Narcissistic Personality Disorder

Narcissistic personality disorder is characterized by distorted and unhealthy patterns of thinking and behaviors. Narcissists have an inflated sense of self-importance, are excessively arrogant, thrive on praise and adoration, lack empathy for other people, and have strained relationships, often valuing people only for what they can offer them. It is difficult for a narcissist to recognize that there is anything wrong with their thinking and this makes getting treatment difficult.

Narcissism is a Personality Disorder


People commonly use the term narcissist in a casual way, to refer to someone who is arrogant or selfish. But a true case of narcissism is a personality disorder, a kind of mental health condition that can be very difficult to cope with and that has a big impact on a person’s life.

A personality disorder causes a person to have a very inflexible way of thinking, behaving, and relating to others that is not healthy. As a result, someone with a personality disorder typically struggles to maintain good relationships and to function at school, at work, and in other situations. Someone with this kind of condition, which usually shows the first signs during the teenage years, may not realize there is anything wrong with their thinking or behaviors and may blame their problems on others.

Narcissistic Personality Disorder Defined


The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) organizes personality disorders into three clusters. Narcissistic personality disorder (NPD) is in cluster B, a group of conditions characterized by extreme emotional reactions, dramatic behaviors, and unpredictable thoughts and actions. Other personality disorders in this group are antisocial, borderline, and histrionic personality disorders.

NPD is characterized by an internal belief in being better than others or about being important, fantasies about power and success, extreme arrogance, an inability to recognize the needs or accomplishments of others, exaggerating achievements, and taking advantage of others. Someone with NPD is not simply arrogant or overly confident. This person has a skewed sense of his or her own abilities and importance, and these beliefs significantly impair relationships and functioning.

Signs and Symptoms of NPD


There are several potential symptoms of NPD that a person may exhibit. Everyone is different and each individual diagnosed with the condition may have some of these symptoms but not all. It is also important to remember that each of these is extreme or excessive in the case of genuine narcissistic personality disorder:

  • Exaggerated sense of self-importance. This is the most common characteristic of NPD. A person with the condition believes he is special and better than other people. They believe they are exceptional and they want to be treated as such, even if they haven’t actually done anything to be considered exceptional.
  • Constant need for admiration. In following with this sense of self-importance, a person with NPD wants to be recognized, admired, and affirmed. They tend to be around people who will provide that admiration but fail to have deeper relationships.
  • Distorted self-perception. People with NPD live in a fantasy world they have constructed, one in which they fantasize about greatness, power, wealth, or other grandiose things.
  • Entitlement. Because they believe themselves to be special and better, a narcissist generally feels entitled and expects to get the things they want. They value other people to the extent that they can provide what the narcissist wants or thinks they are owed.
  • Bullying and intimidation. Someone with NPD may use intimidation and condescension to bully others. This is especially true with someone who seems to have something the narcissist does not, such as an ability or specific skill. Belittling that person is a defense against what they see as a threat.
  • Lack of empathy. A narcissist cannot identify with the feelings, needs, or wants of other people. Others are simply there to serve their own needs. This means they will exploit or manipulate other people without feeling guilty or ashamed.

Some other more specific signs of narcissism include:

  • Envy of others
  • Expecting others to envy them
  • Needing to have the best, such as the most expensive car
  • Expecting special favors or that other people will automatically do what they say
  • Only wanting to associate with people they deem good enough
  • Outbursts when they don’t get what they want
  • Significant problems developing relationships
  • Depression when things don’t go the way they want
  • Secretly feeling inferior

Diagnosing Narcissistic Personality Disorder


NPD is diagnosed according to the criteria set out in the DSM-V. Mental health professionals use these criteria while performing a psychological evaluation to determine if a person should be diagnosed with NPD. The first criterion is that an individual has both one impairment in personal functioning and one impairment in interpersonal functioning. The impairments may include:

  • Self-identity. A person with NPD may look externally to others to define herself, and fluctuate between extremes of self-esteem and emotions.
  • Self-direction. Setting goals or deciding on a life path is highly dependent on achieving external approval. Personal standards may be so high as to think oneself exceptional, or low because of a sense of entitlement.
  • Empathy. Someone with NPD generally cannot sense other people’s feelings or needs, unless they pertain to them.
  • Intimacy. People with NPD tend to have relationships that are superficial and lack real intimacy.

Diagnosis of NPD also requires that a person display significant pathological personality trait of antagonism. This means that they are attention seeking, always looking for admiration from others, to an excessive degree. They are also grandiose, feeling entitled, self-centered, condescending, and believing they are better than other people.

Diagnosis not only requires that these attributes be present but also that they are fairly consistent across a person’s life and that they never really wane or disappear. The attributes and impairments can also not be explained by a developmental stage, environmental factors, or substance abuse.

Causes and Risk Factors


There is no definite, known cause of narcissism. However, there are factors that seem to play a role: genetics, environment, and brain chemistry and structure. In terms of environment, parent-child relationships may impact a child’s personality. A contributing factor to NPD may be a parent who is excessively attached to a child or excessively critical.

There are not many known risk factors, which while they do not guarantee a person will have NPD, do increase the risk. Being male is a risk factor, for example, as more men are diagnosed as narcissists than women. Having an overprotective or neglectful parent is also considered a risk factor.

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Treatment and Outlook for NPD


The main type of treatment for narcissistic personality disorder is psychotherapy. There are no medications to treat this disorder, but antidepressants or anti-anxiety medications may be prescribed for someone diagnosed with NPD who also experiences depression or anxiety. Any type of psychotherapy may be used to treat patients, but the effectiveness depends a lot on how willing the patient is to commit to therapy and to make changes. It also depends on the severity of the distorted beliefs and thoughts, which can vary by individual.

Changing the beliefs and thoughts for someone with NPD is extremely challenging. Even getting to the point of being diagnosed and treated is difficult because it is hard to see that one’s thinking is skewed. With a personality disorder, a person tends to believe that other people are the problem, not them.

The goals of therapy for NPD to begin with are to help the person start to see that their thinking isn’t healthy and that it causes problems in their lives. If this insight can be achieved the therapist can then help that person make positive changes. Intensive individual therapy in a residential setting can help a narcissist learn to relate to and empathize with others so they can develop better relationships, for instance. This can also help someone with acceptance of their own limitations or lack of exception.

Because relationships are such a challenge for someone with NPD, family or couples therapy can be useful. This can help the person with the condition learn to better relate to those close to them. It also helps family members or partners better understand their loved one and learn how to set boundaries and communicate.

Complications of Narcissistic Personality Disorder


It is not uncommon for someone with narcissistic personality disorder to experience complications of the disorder, especially if it goes untreated. The arrogance, self-importance, lack of empathy, and need for admiration and accolades can have serious and negative impacts on all aspects of a person’s life. Some of the potential complications are:

  • Difficult, strained, or one-sided relationships—or a lack of meaningful relationships
  • Issues at work or school
  • Substance abuse
  • Depression, anxiety, and other mental health problems
  • Suicidal thoughts and behaviors

While it is very challenging for someone with NPD to recognize their own faulty thinking or to recognize a need for treatment, it is important to try to get a loved one the help they need. Untreated narcissism makes a normal and satisfying life with good relationships difficult. Treatment must be consistent and long-term, but it can help.