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Is Narcissistic Personality Disorder a Mental Illness

Updated: Oct 21, 2022

Green hoodie with red question mark asking is narcissistic personality disorder a mental illness

Is Narcissistic Personality Disorder a Mental Illness?

Should You Hold Your Abuser Responsible?

Written by Randi Fine, Narcissistic Abuse Expert

Narcissistic Abuse Awareness and Guidance with Randi Fine

People often ask me, "Is narcissistic personality disorder a mental illness?" The answer is yes. It is categorized that way by mental health professionals.

Their follow-up response is usually, “Well, if these people are mentally ill, how can we hold them responsible for their behavior.”

To be mentally ill is to have a disturbed mind. The minds of pathological narcissists are no doubt disturbed. But it is the degree of disturbance that determines what they can and cannot control. Those who are able to control their behavior are accountable for it.

Though narcissists are mentally unwell, they are not insane. It often does not appear so, but narcissists have full control of their faculties and are deliberate in their actions. To be classified as insane, a person must not be able to distinguish fantasy from reality. Narcissists’ realities are skewed, but these people are fully engaged and present in the real world.

Those who are insane cannot control their urges. Narcissists can and do control their urges, though it often does not seem so. They know when and where to exhibit their abusive behaviors. Those who are insane cannot conduct their basic everyday affairs. Narcissists get along swimmingly in life. They can be very successful people.

As survivors of NPD abuse, many of us suffer mild degrees of mental illness as well. That does not excuse us from being responsible for our actions. We do not have a “Get out of Jail Free” card, and neither do narcissists.

When we think of “mental illness” we imagine it at its most severe. But mental illness exists on a continuum. It is a broad category that encompasses many disorders and levels of debilitation.

Mental illness is clinically defined in the fifth and latest addition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as, "A syndrome characterized by clinically significant disturbance in an individual's cognition, emotional regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.”

Mental illness is a very real, ongoing condition that impairs one’s ability to function for its duration. It is a disease that disturbs the person’s behaviors and thoughts, causing the ordinary demands of everyday living to feel overwhelming. The symptoms that accompany a mental disorder can range from very mild to severe.

Mental illness is not a rare occurrence. These types of disorders affect people of all ages and from all walks of life. According to the National Alliance of Mental Health (NAMI), approximately 1 in 5 adults in the U.S. (43.7 million) experiences mental illness in a given year.

More than 200 forms of mental illness have been classified by the American Psychiatric Association. Most of us are only familiar with a few; the ones we hear a lot about such as depression, post-traumatic stress disorder, schizophrenia, obsessive compulsive disorder, and bipolar disorder. In this article I will specifically focus on narcissistic personality disorder, not often discussed or commonly understood.

One in eleven people meet the diagnostic criteria for having a personality disorder. Personality disorders are grouped in the DSM-5 in three clusters; cluster A, cluster B and cluster C. Narcissistic personality disorder is a cluster B disorder, also referred to as “the dramatic, emotional, and erratic cluster,” along with antisocial personality disorder, histrionic personality disorder, and borderline personality disorder.

Personality disorders are extreme manifestations of common behaviors that significantly impair a person’s ability to behaviorally respond to life in an acceptable way, and create difficulty in the person’s interactions with others. They are sets of chronic, inflexible personality traits, or patterns of deviant or abnormal behavior that those who have them will not change, even when their behavior troubles everyone around them and negatively impacts all their relationships.

Personality disorders are not limited to episodic mental illness, are not caused by illness or injury, and aren’t an effect of substance abuse.

There is a great deal of controversy among mental health professionals over how personality disorders are clinically defined, because people with the signs and symptoms of one personality disorder often exhibit symptoms of one or more other disorders. This overlapping often results in multiple diagnoses, putting the validity of each individual qualification in question.

So, is narcissistic personality disorder a mental illness? Yes, it definitely is. But those who have it are not psychotic. These predators are crystal clear in their motives and intentions. It is their conscious objectivity and purpose that make them extremely dangerous to the unsuspecting mind.

Do not pity your abuser. You were targeted and victimized by the predator with full intent and no remorse. Focus your compassion on yourself. The narcissist can never heal but you can.

This is copyrighted material. May only be shared with permission and proper attribution.

Randi Fine is an internationally renowned narcissistic abuse expert and coach. She is the author of the groundbreaking book Close Encounters of the Worst Kind: The Narcissistic Abuse Survivor’s Guide to Healing and Recovery, the most comprehensive, most well researched, and most up-to-date book on this subject. In addition to helping survivors recognize their abuse and heal from it, this book teaches mental health professionals how to recognize and properly treat the associated abuse syndrome. She is also the author of Cliffedge Road: A Memoir, the first and only book to characterize the life-long progression of complications caused by narcissistic child abuse.


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