DIAGNOSTIC CRITERIA FOR NARCISSISTIC PERSONALITY DISORDER (NPD)

Abstract

Introduction: Narcissistic Personality Disorder (NPD) is a chronic mental condition characterized by a persistent pattern of grandiosity, need for admiration, and lack of empathy. It belongs to “Cluster B” (dramatic, emotional, or erratic group) of personality disorders. The pathophysiology of NPD is associated with high levels of alexithymia and reduced deactivation of the right anterior insula, as well as differences in gray matter volume involving prefrontal and insular regions.

Methodology: This study is a narrative literature review, designed to synthesize contemporary scientific evidence on the diagnostic criteria of Narcissistic Personality Disorder. The sample included publications from 2021 to 2025, available in full in English or Portuguese. Exclusion criteria were applied to remove studies lacking diagnostic relevance, duplicate publications, and reviews with low methodological rigor.

Results and Discussion: Based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), NPD is categorized within Cluster B personality disorders, defined by patterns of dramatic, emotional, or unpredictable behavior. In contrast, the International Classification of Diseases, 11th Revision (ICD-11) introduced a fundamental change by abandoning categorical classification and adopting a dimensional model, in which personality disorder is considered a single type but composed of pathological traits that may manifest at varying levels of severity. Furthermore, diagnosis is often challenged by overlap with other Cluster B disorders, especially Borderline Personality Disorder.

Conclusion: The diagnosis of NPD should be conducted from a multidimensional and longitudinal perspective, integrating categorical criteria, dimensional models, and clinical observation of interpersonal functioning over time. This approach allows for greater diagnostic accuracy and contributes to the development of more individualized therapeutic strategies, thereby promoting more effective clinical interventions in the management of this condition.