Narcissistic Personality Disorder

The hallmarks of narcissistic personality disorder (NPD) are grandiosity, a lack of empathy for other people, and a need for admiration. People with this condition are frequently described as arrogant, self-centered, manipulative, and demanding. They may also have grandiose fantasies and may be convinced that they deserve special treatment. These characteristics typically begin in early adulthood and must be consistently evident in multiple contexts, such as at work and in relationships. 

People with NPD often try to associate with other people they believe are unique or gifted in some way, which can enhance their own self-esteem. They tend to seek excessive admiration and attention and have difficulty tolerating criticism or defeat.

Symptoms

Individuals with narcissistic personality disorder, according to the DSM-5, exhibit five or more of the following, which are present by early adulthood and across contexts:

  • A grandiose sense of self-importance
  • Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love 
  • Belief that one is special and can only be understood by or associate with special people or institutions
  • A need for excessive admiration
  • A sense of entitlement (to special treatment)
  • Exploitation of others
  • A lack of empathy
  • Envy of others or the belief that one is the object of envy
  • Arrogant, haughty behavior or attitudes

Individuals with NPD can be easily stung by criticism or defeat and may react with disdain or anger—but social withdrawal or the false appearance of humility may also follow according to the DSM-5. 

A sense of entitlement, disregard for other people, and other aspects of NPD can damage relationships. While a person with NPD may be a high-achiever, the personality disorder can also have a negative impact on performance (due to, for instance, one's sensitivity to criticism).

Researchers have reported associations between NPD and high rates of substance abuse, mood, and anxiety disorders. These may be attributable to characteristics such as impulsivity and the increased experience of shame in people with NPD.

The presence of narcissistic traits in adolescence does not necessarily imply that a person will have NPD as an adult. 

Causes

Causes of narcissistic personality disorder are not yet well-understood. Genetic and biological factors as well as environment and early life experiences are all thought to play a role in the development of this condition. 

Treatment

Treatment for narcissistic personality disorder can be challenging because people with this condition present with a great deal of grandiosity and defensiveness, which makes it difficult for them to acknowledge problems and vulnerabilities. Psychotherapy may be useful in helping people with narcissistic personality disorder relate to others in a healthier and more compassionate way.

References

  • Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
  • U.S. National Library of Medicine
  • Caligor, E., Levy, K. N., & Yeomans, F. E. (2015). Narcissistic personality disorder: diagnostic and clinical challenges. American Journal of Psychiatry, 172(5), 415-422.
  • Kacel, E. L., Ennis, N., & Pereira, D. B. (2017). Narcissistic Personality Disorder in Clinical Health Psychology Practice: Case Studies of Comorbid Psychological Distress and Life-Limiting Illness. Behavioral Medicine, 43(3), 156-164

Last reviewed 02/07/2019