That’s not true. NPD diagnostic criteria in the DSM-5-TR (latest version) still contains manipulation efforts and similar behavior. Quote:

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
3. Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
4. Requires excessive admiration.
5. Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).
6. Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).
7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
8. Is often envious of others or believes that others are envious of him or her.
9. Shows arrogant, haughty behaviors or attitudes.

So… Donald Trump probably meets criteria for a narcissistic personality disorder diagnosis (if he ever agrees to start a “mental health journey”).

And it’s true that many disorders need to cause “clinically significant distress”, but personality disorders can be diagnosed even if they don’t cause distress to the person but causes it to others (e.g. ASPD). The DSM had to consider egosyntonic disorders, after all.

I believe ignorance is a common reason even among professionals. They only think of the grandiose traits; they confuse the vulnerable traits with BPD or MDD; and they think it has to be close to ASPD to be diagnosable.

My loved one developed NPD by having a terrible childhood and early teenage years with undiagnosed AuDHD. Bullying, rejection, isolation, school failures, etc. The solution was to start lying, manipulating, trying to get something (anything) going their way, seeking validation… They received a depression diagnosis only at first 🫥.

Did you know people with ASD score higher in vulnerable narcissism traits? That means this story could be common. Traumatized neurodivergent children are already at higher risk of developing mental disorders.

But no, nobody talks about NPD this way. It’s always about grandiose traits being dangerous for others (which can be part of the experience, but there’s so much more). I hope it changes someday.