Narcissistic personality disorder is typically identified around session four in outpatient settings or after a couple of days in inpatient settings due to the intensive exposure. Diagnosis entails observing consistent patterns of lack of empathy, entitlement, and grandiosity across different situations leading to clinical impairment. However, diagnosing narcissistic individuals can be challenging as they often do not voluntarily seek therapy and may enter treatment for other issues like relationship problems, addiction, depression, anxiety, or external pressures such as court orders or workplace demands.

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