Reviewed by Aaron Horn, LMFT
It may seem like Narcissistic Personality Disorder is painfully obvious to those who have it, and they simply don’t care. Still, NPD is like any other personality disorder: the symptoms typically go unnoticed by the person who is exhibiting them. Although it is vital to seek treatment for Narcissistic Personality Disorder, this can be particularly difficult for people who have the disorder. They may not be aware of their symptoms and the root of their interpersonal and communication issues.
Narcissistic Personality Disorder: A Definition
Narcissistic Personality Disorder is classified as a personality disorder, which means that symptoms focus on behaviors, expression, and thought processes, rather than mood, mental state, or neurological ability. Personality disorders are often seen as inherently nefarious or dangerous, but this is not the case in every personality disorder, including Narcissistic Personality Disorder (or NPD). The difference between Narcissistic Personality Disorder and a narcissist is important to identify because one is a recognized and diagnosed disorder. At the same time, the other (narcissism) is a series of personality traits. What is a narcissist, then? A narcissist is someone who consistently displays a tendency to place himself or herself as the focus of everything at the expense of others and who continually looks down at those around them. Conversely, someone with Narcissistic Personality Disorder boasts a complex series of symptoms, many of which can negatively impair the ability to function well in relationships and create a pattern of isolation, degradation, and pain.
What Causes Narcissism?
A discussion of causes is not complete without discussing risk factors because, in mental health, the two are often interrelated, if not entirely enmeshed. This is because the exact, definitive cause of most mental disorders and illnesses is not truly known. Risk factors act as something of a predictor, or a contributor, without being the outright cause. Although causes are not definite, risk factors have been established, and these include:
- Childhood trauma. Childhood trauma manifests in countless ways, and Narcissistic Personality Disorder is among them. Children who did not feel safe, seen, or heard in childhood may develop unhealthy coping behaviors that can eventually bleed into NPD.
- Unhealthy parental behavior. Parents who heap excessive praise on their children or heavily penalize any and every mistake their child makes may pave the way for NPD. Because children are fragile and rely on parents and caregivers for support, grounding, and worldviews, excessive admiration, and excessive criticism both have the potential to encourage children to develop a perfectionistic persona that can become Narcissistic Personality Disorder.
- Persistent fear and judgment in childhood. Feeling constantly fearful and judged in childhood can also present a risk factor for NPD because it can create a need to develop a persona that shields the child from undue criticism in adulthood.
- Men are more likely than women to exhibit NPD symptoms and receive a subsequent diagnosis, making sex a potential risk factor for Narcissistic Personality Disorder.
While Narcissistic Personality Disorder is fairly common, affecting around 6% of the population by most estimates. Some consistencies are prevalent in the childhoods and diagnoses of individuals with NPD, including the age of onset (typically early to mid-adulthood) and the presence of a damaging or unstable childhood.
NPD Symptoms And Signs
The symptoms of Narcissistic Personality Disorder are vast, and they may differ depending on other personality traits and learned behaviors. For instance, some people may express symptoms outright, while others may be more covert in symptomatic expression. What are the 9 traits of a narcissist? Symptoms of NPD include:
- An exaggerated sense of importance. People with NPD may feel as though they are uniquely equipped to solve problems, run businesses, take on responsibilities, and falsely believe that they are absolutely essential for others to function.
- Predilection toward fantasizing. Similarly, people with NPD may have long and elaborate fantasies about fame, wealth, or power and may use these fantasies as fuel for their goals and decision-making.
- A constant need for admiration. Because NPD is characterized by a fragile sense of self and an easily damaged sense of self-worth, people with NPD need a great deal of admiration in the form of constant praise and encouragement.
- A strong sense of entitlement. Individuals with NPD may feel as though they are entitled to attention, gifts, praise, and more, and may react strongly and harshly to not receiving everything they believe they are owed.
- A tendency to manipulate others. Because people with Narcissistic Personality Disorder are determined to achieve notoriety and positions of wealth and power, they often manipulate others to gain something or to ensure praise and admiration.
- Feelings of intense envy. NPD is typically known for intense envy. People with the disorder may feel that everyone else is being given respect, power, and praise without reason, while they are being left behind and unjustly ignored.
- A distinct lack of empathy. Because NPD is known for overwhelming self-focus, many people with NPD completely lack empathy for others and struggle to recognize the people's emotions and needs.
- A sense of superiority when compared to others. People with Narcissistic Personality Disorder typically feel as though they are better than most people and may refuse to associate with anyone who does not possess a position of power, wealth, or status.
- Attachment and dependency issues. Because being known deeply gives rise to the possibility of being criticized, people with NPD are likely to struggle with healthy attachment. They may find themselves displaying symptoms of codependency or fear of intimacy.
Not each of these symptoms is necessary for a diagnosis of Narcissistic Personality Disorder, but the symptoms' general spirit must be present. This means that a sense of superiority, entitlement, and grandiose self-image are all mainstays of the disorder. A failure to exhibit symptoms in this area negates the likelihood of an NPD diagnosis. Online NPD tests can lend some insight into the likelihood of symptoms pointing to NPD.
Receiving A Diagnosis
Receiving a diagnosis of Narcissistic Personality Disorder comes after a professional evaluation, self-report, and observation. Receiving a diagnosis is not as simple as walking into an office or talking over the phone or the internet one time, then receiving a quick diagnosis, and beginning treatment. Instead, the diagnostic process is likely to take a few sessions. A therapist gathers as much information as possible, including observed signs and symptoms and reported signs and symptoms. This will provide a more robust, consistent, and reliable indication of what is going on. A through exam can give therapists a realistic means of determining what disorder might be at play.
Narcissistic Personality Disorder is a treatable condition following diagnosis, but a diagnosis may not be quite enough to convince someone with the disorder that help is needed. Like many other personality disorders, behaviors and thought processes may be so entrenched that the possibility of needing help is difficult to imagine.
After Diagnosis: What’s Next?
Narcissistic Personality Disorder is treated through psychotherapy. Because narcissism's behaviors and symptoms are not biological in nature and are not attributed to shifts in brain chemistry or other mediated by pharmaceutical intervention, the primary form of treatment for Narcissistic Personality Disorder is therapy with a heavy focus on Cognitive Behavioral Therapy. Because NPD is characterized by fragile self-worth and an easily-toppled sense of self, talk therapy's primary goal is to strengthen self-esteem and develop healthy coping mechanisms to deal with unrealistic expectations, rocky interpersonal relationships, and innate defensiveness, and unpredictable moods.
That being said, some medications can treat comorbid conditions, which can ease the intensity of NPD symptoms. Antidepressants, mood stabilizers, and anti-anxiety medications can all be utilized in conjunction with psychotherapy to treat any depression, anxiety, or mood swings that come with NPD. Because these medications are designed to treat specific disorders (depression and anxiety, for instance), they are not approved for use specifically with NPD. They are instead used as supplementary medications for co-existing symptoms.
NPD Outlook And Recovery
With treatment, Narcissistic Personality Disorder can be managed, and many of the symptoms of NPD can be minimized or neutralized altogether. This is not an easy task. It can be difficult for individuals with the disorder to seek treatment. That is essentially because narcissistic behavior is known for stemming from an intense fear of criticism and treatment can initially feel like a series of criticisms. People with NPD might not want to continue therapy sessions. For those who continue to attend therapy, treat any comorbidities, and practice the techniques designed to improve symptom management and coping techniques, the outlook is often quite positive, with many people able to overcome their setbacks and enjoy rich relationships fulfilling work and home lives. Although beginning therapy can be extremely difficult, and getting past the first few sessions or months of sessions can prove painful, people with NPD can learn how to reframe their thought patterns, develop healthier communication skills, check expectations, and accept criticism and praise alike without a compromised sense of self.