Quick reference
- When to use
- Use F60.81 when the client demonstrates a pervasive, inflexible, and enduring pattern consistent with Narcissistic Personality Disorder that deviates from cultural expectations, causes distress or impairment, and is stable over time. Do not assign based on a single clinical encounter.
- Duration
- Personality disorders are enduring patterns — symptoms should be traceable to adolescence or early adulthood. Minimum of several sessions recommended before diagnosing. Reassess periodically as treatment may modify traits.
- Session codes
- Pair with CPT 90834/90837 for individual therapy. DBT programs: 90853 (group), 90834 (individual), plus phone coaching. 90791 for comprehensive evaluation. Long-term treatment is typical.
- Key indicators
- Enduring pattern of inner experience and behavior • Deviates from cultural expectations • Pervasive across situations • Onset in adolescence/early adulthood • Stable and long-standing • Distress or impairment
What F60.81 represents
NPD involves a pervasive pattern of grandiosity, need for admiration, and lack of empathy. Beneath the surface grandiosity often lies fragile self-esteem and vulnerability to perceived slights.
Key diagnostic criteria
5+ of 9 criteria:
- Grandiose sense of self-importance
- Preoccupied with fantasies of success, power, beauty
- Believes they are special and unique
- Requires excessive admiration
- Sense of entitlement
- Interpersonally exploitative
- Lacks empathy
- Envious of others or believes others are envious
- Arrogant, haughty behaviors or attitudes
Documentation essentials
Document specific criteria met. Note both grandiose and vulnerable features. Record interpersonal impact.
Differential diagnosis
Distinguish from BPD, HPD, antisocial PD, and mania with grandiosity.
Treatment planning
Schema therapy, transference-focused psychotherapy, mentalization-based treatment. Building therapeutic alliance is key.
Insurance & billing
Accepted code. Document functional impairment and interpersonal difficulties.
Updates & changes
NPD is being reconsidered in alternative dimensional models.
Documentation pitfalls
Don't use pejoratively. Recognize both grandiose and vulnerable presentations.
References
- American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).