F60.81 ICD-10 Code: Narcissistic Personality Disorder vs. Narcissistic Traits

Key Takeaways

• F60.81 is the ICD-10-CM code for narcissistic personality disorder (NPD). It's billable, and it didn't change in the 2027 code update.The old ICD-9-CM code, 301.81, is still floating around, but the DSM-5-TR now lists only F60.81.
• An NPD diagnosis requires at least 5 of 9 DSM-5-TR criteria, as part of a long-standing pattern that starts by early adulthood.
• Narcissistic traits are common. NPD is a pervasive, inflexible pattern that causes real distress or impairment.
• When clients call someone else a narcissist, focus on behavior and impact instead of diagnosing someone you haven't assessed.
• There's no medication approved for NPD itself. Psychotherapy is the main treatment.

Somewhere along the way, F60.81 became a social media punchline. Instead of calling an ex a narcissist, people post the diagnosis code.

So it's no surprise that "narcissist" walks into your office pretty regularly. A client wonders if their mom is one. Another client's partner called them one during a fight, and now they can't stop thinking about it.

For therapists, though, F60.81 is a real diagnosis with a specific bar to clear. In this article, you’ll learn the code basics, the DSM-5-TR criteria, how NPD differs from everyday narcissistic traits, and how to talk with clients about narcissism without dismissing what they've been through.

What Is F60.81?

F60.81 is the ICD-10-CM diagnosis code for narcissistic personality disorder. It lives in category F60, "specific personality disorders," alongside codes like F60.3 for borderline personality disorder and F60.2 for antisocial personality disorder.

A few quick facts:

• It's billable. F60.81 is a specific code you can use on claims.
• It's stable. According to ICD10Data, the code hasn't changed since ICD-10-CM took effect, including in the 2027 edition that took effect October 1, 2026.
• 301.81 is retired. The original DSM-5 listed both ICD-9-CM and ICD-10-CM codes during the transition, which is why you'll still see "301.81" on older resources. According to the American Psychiatric Association, ICD-10-CM has been the official U.S. coding system since October 1, 2015, and the DSM-5-TR includes only ICD-10-CM codes.

For a broader refresher on coding, see our guide to ICD-10 codes for mental health therapists.

Narcissistic Personality Disorder DSM-5-TR Criteria

NPD is defined by a long-standing pattern of grandiosity, need for admiration, and lack of empathy. The pattern starts by early adulthood and shows up across different areas of life, like work, friendships, and romantic relationships.

To meet criteria, a person needs at least 5 of these 9:

1. An inflated sense of self-importance, like exaggerating achievements or expecting to be seen as superior
2. Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
3. Believing they're "special" and should only associate with, or be understood by, other special or high-status people
4. Needing excessive admiration
5. A sense of entitlement, like expecting special treatment or automatic compliance
6. Taking advantage of others to reach their own goals
7. Lacking empathy, or being unwilling to recognize other people's feelings and needs
8. Envy, either envying others or believing others envy them
9. Arrogant or haughty behaviors or attitudes

The general personality disorder criteria apply too. The pattern has to be enduring and inflexible, stable over time, and cause significant distress or impairment. It also can't be better explained by another mental health condition, a substance, or a medical condition.

How common is it? Cleveland Clinic estimates that between 0.5% and 5% of people in the U.S. may have NPD, and that 50% to 75% of cases affect males.

Narcissistic Traits vs. NPD: What's the Difference?

Everyone has some narcissistic traits. Wanting recognition, feeling proud of an accomplishment, or getting defensive when criticized are all pretty human responses to situations.

Traits can flare up in certain seasons of life, or under certain circumstances. Think of a new manager who gets a little full of themselves after a promotion, or someone who gets prickly after a big rejection. That's not necessarily indicative of a personality disorder.

The difference comes down to how pervasive, rigid, and costly the pattern is:

A helpful way to explain it to clients: narcissistic traits are on a spectrum. NPD sits at the far end, where the pattern is intense and consistent enough to cause ongoing problems.

Grandiose vs. Vulnerable Narcissism

When most people picture narcissism, they picture the loud version: the boss who takes credit for everything and talks over everyone. That's often called grandiose narcissism.

But there's a quieter presentation too. StatPearls describes two proposed subtypes:

• Grandiose: overt grandiosity, aggression, a profound lack of empathy, exploitation, and boldness
• Vulnerable: hypersensitivity and defensiveness, with a fragile sense of self, and possibly more susceptibility to depression and anxiety

Vulnerable narcissism is what social media usually calls "covert narcissism." It can look like shyness, anxiety, or quiet resentment on the surface.

One important note: neither subtype is an official diagnosis. The DSM-5-TR doesn't formally classify NPD subtypes. If criteria are met, the code is still F60.81.

When to Use F60.81 (and When Not To)

Personality patterns are hard to see clearly in a single intake. Before you use F60.81:

• Assess over time. Look for the pattern across relationships, work, and history. A stressful week can make almost anyone look a little grandiose or defensive.
• Use your own assessment. Never diagnose based on how a partner, parent, or ex describes someone.
• Consider context. The general criteria require the pattern to differ markedly from what's expected in the person's culture.
• Rule out other explanations. More on that below.

Not sure where your scope begins and ends? Our guide on whether therapists can diagnose covers the basics.

Differential Diagnosis for NPD

StatPearls lists several conditions to consider. Here's a quick look at what to watch for:

• Bipolar disorder (manic or hypomanic episodes): Grandiosity can show up during mood episodes, along with other mood symptoms. With NPD, the pattern is steady instead of episodic. See our guide to bipolar ICD-10 codes.
• Borderline personality disorder: Both can involve intense reactions in relationships, but BPD centers more on unstable identity, fear of abandonment, and emotional swings.
• Antisocial personality disorder: Both can involve exploiting others. In ASPD, it's more tied to a broad disregard for rules and other people's rights.
• Histrionic personality disorder: Both involve wanting attention. In NPD, the focus is more specifically on admiration.

Substance use can also produce grandiose behavior, so ask about it. And keep in mind that conditions can co-occur. For more on sorting through overlapping presentations, see our guide to differential diagnosis.

Related Codes

• F60.89: Other specific personality disorders
• F60.9: Personality disorder, unspecified
• Z63.0: Problems in relationship with spouse or partner. This can fit a client who's struggling in a relationship with someone they describe as narcissistic. Z codes don't always support reimbursement on their own, so check payer rules. Our guide to Z codes has more.

How to Talk With Clients About Narcissism

This is where a lot of the real work happens. Most of the time, "narcissist" comes up in session as a word clients use, not a diagnosis you're making.

When a Client Asks, "Am I a Narcissist?"

Start by getting curious about why they're asking. Did a partner say it during a fight? Did a video hit a little too close to home?

Here's an illustrative example (not a real session):

Client: "My girlfriend says I'm a narcissist. Am I?"

Therapist: "That sounds like it really stuck with you. What was happening when she said it?"

Client: "I forgot her work thing because I was stressed about mine. Again."

Therapist: "So there's a pattern you're noticing. Instead of focusing on the label, can we look at what happens for you in those moments?"

Moving from "Am I a narcissist?" to "What happens in these moments?" turns a scary label into something you can actually work with.

When a Client Says Their Partner or Parent Is a Narcissist

This one comes up a lot. The goal is to take the client's experience seriously without diagnosing someone who isn't in the room.

• Validate first. The hurt is real, whatever the label.
• Get specific. "What does he do that makes you think of that word?" helps you understand the actual behavior.
• Gently set the label aside. You can't diagnose someone you haven't assessed. And sometimes a label keeps clients stuck waiting for the other person to change.
• Focus on what the client can control, like boundaries, needs, and decisions about the relationship.

Clients sometimes come in wanting to know how to "outsmart" or "beat" a narcissist. It can help to shift the goal from winning to staying safe and steady.

If a client describes threats, intimidation, controlling behavior, or physical harm, prioritize safety. A safety plan is a good place to start, and the National Domestic Violence Hotline is available 24/7 at 800-799-7233 or by texting START to 88788.

Sharing an NPD Diagnosis With a Client

Assume your client may see their diagnosis at some point. According to HHS, people generally have the right to see and get copies of their medical and billing records, with an exception for psychotherapy notes.

That's a good reason to talk about the diagnosis together. A few tips:

• Lead with patterns and goals. Talk about what's been getting in the way, like conflict at work or relationships that keep ending, before the label.
• Acknowledge the protective side. Many of these patterns once helped someone protect a fragile sense of self.
• Use person-first language. "A client with NPD" lands very differently than "a narcissist."

Psychoeducation can go a long way here, especially when it's collaborative.

Treatment Considerations for NPD

Psychotherapy is the main treatment for NPD. Goals often include relating better to others, understanding what drives emotions and relationship patterns, tolerating criticism, and improving self-esteem.

A few approaches come up often:

• Transference-focused psychotherapy (TFP): StatPearls notes TFP may have more success than other types of therapy.
• CBT, DBT, metacognitive therapy, and family therapy: Cleveland Clinic lists these among common approaches.

Research on NPD treatment is still growing, so expect to adapt as you go.

What you'll likely notice in the room:

• Clients often come in for something else, like depression, a breakup, or trouble at work.
• Feedback can land hard. Even gentle observations may feel like criticism, so pacing and warmth matter.
• Ruptures happen. Repairing them is often part of the work itself. Our guide to the therapeutic alliance has more on building trust.

What about medication? There are no FDA-approved medications for NPD. Medication may help with co-occurring conditions like depression or anxiety, which is a conversation for the client's prescriber.

Documenting F60.81 in Your Notes

Good documentation for F60.81 links the diagnosis to specific, observable patterns. It also avoids loaded words like "arrogant" or "manipulative," which can read as judgment instead of clinical observation.

A few tips:

• Tie criteria to examples. Note what you observed or what the client reported, and in which areas of life.
• Show the pattern over time. Note that it's long-standing and shows up across settings.
• Document impact. How does the pattern affect work, relationships, or daily functioning?
• Write like the client might read it, because they might.

Here's an illustrative DAP note (not a real client):

Data: Client described conflict with manager after receiving critical feedback. Reported feeling "humiliated" and thinking about quitting. Described similar reactions in two previous jobs and in past relationships.

Assessment: Long-standing pattern of strong reactions to perceived criticism and difficulty considering others' perspectives continues to affect work and relationships, consistent with F60.81. With support, client identified one alternative way to read manager's feedback.

Plan: Continue exploring reactions to feedback. Client will practice a perspective-taking exercise before next supervisor meeting. Review next session.

For treatment plans, keep goals behavioral and measurable. For example: "Client will use one strategy for responding to criticism without withdrawing or escalating in 3 of 4 reported situations over the next 8 weeks."

And as always, check each payer's policies and verify benefits before assuming coverage.

Personality patterns take time to track. Blueprint's AI-powered EHR helps therapists write session notes faster and track progress over time, so you can spend less time documenting and more time with clients. See how Blueprint works

F60.81 FAQ

What is diagnosis code F60.81?

F60.81 is the ICD-10-CM code for narcissistic personality disorder. It's a billable, specific code in the F60 category of personality disorders.

Is F60.81 the same as 301.81?

They both refer to NPD, but 301.81 is the old ICD-9-CM code from the original DSM-5. The U.S. switched to ICD-10-CM on October 1, 2015, and the DSM-5-TR lists only F60.81.

What's the difference between narcissistic traits and NPD?

Narcissistic traits are common and can come and go. NPD is a long-standing, inflexible pattern that meets at least 5 of 9 DSM-5-TR criteria and causes real distress or impairment.

What does "pathological narcissist" mean?

It's an informal phrase, not a diagnosis. People usually use it to describe narcissism that's severe enough to cause real problems. The formal diagnosis is narcissistic personality disorder, coded as F60.81.

Is covert narcissism a real diagnosis?

No. "Covert narcissism" is a popular term that overlaps with what researchers call vulnerable narcissism. The DSM-5-TR doesn't formally classify NPD subtypes, so the code is still F60.81 if criteria are met.

Can NPD be treated?

Yes. Psychotherapy is the main treatment, with goals like improving relationships and handling criticism. There are no FDA-approved medications for NPD itself, though medication may help with co-occurring conditions.

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