What Is Narcissistic Personality Disorder

Discover the characteristics, types, and treatment methods for narcissistic personality disorder.

What Is a Narcissist? Narcissistic Personality Disorder Signs

Everyone knows someone in their lives who shows signs of narcissism. This person might talk about themselves often or demonstrate an unwarranted amount of self-confidence. Although they may show narcissistic traits, they might not fall under the diagnosis of narcissistic personality disorder (NPD).

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), there are nine traits and characteristics that define a true diagnosis of narcissistic personality disorder.¹

The Nine Characteristics of a Narcissist

There are nine traits of narcissistic personality disorder—patients must meet five of them for a clinician to diagnose them with this disorder.

Grandiose Self-importance

When talking about a narcissist, the word grandiose refers to an exorbitant sense of superiority and entitlement. Because of their self-important personality disorder, narcissists consider others inferior and hold themselves above all others. They elevate themselves to such a point that the talent and accomplishments of others mean less than their own.¹

Fantasies of Unlimited Power, Brilliance, Beauty, Power, or Adoration

A narcissist has ambitions and high expectations—often above what is reasonable or feasible. They don’t expect to fail and blame others if they do. Their desire for power and success dominates their thoughts. People who show signs of narcissistic behavior disorder believe they are destined for greatness, even when their skills or talents offer no evidence that success is possible.

The Belief in Their Uniqueness and Specialness

We are all special and unique, but a narcissist believes their uniqueness surpasses others. Because of this belief, they feel misunderstood. It is common for those with NPD to think others are intellectually behind and unable to comprehend their special ways, especially when people do not agree with them or follow their line of thinking.

The Need for Excessive Admiration

People with narcissistic personality disorder like to surround themselves with people who admire them. Their strong desire for admiration makes them gravitate to others that look up to them and agree with their opinions. People who are narcissists feel as though admiration from others is deserved.²

Envious of Others

Instead of being happy for the success of others, people with NPD feel envious. When individuals with this disorder see others attain wealth, power, love, or admiration, they want those things for themselves and become jealous. Additionally, narcissists think that others are envious of them. They carry a false belief that people around them are jealous, especially those who dislike or disagree with them.

A Sense of Entitlement

When it comes to the good things in life, those with NPD feel they deserve the best, even when they don’t work hard for success or earn it. What’s more, narcissists think that the rules don’t apply to them or their circumstances, so they can bend—or even break—the rules.

Exploitative Behavior

The ends justify the means for narcissists. People with narcissistic personality disorder exploit others to get what they want. The people around them, including their family, are tools to obtain their desires. Due to their narcissism, they have a severe lack of awareness when others are concerned. Therefore, other people and situations are seen as opportunities to advance their ambitions, regardless of whom they harm.

Lack of Empathy

Empathy allows people to recognize the emotions and humanity in others. People with narcissistic behavior disorder find it difficult to feel empathic because they lack this trait. Narcissists are often unaware of others’ feelings and emotions, leading to callousness and exploitative behavior.

Demonstrations of Arrogant Behaviors and Attitudes

Arrogance demonstrated by a narcissist is what typically ties others into their illness. Arrogant behavior and attitude can strain relationships and affect work or school. People with NPD may demonstrate their arrogance through sarcasm, condescending tones, or rudeness.

How Common is Narcissistic Personality Disorder?

Although the traits for this disorder may seem apparent in someone—self-centered, arrogant, and demanding—only a clinician can make the appropriate diagnosis. While individuals may have a few narcissistic disorder symptoms, it is not enough to meet the criteria. Only about 0.5% to 5% have narcissistic personality disorder. In clinical settings, about 1% to 15% have the condition.³

The difference in percentages shows how narcissistic personality can be present with other disorders and lead to problems in a person’s physical and mental health. For instance, individuals with NPD may have another illness, such as depression, substance use disorder, anorexia, or another type of personality disorder.

Narcissistic Personality Disorder: Causes of Narcissism

Despite what clinicians understand about NPD, very little is known about the causes of narcissism. A family history of narcissistic personality disorder is thought to be a possible cause but not confirmed. Whether genetics or the familial environment play a part is unknown. Still, individuals with narcissistic personality disorder may have a childhood history of:⁴

Unreliable or neglectful parenting
Overly critical parenting
Showering of excessive praise or overindulgence from caregivers
Lack of a validating parental environment
Trauma or abuse

Types of Narcissistic Personality Disorder

Researchers have identified two types of distinct narcissists: grandiose and vulnerable. These two types of NPD are recognized due to their behavior in social situations.

Grandiose Narcissist

Grandiose narcissists have the usual traits of a narcissist and meet the typical public perception of how a narcissist behaves. For example, in addition to seeking social status and exhibiting self-centeredness, grandiose people are also extroverted, assertive, and charming in social situations. They seek admiration from others but have little desire for social inclusion. Because they believe they are better than other people, they don’t feel the need for acceptance of others and are typically impervious to negative criticism.⁵

In social situations, grandiose narcissists enjoy being the center of attention. They tend to talk over others and dominate the conversation. Common traits include arrogance and entitlement and being quick to maximize opportunities for their sole benefit. Their extroversion and social skills are tools for achieving their success and obtaining admiration.

Vulnerable Narcissist

Vulnerable narcissists seek acceptance from the public eye, desire social inclusion, and want to be liked by others. Although they still seek social status and are self-centered, they don’t have the social skills that grandiose narcissists possess. Vulnerable narcissists are socially awkward, withdrawn, and neurotic. In addition, they are exceptionally sensitive to criticism and prone to emotional overreaction and excessive pride—commonly shown in the form of angry outbursts.⁵

This narcissistic personality disorder type doesn’t meet the public’s description of a narcissist, and those with this disorder don’t live up to the standards they seek for themselves. For example, their shy personalities lead others to initially see them as pushovers or humble; however, while vulnerable narcissists struggle with the overwhelming need for success and admiration, they have a negative self-image and internal shame. These opposing characteristics can cause frustration and out-of-control behavior, inducing “narcissistic rage” outbursts and entitlement.⁶

Grandiose Narcissist	Vulnerable Narcissist
Strongly Desires Social Status	Strongly Desires Social Status
Self-Centered	Self-Centered
Deep Desire for Success and Admiration	Deep Desire for Success and Admiration
Little Desire for Social Inclusion	Desires Social Inclusion
Arrogant and Assertive	Withdrawn and Neurotic
Extroverted and Socially Skilled	Withdrawn and Socially Incompetent
Dominant and Charming	Shy and Anxious
Seeks to Maximize Opportunities	Timid and Seeks to Minimize Failure
Confident with High Self-Esteem	Hypersensitive with Low Self-Esteem

Treatment for Narcissistic Personality Disorder

Fortunately, various methods of treatment are available for narcissistic personality disorder; however, people with this disorder don’t usually seek treatment on their own. The common traits of self-centeredness and lack of empathy adversely impact their relationships, preventing opportunities for others to help.

Possible comorbidities, other simultaneously occurring disorders, could lead to seeking treatment and inadvertently finding themselves in treatment for NPD as well. Additionally, people with NPD might find their work or school life suffering because of their entitled behaviors and seek assistance to further their success. Nonetheless, self-reflection can be challenging for those with this disorder, making treatment for narcissism difficult.

Psychotherapy

The most common treatment for narcissism is talk therapy, also known as individual psychodynamic psychotherapy. Talk therapy with narcissistic personality disorder specialists targets underlying conflicts and focuses on learning how to have meaningful relationships with others. Controlling narcissistic personality disorder is difficult and complex, so psychotherapy might take several years to see noticeable changes.

Some types of psychotherapy used for other disorders, mainly borderline personality disorder, are also effective for NPD. These talk therapy methods include mentalization-based treatment, transference-focused psychotherapy, and cognitive behavioral therapy (CBT). These therapies help the person with narcissistic personality disorder to:⁷

Accept personal responsibility for their actions
Maintain healthy relationships, both personal and professional
Recognize and accept their actual competency
Learn ways to curb their self-defeating behaviors
Understand what causes their distrust of others
Learn how to tolerate criticism and failure

Medications

Although there are no medications used specifically for narcissistic personality disorder treatment, there are medications that can assist with alleviating narcissistic disorder symptoms. For example, psychotropic medications, such as antidepressants, antipsychotics, and mood stabilizers, may reduce poor impulse control, emotional lability, and anxiety. Psychotropic medications can improve relationships and stabilize their emotions by mitigating the emotional responses that lead to the more disturbing symptoms of narcissistic personality disorder.

The Importance of Treatment for Narcissistic Personality Disorder

Despite how challenging treatment for narcissistic personality disorder can be, obtaining treatment is essential. This is especially true because narcissistic personality disorder, particularly the grandiose type, is associated with substance use disorder. Research into addiction has found that individuals with substance abuse disorders display higher rates of narcissism and entitlement.⁸

Furthermore, the comorbidities often associated with NPD may cause functional impairment in the long run, reducing an individual’s quality of life and overall well-being. Narcissistic personality disorder treatment allows individuals to enjoy more meaningful relationships and well-earned successes.⁹