Narcissistic personality disorder


  • A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy

Clinical Features

  • Five (or more) of the following criteria, beginning by early adulthood and present in a variety of contexts:[1]
    • 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.

Differential Diagnosis


  • A clinical diagnosis; however if entertaining other organic causes may initiate workup below

General ED Psychiatric Workup


  • 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.


  • Discharge

See Also

External Links


  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.