1. Narcissist-Grandiose (Oblivious) Subtype

Pathological grandiosity has been associated with one of the two subtypes of Narcissistic Personality Disorder (Gabbard, 1989).^[1] Characteristics of the narcissist-grandiose subtype (as opposed to the narcissist-vulnerable subtype) include:

• Being labeled the “oblivious narcissists” as they are oblivious to the impact of their actions on others or how they are perceived.
• Devaluation and criticism of people that threaten self-esteem.
• More likely to regulate self-esteem through overt self-enhancement (over-claiming abilities or exaggerating situations to project superiority)
• Denial of weaknesses. Exaggeration of abilities.
• Controlling others whilst both belittling (criticizing) and taking credit for their actions.
• Inflated demands of entitlement, superiority ("Don't you know who I am?"). Exaggerated beliefs of self-importance, superiority, achievement, and ability; manipulative behaviors as well as expectations of obedience, admiration, and entitlement; and preoccupation with “fantasies about success, power, brilliance, beauty, or the perfect mate".
• Consistent anger when confronted with unmet expectations or any perceived slight or accountability for actions. Prone to easily exploding into rage, overreacting, and possibly even becoming aggressive whenever they feel attacked by even the slightest criticism. Blame shifts when accountable.
• Diminished awareness of the cultural dissonance between their expectations and reality, along with the impact this has on relationships
• Overt presentation of grandiose fantasies, wealth, success, and status.
• Oblivious that expectations of entitlement (overspending, taking advantage) may make a poor impression on other people.
• Conflict within the environment is generally experienced as external to these individuals (i.e., not their fault), rather than as a measure of their own unrealistic expectations

The differences between grandiose and vulnerable narcissist subtypes have been studied (Dickinson & Pincus, 2003):^[2]

This overall finding confirms past theory and research that suggests that these [grandiose subtype] individuals lack knowledge of the impact they have upon others, and thus, have an unrealistic view of themselves in relation to others (Gabbard, 1989, 1998; Kernberg, 1975; Kohut, 1971, 1977). Indeed, this very lack of insight into their impact upon others is what incited Gabbard (1989) to enlist the label “oblivious narcissists” to describe their social presentation and distinguish them from their vulnerable counterparts. Grandiose narcissistic individuals expect another’s immediate and undivided attention, and are oblivious to the effect their direct demands of entitlement have on others. And, by virtue of their ability to maintain the grandiose self through self-enhancement, grandiose narcissistic individuals are less susceptible than their vulnerable peers to the chronic emotional consequences of threats to entitled expectations (e.g., distress, lowered self-esteem, interpersonal fearfulness).

The grandiosity section of the Diagnostic Interview for Narcissism (DIN) (Second edition) is as follows:^[3]

2. In Mania

In mania, grandiosity is typically more pro-active and aggressive than in narcissism. The manic character may boast of future achievements^[4] or exaggerate their personal qualities.^[5]

They may also begin unrealistically ambitious undertakings, before being cut down, or cutting themselves back down, to size.^[6]

3. In Psychopathy

Grandiosity features in Factor 1 Facet 1:Interpersonal in the Hare Psychopathy Checklist-Revised (PCL-R) test.^[7] Individuals endorsing this criterion appear arrogant and boastful, and may be unrealistically optimistic about their future. The American Psychiatric Association's DSM-5 also notes that persons with antisocial personality disorder often display an inflated self-image, and can appear excessively self-important, opinionated and cocky, and often hold others in contempt.

4. Reality-testing

A distinction is made between individuals exhibiting grandiosity, which includes a degree of insight into their unrealistic thoughts (they are aware that their behavior is considered unusual), in contrast to those experiencing grandiose delusions, who lack this capability for reality-testing. Some individuals may transition between these two states, with grandiose ideas initially developing as "daydreams" that the patient recognises as untrue, but which can subsequently turn into full delusions that the patient becomes convinced reflect reality.^[8]

5. Psychoanalysis and the Grandiose Self

Otto Kernberg saw the unhealthily grandiose self as merging childhood feelings of specialness, personal ideals, and fantasies of an ideal parent.^[9]

Heinz Kohut saw the grandiose self as a normal part of the developmental process, only pathological when the grand and humble parts of the self became decisively divided.^[10] Kohut's recommendations for dealing with the patient with a disordered grandiose self were to tolerate and so re-integrate the grandiosity with the realistic self.^[11]

6. Reactive Attachment Disorder

The personality trait of grandiosity also is a component of the reactive attachment disorder (RAD), a severe and relatively uncommon attachment disorder that affects children.^[12] The expression of RAD is characterized by markedly disturbed and developmentally inappropriate ways of relating to other people in most social contexts, such as the persistent failure to initiate or to respond to most social interactions in a developmentally appropriate way, known as the "inhibited form" of reactive attachment disorder.^[13][14]