Overt vs. Covert Narcissistic Personality Disorder—and Their Symptoms
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Medically reviewed by Kira Graves, PhD
Narcissistic personality disorder (NPD) is a mental health condition that causes symptoms such as a pattern of grandiosity, a need for admiration, and a lack of empathy. It's worth noting that NPD is not the same as narcissism—a personality trait that makes a person look vain or self-involved.
With NPD, however, a person's entire identity is based on an inflexible and distorted sense of self that is highly dependent on feedback from others. This distorted sense of self and other symptoms of NPD can affect one's ability to maintain relationships, function at work, and live a fulfilling life.
NPD is one of the least studied personality disorders. The criteria that providers use to diagnose NPD have also been criticized for not accurately capturing how NPD symptoms can look different from person to person. As research improves, experts have started to learn that overt NPD and covert NPD can often cause varying symptoms. For instance, entitlement and attention-seeking are more common in overt NPD, while low self-esteem and isolation are related to covert NPD.
Researchers believe that a combination of genetic and environmental factors (like childhood trauma) can increase your risk of developing NPD. Studies also estimate that up to 5% of the population lives with NPD and symptoms of the condition tend to develop in early adulthood.
Hallmark Symptoms
According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), you must have five or more of the following symptoms to receive an NPD diagnosis. These symptoms must also appear in a variety of settings and situations.
Living With a Grandiose Sense of Self-Importance
People with NPD experience grandiosity that goes beyond having a positive self-esteem. In most cases, their sense of superiority and self-importance doesn’t match the reality of their actual achievements. For example, someone with NPD might:
Exaggerate their accomplishments (e.g., say they are a top performer at their company despite evidence of the contrary)
Overemphasize their talents (e.g., always claim to be the “best”)
Expect to be recognized and rewarded without achievements
Preoccupying Themselves With Fantasies of Success
Those who live with NPD can also experience frequent thoughts or fantasies of wanting to be successful. To keep up with their grand sense of self-image, they may also hold unreasonably high standards about what they believe they can accomplish. Their hunger for success and power is often insatiable, meaning no accomplishment is ever enough. Fantasies about success can include:
Work-related accomplishments
Gaining power (e.g., getting a promotion or holding a leadership role at an organization)
Finding ideal or "perfect" love
Being intellectually brilliant or exceptional (e.g., gaining academic recognition or writing a best-selling novel)
Feeling Superior or Special
Someone with NPD often believes they are better and different than other people. This can make it hard for them to relate to people in their own life. Instead, they might believe they would be better understood by other "special" people or have the desire to be close to communities and institutions that are high-status.
Requiring Excessive Admiration
Receiving recognition, attention, and admiration is an important motivational force for people with NPD. Their identity is also heavily dependent on how others view them—meaning they rely on others to regulate their own sense of identity and self-esteem. This need for admiration can lead to:
Only engaging in goals that lead to external validation (e.g., a task might feel "pointless" if it doesn't lead to recognition)
Seeking attention from others (e.g., redirecting a conversation to focus on their own accomplishments)
Ignoring feedback or criticism that doesn't match their self-image
Devaluing people who don't give them the admiration they are looking for
Having a Sense of Entitlement
People with NPD might believe they deserve special treatment, have unreasonably high expectations for how they should be treated, and believe others should follow their own high standards. In some people with NPD, this sense of entitlement can actually lead to low personal standards (e.g., low performance at a job) because they believe they deserve special treatment and recognition regardless of their actual efforts.
Exploiting Their Relationships
People with NPD often see relationships as transactional. This can lead to more blatant exploitation, like using a loved one for personal gain (e.g., asking for money), or more subtle exploitation, like using a relationship to boost their self-worth without showing genuine interest in the other person.
Because of this, those with NPD often have superficial relationships with others. They may also desperately need people to validate their sense of self and avoid genuine connections that might contradict their distorted self-image.
Lacking Empathy
NPD can also cause people to have an impaired ability to recognize or identify with the feelings and needs of others. As a result, they may also often lack the desire to understand the feelings of others, causing them to show little to no genuine interest in others' experiences. People with NPD are often only attuned to the reactions of others that relate to themselves.
Being Envious of Others
People living with NPD can also be preoccupied with comparing themselves to others. This makes them frequently envious of the accomplishments of the people around them. In contrast, some people with NPD aim to uphold their own self-image and instead believe that others are frequently envious of them.
Displaying Arrogant Behaviors and Attitudes
Someone with NPD might move through the world with an attitude that reflects their grand sense of self-image. This can cause someone to be arrogant in how they treat others. For example, a person with NPD might become quickly angry if someone criticizes them, have an unwillingness to listen to other people's opinions, or look down on people who have a different point of view.
Types of Narcissistic Personality Disorder
Symptoms of NPD can also manifest differently depending on the type of NPD someone has. Researchers have identified two main subtypes of NPD: overt and covert. People with NPD can fluctuate between these subtypes depending on their life circumstances or even experience a combination of symptoms and traits.
Overt NPD: Also called grandiose NPD, this type is the more common type of NPD. People with overt NPD may often experience observable grandiosity, attention-seeking behavior, and entitlement. They may also come off as being socially charming and might actively seek relationships that boost their self-esteem. Unless confronted with an obvious failure, they appear to show few signs of distress or anxiety.
Covert NPD: Also known as vulnerable NPD, people with this type secretly believe they have a higher sense of self than others, but behave self-critical and shy in front of others. Those with this condition may also be unable to cope with the gap between their beliefs about themselves and their reality. This may result in socially isolating themselves, having anxiety or depressive moods, experiencing hypersensitivity, living with low self-worth, and ruminating (or, negatively thinking) about their sense of self.
Symptoms in Women
According to the DSM-5, 75% of people who receive a diagnosis for NPD are assigned males at birth. Some researchers suggest that the criteria for the disorder are biased on sex.
For example, while men are more likely to show more overt or grandiose signs of NPD—which are disproportionally emphasized in the diagnostic criteria—women may be more likely to display covert or vulnerable traits of NPD that healthcare providers might often overlook. As a result, those assigned female at birth may often be underdiagnosed or misdiagnosed with other personality disorders, such as borderline personality disorder (BPD).
When to Contact a Healthcare Provider
People with NPD may not initially feel aware of their own motivations or traits. As such, they may be more likely to seek support for a co-occurring or underlying health condition like substance use disorder, bipolar disorder, or depression. Additionally, a negative life event like a relationship break-up, trouble at work, or a slip into a more vulnerable, covert state can motivate someone with NPD to seek support from a healthcare provider.
It's never too early to contact a mental health care provider if you believe traits of NPD are negatively affecting your life or the life of a loved one. Additionally, if you or a loved one are experiencing suicidal thoughts as a result of NPD or another mental health condition, please call 988 to reach the National Suicide Prevention Lifeline or text HOME to 741741 to reach the Crisis Text Line.
A Quick Review
Narcissistic personality disorder (NPD) is a mental health condition that causes a grand sense of self-image, a need for admiration, and a lack of empathy. This can affect one's ability to form genuine relationships, job satisfaction, and overall quality of life.
There are also two types of NPD: overt and covert. People with overt NPD often believe they are superior to others, tend to see relationships as transactional, and need feedback and attention to regulate their self-esteem. Those with covert NPD, however, may experience social isolation, unstable self-esteem, and co-occurring conditions like substance use disorder and depression.
Frequently Asked Questions
What is the difference between narcissistic and borderline personality disorder?
Both NPD and borderline personality disorder (BPD) can cause a pattern of unstable relationships, anger, and impulsive behavior. While people with NPD are motivated by sustaining their grandiose self-image, people with BPD are often motivated by fears of abandonment and experience an unstable self-image. Unlike people with NPD who have more shallow and transactional relationships, people with BPD desire intense connections with others.
Who treats narcissistic personality disorder?
While there is no established treatment specifically for NPD, a therapist or psychologist might use psychotherapy (or, talk therapy) to support someone with NPD.
Is narcissism the same as NPD?
Narcissism is a personality trait that exists on a spectrum. While many people have narcissistic traits, not everyone who experiences narcissism meets the criteria for NPD. For people living with NPD, narcissism can affect their functioning and behavior in every area of their lives.
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