Most conceptual analyses and empirical investigations in the perfectionism field focus on neurotic perfectionists (i.e., people striving for impossible standards that they feel they cannot attain) and there is little consideration of narcissistic perfectionists (i.e., people with grandiose standards and goals that they regard as personally attainable). This chapter includes an overview of clinical case accounts of narcissistic perfectionism along with a comprehensive review of existing research on narcissistic perfectionism. A central theme is that narcissistic perfectionists need to achieve perfection and they also need to seem perfect in ways that make them highly vulnerable to life setbacks. Historical research on perfectionism conducted with the Narcissistic Personality Inventory is contrasted with more recent research conducted with the Pathological Narcissism Inventory (PNI) and we show that the results of the research involving the PNI more clearly illustrate and reveal the grandiosity and vulnerability of narcissistic perfectionists. Our analysis extends previous accounts of narcissistic perfectionists by illustrating the role of perfectionistic automatic thoughts, as well as the tendency for narcissists to present an image of perfection and a public façade of invulnerability, in order to conceal their vulnerability. The chapter concludes with a discussion of key directions for future research.