Most people who have narcissistic traits, which is most of us, do not qualify for a diagnosis of NPD. What is the difference between a person who has "narcissistic issues" and one who is pathologically narcissistic?
When referred to in everyday language, people who have narcissistic traits are often said to have "big egos". This means that they get obvious gratification from being admired and demonstrating that they are special. They may brag about accomplishments and become prickly and defensive when questioned about them. But essentially, they have a reasonably realistic sense of their own importance in the universe, which a narcissist most assuredly lacks.
To some extent, we all share a desire for admiration and approval, and we want to be loved as individuals. That is part of having a sense of self, which is essential to mental health and social well-being . However, reasonably mature individuals can absorb and eventually neutralize the inevitable insults life sends our way. We can be rejected in love and still feel worthwhile, we can do poorly on a test and still believe we're intelligent. We are able to maintain a positive sense of self even though we know we are not perfect nor universally loved. This is called "healthy narcissism".
There are many people who do not qualify for the diagnosis of NPD but who have narcissistic attributes. They may fundamentally fail to understand that they are not the center of other people's universes. For instance, I often hear people express the belief that when they walk into a room, everyone is scrutinizing them, evaluating their worth with every word they utter. I had a friend once who would call me after a social event stressed over her imagined impact on the group. She overvalued, in terms of impact, her every comment, facial expression, and gesture. What she failed to realize is that no one was paying that level of attention to her and therefore her interpretation of reality was quite distorted. This is a narcissistic issue. More seriously, some people with narcissistic problems expect their own needs and desires to be considered first and foremost, regardless of needs and desires of others.
Like virtually all psychiatric diagnoses, pathological narcissism or NPD exists on a continuum. In other words, someone can have a mild case all the way up to a severe one. If you think of those "big egos", the guys that brag and strut but don't have other symptoms, as being on the very end of a NORMAL continuum, you can start to see where the NPD continuum begins. I believe that what separates the boasters from the NPDs is, in a nutshell, an impairment in the ability to empathize. These people are emotionally shallow. They may profess to have concern for others, but scratch the surface by probing a little and you will find that they really couldn't care less about anyone but themselves.
So what ARE the symptoms of NPD? I have always been dissatisfied with the DSM criteria for NPD so I will share the proposed amended criteria by renowned expert and self proclaimed pathological narcissist Sam Vaknin, in abbreviated form:
1. Feels grandiose and self-important.
2. Is obsessed with fantasies of unlimited success, fame, omnipotence, beauty, etc.
3. Convinced he or she is unique and special and that others must regard him as such.
4. Requires excessive admiration and attention.
5. Has a strong sense of entitlement.
6. Is interpersonally exploitative, i.e., uses others to achieve his/her ends, regardless of the consequences to others.
7. Is devoid of empathy. Is unable to experience genuine concern for the rights and needs of others. Only his own needs matter.
8. Constantly envious of others and tries to hurt or destroy the objects of envy.
9. Behaves arrogantly and haughtily. Because he is so special, he does not believe rules apply to him and may rage when contradicted or confronted.
While a mere braggart is irritating, a pathological narcissist wreaks tremendous havoc in the lives of others, causing substantial misery to those in his path. The more severe the NPD, the less he cares about his impact on others. In other words, the narcissist is at the center of the universe and others are mere players in his game, with no more intrinsic value than chess pieces. A psychopath (or sociopath) is at the extreme end of the narcissistic continuum. A psychopath has NO empathy and feels NO guilt.
One of the reasons extreme narcissists have so much power to harm is that "normal" people simply cannot believe that someone can be devoid of empathy or conscience. For many people, it just doesn't compute...."How can you do this to me and not feel badly?".... People fail to protect themselves when they think that everyone has a moral or ethical line they will not cross.
Another and perhaps more important reason people are taken in by narcissists is that they are often very charming and present a false self in order to ensnare others. A narcissist will be whoever you want him to be, at least at first. By the time his persona starts to crack, a person is already deeply attached to the original (false) self he presented and still believes "he's in there somewhere". He is not.
Pathological narcissists can cause catastrophe in business (think Jeffrey Skilling of Enron and Bernie Madoff as examples) and in politics and global affairs (think Assad, Sadam Hussein, Hitler, Stalin, Robert Mugabe, Idi Amin...this list, unfortunately can go on for quite awhile). But being in a personal relationship with a narcissist can turn your world upside down and make you doubt your sanity. Why? Because a major defense of the pathological narcissist is to blame others, always, for any perceived flaw in his image or behavior. In other words, the narcissist NEVER takes responsibility for his actions. And even if you have an "air tight" case, PROVING that he did something wrong, he will talk in such circles, with such flagrant disregard for the truth, you will start to doubt your own perceptions.
Narcissists are unable to truly love others. They need others to feed their incessant craving for admiration, adoration, and self-importance, and will idealize those who steadily supply them with it. But woe to person (object) who withdraws those supplies, for she will meet with vicious condemnation. Lacking the ability to love, which requires that a person see the other as a distinct individual who is at the center of her own universe, not his, there is no genuine attachment to those who disappoint him. When a narcissist is rejected by a lover, he may go to great lengths to win her back, but love has nothing to do with it. What the narcissist wants back is not the lover per se, but the restoration of his grandiose sense of self which the rejection has injured.
Narcissistic Personality Disorder is often very hard to diagnose, even by seasoned mental health professionals, because it can take a fairly long time for the narcissist to show major cracks in his persona. The blatant disregard that narcissists have for other peoples' rights and boundaries does not often show up in the "wooing phase", that is when a narcissist is charming the other into accepting his distorted image of himself. Indeed, it is quite common for the narcissist to idealize the other at this stage, making the object feel he truly sees her as exceptional. What is really going on is that he is projecting his inflated self-image onto the other, which is what he really loves. Should the person dare not to conform to his idealized projection, idealization is quickly replaced with devaluation; "You are the love of my life " can suddenly become "You are lower than a crushed bug on the bottom of my shoe".