Narcissistic personality disorder (NPD) is a psychiatric condition characterized by a number of dysfunctional traits or behaviors, including a lack of empathy for other people and a highly exaggerated sense of self-importance. Outside of the US, this condition does not officially exist as a distinct form of mental illness. Narcissistic personality disorder produces essentially the same symptoms in both women and men; however, researchers have identified a number of secondary factors that differentiate cases of the disorder in women from cases of the disorder in men. NPD Basics In the United States, an organization called the American Psychiatric Association creates the guidelines that medical professionals use to diagnose and treat various forms of mental illness. The Association updates its guidelines in a periodic publication called the Diagnostic and Statistical Manual of Mental Disorders, or DSM. Narcissistic personality disorder first appeared in the 1980 edition of the DSM, known as DSM-III. As of 2012, current guidelines for NPD appear in a version of the DSM known as DSM-IV-TR. According to these guidelines, doctors can diagnose the presence of NPD in people who have at least five of nine specific symptoms. These symptoms include belief in a special uniqueness that's not understood or appreciated by "average" people; unwillingness or inability to empathize with others; a grandiose belief in one's personal importance; a continual need to be admired by others; an obsession with visions of personal power, brilliance, beauty, or achievement; ongoing displays of arrogance; a strong sense of personal entitlement; a preoccupation with envy toward and from others; and maintenance of relationships that exploit others in some way. While many mentally healthy people (including teenagers) show signs of these narcissistic personality traits, people with NPD have forms of these traits that seriously disrupt their ability to participate functionally in everyday life. No one knows why people develop narcissistic personality disorder, the US National Library of Medicine explains. However, in all likelihood, the condition stems from the interaction of several different social, biological, environmental, and psychological factors. Most people develop NPD by the time they reach their early to mid 20s; in some cases, symptoms of the disorder grow worse as the affected individual nears middle age or old age and undergoes age-related changes in appearance or physical ability. Specific Factors in Women Estimates of the number of people with narcissistic personality disorder range anywhere from 0.5 percent to roughly 6 percent of the US adult population. Women account for only 25 percent of all NPD patients. However, according to a 2008 study published in the "Journal of Clinical Psychiatry," not all women have equal risks for the disorder, and the highest rates for females appear in black and Hispanic women; separated, divorced, and widowed women; and women who have never married. Women also tend to develop certain other mental health disorders in combination with NPD, including borderline personality disorder, bipolar disorder, schizotypal disorder, post-traumatic stress disorder, generalized anxiety disorder, and phobias to specific places, things, or situations. Women with NPD tend not to develop some of the problems that men with the disorder frequently experience, such as drug addiction, alcohol abuse and alcohol addiction. In addition, women tend to develop forms of narcissistic personality disorder that produce less overall mental dysfunction than the forms commonly found in men. Similarities Between Women and Men Because of the nature of the symptoms of narcissistic personality disorder, both men and women with the condition tend not to recognize its presence on their own. Instead, they typically experience severe setbacks in their personal or professional lives that cause them to question their life choices, and also receive input from family members that strongly suggests that these setbacks stem from abnormal or unhealthy personality characteristics. Even with these pressures, women and men with NPD tend not to seek treatment on their own unless they have additional mental health issues. In these cases, doctors usually identify the presence of NPD while diagnosing other disorders. Many of the additional mental health disorders found in women and men with narcissistic personality disorder are comorbid conditions. This means that, when any one of these disorders appears at the same time as NPD, the resulting interaction between them worsens the effect of both conditions and makes them more harmful than they would be on their own. Considerations As mentioned previously, only medical professionals in the US currently recognize narcissistic personality disorder as a distinct mental health condition. Essentially, this is true because only doctors in the US use the Diagnostic and Statistical Manual as their main reference guide on mental illness. Instead of the DSM, doctors outside the US typically use a World Health Organization publication called the International Classification of Diseases, or ICD. Instead of maintaining a separate diagnostic category for narcissistic personality traits, the ICD groups these traits within a general category of conditions known as "other specific personality disorders." In 2013, the newest version of the DSM will also likely do away with NPD and group narcissistic personality traits within a category of conditions known as "antisocial\/psychopathic type personality disorders."