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Narcissistic personality disorder (NPD) affects relationships and self-esteem. This article offers an overview of narcissism and how to get help and feel better.
What is narcissism?
Narcissistic personality disorder (NPD) is characterized by an exaggerated sense of self-importance, a need for excessive admiration, and a lack of empathy for other people. People with NPD may have difficulty dealing with criticism and may become angry or resentful when they do not receive the admiration they feel they deserve. They may also exaggerate their own achievements and talents, expecting to be treated as superior without corresponding achievements. Narcissism as a concept exists on a spectrum, and not everyone who is narcissistic has a clear diagnosis of NPD.
The diagnosis is rooted in psychodynamic theories of personality development but is now a separate diagnosis in the DSM-5, the diagnostic manual used by mental health professionals.
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What is a personality disorder?
Personality disorders are complex psychological conditions that affect an individual’s thoughts, feelings and behaviors in a way that often differs significantly from societal norms and expectations.
As people with personality disorders may have difficulty relating to others, this can lead to problems in both personal and professional relationships.
What causes narcissism?
Narcissism is thought to be caused by a combination of genetic, biological, psychological and environmental factors. Past experiences growing up are fundamental, including ways an individual was cared for as a child. This can include various experiences such as excessive coddling or neglect or emotional abuse. Both of these extremes can contribute to an unhealthy self-image and relational patterns.
Childhood trauma can also contribute to narcissism as well as other psychological factors such as self-esteem and insecurity.
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How common are personality disorders?
The American Psychiatric Association estimates that about nine percent of the American population has a personality disorder (APA, 2024). Clearly, personality disorders are a major mental health concern.
Symptoms of narcissism
The symptoms of narcissism, especially in the case of narcissistic personality disorder (NPD), include several behaviors and attitudes. It is important to note that not everyone who exhibits narcissistic traits has a fully developed personality disorder. Here are some common symptoms:
- Excessive sense of self-importance: The person may exaggerate their own achievements and talents, expecting to be recognized as superior even without corresponding merits.
- Fantasies of unlimited success, power, brilliance, beauty or ideal love: The person may have unrealistic visions of success, power or perfection.
- Belief that they are “special” and unique: The person may believe that they can only be understood by, or should associate with, other special or high-status people (or institutions).
- Requires excessive admiration: There is often a need for excessive attention and admiration.
- Has a sense of entitlement: The person often expects unreasonable favors and concessions from others.
- Exploits others: The person may use others to achieve their own goals.
- Lacks empathy: The person often has difficulty recognizing or identifying with the feelings and needs of others.
- Is jealous of others or believes others are jealous of them: There may be a belief that others are jealous of them, or the person may be jealous of others.
- Displays arrogant and haughty behavior or attitudes: The person may have an inflated self-image and behave in a superior manner.
It is important to remember that these symptoms must be long-lasting and significantly affect the person’s social, work or other important areas of life to be considered part of NPD. Furthermore, it is important that diagnosis and treatment is done by a licensed professional.
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Gender differences in narcissism
There are some gender differences in narcissism, especially in the frequency, expression and type of narcissistic traits. Men may be more likely to show arrogance or assertiveness, while women may show more subtle forms of narcissism, such as excessive concern for their appearance or charm. There are theories of ‘covert narcissism’ (hidden, less obvious narcissism), which can involve feelings of inferiority and hypersensitivity to criticism, but this form is not yet a formal diagnosis.
It is important to note that these differences are generalizations and vary among individuals. In addition, cultural, social and environmental factors influence how narcissistic traits are expressed and experienced. The diagnosis and assessment of NPD should always be made by a licensed professional, taking into account the individual’s unique circumstances and background.
Assessment of personality disorders
Personality disorders are usually diagnosed in specialist psychiatry through a personality assessment. This involves taking an initial medical history to review the background of the symptoms and completing assessment forms. This is followed by a structured diagnostic interview and an interview with family members to see how the symptoms manifest themselves in different areas.
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Approaching the topic of personality disorders can feel overwhelming, but we are here to make the hard part easier. When you feel it’s time to talk to a psychologist or therapist, you can easily book a session with us. No matter when you take the step, our experienced team is always ready to help you or your loved ones.
12 common questions about narcissism
What is a personality disorder?
A personality disorder is an enduring pattern of behavior, worldview and inner experience that is markedly different from what is expected of one’s environment. This is because personality disorders can affect one’s ability to relate to others and function effectively in everyday life.
Is narcissism a type of personality disorder?
Yes, narcissistic personality disorder is one of several types. Individuals with narcissism have an exaggerated sense of self-importance and a lack of empathy towards other people.
How is a psychopath different from other personality syndromes?
A psychopath often shows a lack of conscience and empathy and can manipulate others without any sense of guilt or remorse. It is an extreme form of antisocial personality disorder and it requires professional evaluation and treatment.
How is narcissism diagnosed?
Diagnosis of narcissism is usually carried out by a psychiatrist or psychologist and involves a detailed diagnostic interview and family interview.
What treatment options are available for personality disorders?
Treatment can vary depending on the type of disorder and the unique needs of the individual, but usually involves a combination of psychotherapy and, if necessary, medication.
How can I help someone close to me who has a personality disorder?
The most important step is to encourage the person to seek professional help. You can also offer emotional support, but remember that you are not a substitute for qualified care.
Is there any way to prevent personality disorders?
There is no way to prevent personality disorders, but early intervention can help alleviate symptoms. It is important to have a correct diagnosis and appropriate treatment.
Can you force someone to go to therapy?
While therapy may be mandated at times, particularly in the legal system, voluntary treatment typically works better.
How common are personality disorders?
The American Psychiatric Association estimates that about nine percent of the American population has a personality disorder (APA, 2024).
Is NPD more common among men or women?
Men generally have more narcissistic traits than women, but women may exhibit more forms of covert narcissism, which are more difficult to detect.
What causes narcissism?
Narcissism is thought to be caused by a combination of genetic, biological, psychological and environmental factors.
When can NPD be diagnosed?
Due to fluctuations in personality development throughout childhood and adolescence, NPD is not typically diagnosed until adulthood.
Where can I go if I or someone I know has symptoms of narcissism?
To get help, you can contact local mental health providers with expertise in treating NPD. If there is a safety risk, call 911 or go to your nearest emergency room.
Treatment of narcissistic personality disorder (NPD)
Treatment goals for narcissistic personality disorder (NPD) often include helping the individual to better understand their feelings and behaviors, develop healthier relationships, and manage any co-occurring mental health issues. There are various treatment methods that can be helpful such as psychodynamic therapy, cognitive behavioral therapy, schema therapy, group therapy, family therapy and medication.
Psychodynamic Therapy: This approach focuses on exploring underlying, unconscious conflicts that may contribute or cause narcissistic behaviors. The therapist helps the individual to understand and process these conflicts.
Cognitive behavioral therapy (CBT): CBT can help the individual identify and change destructive thought patterns and behaviors. This may include working to challenge excessive self-centeredness or learning to recognize and respect the needs and feelings of others.
Schema-focused therapy: This form of therapy combines elements from several different therapeutic schools and focuses on identifying and changing deeply-rooted patterns or schemas that have governed the individual’s behavior since childhood.
Group therapy: Group therapy can be particularly beneficial as it provides a social context where the individual can learn empathy and receive feedback from others in a safe environment.
Medication: While there is no specific medication for NPD, medications such as antidepressants or anti-anxiety drugs may be prescribed to address co-occurring mental health issues.
Family therapy: Because narcissistic behavior can deeply affect family relationships, family therapy can be useful in addressing these dynamics and promoting healthier interactions.
It is important to remember that individuals with narcissistic personality disorder often do not seek treatment because they do not see their own behaviors as problematic. This can make engagement and progress in therapy particularly challenging. Longevity and patience are essential in treatment, and progress can be gradual. In addition, it is important that therapy is adapted to the individual’s specific needs and situation.
Advice for people who know someone with a personality disorder
Living with someone with a personality disorder can be a difficult experience and can affect you greatly.
Be careful with boundaries: It is important to set clear boundaries to protect yourself and your own psychological well-being.
Seek professional help: It is not your job to diagnose or treat someone. Let this be handled by licensed health care providers.
Try not to judge: A personality syndrome is a medical diagnosis and not a character flaw. It does not always excuse a person’s behavior, but it can explain it.
Be aware of your own needs: Take care of yourself and seek support, either from friends, family or a professional therapist or psychologist.
