 I'm the author of Malignant Self-Love, Narcissism Revisited. Anxiety disorders, especially generalized anxiety disorder, GAD, are often misdiagnosed as narcissistic personality disorder. Anxiety is uncontrollable and excessive apprehension. Anxiety disorders usually come repeat with obsessive thoughts, compulsive and ritualistic acts, restlessness, fatigue, irritability, difficulty concentrating, and somatic manifestations, such as an increased heart rate, sweating, or in panic attacks, even chest pains. By definition, narcissists are anxious for social approval, for attention. They seek compulsively narcissistic supply. The narcissist cannot control this need, and this creates attendant anxiety. Here, the narcissist requires external feedback in order to regulate his labile sense of self-worth, his self-confidence, his self-esteem, and this dependence makes most narcissists irritable. They fly into rages, and they have a very low threshold of frustration. Like patients who suffer from panic attacks and social phobia, which is another anxiety disorder, narcissists are terrified of being embarrassed or criticized in public. Consequently, most narcissists fail to function well in various settings, social, occupational, or romantic. Many narcissists develop obsessions and compulsions. Life sufferers of generalized anxiety disorder, narcissists are perfections. They are preoccupied with the quality of their performance and the level of their competence. As a diagnostic and statistical manual, page 437 puts it, generalized anxiety disorder patients, especially children, are typically overzealous in seeking approval and require excessive reassurance about their performance and their worries. This could apply equally well to narcissists. They are exactly the same. Both classes of patients are paralyzed by the fear of being judged as imperfect, or lacking, or inadequate. Narcissists, as well as patients with anxiety disorders, constantly fail to measure up to an inner, harsh, and sadistic critic and judge, and to a grandiose, inflated self-image. The narcissistic solution is to avoid comparison and competition altogether, and to demand special treatment. The narcissist's sense of entitlement is incongruent with the narcissist's true accomplishments, which are usually lacking or meager. The narcissist withdraws from the rat race, because he does not deem his opponents, his colleagues, or peers worthy of his efforts. As opposed to narcissists, patients with anxiety disorders are invested in their work and in their profession. To be exact, they are over-invested. Their preoccupation with perfection is counterproductive, and, ironically, renders them underachievers, despite all their continuous efforts. It is easy to mistake the presenting symptoms of certain anxiety disorders with pathological losses. Both types of patients are worried about social approbation and seek it actively. Both types of patients present a haughty or impervious facade to the world. Both are dysfunctional and weighed down by history of personal failure on the job and in the family. But the narcissist is egocintonic, in other words, he is proud and happy of who he is. The anxious patient is distressed, and is looking for help, and for a way out of his or her predicament, hence the differential diagnosis. Narcissists like themselves. Anxious people, most definitely, do not.