Narcissistic personality disorder (NPD) is a persistent mental health condition characterized by an exaggerated sense of self-importance, entitlement, and lack of empathy. This guide examines the signs, causes, different types, and most effective treatment approaches for narcissistic personality disorder, as well as tips for coping with narcissistic people.
Understanding Narcissistic Personality Disorder
Narcissistic personality disorder (NPD) is a cluster B personality disorder recognized by the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5).
The key diagnostic criteria of NPD include:
- Grandiose sense of self-importance and entitlement
- Preoccupation with fantasies of unlimited success, power, and attention
- Belief in being special and unique beyond what achievements warrant
- Requirement of excessive, unwarranted admiration
- Sense of entitlement and expectation of special favors without reciprocation
- Willingness to exploit others and take advantage to achieve goals
- Lack of empathy and unwillingness to recognize others’ needs or feelings
- Envy of others and belief others are envious in return
- Arrogant, haughty behaviors and attitudes
Much clinical debate exists over diagnosing NPD in relation to simply possessing narcissistic traits. Understanding the nuances helps distinguish true NPD.
Common Symptoms and Behaviors
In addition to the hallmark diagnostic criteria, those with NPD frequently display other behavioral and interpersonal symptoms:
- React intensely to criticism with anger, humiliating others, or counter-attacking
- Take advantage of others for own gain without guilt or remorse
- Exaggerate achievements, talents, and importance
- Monopolize conversations without letting others speak
- Express disdain for those perceived as inferior
- Expect constant praise and admiration
- Repeatedly fish for compliments
- Become jealous easily
- Believe others are jealous of them
- Set unrealistic goals influenced by fantasies of success
- Crave status, beauty, power, and attractive partners
- Mistreat subordinates and peers unless needed
Such behaviors harm relationships and impair functioning over the long-term.
Causes and Risk Factors
The exact causes of NPD are unclear but likely involve:
- Family history of NPD or bipolar disorder increases risk
- Certain gene variations involving neurotransmitter systems may contribute
- Lack of proper bonding and attachment with parents
- Excessive parental pampering or total lack of warmth and affection
- Neglect or abuse during childhood
- Inconsistent or unreliable parenting
- Deficits in regulating emotions and self-soothing
- Attempts to compensate for deep-seated insecurities and fragile self-esteem
- Co-occurring mental health issues like depression, anxiety, PTSD or ADHD
Social and Cultural Influences
- Cultural values promoting individualism, competition, status, and wealth
- Social media norms emphasizing image curation, celebrity-like personas, and admiration-seeking
By identifying relevant biological, familial, and sociocultural risk factors, steps can be taken to mitigate developing full-blown NPD.
Different Types of Narcissism
Not all narcissism equates to NPD. Some categories include:
This involves adequate self-esteem, confidence, and self-care without harming others or demanding constant external validation. Setting healthy boundaries and accepting imperfections typifies healthy narcissism.
Narcissistic Personality Traits
Many people exhibit some narcissistic behaviors or traits entrenched in society like self-absorption, vanity, status-seeking, or lack of perspective-taking. But these traits do not necessarily impair life functioning on their own.
This variant manifests as extreme defensiveness and withdrawal when ego threatened rather than attacking others. Shame, anxiety, and loneliness characterize vulnerable narcissism. It reflects deep insecurity and struggles with self-esteem regulation.
Exploiting others without remorse, lacking empathy, and exhibiting antisocial behaviors represents malignant narcissism. It may involve narcissistic traits co-occurring with antisocial personality disorder.
Another term for NPD itself, pathological narcissism produces significant life impairment and inability to regulate self-esteem from within. Rage, exploitativeness, and fragility reflect pathological narcissism.
Unlike the grandiose presentation, this manifests through shy, hypersensitive traits like resentment, insecurity, and need for reassurance alongside self-absorption. It is a less overt variant of NPD.
This centers around demands that one’s altruism and community-oriented actions receive recognition and admiration from others. It involves acting good for adulation, not inherent caring.
Only NPD represents the real psychiatric condition requiring clinical intervention. But narcissistic traits exist on a broad spectrum.
Getting an Accurate Diagnosis
Since narcissistic behaviors occur in many people to some degree, professional diagnosis of true NPD requires:
- Clinical interview assessing function across life domains
- Inventory of present and past symptoms, thoughts, behaviors
- Input from other sources like partners on relationship patterns
- Ruling out causes like manic episodes or substance abuse
- Standardized personality tests like the NPI and MMPI
- Evaluating level of insight into how behaviors affect others
- Assessing actual impairment, not just presence of narcissistic traits
- Considering co-existing conditions like depression, anxiety, PTSD, or OCD that may exacerbate behaviors
Diagnostic criteria must clearly be met for NPD diagnosis, not just narcissism traits. Overdiagnosis and misdiagnosis remain common pitfalls due to lack of insight and overlaps with other disorders.
Effective Treatment Options
Treatment challenges exist due to poor insight and lack of motivation to change behaviors. But treatments can still help manage NPD:
The most common therapies include:
- Cognitive Behavioral Therapy (CBT) – Builds skills for regulating emotions, challenging distorted thinking patterns, and improving relationships.
- Schema Therapy – Identifies and reworks engrained childhood schemas that underlie narcissistic traits.
- Transference-Focused Therapy – Uses the client-therapist relationship to address interpersonal patterns and regulate self-esteem.
- Group Therapy – Provides peer feedback on maladaptive behaviors needing improvement.
- Family Therapy– Mends strained family dynamics exacerbating narcissistic behaviors.
Long-term specialized psychotherapy is typically needed to effect real personality change.
While no medications treat NPD directly, certain drugs help manage related symptoms:
- Antidepressants for co-occurring depression and anxiety
- Mood stabilizers for irritability and rage outbursts
- Anti-psychotics in severe cases with extreme grandiosity or paranoia
Medication should always be combined with psychotherapy for narcissistic personality disorder.
Inpatient and Intensive Treatment
In extreme cases not responding to outpatient protocols, temporary placement in residential or partial hospitalization treatment centers with intensive psychotherapy offers an immersive environment to focus exclusively on recovery and behavioral change.
Using a combination of therapies tailored to the individual provides optimal outcomes over the long-run.
Tips for Coping With a Narcissist – Narcissistic Personality Disorder
If you must interact with someone exhibiting narcissistic traits or NPD, the following strategies help set boundaries and maintain self-care:
- Avoid taking their behaviors personally. Reflect it is a disorder, not your fault.
- Set firm boundaries on what treatment you will accept. Follow through on enforcing them.
- Communicate with empathy, not aggression. Narcissists respond best to feeling heard.
- Establish realistic expectations. Do not expect deep empathy, remorse, or apologies from them.
- Detach from the need for approval or validation. You will likely never get it.
- Spend minimal time alone with them. They exploit 1:1 interactions most.
- Maintain relationships and pursuits separate from them for self-worth.
- Foster a compassionate support system to reality-check perceptions.
- Immediately leave or hang up during aggressive outbursts. Wait until calm to re-engage.
- Make consultation with a therapist to process emotions a priority for yourself.
With unconditional compassion for what likely stems from childhood trauma and proper boundaries, relationships with narcissists can improve. But permanency change will ultimately have to come from within the narcissist themselves.
Look Out for Loved Ones – Narcissistic Personality Disorder
If you suspect a loved one may be struggling with undiagnosed NPD, you can assist by:
- Observing how their behaviors align with NPD criteria
- Documenting real examples of concerning interpersonal patterns
- Checking in on their general well-being and mood symptoms
- Providing emotional support and unconditional positive regard
- Voicing worries using non-judgmental “I statements”
- Recommending a mental health evaluation, couples counseling, or family therapy
- Sharing educational NPD resources compassionately
- Being patient – progress takes time. Setbacks will happen.
- Encouraging self-care practices like journaling, yoga, mindfulness
- Not enabling harmful behaviors or narcissistic traits
Getting a family member or partner effective help starts with caring support.
Causes for Hope With Narcissistic Personality Disorder
Though change is very difficult, NPD treatment outcomes have improved as newer psychotherapy techniques evolve specifically tailored to addressing narcissistic personality patterns. With motivation and consistent effort, those with NPD can:
- Learn to self-soothe emotions without external validation
- Relate to others more empathetically and reciprocally
- Accept imperfections in themselves and others
- Establish more realistic self-appraisals and goals
- Follow through on agreements and obligations
- Develop humility and drop pretentious appearances
- Form genuine intimate connections beyond using people
- Find purpose and meaning not contingent on admiration or achievements
Treatment combined with inner work, self-awareness, patience, and compassion can help those with NPD lead more fulfilling lives aligned with their values.
Narcissistic personality disorder significantly impairs relationships and well-being for those diagnosed.
But various evidence-based treatment options exist to help narcissists regulate emotions, improve insight, care for others genuinely, and achieve realistic goals.
For loved ones of narcissists, maintaining boundaries and seeking your own therapeutic support enable co-existing as comfortably as possible.
Although challenging, narcissistic personality disorder does not have to define a person forever.
Growth is always possible through compassion, self-work, and determination.