To qualify for a diagnosis of APD, the patient must have had a conduct disorder by 15 years old, and show at least four of these traits:

Doesn’t sustain consistent work (or school)
Doesn’t conform to social norms, including unlawful behavior whether or not arrested
Disregards the truth, indicated by repeated lying, conning, using aliases, not paying debts
Impulsive or fails to plan ahead; moves around without a goal
Irritable and aggressive; e.g., fights or assaults
Recklessly disregards safety of self or others
Consistently irresponsible, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
Lacks remorse, and feels justified in having hurt, mistreated, or stolen from another
Doesn’t sustain monogamy for more than one year
Irresponsible and negligent as a parent
Types of Narcissists – Malignant and Closet Narcissist

Some narcissists can look like sociopaths, but there are narcissists who aren’t malicious and who care about their families. Those who have all or most of the 9 criteria for a diagnosis of NPD (only five are necessary), and who exhibit them intensely and/or frequently, are considered malignant narcissists. They’re more exploitative, vicious, and destructive.

There are several types of narcissists – ranging from the common “Exhibitionist Narcissist” to the inhibited or “Closet Narcissist,” coined by psychoanalyst James Masterson. They may have an inferior self-image and show evidence of depression and emptiness, which the exhibitionist narcissist also has but hides, (also from him or herself). Rather than seek attention, the closet narcissist may shun it and even act humble. Like codependents, they are uplifted through the idealization of others. Contrary to some popular beliefs, this does not make codependents closet narcissists. The latter still lack real empathy and believe in their specialness and sense of entitlement, even in their martyrdom.

Both sociopaths and malignant narcissists can be charming, intelligent, seductive, and successful. They share similar traits of being unreliable, self-centered, insincere, dishonest, and needing control. Both malignant narcissists and people with APD have an inflated view of themselves and sense of entitlement. Even when they’re abusive, they believe they’re justified and deny responsibility for their behavior. They lack insight, empathy, and emotional responsiveness. Although they might feign appropriate emotional reactions, this is a learned behavior and not sincerely felt. Narcissists who have fewer and less severe symptoms, along with “narcissistic” people who don’t have full-blown NPD, can have insight, guilt, remorse, and an ability to emotionally connect, as well as love.

While sociopaths qualify as narcissists, not all narcissists are sociopaths. What drives them differs. But the main distinction is that a sociopath is more cunning and manipulative, because their ego isn’t always at stake. In fact, they don’t have any real personality. They’re the ultimate con artists and can take on any persona that suits them. Thus, they may be harder to spot, because they’re not trying to impress you or win your approval – unless it serves their agenda. Instead of bragging, their conversation might center on you rather than on themselves, and they can even be self-effacing and apologetic if it serves their goal.

Like premeditated killers, a sociopath is more calculating and might plot and plan an attack months in advance; whereas, a narcissist is more likely to react sooner, using intimidation and lies. Sociopaths are lazier and try to swindle, steal, or exploit others financially, while many narcissists though exploitative, work hard to achieve their aims or perfection. Although both characters may be motivated to win at all costs, narcissists are more interested in what you think of them. They need others’ admiration. This makes them dependent and codependent on others, and actually capable of being manipulated. They’re less likely to divorce their spouse than a sociopath, who might leave or vanish if they’re exposed or don’t get what they want.

People with NPD or APD don’t usually seek treatment, unless, in the case of NPD, they’re experiencing severe stress, depression, or their partner insists. Those with APD are sometimes unwillingly court-ordered to therapy, which in itself becomes a hurdle to overcome in terms of trust and receptivity. Therapy should focus on helping them access their feelings and learn from the negative consequences of their behavior.

Many narcissists can improve with treatment, and those who have insight can benefit from psychodynamic psychotherapy. If you suspect you’re in a relationship with a narcissist, learn more about and get a checklist of narcissistic behaviors.