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
There are nine traits of narcissistic personality disorder—patients must meet five of them for a clinician to diagnose them with this 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.
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
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 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
Strongly Desires Social Status
Strongly Desires Social Status
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
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.
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
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.
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
If you or a loved one needs help, please call us at
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