9 Signs of Narcissistic Personality Disorder

Narcissism vs. Narcissistic Personality Disorder

By Larissa Biggers
December 15, 2022
An illustration of a man standing on a raised platform with his hands in the air. He is reflected in a mirror holding up a crown. Text reads Narcissistic Personality Disorder.

Having narcissistic tendencies -- like bragging or making yourself the center of attention -- are normal when they occur occasionally. Narcissistic personality disorder (NPD) is different. Symptoms are more severe, occur across different situations and environments, and make relationships with others challenging, if not impossible. 

Here, Zachary Rosenthal PhD, a clinical psychologist at Duke Health, answers questions about NPD and what you can do if you suspect that you or a loved one has the condition.

Dr. Zach Rosenthal discusses the symptoms of NPD, how it is diagnosed, and the individualized approach he takes for treating the disorder.

What are the symptoms of narcissistic personality disorder?

Use the acronym “SPECIAL ME” to remember the nine signs of NPD. 


  1. Sense of self-importance
  2. Preoccupation with power, beauty, or success 
  3. Entitled
  4. Can only be around people who are important or special
  5. Interpersonally exploitative for their own gain
  6. Arrogant
  7. Lack empathy
  8. Must be admired
  9. Envious of others or believe that others are envious of them

How is NPD diagnosed?

Trained mental health professionals conduct a structured interview to learn more about an individual’s typical behavior patterns. If someone consistently displays at least five of the SPECIAL ME traits, they meet the diagnostic criteria for the condition.  

Is NPD genetic?

No, there is no gene for NPD, and people are not born with it. Like other mental health conditions, environment is a major factor. Children who are encouraged to believe they are extraordinary and always deserve the best -- sometimes at the expense of others -- could later develop NPD. In these children, traits like confidence are rewarded, while qualities like empathy are not.

Are narcissists bad people?

Narcissists are not bad people; it’s their behavior that’s problematic. They have been conditioned to believe that they are special and deserve to be treated better than others and approach the world accordingly.

Can I have a relationship with someone with NPD? 

It depends. If your romantic partner, family member, or boss has NPD, they can make your life challenging. Because they put themselves first, you may feel belittled, and your mental health could suffer. Coping strategies include setting personal boundaries and gently walking away if they are breached. However, this is not always easy to do. Calling your partner a narcissist won't help either. Instead, you should focus on your well-being and decide what you are willing to tolerate.

Can people recover from NPD?

Yes, but changing a learned behavior takes time and effort. People with NPD do not generally seek help on their own, and if they do, it is often because of a co-existing problem, like anxiety. Because there is no proven medication or therapy to treat NPD, providers take an individualized approach. Getting to know the patient and establishing a trusting relationship are key components of treatment. If a person is willing to change and their therapist can help them bridge the gap between their current and desired behaviors, there is hope for recovery.