Narcissistic Personality Disorder
The hallmarks of narcissistic personality disorder (NPD) are grandiosity, a lack of empathy for other people, and a need for admiration. People with this condition are frequently described as arrogant, self-centered, manipulative, and demanding. They may also have grandiose fantasies and may be convinced that they deserve special treatment. These characteristics typically begin in early adulthood and must be consistently evident in multiple contexts, such as at work and in relationships.
People with NPD often try to associate with other people they believe are unique or gifted in some way, which can enhance their own self-esteem. They tend to seek excessive admiration and attention and have difficulty tolerating criticism or defeat.
Although NPD is a difficult disorder to treat, therapy can help those with the condition develop their sense of self and their relationships.
NPD refers to the diagnosable mental disorder, while the term "narcissism" is a trait that ranges in degree from person to person.
Individuals with narcissistic personality disorder, according to the DSM-5, exhibit five or more of the following, which are present by early adulthood and across contexts:
- A grandiose sense of self-importance
- Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
- Belief that one is special and can only be understood by or associate with special people or institutions
- A need for excessive admiration
- A sense of entitlement (to special treatment)
- Exploitation of others
- A lack of empathy
- Envy of others or the belief that one is the object of envy
- Arrogant, haughty behavior, or attitudes
Individuals with NPD can be easily stung by criticism or defeat and may react with disdain or anger—but social withdrawal or the false appearance of humility may also follow according to the DSM-5.
A sense of entitlement, disregard for other people, and other aspects of NPD can damage relationships. While a person with NPD may be a high-achiever, the personality disorder can also have a negative impact on performance (due to, for instance, one's sensitivity to criticism).
Researchers have reported associations between NPD and high rates of substance abuse, mood, and anxiety disorders. These may be attributable to characteristics such as impulsivity and the increased experience of shame in people with NPD.
The presence of narcissistic traits in adolescence does not necessarily imply that a person will have NPD as an adult.
There are two types of narcissism: grandiose (or overt) and vulnerable (or covert). Grandiose narcissism is marked by extroversion, self-confidence, attention seeking, and aggression. Vulnerable narcissism is characterized by introversion, high sensitivity, negative emotions, and a need for constant recognition and reassurance. A unifying theme of all forms of narcissistic personality disorder is self-enhancement, the belief that one’s thoughts and actions set them apart from others.
The term “narcissist” has become culturally entrenched, and the label is sometimes overused. The trait occurs on a spectrum, and it’s healthy for people to have a small dose of narcissism—it provides confidence to forge relationships, explore life, and take risks. Narcissism only becomes a disorder when it impairs a person’s daily life, through their relationships, sense of self, occupation, or legal standing.
Antisocial personality disorder, paranoid personality disorder, and substance use disorders tend to overlap more frequently with grandiose narcissism, while depression, anxiety, and self-harm tend to co-occur with vulnerable narcissism, research suggests. However, not everyone with narcissistic personality disorder has other conditions.
Causes of narcissistic personality disorder are not yet well-understood, but biological and environmental factors both play a role.
In addition to the genetic roots of the disorder, research suggests that early experiences—such as parenting styles and social and cultural environments—also influence the course of the disorder. For example, narcissism is higher among individualistic cultures than collective ones, and competitive environments like New York more than non-competitive environments like Iowa.
In terms of parenting, focusing intensely on competition and success can breed narcissism, while warmth, affection, and expecting children to simply try their best can foster healthy development.
The prevalence of narcissistic personality disorder is estimated to be between 1 and 5 percent, research suggests. The disorder manifests more frequently among men and among younger people.
There’s debate as to whether narcissism as a trait or disorder has increased over time. Some research suggests that the disorder has remained stable while the trait has risen, but cross-generational comparisons may not be reliable; technology, society, and social norms have all changed.
On an individual level, research shows that people are generally more narcissistic when they’re younger—in adolescence and young adulthood—and that they become less narcissistic as they get older.
Some research suggests that narcissistic traits begin to emerge around age 8, as children are developing their sense of self. However, the identity may still be forming, and displaying signs of narcissism in adolescence doesn’t necessarily signal the development of a personality disorder, according to the DSM-5.
Treatment for narcissistic personality disorder can be challenging because people with this condition have a great deal of grandiosity and defensiveness, which makes it difficult for them to acknowledge problems and vulnerabilities.
Even though change is difficult, it’s not impossible. A key is to find a therapist who is trained to work with patients who have narcissistic personality disorder.
Therapy can help people with narcissistic personality disorder learn to relate to themselves and others in a more compassionate way. By exploring their experience, developing the therapeutic relationship, and continually focusing patients on relationships, community, and connection, narcissists can develop a healthier sense of self, and with it, healthier relationships with others.
Successful therapy for narcissistic personality disorder includes a series of steps, including helping patients to find relief from immediate distress, recognize unhealthy coping mechanisms, develop new coping skills, unpack childhood experiences, learn to empathize with themselves, and eventually learn to empathize with others and live authentically.