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DSM-5 Criteria for Narcissistic Personality Disorder

Narcissistic personality disorder is “a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts,” according to the DSM-5.

In addition, five or more from the following list of DSM-5 criteria need to be present for an official diagnosis.

  • has a grandiose sense of self-importance (exaggerates achievements and abilities)
  • preoccupied with dreams of unlimited power, success, physical attractiveness, and love
  • holds the belief that he is of special or high status and can only be understood by similar people or should only associate with those people (or institutions)
  • has a need for excessive admiration
  • possesses a sense of entitlement and expects favorable treatment or compliance
  • exploits other people to achieve personal goals
  • lacks empathy regarding the needs and feelings of other people
  • is envious of other people or think other people envy him
  • has arrogant behaviors and attitudes

People with this disorder may monopolize conversations and look down on people whom they feel are “inferior” to them. 

They will take advantage of you to get what they want, no matter who gets hurt along the way.

Individuals with NPD live with many negative outcomes of their personality disorder. Some examples of the problems that they face include the following:

  • trouble handling criticism
  • easily become impatient or angry if they don’t think they are being treated correctly
  • feel easily slighted and may have relationship problems
  • try to belittle others or react with rage to make themselves seem superior
  • have trouble regulating their behavior and emotions
  • trouble adapting to change and dealing with stress
  • can become depressed if they fall short of what they feel is ideal
  • secretly feel insecure, vulnerable, and humiliated and have fragile self-esteem

DSM-5 Criteria for Antisocial Personality Disorder

Antisocial personality disorder is “a pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years,” according to the DSM-5.

In addition, an individual must show at least three of the following:

  • the repeated failure to follow social norms resulting in grounds for arrest
  • engaging in deceitfulness (lying, using aliases, not paying off debts)
  • impulsivity and not planning ahead; moving around constantly
  • irritability and aggressiveness (resulting in physical fights/assaults)
  • reckless disregard or concern for the safety of other people
  • chronic irresponsibility reflected by a continued failure to maintain a job, finish school, or stay on top of financial commitments
  • lack of remorse about hurting others (indifferent or rationalizes)

The individual must be at least 18 years old and have had evidence of a conduct disorder by age 15.

The Narcissistic Sociopath

Now that we have a picture of narcissistic personality disorder and antisocial personality disorder, we can start to construct an understanding of what it means to be a narcissistic sociopath. In order for someone to fall into this category, they would need to be diagnosed with both features of NPD and APD.

A picture starts to emerge of a person who lacks empathy as they go about their daily lives. Narcissism intensifies with qualities of APD (or sociopathy) to worsen outcomes. A sociopathic narcissist will be cold and callous but will also be seeking the admiration of others (and will believe that he deserves it). He will have a disdain for people and think it’s okay to exploit and dispose of others in whatever way it helps him to get ahead.

While a sociopath doesn’t think about other people unless they can benefit her in some way, a narcissist only thinks of others in terms of how they reflect back on her.

When you put these two qualities together, a picture emerges of a person on a quest for power and control, who uses the love and admiration of others as a tool to dominate and manipulate, and who goes about all of this thinking that it is his right and that he is justified. There will be no guilt, no apologies, and no remorse coming from the narcissistic sociopath.

Even if these behaviors land this person in trouble, or worse, in prison—he won’t stop. After all, it’s all just a game and the people are pawns. When he gets tired of those people or they aren’t serving a useful role in his life (his game) anymore, then he will cast them aside.

A narcissist without APD might have some ability to feel guilt or remorse and may be able to be helped with appropriate psychotherapy. A narcissistic sociopath, however, is unlikely to feel those emotions or be helped in a genuine way through psychotherapy. Therapy is a game to be manipulated and the therapist is a pawn.

The Prototypical Narcissistic Sociopath

What would a prototypical narcissistic sociopath look like? While there are variations in the severity of symptoms, we can start to assemble a picture that will help you to identify these people in real life.

Most likely, you’ve encountered these types of people in news reports. You may see them associated with serial killings or financial scandals. The prison population is composed of a large percentage of these individuals (70 percent in prison versus .2 to 3.3 percent in the general population for APD). At the less severe end of the spectrum, you might find these individuals climbing the corporate ladder (but stepping on people to get there) or holding positions of power in local and national government, as frightening as that might be.

The scariest part is that people with this disorder will be hard to spot. They may be polished, well-dressed, successful, and charming. They may take part in charitable causes or charitable activities, not because they care, but because it makes them look good. To the outside observer, it might be hard to tell the difference.

In particular, people with money and privilege with these disorders may be particularly hard to spot. A narcissistic sociopathic business owner might default on debts or misrepresent what the company is selling.

Some will be physically aggressive while others may be harmful on an emotional level. Regardless of the harm that they do, these people believe they are exempt from the moral code that everyone else follows, which is what makes them so dangerous and so difficult to spot.

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