Facts

• It is estimated that those with a narcissistic personality disorder constitute less than one percent of the general population and from two to 16 percent of the clinical population. Of those diagnosed with narcissistic personality disorder, 50 to 75 percent are estimated to be male.
  
  

Types

• According to the most recent edition of The Diagnostic Statistical Manual of Mental Disorders (DSM IV-TR), there are no official subtypes of narcissistic personality disorder. This manual is the definitive diagnostic aid used by mental health professionals in the United States.
  
  While the DSM IV-TR does not currently recognize any NPD subtypes, the current literature suggests that there are subtypes present. However, there is no consensus among researchers and clinicians regarding the number of subtypes or the specific characteristics associated with each subtype.
  
  

Features

• There are currently nine DSM IV --TR diagnostic criteria (no subtypes present) for narcissistic personality disorder. These include an exaggerated sense of self-importance; preoccupation with a sense of unlimited success; an unwavering belief that one is special and unique; requires disproportionate admiration for even minor accomplishments; expects automatic conformity with their beliefs; takes advantage of others; lacks empathy for others; is often jealous and exhibits egotistical beliefs and attitudes. Of these nine criteria, five or more need to be present for an individual to be diagnosed with NPD.
  
  

Theories

• There are two theories concerning possible narcissistic personality disorder subtypes. Rivas explains this first theory in a 2001 literature review in the Journal of Mental Health Counseling. In this review, Rivas finds that there are two subtypes---overt and covert. An overt narcissistic personality exhibits the same characteristics as the current and accepted DSM IV-TR description. An individual with covert narcissistic personality disorder is described as hypervigilant, dissociative and vulnerable, in addition to the other classic characteristics of the disorder set out in the DSM IV-TR.
  
  The second theory proposed by Shedler in a November 2008 American Journal of Psychiatry article suggests there are three narcissistic personality disorder subtypes. These three are grandiose/malignant, fragile and high-functioning/exhibitionist. The grandiose or malignant subtype is identified by marked arrogance, contempt for others and a belief that they should only associate with other special people like themselves. A fragile narcissistic personality exhibits the typical characteristics associated with the disorder but also tends to be despondent and depressed. The third subtype, high functioning, is socially at-ease and articulate but still exhibits the inflated self-esteem representative of those with narcissistic personality disorder.
  
  

Considerations

• The DSM IV-TR is the authoritative guide for diagnosing mental illness in the United States. While there may be evidence of the presence of subtypes for narcissistic personality disorder, until the DSM IV-TR is updated to include the proposed subtypes, they cannot be officially diagnosed. The DSM V is scheduled for release by the American Psychiatric Association in May of 2012.