ceptual dysregulation) are not diagnostic crit eria for borderline personality disorder (see
Criterion B) but can be specif ied when appropriate. Furthermore, although moderate or
greater impairment in personality functioning is required for the di agnosis of borderline
personality disorder (Criterion A), the level of personality func tioning can also be specified.
Narcissistic Personality Disorder
Typical features of narcissistic personality disorder are variable and vulnerable self-esteem,
with attempts at regulation through attentio n and approval seeking, and either overt or
covert grandiosity. Characteristic difficulties are apparent in identity, self-direction, em-
pathy, and/or intimacy, as desc ribed below, along with specif ic maladaptive traits in the
domain of Antagonism.
Proposed Diagnostic Criteria
A. Moderate or greater impairment in personality functioning, manifested by characteristic
difficulties in two or more of the following four areas:
1.Identity:  Excessive reference to others for self-definition and self-esteem regula-
tion; exaggerated self-appraisal inflated or deflated, or vacillating between extremes;
emotional regulation mirrors fl uctuations in self-esteem.
2.Self-direction:  Goal setting based on gaining approval from others; personal stan-
dards unreasonably high in order to see oneself as exceptional, or too low based
on a sense of entitlement; often unaware of own motivations.
3.Empathy:  Impaired ability to recognize or identify with the feelings and needs of
others; excessively attuned to reactions of others, but only if perceived as relevant
to self; over- or underestimate of own effect on others.
4.Intimacy:  Relationships largely superficial and exist to serve self-esteem regula-
tion; mutuality constrained by little genuine interest in others’ experiences and pre-
dominance of a need for personal gain.