The DSM-IV diagnostic criteria for narcissistic personality disorder are listed her. Note that all of them focus on just one of the three modes, the Self-Aggrandizer.
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.
We are critical of these DSM-IV criteria because they focus almost exclusively on the outward, compensatory behaviors of patients and do not focus on the other modes that we believe are central to the problems of these patients. Furthermore, by focusing solely on the Self-Aggrandizer mode, DSM-IV leads many clinicians to hold an unsympathetic view of patients with narcissistic personality disorder rather than one of empathy and concern for the deeper level of pain that most of these individuals share. Finally, we believe that the diagnostic criteria for narcissistic personality disorder—as with many other Axis II disorders—do not lead to effective treatments. The criteria describe only the patient’s coping styles and do not guide clinicians to understand the relevant underlying themes or schemas, which we are convinced must change for Axis II patients to achieve lasting improvement.