ality disorder and obsessive-compulsive personality disorder, the individual may profess
a commitment to perfectionism and believe that  others cannot do things as well. In con-
trast to the accompanying self-criticism of those with obsessive-compulsive personality
disorder, individuals with narcissistic persona lity disorder are more likely to believe that
they have achieved perfection. Suspiciousness and social withdrawal usually distinguish
those with schizotypal or paranoid personalit y disorder from those with narcissistic per-
sonality disorder. When these qualities are pres ent in individuals with narcissistic person-
ality disorder, they derive primarily from fear s of having imperfections or flaws revealed. 
Many highly successful individuals display pe rsonality traits that might be considered
narcissistic. Only when these traits are inflexible, maladaptive, and persisting and cause
significant functional impairment or subjective  distress do they constitute narcissistic per-
sonality disorder.
Mania or hypomania. Grandiosity may emerge as part of manic or hypomanic episodes,
but the association with mood change or functional impairments helps distinguish these
episodes from narcissistic personality disorder. 
Substance use disorders. Narcissistic personality disorder must also be distinguished
from symptoms that may develop in a ssociation with persistent substance use.
Cluster C Personality Disorders
Avoidant Personality Disorder
Diagnostic Criteria 301.82 (F60.6)
A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to neg-
ative evaluation, beginning by early adulthood and present in a variety of contexts, as in-
dicated by four (or more) of the following:
1. Avoids occupational activities that invo lve significant interpersonal contact because of
fears of criticism, disapproval, or rejection.