Which mental status exam (MSE) findings are characteristic of narcissistic personality disorder (NPD)?

Updated: May 16, 2018
  • Author: Sheenie Ambardar, MD; Chief Editor: David Bienenfeld, MD  more...
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Mental status examination (MSE) may reveal depressed mood due to dysthymia or major depressive disorder, both of which may be related to the paradoxically low self-esteem often present in patients with NPD. Conversely, patients in the throes of narcissistic grandiosity may display signs of hypomania or mania. [1]

The following is a sample MSE for a patient with NPD:

  • General appearance and behavior - Well-groomed, well-dressed male in no acute distress

  • Attitude - Resistant and haughty

  • Psychomotor activity - Normal, no agitation or retardation

  • Eye contact - Intense

  • Affect - Restricted

  • Mood - Angry

  • Speech - Normal rate and tone, high volume; no pressured speech

  • Thought process - No evidence of thought blocking, flight of ideas, loose associations, or ideas of reference; some tangentiality present

  • Thought content - Denies suicidal ideation and homicidal ideation; denies audiovisual hallucinations; no paranoid delusions elicited or endorsed

  • Orientation - Oriented to person, place, and time

  • Attention and concentration - Good

  • Insight - Poor

  • Judgment - Limited

The video below includes an actor’s portrayal of an individual with NPD.

This is an actor portrayal of a patient with narcissistic personality disorder. This video clip was provided courtesy of Donald C. Fidler, MD, FRCP-I.

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