Narcissistic personality disorder (NPD) is a mental health condition and one of several types of personality disorders. Those with NPD may come across as superior with an inflated opinion of themselves, but a person with narcissistic personality disorder likely has a deep need for excessive attention and admiration, which leads to troubled relationships and a true lack of empathy for others. Underneath that tough and difficult exterior, however, is a fragile sense of self-worth that is vulnerable to even the smallest criticism. Fortunately, there are tested methods to diagnose and treat the symptoms of this disorder.

What is Narcissistic Personality Disorder? 

To understand this particular personality disorder, it is important to define what makes someone a narcissist. “Narcissist” is a common phrase used to describe those who are self-absorbed or vain, but narcissistic personality disorder means something different and is considered a serious mental health condition. Someone diagnosed with narcissistic personality disorder likely finds it difficult to relate to others or experience any true self-worth, and at the same time, feel generally unhappy when they are not given the praise they believe is inherently deserved.

From the outside, a person with narcissistic personality disorder may come across as snobbish, conceited and difficult to be around. As a result, this can cause a person problems across their work life, studies and personal relationships. Fortunately, this disorder can be addressed and managed through psychotherapy, or talk therapy, as well as through lifestyle changes. For the 6% percent of people who are estimated to have this type of personality disorder, symptoms can start to appear in the late teen years and in early adulthood.

What Are Personality Disorders?

Individuals with personality disorders like narcissistic personality disorder experience thought patterns and actions outside of the “norm,” according to the American Psychiatric Association. For instance, they will likely have poor coping skills and difficulty forming and maintaining healthy relationships with others. These troubling personality traits can get in the way of a person’s relationships, work life, and overall happiness. Those who have a personality disorder are generally not aware they have a problem and likely do not believe the atypical characteristics of their personality are causing issues in their life and/or impacting their behavior.

Narcissistic Personality Disorder Symptoms 

When identifying a person who has narcissistic personality disorder, arrogance, being self-centered, and demanding often come to mind. People with narcissistic personality disorder may engage in impulsive behaviors such as gambling and risky sexual encounters. The severity of the signs and symptoms vary and can include:

  • Feeling an exaggerated sense of self-importance
  • Feeling a sense of entitlement and requiring constant, excessive admiration
  • Expecting to be recognized as superior even without achievements that warrant it
  • Exaggerating achievements and talents
  • Being preoccupied with fantasies about success, power, brilliance, beauty, or the perfect partner
  • Believing that they are superior and can only associate with equally special people
  • Monopolizing conversations and belittling people they perceive as inferior
  • Expecting special favors and unquestioning compliance with their expectations
  • Taking advantage of others to get what they want
  • Having an inability or unwillingness to recognize the needs and feelings of others
  • Being envious of others and believing others envy them
  • Behaving in an arrogant or haughty manner, coming across as conceited, boastful, and pretentious
  • Insisting on having the best of everything, such as the best car or office

In addition to these common symptoms, people who have narcissistic personality disorder have difficulty coping with anything that could be considered criticism. When criticism does occur, it may result in the following reactions:

  • Reacting with anger, impatience or anger when they don’t receive special treatment 
  • Struggling to regulate their emotions and behavior in reaction to criticism or perceived criticism 
  • Developing interpersonal problems with the people around them because of symptoms
  • Feeling depressed or moody with underlying feelings of shame, insecurity, and humiliation 
  • Having a hard time adapting to change or dealing with stressors 

DSM-5 Criteria for Narcissistic Personality Disorder

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders details nine specific traits that a medical professional uses to diagnose a person with narcissistic personality disorder. These will generally start presenting themselves in early adulthood and can show up in a variety of contexts. A person must indicate five (or more) of the following characteristics to receive a concrete diagnosis: 

  1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
  2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
  3. Believes that they are “special” and unique and can only be understood by or should be associated with, other special or high-status people (or institutions)
  4. Requires excessive admiration
  5. Has a sense of entitlement (i.e. unreasonable expectation of especially favorable treatment or automatic compliance with their expectations)
  6. Is interpersonally exploitative (i.e., takes advantage of others to achieve their own ends)
  7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
  8. Is often envious of others or believes that others are envious of them
  9. Shows arrogant, haughty behaviors and attitudes

While the criteria listed above may appear somewhat straight-forward, there are actually many different types and subtypes of narcissistic personality disorder. In one example, a more grandiose and boisterous “overt” subtype will have very little observable anxiety. In contrast, an individual who is more of a “covert” subtype will be more fragile, thin-skinned and hypersensitive to others’ slights. No matter how these traits present themselves, both types are self-absorbed, and a person can easily fluctuate between the two ends of the spectrum.

When to Seek Help

Because of the nature of narcissistic personality disorder, that person may not think anything is wrong and not want to seek treatment on their own. Exploring treatment options is more likely to be a part of depression symptoms, drug or alcohol use associated with this disorder, and treatment may be difficult to accept because it is perceived as a slight or insult. If you recognize parts of your personality are common to narcissistic personality disorder, or if you are feeling overwhelmed by sadness, a trusted doctor or mental health provider can help with treatment and make strides toward a more balanced perspective. 

Narcissistic Personality Disorder Causes and Risks

While the exact causes of narcissistic personality disorder are not known, mental health professionals do understand how personality disorders come to be. It is widely believed that a combination of factors can contribute to the development of this disorder, including:

  • Trauma in any form during childhood 
  • Difficult relationships with parents, friends or other family members 
  • Genetics 
  • Overly sensitive to stimuli like texture, noise, or light in childhood
  • Personality or temperament 

Generally speaking, narcissistic personality disorder impacts more men than women, and starts showing signs during the teenage years or early adulthood. It is important to note that some children may show signs of narcissism, but this is mostly typical of their age and does not mean a disorder will be developed. While the cause of narcissistic personality disorder is unknown, researchers believe biologically vulnerable children and parenting styles that are overprotective or neglectful may play a role in the development of this disorder. 

If left untreated, some complications of narcissistic personality disorder can include:

  • Relationship difficulties
  • Problems at work or school
  • Depression and anxiety
  • Physical health problems
  • Drug or alcohol misuse
  • Suicidal thoughts or behavior
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Seeking Diagnosis for Narcissistic Personality Disorder

If you or someone you know is showing signs and symptoms of narcissistic personality disorder, there are ways to seek a diagnosis in order to get treatment. A mental health professional, such as a psychologist or psychiatrist, can actually diagnose that person. In an initial session, the mental health professional will go over what is causing a person distress and review any long-term patterns of thinking, feeling, behaving, and engaging with others.

As part of a diagnosis, a psychotherapist may also conduct a personality test to uncover any narcissistic traits. The key is to answer questions honestly to provide true insight into how you think. These diagnostic tests may include any of the following:

  • Personality diagnostic questionnaire-4 (PDQ-4) — This self-reporting tool measures and is used to screen for personality disorders
  • Millon clinical multiaxial inventory III (MCMI-III) This tool reports patient personality characteristics and an assessment of clinical syndromes
  • International personality disorder examination (IPDE) This is a structured clinical interview that is used to assess the major categories of personality disorders

Treating Narcissistic Personality Disorder

There are a variety of long-term treatment options for narcissistic personality disorder, and they are all intended to help a person gain greater insight into their problems and help manage them. These treatments are centered around psychotherapy (or talk therapy) and medications. Finding the right treatment mix can help people with this disorder relate to others in a more positive way, develop more healthy self-esteem and have more realistic expectations of others, among other benefits. Often, treatment will also help address symptoms occurring alongside narcissistic personality disorder, such as depression or other mental health conditions. 

Psychotherapy (or Talk Therapy)

Narcissistic personality disorder treatment is generally centered around talk therapy. Talk therapy is effective in helping the individual relate better to others to make their relationships more enjoyable and rewarding. It also helps clarify what is causing certain emotions and what drives a person to compete or have low self-esteem. Talk therapy can also help someone accept responsibility and learn to:

  • Accept and maintain real personal relationships and collaboration with co-workers
  • Recognize and accept actual competence and potential to better tolerate criticisms
  • Increase the ability to understand and regulate feelings
  • Understand and tolerate the impact of issues related to self-esteem
  • Release your desire for unattainable goals and ideal conditions and gain an acceptance of what’s actually possible 

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Personality traits can be difficult to shift so it may take a few years of consistent therapy before any tangible improvements are made. Don’t feel discouraged, work on sticking with the treatment, and attending all therapy sessions while taking any prescribed medications. Over time, the positive differences and improvements will make the process worth it. 

Medications

While there are no specific medications used to treat narcissistic personality disorder, a medical professional may recommend certain medications to treat underlying symptoms of anxiety and depression. These medications may include:

  • Antidepressants Antidepressant medications aim to ease your depression symptoms by regulating primary chemical processes that contribute to depression. 
  • Mood stabilizers Mood stabilizers are medications used in the treatment of bipolar disorder and can help reduce mood swings and prevent manic and depressive episodes. 
  • Antipsychotic drugs These medications can reduce or relieve symptoms of psychosis, such as delusions (false beliefs), as well as help with symptoms of depression and anxiety. Aripiprazole and risperidone are two kinds of antipsychotic drugs that may be prescribed.

Psychiatry

Psychiatric treatment from a licensed prescriber

Lifestyle Changes

A person with narcissistic personality disorder may feel that psychotherapy and any medications prescribed are unnecessary, but it is important to stick to the treatment plan put forward by your doctor to actually see results. As you follow a treatment plan, be sure to avoid alcohol, drugs and other substances that can trigger negative behavior, while getting in regular exercise and finding relaxation techniques to de-stress. Throughout treatment, keep in my mind the following to stay motivated:

  • Keep an open mind Focus on the rewards of treatment.
  • Stick to your treatment plan Attend scheduled therapy sessions and take any medications as advised. Keep in mind that set-backs may happen, but that does not mean treatment is not working or effective. 
  • Stay focused on your goal Stay motivated by keeping your goals in mind and reminding yourself that you can work to repair damaged relationships and become more at peace with your life. 
  • Get treatment for alcohol or drug misuse or other mental health problems  —Addictions, depression, anxiety and stress can feed off each other, leading to a cycle of emotional pain and unhealthy behavior. Seek treatment to stop these unhealthy patterns whenever possible. 

Preparing to Get Help

The first time you speak to your doctor about narcissistic personality disorder might feel intimidating. Keep in mind that they will likely refer you to a mental health provider for talk therapy and ask specific questions about your mental health, personal information, medical background and inquire about any medications you are taking. Preparation can help reduce any uncertainty in your initial discussion, and you might want to come up with a set of questions in advance. These may include:

  • What type of disorder do I have?
  • Could I have other mental health conditions?
  • What is the goal of treatment?
  • What treatments are most likely to be effective for me?
  • How much do you expect my quality of life may improve with treatment?
  • How often will I need therapy sessions, and for how long?
  • Would family or group therapy be helpful in my case?
  • Are there medications that can help my symptoms?
  • I have these other health conditions. How can I best manage them together?
  • Are there any brochures or other printed materials that I can have? What websites do you recommend?

With help, the symptoms of narcissistic personality disorder will improve over time. But the benefits of medication and therapy treatments will depend on the severity of your symptoms and how willing a person is to fully commit to treatment. Staying motivated and actively working toward change is the only clear way to mend relationships and find greater happiness. 

Remember, narcissistic personality disorder is a mental health condition and one of several types of personality disorders. Those who have this diagnosis likely come across as superior and have an inflated opinion of themselves — but underneath that tough and difficult exterior, is a fragile sense of self-worth that is vulnerable to even the smallest criticism. There are long-term treatment options for this mental health disorder, and they are all intended to help a person gain greater insight into their problems and help to manage them. These treatments are centered around psychotherapy and medications to manage uncomfortable symptoms, and ultimately help an individual see positive differences and improvements over time.