Diagnosis of NPD Clinical criteria (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5]) For a diagnosis of narcissistic personality disorder, patients must have A persistent pattern of grandiosity, need for admiration, and lack of empathy This pattern is shown by the presence of ≥ 5 of the following: An exaggerated, unfounded sense of their own importance and talents (grandiosity) Preoccupation with fantasies of unlimited achievements, influence, power, intelligence, beauty, or perfect love Belief that they are special and unique and should associate only with people of the highest caliber A need to be unconditionally admired A sense of entitlement Exploitation of others to achieve their own goals A lack of empathy Envy of others and a belief that others envy them Arrogance and haughtiness Also, symptoms must have begun by early adulthood.