What are the Signs and Symptoms of Narcissistic Personality Disorder?

Narcissistic personality disorder (NPD) impacts every area of a person’s life. It shapes their perspectives, attitudes, and behavior, and its influence is largely negative and disruptive. People who manifest the symptoms of NPD may struggle to maintain healthy relationships, and their path to career and life success may be blocked by their inability to empathize with others or recognize their own flaws and limitations. But with time and treatment services, the symptoms of narcissistic personality disorder can be managed and their deleterious effects minimized.

Narcissistic Personality Disorder: A Brief Introduction

Narcissistic personality disorder (NPD) is the most commonly diagnosed type of personality disorder. About 6.2 percent of American adults meet the lifetime criteria for NPD, including 7.7 percent of men and 4.8 percent of women.

People with narcissistic personality disorder (NPD) have an exaggerated sense of their own self-importance and a distorted view of their own abilities. They see themselves as masterful beings accomplishing amazing things, and any evidence that contradicts this self-perception is rejected or ignored.

Imprisoned inside their own self-awareness, men and women with NPD lack empathy for others, which leaves them unable to understand or appreciate alternative perspectives or opinions. They are capable of love, but they expect their partners to acknowledge their special qualities frequently, even though they feel no compulsion to return the favor.

There are elements of selfishness to narcissism. However, people with NPD aren’t intentionally self-centered or thoughtless. Since they lack empathy, they simply cannot imagine what it’s like to walk in another person’s shoes. They don’t understand how their words and actions affect others, and they won’t accept responsibility for the damage they cause if anyone tries to point it out.

The Two Faces of Narcissism

The public face of the typical person with narcissistic personality disorder is boastful, arrogant, self-involved, and supremely self-confident.

But there is more to NPD than meets the eye. The obsessive self-centeredness of the narcissist hides a secret identity, one that is far less secure and self-satisfied than their outward persona would indicate.

Rather than a true reflection of subconscious beliefs, narcissistic thoughts, behaviors, and attitudes are a screen for deep-seated self-esteem problems, which gain strength because they are suppressed and denied. Despite their apparent self-confidence, narcissists are notoriously thin-skinned and need constant reinforcement from others, which is a sign of self-doubt and uncertainty.

It is important to recognize that narcissists are not consciously practicing a deception. By wearing a cloak of self-love and self-admiration, they are lying to themselves more than trying to fool anyone else. Their sensitivity to criticism and inability to admit mistakes reveals the fragility of their self-flattering beliefs.

Psychological, Emotional, and Behavioral Symptoms of Narcissistic Personality Disorder

Unlike mental health conditions that only manifest periodically or situationally, narcissistic personality disorder is pervasive and all-encompassing. Personality disorders are like a second skin that sufferers must wear wherever they go and whatever they do, and a person with undiagnosed and/or untreated NPD cannot avoid its life-altering impact.

Psychological Symptoms

While narcissism may cover for deeper feelings of inferiority or inadequacy, at a psychological level people with NPD are entirely sincere in their self-devotion and utterly convinced of their own greatness.

As a reflection of these conscious beliefs, the psychological symptoms of NPD include:

  • Exaggerated feelings of self-importance
  • A sense of entitlement, disconnected from any actual deeds
  • Feeling superior to other people
  • Preoccupation with fantasies of wealth, power, fame, and public praise
  • Prioritizing competition over cooperation
  • Cynical attitudes toward those who act unselfishly or express idealistic beliefs
  • A lack of empathy and understanding of others’ motives
  • Inability to see their own flaws or admit when they are wrong
  • A belief that their interests are more important than the interests of other people
  • A habit of dividing the world into winners and losers

People with untreated NPD do not like to have their beliefs challenged or questioned, and anyone who does so will be viewed with suspicion and hostility.

Emotional Symptoms

Despite their conscious feelings of superiority, people with NPD have many insecurities and are plagued by fears of failure. Their wounded self-esteem becomes visible through their emotional reactions to outside events, which contradict their supposedly unlimited self-confidence.

The emotional symptoms of NPD include:

  • A need for constant attention and flattery
  • Frequent feelings of envy and resentment
  • Impatience and a quick temper
  • Extreme sensitivity to criticism
  • Inability to adapt to change without feeling rage or frustration
  • Unacknowledged feelings of insecurity, shame, vulnerability
  • Moodiness, often accompanied by signs of depression
  • Deep fear of being helpless or powerless
  • An obsessive desire for revenge against anyone perceived as an enemy

The people who draw the ire of narcissists usually haven’t done anything to intentionally hurt them. But their actions and achievements somehow remind the person with NPD of their limitations, weaknesses, or failures.

Their “crime” is shattering the illusions of the NPD sufferer, causing them emotional pain and provoking the urge to lash out or make harsh judgments.

Behavioral Symptoms

People with narcissistic personality disorder can be charismatic and charming one moment, and angry and vindictive the next. Their behavior makes a strong impression—sometimes positive and sometimes negative—on everyone they know and meet. They tend to be involved in many conflicts, and predictably they blame those conflicts and the ill will and bad actions of the other party.

In their social interactions, people with narcissistic personality disorder will:

  • Brag and boast (and sometimes lie) about their accomplishments
  • Go out of their way to avoid associating with anyone they consider beneath them
  • Dominate conversations by interrupting constantly and refusing to let others choose the topics for discussion
  • Insult or demean other people as a way to make themselves look better
  • Flatter those who flatter them, and criticize or denigrate those who criticize them
  • React with indignation and offense when humorous remarks are directed their way, or if they are the subject of teasing

People with NPD believe they deserve the best of everything, and they will often live beyond their means in their attempt to get it. They are not above taking shortcuts if they can benefit in some way from doing so, but they will be the first to direct their outrage at others who do the same.

NPD sufferers are sometimes accused of being bad people, but they simply lack the capacity to evaluate themselves and their own behavior honestly and objectively. In many instances, they are genuinely surprised to discover their behavior has offended others.

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NPD and Co-occurring Disorders

Despite their apparent self-confidence and air of superiority, people with narcissistic personality disorder struggle with low self-esteem and feelings of unworthiness, which often go unrecognized. This puts them at risk for co-occurring mental health disorders and substance abuse, the latter of which is a common coping mechanism for people with psychiatric conditions they’re trying to escape.

Narcissistic Personality Disorder and Co-occurring Disorders

By lifetime rate of incidence, the most common co-occurring conditions among adults diagnosed with narcissistic personality disorder are:

  • Alcohol use disorder: 21.7 percent
  • Post-traumatic stress disorder (PTSD): 19.5 percent
  • Specific phobia: 17.3 percent
  • Bipolar I disorder: 14.1 percent
  • Generalized anxiety disorder: 13.5 percent
  • Major depression: 9.6 percent
  • Drug use disorder: 9.3 percent
  • Social anxiety disorder: 8.6 percent

Overall, the lifetime rates of incidence for any mood disorder, substance use disorder, or anxiety disorder among people with NPD are 28.6 percent, 40.6 percent, and 40 percent respectively.

Treatment and Long-term Prognosis

Mental health professionals diagnose narcissistic personality disorder based on the presence of its distinctive symptoms and the life complications they create.

While treatment for NPD can take an extended period to produce results, over time sufferers can learn to recognize the self-sabotaging nature of their condition and take steps to control its influence over their lives.

There are no medications that can ameliorate the symptoms of narcissistic personality disorder. However, long-term psychotherapy can help NPD sufferers come to terms with the damage their behavior has caused, to themselves and their loved ones. Slowly but surely, people with NPD can develop more realistic views of the world and their place in it, and as they learn to reorient their perspectives they can begin to make constructive changes.

Men and women with NPD who’ve been diagnosed with co-occurring emotional or behavioral health problems will require comprehensive, integrated mental health treatment services, preferably in a residential treatment center where staff members have extensive experience helping people with multiple psychiatric conditions. If substance abuse is diagnosed, trained addiction specialists should be included in the treatment team, since mental health problems cannot be effectively managed unless patients remain clean and sober.

Personality traits are more flexible and open to adjustment than people think. Narcissistic personality disorder cannot be cured, but its capacity to control a person’s life can be reduced significantly.

Commitment to recovery is absolutely essential, and NPD sufferers who are highly motivated to change have an excellent chance of gaining long-term benefits from their treatment regimens.