairs interpersonal relationships and functioning.[1]

Judging from email questions I have received, many readers are somewhat confused about the differences between people who are narcissistic versus those who have a narcissistic personality disorder. There is a large difference between the two. Let’s explore those differences.

What is Narcissistic Personality Disorder?

NPD is a personality disorder and mental health disorder outlined in the DSM-5.


People with NPD often have an inflated sense of self-importance and believe they are superior to others. They frequently seek excessive admiration and validation from others, while simultaneously lacking empathy and disregarding the feelings and needs of others.[1]

Individuals with NPD may display various behavioral and interpersonal traits consistent with the disorder. They may exaggerate their achievements and talents, expecting constant praise and recognition from others. People with NPD often have a sense of entitlement, believing they deserve special treatment and are entitled to privileges that others do not have. They may exploit or manipulate others to achieve their own goals and may become envious or resentful of others’ success.[1]

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NPD can significantly impact an individual’s relationships, work, and overall functioning. While some people with NPD may appear confident and successful on the surface, their interpersonal relationships are often superficial and marked by difficulties. They may struggle to maintain meaningful connections with others due to their lack of empathy and inability to consider the perspectives of others. Despite their outward appearance of confidence, individuals with NPD may experience deep-seated feelings of insecurity and vulnerability, which they often mask with grandiosity and arrogance.[1]

These are people who do not function well. They alienate friends and family and come to feel socially isolated and depressed. This is very difficult for them because they do not want to think anything is wrong. People with NPD are caught between thinking they are superior and feeling miserable, all at the same time.

NPD Prevalence and Demographics

According to the DSM-5, NPD is estimated to affect around 0.5% to 1% of the general population.[1] Another source estimated NPD prevalence to be between .5% and 5% of the U.S. population and up to 15% in clinical settings.[2] Co-occurring disorders, such as addiction and other personality disorders, can also make diagnosis challenging, and thus, complicate prevalence estimates.[2]

It’s also important to note that prevalence rates may change over time due to various factors, including changes in diagnostic criteria, increased awareness, and evolving societal attitudes toward mental health.

Regarding gender differences in NPD diagnosis, research suggests that men are more likely to be diagnosed with NPD than women. However, recent studies have highlighted the importance of considering gender bias and societal expectations in the diagnosis of NPD. Some research indicates that women may display narcissistic traits differently than men and may be less likely to meet the diagnostic criteria for NPD due to cultural and social norms.[3]

Symptoms of Narcissistic Personality Disorder

Symptoms of narcissistic personality disorder may include:[1],[2]

  • Grandiose sense of self-importance, exaggerating achievements and talents
  • Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
  • Belief of being special and unique, requiring excessive admiration from others
  • Sense of entitlement, expecting favorable treatment and compliance with their expectations
  • Exploitation of others for personal gain, taking advantage of others to achieve their own goals
  • Lack of empathy, inability to recognize or identify with the feelings and needs of others
  • Envious of others or believes others are envious of them
  • Arrogant and haughty behaviors or attitudes

Narcissism vs. NPD

While narcissistic traits can be part of normal human behavior and even be beneficial in some circumstances, individuals with NPD exhibit a more severe and rigid pattern of these traits that significantly impair daily functioning and interpersonal relationships.[1 

Narcissistic traits:

  • Confidence and self-assuredness
  • Desire for achievement and success
  • Seeking acknowledgment for accomplishments
  • Healthy self-esteem and self-worth

NPD symptoms:

  • Grandiosity without merit
  • Fantasies of unrealistic success
  • Excessive need for admiration
  • Exploitation of others
  • Lack of empathy
  • Arrogant or haughty behaviors

What Causes NPD?: Risk Factors

Narcissistic personality disorder is a complex and multifaceted mental health condition caused by many different intersecting risk factors and vulnerabilities. There is no single cause or explanation for the development of this personality disorder—rather, many genetic and environmental factors are at play.

Some causes and risk factors for NPD may include:[1],[2],[4],[5]

  • Genetic predisposition or hereditary factors
  • Certain traits like low distress tolerance, poor emotional regulation, and aggression
  • Childhood rejection
  • Child neglect
  • Fragile ego
  • Excessive praise from a parent or caregiver
  • Dysfunctional family dynamics, such as enmeshment
  • Neurobiological factors and brain development or structures
  • Cultural influences such as emphasis on individualism and competition

Genetic predispositions may make individuals more susceptible to NPD traits, while environmental stressors and neurobiological differences contribute to the expression and severity of symptoms.

Parenting Styles and NPD Risk

Some parenting styles may increase a child’s risk of developing NPD later in life. Here are some examples:[5]

  • Overindulgent or neglectful parenting styles that fail to set appropriate boundaries or instill empathy
  • Excessive praise and unrealistic expectations without genuine emotional connection may contribute to a sense of entitlement and grandiosity
  • Traumatic experiences or inconsistent caregiving during early childhood can disrupt attachment and emotional regulation, increasing the risk of developing NPD

What is Narcissism as a Trait?

There are people who are narcissistic but who do not have a mental illness. These people are experienced as obnoxious because they feel superior to others and see nothing wrong with that. They have little or no empathy for the feelings, conditions, situations, or plight of others. These are people who feel entitled to the best of everything while looking down on those who show admiration for them. They also have no difficulty exploiting others to get what they want. It’s important to understand that they have no awareness and no insight into what they do. As a result, they feel no shame or remorse.

It is said that both in the present and historically, there have been leaders who were narcissists. Narcissists have a knack for getting into positions of power and have no difficulty exercising that power. Some of them exemplify evil in the world. Among these are Adolf Hitler, Joseph Stalin, Pol Pot and others. There are some who are successful in business because they have friends who help guide them. One example is Bill Gates, Larry Ellison, and more.

It’s important to remember that the major distinction between the narcissist and the narcissistic personality disorder is that the narcissist is not mentally ill, does not have a personality disorder, and is most interested in gaining power, money, and prestige. Too many narcissists succeed in their pursuits. There is no need to worry about the self-esteem of the narcissist, they have an over-abundance of it.

Your comments are welcome.

Allan N. Schwartz, PhD

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