What Causes Narcissistic Personality Disorder?

Narcissistic personality disorder emerges from a confluence of genetic factors and environmental influences. Exposure to abusive, overly demanding, or permissive parenting styles in childhood is the primary cause of narcissistic personality disorder, which is a cover for deep-seated self-esteem and self-confidence issues. Narcissistic personality disorder sufferers are lifetime underachievers who struggle to build stable relationships, but with comprehensive, long-term treatment narcissists can become more self-aware and begin to make positive changes in their thoughts, behaviors, and attitudes.

At the core of narcissistic personality disorder (NPD) there lies a contradiction: people diagnosed with NPD see themselves as superior and more deserving of consideration than others, but the real cause of their delusions is a deeply-felt sense of insecurity supported by chronically poor self-esteem.

Rather than surrender to their feelings of unworthiness and lack of trust in themselves, NPD sufferers hide behind an inflated ego and a self-centered approach to human relations. They fail to develop empathy and react to others with cynicism and an overly competitive attitude. Narcissists don a mask of supreme self-confidence and infallibility, but they do it more to fool themselves than to fool others.

And that is a strategy that works. Caught in a web of self-deception, narcissists truly believe their own lies and the delusions of grandeur that sprout from them. Their distorted personalities are a side effect of their low self-esteem and lack of healthy interpersonal boundaries, which can be traced back to childhood experiences that set them up for a lifetime of dysfunctional relationships and chaotic living.

In particular, it is the impact of parenting and parenting styles that put young people at risk for narcissistic personality disorder later in life, although there are genetic factors involved as well.

Genetic Causes of Narcissistic Personality Disorder

Childhood experiences are known to be essential to the development of narcissistic personality disorder. Nevertheless, there are genetic factors involved that create a greater vulnerability for the disorder, just as there are for every other type of mental illness. Without an elevated genetic predisposition for narcissism, NPD is unlikely to develop unless environmental causes are unusually strong.

The question of genetics and personality disorder have been studied extensively in recent years, and findings show a consistent connection between narcissistic traits and inheritable factors. The effect is not overwhelming, but it is strong enough to play a meaningful role in the development of the disorder.

In one 2008 Norwegian study involving nearly 3,000 non-identical twins, genetic factors were found to be one-quarter responsible for the development of narcissistic traits in study participants, with environmental influences providing the remaining causal impetus. Of the four Cluster B personality disorders studied (narcissistic, histrionic, borderline, and antisocial), narcissistic personality disorder was the least affected by a genetic predisposition, emphasizing the relative primacy of environmental influences for NPD.

Meanwhile, another recent study (2014) carried out in China on two specific characteristics of NPD—feelings of grandiosity and a sense of entitlement— revealed an inheritance factor of 23 percent for the former and 35 percent for the latter. This confirms the contributions of genetic influences even when narcissistic symptoms are examined in isolation.

Environmental Causes: Parenting Styles and Narcissistic Personality Disorder

In assessing the environmental factors responsible for the onset of mental illness, most of the focus is inevitably on childhood experiences, which set a tone and a template for future mental health and personality development.

Family dynamics and parenting styles are especially critical to a child’s emotional and psychological wellbeing (or lack thereof), and it is the latter factor in particular that seems to be decisive in the onset of narcissistic personality disorder during adulthood.

Based on research findings, mental health experts have identified three types of dysfunctional and ineffective parenting that are heavily implicated in the development of NPD: authoritarian parenting, permissive/indulgent parenting, and pathological or abusive parenting.

Authoritarian parenting

Parents who adopt an authoritarian style are overly controlling, highly demanding, and slow to give approval. Their style lacks warmth and affection, and they seldom show trust in their kids or give them room to grow and make their own mistakes.

Because their style is more critical than empathic, authoritarian parents do little to build their children’s self-esteem, self-confidence, or ability to feel empathy for others. Extreme demands produce highly insecure kids, and as they mature they may develop narcissistic personality traits as a coping mechanism.

In adulthood their personality comes to mirror that of their parents, as they recreate ego-centered patterns of thinking and behavior they experienced as normal.

Permissive/indulgent parenting

At the opposite end of the spectrum from authoritarian behavior, overly indulgent parents tend to praise or pamper their kids incessantly, either as a way to keep them pacified or because they truly believe their sons and daughters are special. They don’t set clear standards for their children to live up to, creating confusion by offering compliments and attention regardless of actual behavior or performance.

Constant praise and permissive attitudes can lead to inflated egos in children, who grow up as adults believing they can do no wrong. On the other hand, if kids sense their parents won’t discipline them or establish boundaries because they don’t care enough to do so (where indulgence is a cover for emotional detachment), their self-esteem may be damaged and they may adopt cynical and unsympathetic attitudes toward other people.

Feelings of grandiosity and an exaggerated sense of self-importance may come naturally, as empathy and trust for others fails to develop.

Pathological parenting

Exposure to physical, emotional, and sexual abuse in childhood is a common factor for many people diagnosed with mental health disorders, including those with narcissistic personality disorder.

In one 2007 study reported on by the Journal of Personality Disorders, people who’d experienced extreme abuse and mistreatment in childhood were 2.93 times more likely to be diagnosed with NPD than members of the general public. This level of risk was the highest among the four types of Cluster B personality disorders, and the second highest among all mental health disorders measured, trailing only obsessive-compulsive disorder.

Another study on environmental influences and personality disorders, carried out two years later and discussed in the peer-reviewed journal Psychiatry Research, asked participants to reveal information about their experience with both childhood abuse and various symptoms of mental illness.

In comparison to those who reported abuse-free histories, people who’d been physically, emotionally, or sexually abused as kids reported three-and-a-half times as many narcissistic symptoms. None of the study participants with abuse-free childhoods reported more than two such symptoms, but nearly 20 percent of those who’d been abused as kids reported four or more symptoms of narcissism, putting them on or over the threshold for full-blown narcissistic personality disorder.

Early Warning Signs for NPD

Narcissism is difficult to detect in children, but NPD sufferers often manifest their initial symptoms during adolescence, as they begin the transition to adulthood.

The telltale warning signs of a developing narcissism problem in teens include:

  • Reports of bullying behavior
  • Denigrating others based on their appearance, social status, cultural background, ethnicity, etc.
  • Habitual lying
  • Supreme self-confidence, bordering on egomania
  • Being more competitive than cooperative
  • Always wanting to win, and not handling failure with grace
  • A sense of entitlement with no actual achievements to back it up
  • Lack of interest in the lives of other family members
  • Inability to handle even minor criticisms without getting aggressive or defensive

Parents with teens who exhibit such symptoms should seek the assistance of a trained mental health professional, who can offer treatment services that may slow or halt the progress of narcissistic personality disorder while it is still in its infancy.

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Diagnosis and Treatment for Narcissistic Personality Disorder

Narcissistic personality disorder is diagnosed based on the presence of at least five of nine distinctive symptoms associated with the disorder, which are:

  1. A grandiose sense of self-importance
  2. Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
  3. Feelings of being special and unique, belonging only with others who have equally high status
  4. Need for constant and excessive admiration
  5. A sense of entitlement, expecting special treatment and recognition regardless of actual accomplishments
  6. Exploitative actions, treating others as a means to an end
  7. Lack of empathy
  8. Excessive envy (and assumptions that others are equally envious)
  9. Arrogant, haughty behaviors and attitudes

Treatment for narcissistic personality disorder involves intensive, long-term individual, group, and family psychotherapy, which should begin in a residential treatment center before the patient transitions into outpatient treatment and aftercare. When people with NPD concentrate on their process of healing and self-discovery in a safe, non-threatening, non-judgmental environment, their chances of achieving a breakthrough are significantly enhanced.

Unfortunately, many NPD sufferers are unable to admit they have a problem or accept responsibility for the relationship, employment, and life problems that normally accompany chronic narcissistic behavior. The toxic combination of grandiosity and a hidden, fragile ego makes it extremely difficult for them to face their own weaknesses and limitations, and that makes many NPD sufferers highly resistant to treatment.

But if NPD sufferers in recovery can overcome that initial resistance and the controlling effects of their narcissistic symptoms, even those who’ve suffered the ill effects of narcissistic personality disorder for decades can experience real signs of improvement. It won’t happen overnight, but with a committed approach to self-betterment NPD sufferers can heal the breaches that separate them from family, friends, coworkers, and a more satisfying and fulfilling life.