Narcissistic personality disorder
- A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy
- Five (or more) of the following criteria, beginning by early adulthood and present in a variety of contexts:
- Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
- Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
- Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
- Requires excessive admiration.
- Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).
- Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).
- Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
- Is often envious of others or believes that others are envious of him or her.
- Shows arrogant, haughty behaviors or attitudes.
- A clinical diagnosis; however if entertaining other organic causes may initiate workup below
- Point-of-care glucose
- Chem 7
- ECG (for toxicology evaluation)
- ASA level
- Tylenol level
- Urine toxicology screen/Blood toxicology screen
- Urine pregnancy/beta-hCG (if female of childbearing age)
- Set clear boundaries and expectations, be fact-based and up front about what you can and cannot do
- If patient making unreasonable demands/entitlement, circle back to emphasize the patient does deserve excellent medical care
- Tolerate emotions but not outbursts
- Referral for outpatient psychiatric treatment, as psychotherapy is the primary treatment.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.