Narcissistic Personality Disorder

Individuals with this disorder exhibit a lack of ability to empathize with others and an inflated sense of self-importance. 

Definition

The hallmarks of Narcissistic Personality Disorder (NPD) are grandiosity, a lack of empathy for other people, and a need for admiration. People with this condition are frequently described as arrogant, self-centered, manipulative, and demanding. They may also concentrate on grandiose fantasies (e.g. their own success, beauty, brilliance) and may be convinced that they deserve special treatment. These characteristics typically begin in early adulthood and must be consistently evident in multiple contexts, such as at work and in relationships. 

People with narcissistic personality disorder believe they are superior or special, and often try to associate with other people they believe are unique or gifted in some way. This association enhances their self-esteem, which is typically quite fragile underneath the surface. Individuals with NPD seek excessive admiration and attention in order to know that others think highly of them. Individuals with narcissistic personality disorder have difficulty tolerating criticism or defeat, and may be left feeling humiliated or empty when they experience an "injury" in the form of criticism or rejection. 

Related Personality Disorders: Antisocial, Borderline, Histrionic, Paranoid. 

Symptoms

Narcissistic personality disorder is indicated by five or more of the following symptoms:

  • Exaggerates own importance

  • Is preoccupied with fantasies of success, power, beauty, intelligence or ideal romance

  • Believes he or she is special and can only be understood by other special people or institutions

  • Requires constant attention and admiration from others

  • Has unreasonable expectations of favorable treatment

  • Takes advantage of others to reach his or her own goals

  • Disregards the feelings of others, lacks empathy

  • Is often envious of others or believes other people are envious of him or her

  • Shows arrogant behaviors and attitudes

50 to 75 percent of the people diagnosed with narcissistic personality disorder are male. Additionally, it is common for many adolescents to display the characteristics listed above; this does not indicate that they will later develop narcissistic personality disorder.

Causes

Causes of narcissistic personality disorder are not yet well-understood. Genetic and biological factors as well as environment and early life experiences are all thought to play a role in the development of this condition. 

Treatments

Treatment for narcissistic personality disorder can be challenging because people with this condition present with a great deal of grandiosity and defensiveness, which makes it difficult for them to acknowledge problems and vulnerabilities. Individual and group psychotherapy may be useful in helping people with narcissistic personality disorder relate to others in a healthier and more compassionate way. Mentalization-based therapy, transference-focused psychotherapy, and schema-focused psychotherapy have all been suggested as effective ways of treating narcissistic personality disorder.

References

  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised.
  • Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
  • 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
  • Caligor, E., Levy, K. N., & Yeomans, F. E. (2015). Narcissistic personality disorder: diagnostic and clinical challenges. American Journal of Psychiatry, 172(5), 415-422.

Last reviewed 04/17/2017