What Is Narcissistic Personality Disorder?

Narcissistic personality disorder (NPD) is a mental health condition that causes people to have an inflated sense of self-importance and a need for attention and admiration. They often lack empathy for others and may exploit or devalue them to maintain a sense of superiority.

NPD is thought to develop from early life experiences, and it is more common in people assigned male at birth. It typically develops in early adulthood and can have a profound impact on a person’s personal and professional life.

Treating NPD can be challenging, but certain psychotherapy approaches can be effective. There is no one-size-fits-all treatment, and the best approach will vary depending on the individual.

Types of Narcissistic Personality Disorder

Narcissistic personality disorder (NPD) is a complex mental health condition that can manifest in many different ways. It is characterized by an inflated sense of self-importance, a need for admiration, and a lack of empathy for others.

There are three main subtypes of NPD:

• Grandiose narcissism: People with grandiose NPD have an inflated sense of self-importance and a need for admiration. They may:
  • Boast about their accomplishments, even if they are minor.
  • Expect special treatment, such as being served first or having their opinions given more weight than others.
  • Be very sensitive to criticism, even if it is constructive. They may become defensive or angry when they are criticized.
  • Have a sense of entitlement, believing that they deserve special treatment because they are superior to others.
  • Be preoccupied with their own power, success, and brilliance.
  • Need constant attention and admiration from others.
  • Use other people to boost their own ego.
• Vulnerable narcissism: People with vulnerable NPD have a fragile self-esteem and a fear of rejection. They may:
  • Be very sensitive to criticism, even if it is constructive. They may become defensive or angry when they are criticized.
  • Have a fear of being abandoned or rejected.
  • Be very self-conscious and worry about how others perceive them.
  • Have a difficult time accepting compliments.
  • Be very sensitive to social cues and may misinterpret them as being negative.
  • Have a hard time trusting others.
• High-functioning narcissism: People with high-functioning NPD are often very successful in their careers. They may:
  • Be outgoing, articulate, and socially engaging.
  • Be very ambitious and driven to succeed.
  • Be very intelligent and capable.
  • Have a strong sense of entitlement.
  • Use their charm and charisma to manipulate others.
  • Lack empathy for others.

It is important to note that not everyone with NPD will exhibit all of the symptoms of a particular subtype. The severity of the symptoms can also vary from person to person.

Symptoms

Narcissistic personality disorder (NPD) is a mental health condition characterized by an inflated sense of self-importance, a need for admiration, and a lack of empathy for others. People with NPD often have a grandiose sense of self-worth and may believe that they are superior to others. They may also have a strong need for attention and admiration, and may become easily upset or angry when they do not receive it.

Here are some of the symptoms of NPD:

• Feeling superior, unique, and special: People with NPD often have an exaggerated sense of self-importance. They may believe that they are better than others, and that they deserve special treatment.
• Exaggerating their achievements and abilities: People with NPD may boast about their accomplishments, even if they are minor. They may also exaggerate their abilities, and may claim to be experts in areas where they are not.
• Preoccupying themselves with fantasies about beauty, intelligence, prestige, success, or love: People with NPD may spend a lot of time daydreaming about their own greatness. They may also have unrealistic expectations for themselves, and may be constantly striving for perfection.
• Needing constant attention and approval: People with NPD often need constant attention and approval from others. They may become upset or angry if they do not receive the attention they crave.
• Being hypersensitive to criticism, failure, and rejection: People with NPD are often very sensitive to criticism, failure, and rejection. They may become defensive or angry when they are criticized, and may avoid situations where they might be exposed to these things.
• Having an inflated sense of entitlement: People with NPD often feel that they deserve special treatment. They may believe that they are entitled to have things their way, and that others should defer to them.
• Exploiting and taking advantage of others for selfish gain: People with NPD may exploit and take advantage of others for their own benefit. They may manipulate others, or use them to get what they want.
• Disregarding the feelings of others and an inability to empathize: People with NPD often have difficulty empathizing with others. They may not be able to understand or appreciate the feelings of others, and may even be seen as being cold or indifferent.
• Expecting special treatment: People with NPD often expect special treatment from others. They may believe that they deserve to be treated better than others, and may become upset or angry if they do not receive the special treatment they believe they deserve.

Causes

There is no single cause of narcissistic personality disorder (NPD). However, research suggests that a combination of genetics, early life experiences, and cultural and environmental factors may play a role in its development.

Early life experiences

People who have experienced childhood trauma, such as neglect, abuse, or abandonment, may be more likely to develop NPD. This is because these experiences can lead to a distorted sense of self-worth and a need for attention and admiration. Research suggests that childhood experiences can contribute to the development of NPD, including:

• Not receiving emotional support or validation as a child: Children who do not receive enough emotional support from their caregivers may be more likely to develop NPD as a way of compensating for their unmet needs.
• Rejection or criticism from a loved one: Children who are frequently rejected or criticized by their loved ones may develop a negative self-image and a need for attention and admiration in order to feel good about themselves.
• Experiences of abuse or neglect: Children who experience abuse or neglect may develop a sense of entitlement and a belief that they are superior to others as a way of coping with their trauma.
• Excessive praise: Children who are excessively praised for their accomplishments may develop an inflated sense of self-importance and a need for constant attention and admiration.
• A lack of discipline and boundaries in childhood: Children who do not receive enough discipline and boundaries from their caregivers may develop a sense of entitlement and a belief that they are above the rules.
• Over-protective parenting: Children who are over-protected by their caregivers may develop a sense of vulnerability and a need for constant attention and reassurance.
• Traumatic events: Traumatic events, such as the death of a loved one or a natural disaster, can also contribute to the development of NPD.

Genetics

NPD can run in families, which suggests that genetics might play a role in the development of the disorder. Some research has found evidence of 94 genes that can increase your risk of NPD and other psychiatric disorders. Experts currently believe that inheriting a specific gene from one or both of your parents may increase the risk of NPD.

Cultural and environmental factors

The culture you grow up in can influence certain personality traits, including traits of NPD. Research suggests that narcissistic traits are more common in individualistic than collectivistic cultures. Individualistic cultures emphasize the importance of self, success, power, and individualism, which may increase narcissism.

On the other hand, collectivist cultures emphasize the group’s needs over the individual and value harmony, cohesion, and interdependence, which may explain why people who grow up in collectivist cultures have fewer narcissistic traits.

Biological factors

Certain biological factors may also play a role in NPD. Research shows that people with NPD have higher levels of oxidative stress, which can affect your physical and mental health. People with NPD also have elevated levels of a certain biomarker of oxidative stress that links to hypersensitivity. This may contribute to oversensitivity to criticism in people with NPD. Brain scans of people with NPD show that they may have structural brain differences, such as a lower volume of gray matter in brain areas that are associated with empathy, emotional regulation, and compassion.

Diagnosis

The evaluation may include clinical interviews and self-report questionnaires that help healthcare providers look for patterns of symptoms and behaviors consistent with NPD. In some cases, people close to the person who is being evaluated with NPD may also give their insight to the provider.

A diagnosis of NPD is made based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The DSM-5 lists nine criteria for NPD, and a person must meet five or more of these criteria to receive a diagnosis. The criteria include:

• Grandiose sense of self-importance: People with NPD have an inflated sense of their own importance and abilities. They may exaggerate their accomplishments or talents, or believe that they are superior to others.
• Preoccupation with fantasies of success, power, brilliance, beauty, or ideal love: People with NPD may spend a lot of time daydreaming about their own greatness. They may also have unrealistic expectations for themselves, and may be constantly striving for perfection.
• A belief that they are "special" or unique: People with NPD believe that they are special or unique, and that they deserve to be treated differently from others. They may only want to associate with other people who they believe are also special or unique.
• Need for constant admiration: People with NPD need constant admiration and attention from others. They may become upset or angry if they do not receive the attention they crave.
• Feeling entitled to special treatment: People with NPD feel entitled to special treatment. They may believe that they deserve to have things their way, and that others should defer to them.
• Exploitation of others for personal gain: People with NPD may exploit or take advantage of others for their own benefit. They may manipulate others, or use them to get what they want.
• Lack of empathy: People with NPD have difficulty empathizing with others. They may not be able to understand or appreciate the feelings of others, and may even be seen as being cold or indifferent.
• Being envious of others or a belief that others are envious of them: People with NPD may be envious of others who they believe are more successful or talented than them. They may also believe that others are envious of them.
• Arrogant or haughty (snobby) attitudes and behaviors: People with NPD may have arrogant or haughty attitudes and behaviors. They may come across as being conceited or self-centered.

Treatment

Treating narcissistic personality disorder (NPD) can be challenging because many people with NPD struggle to acknowledge their symptoms, resist feedback, and blame others for their problems and behaviors. As a result, they are often hesitant to seek treatment.

However, there are effective treatment approaches available, such as psychotherapy. Psychotherapy can help people with NPD develop a more realistic self-image, gain insights into their behaviors, learn skills to manage their behaviors better, and form healthier relationships with others.

Some of the most common psychotherapy approaches for treating NPD include:

• Cognitive-behavioral therapy (CBT): CBT aims to identify negative thoughts and behavior patterns and replace them with positive thoughts and behaviors. This type of therapy can help people with NPD identify harmful behavior patterns and develop greater self-awareness and insight into their behaviors. It also helps people with NPD understand the emotions of others to promote empathy.
• Psychodynamic therapy: Psychodynamic therapy involves working with a therapist to explore past experiences and connect them to current emotions and thoughts. This form of therapy can help people with NPD identify harmful behavior patterns and develop greater self-awareness and insight into their behaviors. It also helps people with NPD understand the emotions of others to promote empathy. However, it is a long-term treatment that can take months or even years.
• Schema therapy: Schema therapy focuses on identifying and changing unstable or dysfunctional patterns of thinking and behavior that developed in childhood. In schema therapy, people with NPD work with a therapist to identify their core schemas—or, deep-seated beliefs about themselves and the world around them. Once these schemas are identified, people learn to challenge and replace unhelpful schemas with healthier beliefs and positive coping mechanisms.

If you or someone you know is struggling with NPD, it is important to seek professional help. A therapist can help you assess the situation and develop a treatment plan that is right for you.

Here are some additional tips for treating NPD:

• Be patient and persistent. Treatment for NPD can be challenging and take time. It is important to be patient and persistent with your treatment plan.
• Set realistic expectations. It is important to set realistic expectations for treatment. NPD is a complex disorder, and it may take time to see significant improvement.
• Encourage your loved one to get help. If you are concerned about someone with NPD, encourage them to seek professional help. You can offer your support and encouragement, but ultimately, they need to be the one to make the decision to get treatment.

How to Prevent Narcissistic Personality Disorder

There is no known way to prevent narcissistic personality disorder (NPD) because it is a complex disorder with many contributing factors. However, there are certain parenting approaches that may help prevent the development of NPD in young children. These include:

• Providing consistent, nurturing, and supportive parenting: This means providing children with a safe and loving environment where they feel valued and respected. It also means setting clear boundaries and expectations, and providing positive reinforcement for good behavior.
• Avoiding parental indulgence: This means not giving children everything they want and allowing them to get away with bad behavior. It is important to teach children the difference between right and wrong, and to hold them accountable for their actions.
• Encouraging healthy self-esteem and self-worth: This means helping children develop a realistic sense of their own abilities and accomplishments. It also means teaching them to be independent and to set their own goals.
• Seeking help for mental health problems: If you are concerned that your child may have a mental health problem, it is important to seek professional help early on. Early intervention can help to prevent the problem from getting worse.
• Participating in family therapy: If your family is struggling to communicate or connect, family therapy can help you develop healthier ways to interact with each other.

It is important to note that these are just some general parenting tips that may help to prevent NPD. If you are concerned about your child’s development, it is always best to talk to a doctor or mental health professional.

Comorbid Conditions

Many people with narcissistic personality disorder (NPD) have other mental health disorders, which can complicate the diagnosis and treatment process. This is why a comprehensive psychiatric evaluation is needed to learn about a person’s NPD symptoms and any other comorbid (co-occurring) conditions they may have.

Some of the most common comorbid conditions associated with NPD include:

• Depression: People with NPD may experience symptoms of depression, such as sadness, hopelessness, and worthlessness.
• Anxiety: People with NPD may also experience symptoms of anxiety, such as worry, fear, and panic attacks.
• Substance use disorder: People with NPD may use substances to cope with their symptoms, such as alcohol or drugs.
• Other personality disorders: People with NPD may also have other personality disorders, such as borderline personality disorder, histrionic personality disorder, or antisocial personality disorder.
• Anorexia nervosa: People with NPD may also have an eating disorder, such as anorexia nervosa.

Living With Narcissistic Personality Disorder

If you have NPD, you may have distorted thoughts and behaviors that negatively impact your relationships, work, and quality of life. Seeking treatment can help you identify and understand your unhealthy patterns and develop healthier thoughts and behaviors. Change is possible, and it is likely to benefit every part of your life.

Living with or caring for someone with NPD can be emotionally taxing and challenging. There are ways to cope and protect yourself from harmful narcissistic behaviors. First, learn as much as possible about what drives narcissistic behaviors. You may also want to work with a mental health professional to process your experiences and develop healthy coping mechanisms. Secondly, put what you learn to practice by setting and holding firm boundaries, disengaging from emotional outbursts and gaslighting attempts, and leaning on other friends and family for support.