DSM XI of nacissistic pd is on the WHO website.

NPDs are of the worst because of thier delusional grandiosity, thier cruelty and thier ability to suck other humans dry to the bone with no ability to feel remorse. NPDs take take take, cheat, cheat, cheat, lie constantly, and have ZERO empathy unless it is "feigned" faked, for the NPDs personal gain. The NPD differs from the other mental illnesses in that the NPDs disease is to EXPLOIT others and suck others dry.
Some sayings that came from those who have known NPDs
"You can't get blood from a stone" -NPDs TAKE take take and never give unless it is to bait, entrap and exploit another.
"Never love anything that can't love you back" NPDs are so damaged in thier affective development stage they can not love, NPDs view love as a WEAKNESS to EXPLOIT, for grandious delusional NPD self aggrandisement and deranged NPD self serving purposes, that is what separates NPDs from other pd's and other mental illnesses. even to those educated in treating and dealing with NPDs the NPD is an odious case due to the NPD dysfunctional offensive personality disorder defenses, which is the pd construct, NPDs are similar to bottomless cups that take take take and the bottomless cup never gets full. Very unhealthy, NPD's are self absorbed pds.
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DSM hairsplits the different pd's and mental illnesses in effort to treat them, identify them to see which can be salvaged, redeemed or helped and to profile them, identify them early, for the safety of themselves and others.(Profiling is very difficult work in any field) Clerics traditionally call NPDs reprobates and unredeemable, as the NPDs refuse to be helped, they experience no cognitive dissonance from being evil, NPDs like hurting and exploiting others.
NPDs are the worst because they exploit others for deranged disordered NPD delusional self grandiousity.
NPD can also be a primary diagnosis or a co morbid, secondary diagnosis.
All these pds can be corrected if children were protected and loved from birth to at least age 5 or 10, 18 to 21 preferably.
Many advanced aware cultures spend and direct most of thier resources on loving children and protecting children in the childrens crucial (blueprint) developmental stages, pre natal to birth to age 5 or 10 or more, because as one psycologist stated,'if the children are loved and nutured and correctly cared for in the first 5 or so years of development you end up with a loving healthy human being capable of healthy functioning that can love and feel empathy and contribute to self and others and to the community' and even to the world. 'Loved children grow up to be part of the solution'.
Those deprived of love or correct nuturing in early childhood development often become part of the problem rather then part of the solution. That is why early intervention and counseling and corrective therapy is so important and crucial.
Untreated NPDs are unreedemable by DSM opinion. And NPDs actually resist cures or healing as the NPDs in thier disordered thinking see nothing wrong with being exploiters of others.

when and how is narcissism a choice? i believe it is, but it gets out of that kind of control at some point. and yes, it appears it is a point of no return, sadly.

i wasn't aware that people "chosse" to have personality disorders.
granted, the amount of suffering caused by these individuals, as well as borderlines and people with antisocial personality disorder is mammoth, but mental illness is not a choice!!!!!!!!!!!!!!!!!!!!!!!!!!