Narcissistic Personality Disorder

Individuals with narcissistic personality disorder generally believe that the world revolves around them. This condition is characterized by a lack of ability to empathize with others and a desire to keep the focus on themselves at all times.


Narcissistic Personality Disorder involves arrogant behavior, a lack of empathy for other people, and a need for admiration-all of which must be consistently evident at work and in relationships. People who are narcissistic are frequently described as cocky, self-centered, manipulative, and demanding. Narcissists may concentrate on unlikely personal outcomes (e.g., fame) and may be convinced that they deserve special treatment. Related Personality Disorders: Antisocial, Borderline, Histrionic. Narcissism is a less extreme version of Narcissistic Personality Disorder. Narcissism involves cockiness, manipulativeness, selfishness, power motives, and vanity-a love of mirrors. Related personality traits include: Psychopathy, Machiavellianism.

Narcissists tend to have high self-esteem. However, narcissism is not the same thing as self-esteem; people who have high self-esteem are often humble, whereas narcissists rarely are. It was once thought that narcissists have high self-esteem on the surface, but deep down they are insecure. However, the latest evidence indicates that narcissists are actually secure or grandiose at both levels. Onlookers may infer that insecurity is there because narcissists tend to be defensive when their self-esteem is threatened (e.g., being ridiculed); narcissists can be aggressive. The sometimes dangerous lifestyle may more generally reflect sensation-seeking or impulsivity (e.g., risky sex, bold financial decisions).


  • Reacts to criticism with anger, shame or humiliation
  • Takes advantage of others to reach his or her own goals
  • Exaggerates own importance
  • Exaggerates achievements and talents
  • Entertains unrealistic fantasies about success, power, beauty, intelligence or romance
  • Has unreasonable expectation of favorable treatment
  • Requires constant attention and positive reinforcement from others
  • Is easily jealous
  • Disregards the feelings of others, lacks empathy
  • Has obsessive self-interest
  • Pursues mainly selfish goals

Also, narcissists are usually physically attractive and charming at first glance, so they may have advantages when they first meet people (making a sale, getting a first date, gaining popularity). However, the long-term outcomes for narcissists are usually quite dismal, especially socially (e.g., long-term relationship difficulties). On average, levels of narcissism drop quite dramatically by age 30.


Causes are not yet well-understood. Genes play a significant role (approximately 50%), but the unique ways that environments shape people (e.g., peer interactions) also influence narcissism. Related hypotheses include:

  1. Heritable narcissistic traits emerged in part due to natural selection for promiscuous sexuality.
  2. Some people develop into narcissists because of self-reflection on largely heritable traits-"I am attractive and therefore I deserve special treatment."
  3. Cultural factors may bring-about narcissistic qualities (e.g., watching narcissistic role models on TV; adverse, war-torn environments).


Clinical treatment is rare because most narcissists avoid therapy. However, narcissists can learn to be more caring about others, and narcissism can be reduced when these individuals are included in social groups.

Psychotherapy may be useful in getting the individual with narcissistic personality disorder to relate to others in a less maladaptive manner.

(Additional information by Nicholas S. Holtzman)


  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised.
  • Center for Substance Abuse Treatment. Assessment and Treatment of Patients with Coexisting Mental Illness and Alcohol and Other Drug Abuse. Treatment Improvement Protocol (TIP) Series, No.9.
  • National Institutes of Health - National Library of Medicine
  • Brad Bushman, W. Keith Campbell, Del Paulhus, Richard W. Robins
Last reviewed 02/17/2015