Individuals with narcissistic personality disorder appear arrogant and entitled but suffer from extremely low self-esteem.

Epidemiology
Lifetime prevalence is estimated at 1 % in the general population and 2% to 16% in clinical populations.
Fifty to 75% of those with this diagnosis are men.

Etiology
The etiology of this disorder is unknown.

Clinical Manifestations
History and Mental Status Examination
People with narcissistic personality disorder demonstrate an apparently paradoxical combination of self-centeredness and worthlessness. Their sense of self-importance is generally extravagant, and they demand attention and admiration. Concern or empathy for others is typically absent. They often appear arrogant, exploitative, and entitled. However, despite their inflated sense of self. below their brittle facade lies low self-esteem and intense envy of those whom they regard as more desirable, worthy, or able.

Differential Diagnosis
The grandiosity of narcissism can be differentiated from the grandiosity of bipolar disorder by the presence of characteristic mood symptoms in bipolar disorder.