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People who meet the criteria for the diagnosis of narcissistic personality disorder (NPD) base their self-esteem excessively on the views of other people. They see themselves as exceptional and have a strong sense of entitlement. Because they see themselves as exceptional, they may set their personal standards as unrealistically high. Conversely, they may regard themselves as entitled to whatever they want and therefore set their personal standards far too low. Their impairments in goal setting also include a constant attempt to gain approval from other people.
In terms of their own sense of identity, people with NPD derive their self-definition and self-esteem from the way that they believe other people view them. However, although sensitive to others' opinions, they are unable to empathize with other people. They entirely direct whatever concern they have for others toward determining whether people like them or not. In their special personal relationships, they cannot establish true closeness with an intimate partner because they are so focused on themselves, their feelings, and how people perceive them. Their sense of entitlement translates into personality traits of grandiosity, and their desire for admiration leads them to seek out recognition whenever possible.
Although people with NPD may appear to think of themselves as better than others, this grandiosity may mask an underlying vulnerability in their sense of self. Some individuals with NPD may have a truly inflated and grandiose sense of self; hence, clinicians refer to them as high on grandiose narcissism. However, clinicians more accurately characterize others as high on vulnerable narcissism. These are individuals who rely excessively on other people to confirm their worth. Those high on vulnerable narcissism are more sensitive to rejection, more likely to feel a sense of shame, and are less able to bolster their fragile sense of self by making up grandiose fantasies. They may appear shy and even emphatic. When they feel that they have not lived up to their standards, they are more likely to become socially withdrawn.
People who are higher on grandiose narcissism are more threatened by failure in the realm of personal accomplishments. Those high on vulnerable narcissism, by contrast, react more negatively when they feel that someone who is important to them is humiliating or betraying them. The DSM-5 does not explicitly make this distinction, but clinicians and researchers maintain that it is an important differentiation.