A 45-year-old male attorney presents for evaluation at the request of his firm's employee assistance program following interpersonal conflicts with colleagues. He describes a longstanding pattern since early adulthood of believing he is uniquely talented, expecting preferential treatment, becoming enraged when others do not acknowledge his superiority, exploiting professional relationships for personal advancement, and lacking empathy for subordinates he has demeaned. These patterns are consistent and persistent across settings. He denies periods of elevated or depressed mood, sleep disturbance, or changes in energy level. He states, 'I'm here because other people can't handle someone who is simply better than they are.'