Narcissistic Personality Disorder

What is Narcissistic Personality Disorder?

Narcissistic personality disorder (NPD) is a mental disorder that includes inflated self-esteem and ego. Defining the word narcissist, it describes an individual who has an increased interest or admiration of their own being.

Narcissistic personality disorder includes the following traits:

  • Inflated level of self-importance
  • Increased need for recognition or praise
  • Lack of empathy or consideration of others
  • Strong sense of entitlement
  • Inability to feel guilt or shame
  • Grandiose fantasies
  • Frequent lies
  • A tendency to break rules and violate boundaries
  • Exploits or uses others for gain

To someone with a narcissistic personality disorder, the world revolves around their needs and wants. While NPD is most common in men, traits can be found in both men and women. 

The inward thinking that is found with NPD can significantly affect relationships, both professional and personal. Individuals with narcissistic personality disorder will often have conflict in many of their relationships.

It is important to note that narcissism as a trait, is not the same thing as a narcissistic personality disorder. Simply having traits that could be described as narcissistic, such as an inflated ego or an increased need for recognition, especially in a situational environment, does not always mean that person has a narcissistic personality disorder. In order to be diagnosed with a narcissistic personality disorder, an individual must meet a minimum of five of the above-listed traits.

What Causes Narcissistic Personality Disorder?

While the exact cause of a narcissistic personality disorder is not known, it is believed that multiple factors are responsible in the development of these traits. Some believe that genetics play an important role in developing a personality disorder. However, there is question as to whether this is an actual genetic component, or it is the personality of the parent with NPD, instead instills these personality traits into their children through environmental interactions.

It is likely that both genetics and the environment contribute to the symptoms of narcissistic personality disorder.

Specific things that could contribute to a narcissistic personality disorder include:

  • Abuse or neglect during childhood
  • Over-controlling or over-protecting parenting
  • Unachievable expectations and excessive guilt during childhood
  • Hypersensitive parenting

Some might also be surprised that narcissistic traits can be rooted in significant feelings of insecurity and low self-esteem. Developing narcissistic traits can be a coping mechanism that is used to ignore feelings or aspects of the self that are deemed negative. This could be in response to childhood trauma, including abuse, bullying, threats, or neglect. Over time, the individual learns to deal with low self-esteem by developing traits that protect them internally.

The traits of a narcissistic personality disorder often first show up during the late teen to early adulthood years. But, NPD is not often diagnosed until adulthood, when it is more easily recognized as problematic. It is, however, possible to receive a diagnosis of NPD as a teen as long as the symptoms have lasted for a minimum of one year. Many mental health professionals are hesitant to diagnose a personality disorder during the adolescence or teen years, because the individual is still developing their personality.

What Treatments Improve the Symptoms of Narcissistic Personality Disorder?

Perhaps one of the biggest challenges to treating the maladaptive traits of a narcissistic personality disorder is awareness. It can be difficult to encourage self-awareness in someone who exhibits grandiose feelings of their self. Even when individuals with a narcissistic personality disorder can recognize disputes or challenges in their life, they will often place the blame on others.

Any accusations or mention of a negative personality trait can lead someone with NPD to become defensive and feel like they are being attacked. They have often developed a fantasy world in which their feelings and goals are most important and getting them to not only recognize, but work on leaving that world, can be difficult.

Talk-therapy is often used to not only recognize narcissistic traits, but to also identify where and why these traits might have developed. Personality traits are not always easy to change, as they become instilled into our sense of being during development. However, therapy in combination with a desire to change habits can lead to significant improvement of symptoms.

Treatment for a narcissistic personality disorder often includes:

  • Relationship building
  • Developing emotional intelligence/empathy
  • Developing communication skills
  • Learning to recognize and manage emotions
  • Marriage and family therapy
  • Learning to set goals
  • Learning to manage stress
  • Practicing social skills

Family and marriage therapy is often useful when dealing with a spouse or family member with a narcissistic personality disorder. Because individuals with NPD will often demean or belittle others in an attempt to avoid self-reflection, they will often have conflict in their personal relationships. Therapy can play an important role in evaluating these conflicted relationships, developing awareness, and working toward the respect of boundaries.

Depending on the individual, medications can also be used in the treatment of NPD. While there are no medications that specifically treat a narcissistic personality disorder, they can be used to treat symptoms of other co-occurring disorders. For example, antidepressants might be used to manage symptoms of depression. Anti-anxiety medications can be used to minimize anxiety.

What Disorders are Similar to Narcissistic Personality Disorder?

Narcissistic personality disorder is included in Cluster B of personality disorders. Cluster B is made up of personality disorders that lead to difficulties regulating emotions and impulse control. Other personality disorders that are similar to NPD include:

This group of personality disorders will often find it difficult to maintain relationships. They may also find it overwhelming to control emotions.

What Mental Health Disorders Often Co-Occur With Narcissistic Personality Disorder?

Co-occurring disorders are not uncommon, especially with a personality disorder. These are a few of the most common disorders that accompany a narcissistic personality disorder.

  • Post-traumatic stress disorder (PTSD)
  • Phobias
  • Bipolar I disorder
  • Generalized anxiety disorder
  • Major depressive disorder
  • Obsessive-compulsive disorder

Symptoms of more than one personality disorder are also possible. Individuals might display symptoms of multiple Cluster B personality disorders. Drug and alcohol use may also be a concern. Individuals with NPD may turn to drugs or alcohol to cope with estranged or problematic relationships or to deal with stress. A narcissistic personality with alcoholism can make it difficult for the individual to identify problematic behaviors.

Fast Facts About Narcissistic Personality Disorder

  • Narcissistic personality disorder is most often found in men (7.7%) compared to (4.8%) in women.
  • It is estimated that about 5% of the U.S. population has NPD. However, identifying how many people actually have NPD is difficult with barriers to diagnosis. Other studies estimate it as high as 6.2%, whereas others determine it is as low as 0.5-1% of the population.
  • Many professionals believe that the rate of NPD is increasing. However, it is unknown whether this is due to more awareness of personality disorders and mental health, or a shift in overall cultural expectations.
  • Individuals with NPD tend to be high-functioning. They often hold high positions in financial or business industries.

The traits that are present with a narcissistic personality disorder can make it difficult to seek help. Fortunately, there are techniques that can improve both relationships and symptoms.