By Amy Broadway, researcher at the Brogaard Lab for Multisensory Research.


In our last post, we considered the tellin signs that Elliot Rodger had narcissistic personality disorder (NPD), according to NPD's DSM-5 criteria. Researchers estimate that 1% of the general population has lifelong NPD. That's one person in one hundred. And the prevalence of narcissism may be increasing. (Twenge et al, 2014) That means you and I encounter NPD often, in other people and perhaps in ourselves.

Not all narcissism is pathological. Besides those with a disorder, many of us present narcissistic behaviors less frequently or intensely than the behaviors that constitute the official disorder. We may even go through phases of being more narcissistic, such as in adolescence. Some even argue there are benefits to a little narcissism. Still, if someone experiences the three Ds (dysfunction, distress, and deviance) from five or more NPD behaviors, psychologists consider that person ill. To treat a mental illness, it's important to understand its possible causes.

CAUSES: Most psychologists today understand mental illness through the biopsychosocial model. The biopsychosocial model (BPS) assumes a mixture of factors contributes to a person's physical and mental wellbeing. These factors may be biological (e.g. a genetic predisposition), psychological (e.g. thought patterns) or social (e.g. the family environment). Here are just a few possible factors that support NPD.

  • Biological: Researchers have found that part of the brain associated with empathythe left anterior insula, has less gray matter in those with NPD. Gray matter is made up of neuron cell bodies and non-neuron brain cells, which provide nutrients and energy to neurons. Neurons send and receive information in the nervous system. Researchers have found the degree to which people empathize with others is related to the size of gray matter in this region. MEDIUM_429_2010_260_Fig5_HTML
  • Psychological: In NPD, the disease can also be one of its causes. By practicing self-absorbed thinking, people may be more likely to have self-absorbed thoughts in the future. By not attending to other people's feelings and interests, people don't strengthen their ability to empathize or make empathizing a habit. In the case of Elliot Rodger, he repeatedly told himself that people have wronged him and are unworthy of respect. This may have solidified those beliefs, making him feel justified in treating his victims as objects rather than as individuals with rights.
  • Social: There's a list of ways researchers have found that parents may contribute to NPD. This list could be applied to any caregiver and not just parents. There are also societal contributors to narcissism. Individualistic cultures, like the United States, coach people to strive to be special or better than our peers. Jean Twenge, a professor of psychology at San Diego State University, says that parenting, celebrity culture and the internet are among causes of increasing cases of NPD.

TREATMENTS: Psychologists have trouble treating those with NPD. One obstacle is that those with NPD don't typically seek treatment. Those with NPD may at one level loathe themselves but consciously think they are superior and faultless. If they're having problems, it's the world's fault, not theirs. When a severe narcissist seeks treatment, it's often because of a major crisis or because someone forces him into treatment. Once in treatment, narcissists have trouble receiving treatment, because they are uncooperative. It takes humility to try to change. The prognosis depends on the severity of a person's symptoms and his willingness to change. Here are a few possible ways to ameliorate narcissistic symptoms.

  • Practicing mindfulness: Previously we talked about how mindfulness helps people access self-knowledge.  Some think that narcissists build a superior image of themselves to counteract an underlying sense of inferiority. By practicing mindfulness, narcissists can observe their behaviors without evaluation, which triggers the impulse to self-inflate. If they can observe themselves without judging themselves, narcissists have less reason to deceive themselves about who they are.
  • Group therapy: Narcissists tend to not have intimate relationships. This is because they don't like to interact with people who threaten their inflated self-image. If someone gets to know a narcissist well and sees past the image he wants to present, that relationship could force a narcissist to see himself as less than perfect. However, relationships and social interactions may actually benefit narcissists. In group therapy, the goal of someone with NPD is to develop a healthy sense of self within the group and acknowledge other people as separate persons. By repeatedly interacting with people on an intimate level, narcissists are forced to repeatedly see evidence for the humanness of others and himself within a group.
  • Cognitive-behavioral therapy: Using cognitive-behavioral therapy, psychologists teach patients to identify false, maladaptive beliefs and replace them with true, healthy beliefs. This form of therapy may be tricky for narcissists, since it entails a direct confrontation with their beliefs, which can make them defensive and less cooperative.


Twenge, Jean M;  Miller, Joshua D; Cambell, W. Keith, "The Narcissism Epidemic: Commentary on Modernity and Narcissistic Personality Disorder," Personality Disorders: Theory, Research, and Treatment Vol. 5, No. 2, 227–229

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