Skip to content
Start Your Recovery Call 866-833-1822
Our Blog
Mission Connection
  • Patients
    • For Adults
    • For Ages 12-17
    • For Parents & Family
    • Privacy Practices
  • Referrals
    • Start a Referral
    • Clinical & Medical Professionals
    • Behavioral Health & Wellness Practitioners
    • Legal, Protective & Government Services
    • Institutional & Workplace Advocates
    • Local Referral Support
  • How It Works
    • Programs Hub
      • Virtual Telehealth Program
      • In-Person Program
      • Hybrid Telehealth & In-Person Program
    • Therapies
    • Conditions We Treat
    • Alumni & Support Network
    • Locations & Services Areas
      • California
      • Virginia​
      • Washington
    • Payment Options & Cost
  • Resources
    • Mental Health Conditions
    • Mental Health Symptoms
    • Medications
    • Self Assessments
    • Guides & FAQs
    • News & Blog
  • About
    • Mission & Values
    • Staff
    • Reviews & Testimonials
    • Outcomes Study
    • Careers
Get Started
  • Patients
    • For Adults
    • For Ages 12-17
    • For Parents & Family
    • Privacy Practices
  • Referrals
    • Start a Referral
    • Clinical & Medical Professionals
    • Behavioral Health & Wellness Practitioners
    • Legal, Protective & Government Services
    • Institutional & Workplace Advocates
    • Local Referral Support
  • How It Works
    • Programs Hub
      • Virtual Telehealth Program
      • In-Person Program
      • Hybrid Telehealth & In-Person Program
    • Therapies
    • Conditions We Treat
    • Alumni & Support Network
    • Locations & Services Areas
      • California
      • Virginia​
      • Washington
    • Payment Options & Cost
  • Resources
    • Mental Health Conditions
    • Mental Health Symptoms
    • Medications
    • Self Assessments
    • Guides & FAQs
    • News & Blog
  • About
    • Mission & Values
    • Staff
    • Reviews & Testimonials
    • Outcomes Study
    • Careers
Call Today
  1. Home
  2. Mental Health Conditions
  3. Narcissistic Personality Disorder
  4. Narcissistic Personality Disorder Symptoms, Early Warning Signs, & Ways to Cope

Narcissistic Personality Disorder Symptoms, Early Warning Signs, & Ways to Cope

PUBLISHED: 09/29/2025 | UPDATED: 02/26/2026
Authored by: Eilaf Meenai, MD | Edited by: Emma Loker, BSc, PgDip
    man and woman holding hands after psychodynamic therapy woman with engagement ring on - Mission Connection

    Narcissistic personality disorder (NPD) is a condition marked by a fragile and unstable sense of self. Yet, this core issue is typically hidden behind patterns of grandiosity, entitlement, and a need for constant validation.

    Many people occasionally show narcissistic traits, but NPD represents a much more pervasive and rigid personality style that interferes with daily life. Research suggests that NPD affects about 1-2% of the general population and up to 20% of clinical populations.[1]

    Like other personality disorders, NPD cannot be diagnosed through a blood test or a brain scan. This is because there are no physical symptoms to detect. Instead, the diagnosis relies on a careful evaluation of thoughts and behaviors.

    Detecting NPD warning signs early can allow for a more successful outcome, easing the weight of symptoms for both those with them and their loved ones. If you’re concerned about the presence of NPD, a mental health professional can guide you in this process.

    This page can also work as a useful tool for recognizing narcissistic personality disorder symptoms, as it explores:

    • The nine signs of NPD
    • How to tell the difference between symptoms of grandiose vs vulnerable narcissism
    • How the NPD diagnostic process works
    • Where to find professional mental health support

    The 9 Signs of Narcissistic Personality Disorder

    The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the standard reference manual used worldwide to diagnose mental health conditions. For NPD, it specifies the following nine symptoms that clinicians look for when making a diagnosis.[2]


    1. Grandiose Sense of Self-Importance

    Grandiosity means acting “larger than life.” Specifically, the DSM-5 describes grandiosity as “exaggerating achievements and talents” and “expecting to be recognized as superior without actual achievements to match.” For example, people with NPD often insist on being treated as special, even when the facts don’t back this type of treatment up.

    Grandiosity seems to do two main jobs for the person who displays it:

    1. It protects a fragile self to keep shame at bay.
    2. It functions as a social strategy of projecting high status to secure admiration, resources, or influence.[3]

    As you may expect, people with narcissism who show signs of grandiosity are typically very outgoing and bold. They often love attention and may step into the spotlight to charm a room, but this charisma tends to hide a sense of entitlement.

    2. Preoccupation With Fantasies of Success, Power, or Beauty

    People with NPD spend real mental space (daydreams and internal narratives) imagining themselves in exceptional roles – beyond what’s realistic. In close relationships, people around them might notice how conversations keep circling back to grandeur or future glory.

    In fact, intimate partners of those with NPD often report that pathological narcissism isn’t about simply being boastful; fantasies become part of the person’s emotional life. These reports came from a study interviewing partners and family of people with narcissism, as they described how these people retreated into imagined versions of themselves when criticised.[4]

    In addition, these fantasies aren’t plausible. Based on findings, researchers judged grandiose fantasies as more ambitious and less realistic than regular positive future thinking.[5]

    Some ways this preoccupation with fantasizing may show up in behaviors and conversations include:

    • Curating social media to reflect the version of themselves they believe is their rightful legacy
    • Setting extremely ambitious and unrealistic goals (for example, “I’ll write a book that reshapes culture”) without grounding in feasible steps
    • Stockpiling material items, such as extravagant cars or flashy clothes
    • Hinting at or openly asserting that they are destined for greatness

    3. Beliefs of Being Special and Unique

    Another striking sign of NPD is the strong conviction of being special. This means believing that they can only be understood by, or should only associate with, other high-status people.

    A person with this trait typically dismisses the opinions of others whom they view as less accomplished. They may also actively seek out connections with people or organizations that improve their image of prestige. Examples of such organizations include elite schools, exclusive social circles, and high-profile workplaces.

    Additionally, a large review on pathological narcissism notes that “special and unique” beliefs fuel entitlement. They also typically make people hypersensitive to others not recognizing their supposed exceptional status.[4]

    Further, studies using narcissism assessment tools, such as the Five-Factor Narcissism Inventory, have also found that these beliefs are strongly tied to interpersonal problems, particularly arrogance toward peers.[6]

    4. Need for Excessive Admiration

    People with narcissistic traits often expect more attention and validation than others, and they behave in ways to secure it.

    They might fish for compliments or set up situations where admiration is almost guaranteed (like social media posts meant to impress). They may also have a tendency to show off accomplishments in exaggerated terms.

    Moreover, they may expect others to point out their strengths even when nothing special has happened. When they don’t get admiration, their default response is often to feel hurt and unnoticed. They may even interpret neutral feedback as criticism.

    In a large sample of undergraduates, admiration scores on the Narcissistic Admiration and Rivalry Questionnaire (NARQ) predicted how socially charming someone with NPD can appear initially. However, later, higher scores also predicted problems when admiration was not sustained.[7]

    5. Sense of Entitlement

    A “sense of entitlement” means believing one deserves special treatment without earning it in the usual way. It is a stable belief that others should bend to one’s needs and help them automatically.

    The Narcissistic Personality Inventory (NPI) is another NPD assessment tool that has an “Exploitiveness/Entitlement” subscale. Studies using this tool show how people who score high on entitlement tend to have more mood swings when they don’t feel they are being treated “correctly.”[8] Further, a recent study also found that entitlement is closely linked to being disagreeable (less warm and cooperative) and having problematic relationships.[9]

    Both grandiose and vulnerable narcissism share signs of entitlement, but they show up differently. Grandiose narcissists believe they are inherently superior, so they think they deserve more because “they just do.”

    In contrast, vulnerable narcissists typically feel that they’ve been disadvantaged, so their sense of being owed comes from a feeling of unfairness.

    6. Exploitative Behavior in Relationships

    Exploitative behavior refers to using other people to get what you want without regard for their feelings.

    People with this trait might treat others more like tools than partners. For example, they may demand emotional support, money, favors, and admiration from others while expecting them to adjust to their schedule. When these expectations are challenged, there can be anger, blame, gaslighting, and withdrawal rather than acknowledgement.

    Unfortunately, a study looked at people in intimate relationships with someone scoring high in narcissistic traits and found that many reported emotional, verbal, and financial exploitation.[10]

    7. Lack of Empathy

    The unwillingness or inability to recognize the feelings and needs of others is a major sign of NPD. Research classifies empathy into two types:

    1. Cognitive empathy, which is understanding what someone else is thinking or feeling
    2. Emotional empathy, which is feeling with others and sharing their suffering or joy

    People with NPD tend to have pretty good cognitive empathy but trouble with emotional empathy.[11] For example, they might correctly identify sadness in someone’s behavior (cognitive empathy), yet fail to respond with genuine warmth and concern (emotional empathy).

    Research describes empathy in NPD as “dysfunctional,” not simply “absent.” This means the empathy someone with NPD has may come on inconsistently, depending on whether it serves a purpose for themselves.[12]

    8. Envy of Others or Belief Others Envy Them

    The DSM-5 also mentions that people with NPD display two types of envious behaviors:

    1. Envying what others have, like success, status, appearance, and relationships
    2. Believing that others are envious of them for the same reasons

    Vulnerable narcissists tend to report higher dispositional envy (which is a baseline tendency to envy others). In contrast, grandiose narcissists may downplay envy unless threatened, though they might strongly believe others envy them.

    In research experiments where people see a peer getting high monetary benefits, vulnerable narcissists were visibly envious. However, grandiose ones reacted with dismissive and hostile behaviors – they also maintained that they were the ones who deserved more admiration.[13]

    Additionally, feeling entitled could amplify envy in people with narcissism. This is because, when someone believes they deserve special treatment or success, seeing someone else get it might feel unfair.

    9. Arrogant and Haughty Attitudes

    According to criteria, people with NPD tend to show visibly arrogant behaviors. For example, they could:

    • Subtly or blatantly belittle others
    • Dismiss contributions
    • Correct people condescendingly
    • Act as though they need not follow norms

    Put simply, they may behave as if only their perspective matters. Such a sense of arrogance is also often projected through self-promoting behaviors. For instance, showing off talents, seeking attention in public, choosing tasks where they can be admired, and performing helpful acts only when it enhances their image.

    In addition, research finds that narcissists are more willing to verbally demean others when their own status feels threatened.[14]

    Differentiating Signs and Symptoms of Grandiose vs. Vulnerable Narcissism

    NPD is categorized into two main types: grandiose and vulnerable. Both involve the same underlying issues with self-esteem, regulation, and relationships. But their symptoms are strikingly different.[15]

    The key differentiating signs of grandiose narcissism are:

    • Being openly boastful and dominant
    • Dismissing others and belittling their opinions
    • Expecting special treatment
    • Being exploitative, bold, and unapologetic
    • Being preoccupied with fantasies of success, power, or beauty
    • Lacking empathy (which can come across as indifference)
    • Being extroverted and attention-seeking
    • Thriving in competitive or visible roles

    People with vulnerable narcissism, however, are typically more quietly resentful. Their symptoms may include:

    • Self-doubt mixed with underlying entitlement
    • Hypersensitivity to criticism
    • Covert arrogance that comes across as passive-aggressive
    • Exploitative behaviors that are subtle, using guilt, withdrawal, or emotional manipulation
    • Preoccupation with fantasies that are more hidden and limited to daydreaming about being recognized rather than boasting
    • Being introverted

    Ready to Talk About Personality Disorder? We're available 24/7 for a free, confidential consultation.

    866-833-1822

    The Diagnosis of NPD Based on Signs and Symptoms

    The signs and symptoms we’ve discussed so far are not a checklist where every single item has to be ticked off to make a diagnosis. According to the DSM-5, at least five out of the nine listed criteria must be present for a diagnosis of NPD to be considered.2

    These traits also have to be pervasive and stable over time. In other words, they must begin by early adulthood and should be present across different situations (not just at work or only at home).

    Based on this information, you shouldn’t just label someone with a diagnosis of NPD because they show the odd trait every so often. Diagnosis must be rooted in consistent patterns that run through the person’s life.

    Everyone Deserves to Thrive.

    We're here to help you learn the skills to manage your Personality Disorder symptoms. There's no commitment required. Just an honest, confidential conversation about the support you need. Let's take the first step together.

    Call 866-833-1822Start Online

    Get Mental Health Support for Narcissism at Mission Connection

    Unfortunately, there’s no miracle drug that can “cure” a personality disorder. These patterns are deeply ingrained ways of thinking and behaving that develop over years. Therefore, they don’t disappear overnight – and they certainly can’t be fixed with a pill.

    Evidence, however, shows that psychotherapy can help people with NPD reduce harmful behaviors and improve their relationships. It does so by assisting them with feeling more capable of handling criticism without falling apart and connecting them with people in a healthier, natural way.

    At Mission Connection, we provide comprehensive personality assessments to give you clarity about what you’re experiencing. Our licensed therapists also specialize in evidence-based approaches tailored to personality disorders, like cognitive-behavioral therapy, schema therapy, or psychodynamic techniques.

    We also offer both online and in-person sessions, and are here to support you every step of the way. Contact us online if you’re ready to get started.

    References

    1. Weinberg, I., & Ronningstam, E.. (2022). Narcissistic personality disorder: progress in understanding and treatment. FOCUS, 20(4). 368–377. (https://doi.org/10.1176/appi.focus.20220052).
    2. Okoye, H.. (2011). Narcissistic personality disorder dsm-5 301.81 (f60.81) – therapedia. Theravive.com. (https://www.theravive.com/therapedia/narcissistic-personality-disorder-dsm–5-301.81-(f60.81)).
    3. O’Reilly, C. A., & Hall, N.. (2021). Grandiose narcissists and decision making: impulsive, overconfident, and skeptical of experts–but seldom in doubt. Personality and Individual Differences, 168. 110280. (https://doi.org/10.1016/j.paid.2020.110280).
    4. Day, N. J. S. et al. (2019). Pathological narcissism: a study of burden on partners and family. Journal of Personality Disorders, 34(6). 1–15. (https://doi.org/10.1521/pedi_2019_33_413).
    5. Finch, E. F., & Hooley, J. M.. (2023). Functional fantasies: the regulatory role of grandiose fantasizing in pathological narcissism. Frontiers in Psychiatry, 14. 1274545. (https://doi.org/10.3389/fpsyt.2023.1274545).
    6. Miller, J. D., Lynam, D. R., McCain, J. L., et al.. (2016). Thinking structurally about narcissism: an examination of the five-factor narcissism inventory and its components. Journal of Personality Disorders, 30(1). 1–18. (https://doi.org/10.1521/pedi_2015_29_177).
    7. Szücs, A. et al. (2020). Status, rivalry and admiration-seeking in narcissism and depression: a behavioral study. PLOS ONE, 15(12). e0243588. (https://doi.org/10.1371/journal.pone.0243588).
    8. Pryor, L. R., Miller, J. D., & Gaughan, E. T.. (2008). A comparison of the psychological entitlement scale and the narcissistic personality inventory’s entitlement scale: relations with general personality traits and personality disorders. Journal of Personality Assessment, 90(5). 517–520. (https://doi.org/10.1080/00223890802248893).
    9. Emmons, R. A.. (1987). Narcissism: theory and measurement. Journal of Personality and Social Psychology, 52(1). 11–17. (https://doi.org/10.1037//0022-3514.52.1.11).
    10. Day, N. J. S., Townsend, M. L., & Grenyer, B. F. S.. (2021). Pathological narcissism: an analysis of interpersonal dysfunction within intimate relationships. Personality and Mental Health, 16(3). (https://doi.org/10.1002/pmh.1532).
    11. Baskin-Sommers, A., Krusemark, E., & Ronningstam, E.. (2014). Empathy in narcissistic personality disorder: from clinical and empirical perspectives. Personality Disorders: Theory, Research, and Treatment, 5(3). 323–333. (https://doi.org/10.1037/per0000061).
    12. di Giacomo, E. et al. (2023). The dark side of empathy in narcissistic personality disorder. Frontiers in Psychiatry, 14. 1074558. (https://doi.org/10.3389/fpsyt.2023.1074558).
    13. Neufeld, D. C., & Johnson, E. A.. (2015). Burning with envy? dispositional and situational influences on envy in grandiose and vulnerable narcissism. Journal of Personality, 84(5). 685–696. (https://doi.org/10.1111/jopy.12192).
    14. Day, N. J. S., Townsend, M. L., & Grenyer, B. F. S.. (2020). Living with pathological narcissism: a qualitative study. Borderline Personality Disorder and Emotion Dysregulation, 7(1). 1–14. (https://doi.org/10.1186/s40479-020-00132-8).
    15. Zajenkowski, M. et al. (2018). Vulnerable and grandiose narcissism are differentially associated with ability and trait emotional intelligence. Frontiers in Psychology, 9. 1606. (https://doi.org/10.3389/fpsyg.2018.01606).

    Quick Links

    • Our Approach to Care
    • Virtual Treatment Program
    • Conditions We Treat
    • Our Locations

    Related Articles

    MC 1 4 1 1 - Mission Connection

    Causes of Narcissistic Personality Disorder: NPD Risk Factors

    Learn more
    Untitled design 2025 09 30T171105.029 - Mission Connection

    Narcissistic Personality Disorder Impact on Relationships & Mental Health Support Options

    Learn more
    Struggling with Narcissistic Personality Disorder Issues? We're Here to Help!

    Making your mental health a priority has never been so easy. We offer flexible schedules during the day, in the evening, and on weekends, so you can find the perfect time for you.

    Start Online
    Mission Connection
    30300 Rancho Viejo Rd.
    San Juan Capistrano CA 92675
    info@missionconnectionhealthcare.com
    Call 866-833-1822

    Licenses & Accreditations

    The Joint Commission National Quality Approval gold seal
    NABH
    NAATP
    HIPAA Compliant
    CDSS logo
    DHCS
    WADOH
    DBHDS
    LegitScript Certified Badge

    Quick Links

    • Our Approach
    • Programs
    • California
    • Virginia
    • Washington
    • Contact Us
    • About Us
    • Reviews
    • Outcomes
    • Careers
    • Resources
    Privacy Policy | Terms of Use | Cookie Policy | Sitemap
    Copyright 2026 © Mission Connection All Rights Reserved