The Psych Writer on Narcissistic Personality Disorder

Gilderoy Lockhart. Zaphod Beeblebrox. Scarlett O’Hara. What do these three characters have in common?

Well, if you read the title, then you could guess they’re all different portrayals of Narcissistic Personality Disorder (NPD). Even though I enjoyed reading those books, and find many parts of their characterizations to be spot-on accurate, your job as a writer is not to copy those characters. You need to make your own. Make them human. Because a person has a PD does not make them any less human, but they are extremes of the human condition.

The Psych Writer is here to help you with this. Remember, this is not a substitute for therapeutic advice. If you somehow manage to see yourself in these symptoms and it also somehow bothers you (or, you know, if your loved ones are ready to throw you out of the house because you have these signs and symptoms), then seek the advice of a professional health care provider.

Without further ado, here is the lowdown on NPD.

NPD is part of the Cluster B personality disorders. They used to be in the Axis II, but the DSM no longer uses that multiaxial diagnosis (much to their detriment, if I’m to be blunt). Cluster B is the cluster of dramatic, emotional, and erratic personality disorders. That means it’s in the same group as Borderline, Histrionic, and Antisocial personality disorders. (There are ten total, in three clusters.)

People who fit into Cluster B have difficulties with impulse control and regulating their emotions. Ever seen someone in line at the store who is just outrageously angry because the cashier won’t honor a coupon, and they start threatening to sue the store and the cashier personally, calling the employee every name in the book and demanding to speak to the president of the company? Yeah, like that. That’s a problem with regulating one’s emotions.

In order to receive a diagnosis of NPD, the person must have an enduring and persistent pattern of grandiose behavior and feelings, a continuous desire for admiration, and a lack of empathy for others.

NPD begins in early adulthood and is often lifelong (especially if untreated), and can be observed in a variety of contexts (home, work, school, social gatherings, public areas).

The disorder is only diagnosed if the person exhibits five or more of the following signs/symptoms (again, some have all nine, but this isn’t seen often):

  1. Has an exaggerated sense of self-importance that’s grandiose. In other words, they expect you to recognize them as your superior without proportionate credentials or achievements.
  2. They are preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love. (In some cases, they are so preoccupied with the fantasy that they don’t do the work to make those dreams a reality, such as putting in work for promotions or completing their coursework.
  3. They believe they are special and unique to the point where they can only be understood and appreciated by high-status people or institutions, or they may also believe that they should only associate with the above-mentioned.
  4. They require excessive admiration. (If they aren’t constantly complimented and admired, they often become depressed or use manipulative tactics to gather attention.)
  5. They have an enormous sense of entitlement, unreasonably expecting favorable treatment, or having their expectations met without resistance or delay. Think about the coupon explanation above as an example.
  6. They are interpersonally exploitative. That means they’ll take advantage of others to achieve their own ends.
  7. They lack empathy. They refuse to identify or recognize other people’s feelings or needs.
  8. Envy issues: they think people are envious of them, and/or are often envious of others.
  9. They display  and possess attitudes of arrogance and haughtiness.

Behavioral characteristics include what’s known as “narcissistic rages,” which are hellish for the people who have to endure them. Some threaten suicide, some threaten homicide. Some come close to going through with it, and some complete it. Mostly, though, these rages are part of the loss of emotional regulation and sometimes impulse control. Occasionally, they are done to manipulate the other person into the behavior that the person with NPD wants from them.

Are they like this all the time? Yes. The majority of the time they are like this. That’s what pervasive and consistent mean. Don’t forget that when you’re writing the character!

When you do write a character with NPD, remember, you don’t have to hit all of these points. Not everyone is a textbook case and not everyone has every single symptom (in fact, they rarely do have all of them). Infuse your characters with what makes them uniquely human.

Happy writing.


Anne Hogue-Boucher won’t go into a narcissistic rage if you don’t follow her on Twitter or Facebook, but why risk it? You can also buy her books, and that will enable her to eat a sandwich.

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The Psych Writer: Exploring Borderline Personality Disorder

I had an idea for introducing the personality disorders after I went through some of the others, but I also take requests, as I said in one of my previous posts. Via Facebook, a request came in for me to write about Borderline Personality Disorder. So I’ll be moving into the Personality Disorders a little earlier than I expected.

That having been said, personality disorders are what we consider “bigger” in therapy. Personality disorders are deeply ingrained into the personality of the client. They are invasive, pervasive, and ever-present.

I live in Georgia. Here in Georgia we have an invasive plant called kudzu. It’s everywhere. It grows all over the place and it can’t just be cut down or even burned (burning is illegal anyway because duh, we’re in a drought most of the time and the place would go up in flames faster than Michael Jackson’s hair in that Pepsi commercial). It has to be uprooted from the ground by its root crown.

That’s exactly what personality disorders are–they’re the kudzu of our personalities. They strangle the existing plant and take over completely. They become the plant itself.

So when we’re dealing with a personality disorder, it takes a long time to get to that root crown and eliminate it so that the person can be less miserable and learn to function better so that the people around them can have improved relationships with them. With several of the personality disorders, close relatives and friends grow weary of the “antics.” It makes it difficult to sustain and maintain relationships.

Personality disorders can also interfere with work relationships and productivity, as well as the general day-to-day functioning of the patient. While the same can be said for any disorder in the DSM-5, with a personality disorder, it is much  more treatment resistant, prone to severe relapse, and is lifelong.

A patient has a personality disorder for life. They are never cured. But they can manage it, find relief, improve their relationships, and even help themselves hold down steady employment. They can work towards stability if they work hard enough. It takes a demanding amount of work.

Borderline Personality Disorder (BPD) falls into “cluster B” of the personality disorders. If you don’t count Personality Change due to Another Medical Condition or Other Specified Personalty Disorder and Unspecified Personality Disorder (which we don’t), you have ten personality disorders in three clusters:

  • Cluster A: This is know as the odd or eccentric cluster. It includes Paranoid Personality Disorder, Schizoid Personalty Disorder, and Schizotypal Personality Disorder.
  • Cluster B: This is the dramatic, emotional, erratic cluster. It includes Antisocial Personality Disorder, Borderline Personality Disorder, Histrionic Personality Disorder, and Narcissistic Personality Disorder.
  • Cluster C: This is the anxious and fearful cluster. It includes Avoidant Personality Disorder, Dependent Personality Disorder, and Obsessive-Compulsive Personality Disorder (which is not the same as OCD).

Borderline is considered to be in the dramatic, emotional, erratic cluster. It is characterized by a lifelong pattern of of instability in interpersonal relationships, self-image and affects, and marked impulse control issues (DSM-5, p. 645).

So what the hell does that mean? That means the patient has little to no stability in their relationships with others (professional and personal), erratic behavior and lack of self-control to the point where self or others are harmed.

According to the DSM-5, the signs and symptoms of BPD are a pervasive pattern (as stated above)–but what makes up these patterns? The DSM-5 reports that for a person to be diagnosed with BPD, they must have five (or more) of the following (which I will give in plain English):

  • Frantic efforts to keep from being abandoned, whether that threat of abandonment is real or imaginary. This does not include suicidal behavior or self-mutilation as that is a separate criterion.
  • Repeated unstable and intense relationships that alternate between extremes of idealization and devaluation. Going from “you’re perfect” to “you’re the scum of the earth.”
  • Unstable sense of self. This instability is marked and persistent and goes to extremes. Not only does the love-hate relationship apply to other people, it applies to themselves and their self-image.
  • Recklessness/lack of impulse control in at least two areas of life that will cause them harm, such as unprotected sex with strangers that could result in STIs, overspending, substance abuse, reckless driving, binge eating, etc.). This still doesn’t include suicidal behavior or self-harm.
  • Recurrent suicide attempts, threats, gestures and behavior, or self-mutilation.
  • ‘Affective instability due to a marked reactivity of mood.’ This one’s a bit hard to explain. Imagine the worst overreacting you’ve ever seen. Now imagine it could happen at any time for any reason. You run out of cotton balls and the person has a massive anxiety attack and the anxiety affect lasts for a few hours. It’s a bit like that.
  • Chronic feelings of emptiness. (Exact words from the DSM. Self-explanatory.)
  • Difficulty controlling anger. Intense anger fits. Inappropriate anger to the stimulus. Imagine telling the person you’re out of donuts and they smash a table in response, demand to see your manager, threaten to sue, and threaten to kill you. While that might be funny and unbelievable, yes, it is that extreme.
  • Stress-related paranoia or severe dissociative symptoms that are transient. In other words, it doesn’t last, but the person will abruptly become paranoid, or they’ll dissociate (the world isn’t real, people are inhuman or automatons, etc.).

Now, writing a character with BPD is actually a challenge. Sure, you can go through all nine of the criteria, but I could almost guarantee you that you’ll create a caricature instead of a character. Even with black-and-white perceptions that many people with BPD have, they are still human beings. Avoid making a cookie cutter. You’ll want to add lines of sympathy to that character. He or she didn’t get there on their own. In many cases of BPD, there is not just a genetic component–there is often a history of abuse–sexual, physical, etc.

The person with BPD does not mean to do these things. They cannot help it. That’s why Dialectical Behavior Therapy helps so much. Patients learn from a system of mindfulness and awareness. DBT was developed by Marsha M. Linehan, who has successfully managed the disorder herself. Bear in mind that if you are writing someone with BPD, remember, they cannot help themselves when they do these things. Yes, some of the behaviors are purposefully manipulative, but they are not malingering. Until they get professional help, they are often unaware that these things are not acceptable, because even though people tell them so, they are often focused on assigning blame to others for their reactions.

Always remember, you are still writing a human being, though these are the extremes of the human condition.

If you came here looking for help with BPD, know that it’s out there. Start with this article here and then search for a therapist in your area who specializes in DBT.


Anne is a former supervised therapist and current author. You can read her books, stare at her Twitter, or stalk her on Facebook if you want.