Narcissistic Personality Disorder

The most recognizable signs are an exaggerated sense of self-importance, a deep need for admiration, a sense of entitlement, and a lack of empathy for others. People with NPD often exaggerate achievements, believe they are uniquely special, take advantage of others, and react to criticism with anger, shame, or rage. From the outside, they may come across as arrogant, conceited, and difficult to be around. Despite this exterior, underneath is a fragile self-worth highly vulnerable to even minor criticism.

A mental health professional conducts an initial session covering what is causing distress and reviewing long-term patterns of thinking, feeling, behaving, and relating to others. A personality test may also be used. The DSM-5 requires five or more of nine specific criteria to be met for a formal NPD diagnosis. Diagnostic tools may include the PDQ-4 (self-reporting screening), MCMI-III (personality characteristics and clinical syndromes), and IPDE (structured clinical interview for personality disorders). Answering assessment questions honestly is essential for accurate insight.

A psychologist, psychiatrist, or licensed clinical therapist is qualified to diagnose NPD. A primary care physician may refer to a mental health specialist. Because personality disorders require comprehensive evaluation of deeply ingrained, long-standing behavioral patterns, diagnosis is best made by an experienced mental health clinician. Per the American Psychiatric Association, people with NPD are typically unaware they have a problem — diagnosis often happens when they seek help for co-occurring conditions like depression or anxiety.

Yes. Licensed therapists and psychiatrists practicing via telehealth platforms can conduct comprehensive clinical evaluations and diagnose NPD. Online therapy is also an effective option for the ongoing psychotherapy that is the primary treatment for NPD.

Psychotherapy (“talk therapy”) is the primary and most effective treatment for NPD. It helps the person relate better to others, understand the roots of their emotional patterns, and develop healthier self-esteem. Specific therapy goals include: accepting genuine relationships; developing tolerance for criticism; improving emotional regulation; and releasing the pursuit of unattainable ideals. Personality traits take time to shift — consistent attendance over several years may be needed before meaningful change occurs.

Because NPD typically prevents self-recognition, professional help is most often sought for co-occurring conditions — depression, anxiety, or substance misuse — rather than for the disorder itself. If you recognize patterns in yourself consistent with NPD, or if you are overwhelmed by sadness, relationship failures, or emotional instability, a trusted doctor or mental health provider is a good first step. Early treatment leads to better outcomes and reduces the risk of serious untreated complications.

Yes. NPD can be managed with treatment. Psychotherapy is the primary approach — it helps people relate better to others, develop healthier self-esteem, and build more realistic expectations. Medication may be prescribed to address co-occurring symptoms like depression and anxiety. Progress takes time; personality traits are deeply ingrained, and consistent engagement with treatment over potentially several years is key. With help, symptoms improve and quality of life can increase meaningfully.

Per the American Psychiatric Association, individuals with personality disorders experience thought patterns and behaviors outside the norm — with poor coping skills and difficulty forming and maintaining healthy relationships. These traits interfere with relationships, work, and overall happiness. Critically, people with personality disorders are generally not aware they have a problem and do not believe their behavior is causing issues for themselves or others.

The DSM-5 requires five or more of the following nine traits for a formal NPD diagnosis. These generally begin presenting in early adulthood and appear across multiple contexts:

A more grandiose “overt” subtype shows little observable anxiety; a “covert” subtype is more fragile, thin-skinned, and hypersensitive. A person can fluctuate between both ends of the spectrum.

• Grandiose sense of self-importance; exaggerates achievements and expects recognition as superior without commensurate achievements
• Preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
• Believes they are “special” and can only associate with other special or high-status people or institutions
• Requires excessive admiration
• Sense of entitlement — unreasonable expectations of favorable treatment or automatic compliance
• Interpersonally exploitative — takes advantage of others to achieve their own ends
• Lacks empathy; unwilling to recognize or identify with others’ feelings and needs
• Often envious of others or believes others are envious of them
• Shows arrogant, haughty behaviors and attitudes

Because of the nature of NPD, the person may not recognize anything is wrong and may resist treatment. Help is most often sought for co-occurring issues — depression, anxiety, or drug and alcohol use — rather than the disorder itself. Treatment may initially feel like a perceived slight or insult. If you recognize patterns of NPD in yourself or are overwhelmed by sadness, a trusted doctor or mental health provider can help begin treatment toward a more balanced perspective.

Talk therapy helps people with NPD accept responsibility and develop skills for healthier relating, including:

Personality traits can take several years of consistent therapy to shift meaningfully. Sticking with the treatment plan and attending all sessions gives the best chance of lasting improvement.

• Accepting and maintaining genuine personal relationships and workplace collaboration
• Recognizing actual competence to better tolerate criticism
• Increasing the ability to understand and regulate feelings
• Understanding and tolerating self-esteem-related issues
• Releasing pursuit of unattainable goals and accepting what is actually possible

There are no medications specific to NPD. A medical professional may prescribe the following to treat underlying or co-occurring symptoms:

• Antidepressants: Regulate chemical processes that contribute to depression.
• Mood stabilizers: Reduce mood swings and prevent manic and depressive episodes.
• Antipsychotics: Reduce psychosis, depression, and anxiety symptoms. Aripiprazole and risperidone are two common examples.

People with NPD may resist therapy and medication as unnecessary. Strategies for staying committed to treatment:

Avoid alcohol, drugs, and other substances that trigger negative behavior. Regular exercise and relaxation techniques also support treatment.

• Keep an open mind: Focus on the rewards of treatment.
• Stick to the plan: Attend all therapy sessions and take medications as directed. Setbacks are normal and don’t mean treatment isn’t working.
• Stay goal-focused: Keep the goal of repairing relationships and finding greater peace in mind.
• Address co-occurring issues: Treat any addictions, depression, anxiety, or substance misuse — these conditions reinforce each other.

Your doctor will likely refer you to a mental health provider for talk therapy and ask about your mental health, personal history, medical background, and current medications. Preparing questions in advance can help reduce uncertainty. Useful questions include: What type of disorder do I have? What treatments are most likely to be effective? How often will I need therapy, and for how long? Are there medications that can help? With professional help, symptoms of NPD will improve over time. Progress depends on symptom severity and willingness to commit to treatment.