# [Cyra’s](https://kindnessoverperfection.tumblr.

com) Criteria for NPD

Not official, rewritten by someone with NPD.

The essential features of a personality disorder are impairments in personality

(*self* and *interpersonal*) functioning and the presence of maladaptive traits. To
diagnose narcissistic personality disorder, the following criteria must be met:

**A**. Significant impairments in **personality functioning** manifest by:

**1**. Impairments in ***self-functioning*** (**a** or **b**):

- [ ] **a**. **Identity**: Excessive reference to others for self-definition and

self-esteem regulation; exaggerated self-appraisal may be inflated or deflated, or
vacillate between extremes; emotional regulation mirrors fluctuations in self-
esteem.

- [ ] **b**. **Self-direction**: Goal-setting is based on gaining approval from

others; personal standards are unreasonably high in order to see oneself as
exceptional, or too low based on a sense of entitlement; often unaware of own
motivations.

**AND**

**2**. Impairments in ***interpersonal functioning*** (**a** or **b**):

- [ ] **a**. **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.

- [ ] **b**. **Intimacy**: A sense of detachment in relationships; higher levels

of emotional withdrawal associated with larger degrees of closeness; a tendency to
focus on all aspects of the relationship except for the feelings and experiences of
the other, unless perceived as relevant to self.

**B**. **Maladaptive traits** characterized by an attempt to protect oneself from

potential criticism, and from mistreatment or general life dissatisfaction
associated with criticism, beginning by early adulthood and present in a variety of
contexts, as indicated by five (or more) of the following:

- [ ] 1. **Grandiose sense of self** (e.g., believes that they are inherently more
powerful or capable than others in some way and may place an enormous pressure on
themself to measure up to this self-image, believes that they are uniquely bad or
inferior in some way, may struggle with paranoia due to an over-estimation of
effect on others).

- [ ] 2. **Attempt to regulate emotions and self-esteem through fantasies** of

unlimited success, power, brilliance, beauty, or ideal love, while avoiding real-
life situations that conflict with this internal narrative.

- [ ] 3. **Association with or avoidance of people, groups, or institutions**

based upon an attempt to gain admiration or avoid criticism.

- [ ] 4. **Seeks out admiration in an attempt to regulate mood**; may struggle

with self-destructive behaviors (i.e., isolation, impulsivity, self-punishment,
overexertion, etc.), intensely unpleasant emotions, or lack of motivation when they
don’t feel admired.
- [ ] 5. **An expectation of automatic agreement or compliance associated with
feelings of security**, i.e., an expectation that others will automatically agree
or comply with them followed by confusion or distress if these expectations are
unmet, attempts to attain closeness with others via agreeing and complying with
everything the other person wants, or attempts to get the other person to agree and
comply with everything they want.

- [ ] 6. **Periods of intense boredom or dissatisfaction** resulting from a lack

of connection with others; an attempt to regulate these emotions through material
pursuits, personal gain, or self-destructive behaviors.

- [ ] 7. **May miss social cues** or **struggle with self-awareness** due to a

lack of empathy or a preoccupation with their self-image.

- [ ] 8. **Frequent comparisons to others**, often followed by bitterness towards

self or others for perceived differences in likability.

- [ ] 9. **Difficulties in emotional and behavioral regulation in response to

perceived criticism** or slights, as characterized by one (or more) of the
following:

- [ ] **C**. The impairments in personality functioning and the individual’s

personality trait expression are relatively stable across time and consistent
across situations.
- [ ] **D**. The impairments in personality functioning and the individual’s
personality trait expression are not better understood as normative for the
individual’s developmental stage or socio-cultural environment.
- [ ] **E**. The impairments in personality functioning and the individual’s
personality trait expression are not solely due to the direct physiological effects
of a substance (e.g., a drug of abuse, medication) or a general medical condition
(e.g., severe head trauma).

- Fight response (e.g., intense anger towards self or others, self-punishment,

hostility, destructive behavior)
- Flight response (e.g., isolation, avoidance of the source of perceived criticism,
frantic attempts to distract self)
- Freeze response (e.g., brain fog, dissociation, major drops in motivation, not
addressing or resolving the situation)
- Fawn response (e.g., over-apologizing, heavily internalizing the perceived
criticism, preoccupation with seeking approval or assurance)

## Changes they made and why

**1. *Re-wrote the section for intimacy in 2B*.** Its original wording didn’t
address the actual problem present within the disorder, and instead focused on how
others might perceive the symptom. In people who have a history of trauma or who
were otherwise denied the opportunity to form safe and healthy connections with
others, it’s a natural defense mechanism to fixate on oneself within a
relationship:

> Preoccupation with how they’re perceived by the other person (Subconscious
conditioning: Are they about to hurt me for something they dislike about me? If so,
how can I change myself or their viewpoint of me to protect myself?)
>

> Positive feelings, and feelings of closeness, prompted by feeling

adored (Subconscious conditioning: We’re all born with the need for human
connection, but when we grow up being abused and neglected when caregivers dislike
something about us, the only times we’re safe to feel positive and close feelings
with another person are when it’s clear that they’re happy with us)
>

> Opportunity for personal gain potentially being one of the biggest factors in
deciding whether or not to enter or remain in a relationship (Subconscious
conditioning: If an unsafe caregiver isn’t providing necessities or something that
will help with self-soothing or happiness, then there’s no point risking one’s
safety by interacting with them more than necessary)
>

> Detachment from the other person (Subconscious conditioning: caring about* and
having a personal interest in other people turned out to be exceedingly painful and
potentially dangerous, and may have been used against me)
>

> *They are not saying that detachment necessarily means not caring about the other
person- just that one may be more prone to emotionally detaching or not being as
preoccupied with the experiences of the other person.
>

In every relationship, there is a focus on the **self**, a focus on the **other

person**, and a focus on the **experiences** that come with the relationship. The
lack of focus on the other person doesn’t mean that the other two focuses are
abnormal or shouldn’t exist; it simply means that someone may struggle with
mutuality, usually due to past experiences with trauma. While this obviously can
put a strain on relationships, it does *not* mean that someone is intentionally
being exploitative, that they only care about the other person’s well-being as long
as they’re benefiting them in some way, or even that they don’t desire a genuinely
close relationship with someone.

**2. *Rewrote the entire B section and re-introduced elements from the DSM-
IV*.** The B section in the DSM-V had a lot of subjective and ambiguous parts and
lacked focus on the actual issue and the various ways that issue could present.
They also changed the wording from “pathological personality traits” to
“maladaptive traits”.

**3. *Changed or rewrote symptoms listed in section B*** to be less subjective and
to place emphasis on how the disorder affects the person who has it, as opposed to
how others may perceive the symptoms. They also expanded it somewhat to include
variations in how the root issue may present.