Narcissistic Personality Disorder is a personality disorder that is most often understood as a person that thinks highly of themselves when compared to others. People with narcissistic personality disorder often display snobbish, disdainful, or patronizing attitudes. Narcissistic personality disorder should not be confused with high self-confidence and self-esteem. Of those diagnosed with narcissistic personality disorder, 50%- 75% are male. Narcissistic traits may be common in adolescents, but that does not necessarily mean that as they grow into adults, they will develop narcissistic personality disorder. Problems occur across areas in their life including work, school, financial affairs, relationships, etc.
Narcissistic Personality Disorder Defined
Narcissistic personality disorder is characterized by an excessive and deep need for admiration, lack of empathy for others, an inflated sense of self importance and a series of troubled relationships. People with narcissistic personality disorder believe they are superior or special, and often try to associate with other people they believe are unique or gifted in some way. These kinds of associations often heighten their self-esteem. Behind what many see as a high self- esteem is actually a fragile self-esteem that is sensitive to “injury” from defeat or criticism. These individuals may not share with others that the criticism impacts them, therefore concealing it, leaving them feeling degraded, humiliated and hollow inside. These individuals may find relationships unfulfilling while others may not enjoy being around others in general.
Different Types of Narcissistic Personality Disorders
There are no subtypes of narcissistic personality disorder but it is classified under Cluster B under personality disorders in the Diagnostic and Statistical Manual of Mental Disorders. Cluster B personality disorders are characterized by dramatic, overly emotional or unpredictable thinking or behavior.
Narcissistic Personality Disorder Causes
The cause of narcissistic personality disorder is not fully understood but there is an agreement that it is caused by a combination of factors. Genetics may play a role in the development of narcissistic personality disorder. While there is no specific gene related to narcissistic personality disorder, research suggests that there is a slightly increased risk for this disorder to be inherited by their children. While some of this has to do with genetics, some is also likely due to the child’s personality and temperament, as well as the parenting behavior of one or both of the parents.
Narcissistic Personality Disorder Symptoms
To be diagnosed with narcissistic personality disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, the following criteria must be met:
A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of context, as indicated by five (or more) of the following:
- Has a grandiose sense of self- importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
- Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
- Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high- status people (or institutions).
- Requires excessive admiration.
- Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).
- Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).
- Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
- Is often envious of others or believes that others are envious of him or her.
- Shows arrogant, haughty behaviors or attitudes.
Other symptoms of individuals with narcissistic personality disorder that have trouble handling anything they perceive as criticism:
- Have secret feelings of insecurity, shame, vulnerability and humiliation
- Become impatient or angry when they don’t receive special treatment
- Have difficulty regulating emotions and behavior
- Experience major problems dealing with stress and adapting to change
- React with rage or contempt and try to belittle the other person to make themselves appear superior
- Have significant interpersonal problems and easily feel slighted
- Feel depressed and moody because they fall short of perfection
How to Approach a Loved One
There is not a perfect way to approach a loved one that you assume or know has narcissistic personality disorder. People with narcissistic personality disorder may not believe anything is wrong with them, so they may resist treatment or not listen to the concerns of their family and friends. While preventing a loved one from developing narcissistic personality disorder is not possible, providing support and being aware of what they’re learning in treatment can be helpful.
Types of Narcissistic Personality Disorder Treatment
Narcissistic personality disorder can be a challenge to treat not only because individuals with narcissistic personality disorder may not feel that therapy is not worth their time and attention. These individuals have a great deal of grandiosity and defensiveness, which makes it difficult for them to acknowledge problems and vulnerabilities. Therapy can be short term to manage times of stress or crisis, or can be provided on an ongoing basis. Often, including family members or significant others in therapy can be helpful. When considering treatment, it is important to consider co-occurring conditions that may exist, like anxiety or depression. Treatment can improve an individual’s life, making it more enjoyable and rewarding.
Psychotherapy is the most common method of treatment for narcissistic personality disorder. Through psychotherapy, people with narcissistic personality disorder may process and work through their interpersonal problems. Psychotherapy can help individuals to learn how to have intimate, reciprocal, and enjoyable relationships. The relationship with the therapist and the skills taught, teach people how to relate better with other and get to the root of their emotions that cause them to distrust people, compete with others and despise others, as well as themselves.
To date there are no drugs approved by the FDA that have been specifically created to treat narcissistic personality disorder. Medications can be useful when treating other symptoms that may occur simultaneously with narcissistic personality disorder, such as anxiety or depression.
Differences Between Common Disorders
There are other disorders that may resemble narcissistic personality disorder, so it is important to differentiate the difference between common disorders that may get confused with this disorder.
- Other personality disorders and personality traits-Other personality disorders may be confused with narcissistic personality disorder due to their similarities in symptoms and features. If an individual meets criteria for narcissistic personality disorder as well as another personality disorder, both can be diagnosed. The most useful feature in discriminating narcissistic personality disorder from other personality disorders like antisocial, histrionic, and borderline personality disorder is the grandiosity characteristic of narcissistic personality disorder. Another example is the lack of emotional display, excessive pride in achievements, and disdain for others sensitivities, help distinguish narcissistic personality disorder from histrionic personality disorder. It is common that highly successful individuals display traits similar to narcissistic personality disorder, but it is only if these traits are inflexible, persisting, maladaptive, and cause significant functional impairment or distress, does it constitute as narcissistic personality disorder.
- Mania or hypomania-Grandiosity may emerge as part of manic or hypomanic episodes, but the association with mood change or fictional impairment helps distinguish these episodes from narcissistic personality disorder.
- Substance use disorders- Narcissistic personality disorder must be differentiated from symptoms that may develop that are associated with persistent substance use.
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders.
(5th ed.) Arlington, VA: American Psychiatric Association.
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