What Is Narcissistic Personality Disorder?

Narcissistic personality disorder (NPD) is a mental health condition that causes someone to have an inflated sense of self-importance, an excessive need for attention and admiration, and a lack of empathy for others. People with NPD tend to feel entitled to special treatment and may exploit or devalue others to maintain a sense of superiority. 

Early life experiences can contribute to the development of NPD—which affects about 6% of the population and is more common in people assigned male at birth. NPD typically develops in early adulthood and can profoundly affect a person's personal and professional life. Treating NPD can be challenging, but certain psychotherapy approaches can be effective. 

Types of Narcissistic Personality Disorder

Narcissistic personality disorder is a complex condition that can manifest in many ways. NPD is currently the only official narcissism-related condition in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)—a guidebook created by the American Psychiatric Association that outlines mental health conditions and their diagnostic criteria.

However, it's important to note that narcissism exists on a spectrum and certain traits and patterns of behavior point to different subtypes of NPD. These include:

• Grandiose narcissism: Also known as overt narcissism, symptoms of grandiose narcissism include high self-esteem, an obsessive need for admiration, a lack of empathy toward others, and exaggerated feelings of superiority. People with this subtype of NPD are often impulsive, overconfident, hostile and aggressive when challenged, and willing to exploit others for their own personal gain.
• Vulnerable narcissism: Also known as covert narcissism, symptoms of vulnerable narcissism include hypersensitivity, insecurity, and neuroticism. People with this subtype of NPD often have a fragile self-esteem, fear of rejection, and an intense desire for approval. They may withdraw from social situations or relationships when not receiving the attention and admiration they crave.
• High-functioning narcissism: Also known as exhibitionistic narcissism, symptoms of high-functioning narcissism include grandiose, competitive, attention-seeking, and sexually provocative behaviors. High-functioning narcissists are often outgoing, articulate, socially engaging, and highly successful, using their narcissistic traits to succeed and gain the admiration of others.

Symptoms

Narcissistic personality disorder is characterized by an exaggerated sense of self, a high desire for success and power, a lack of empathy for others, and a constant need for attention and admiration.

People with NPD display symptoms such as:

• Feeling superior, unique, and special
• Exaggerating their achievements and abilities 
• Preoccupying themselves with fantasies about beauty, intelligence, prestige, success, or love
• Needing constant attention and approval 
• Being hypersensitive to criticism, failure, and rejection 
• Having an inflated sense of entitlement 
• Exploiting and taking advantage of others for selfish gain 
• Disregarding the feelings of others and an inability to empathize 
• Expecting special treatment 

Others may describe people with NPD as being self-centered, arrogant, and conceited. People with NPD may also surround themselves with extraordinary and successful people or expensive and lavish possessions to enhance their self-esteem.

Causes

There is no single cause of narcissistic personality disorder, but a combination of genetics, early life experiences, and cultural and environmental factors are likely to play a role in someone's development of the condition. 

Early Life Experiences 

Research suggests that childhood experiences can contribute to the development of NPD, including:

• Not receiving emotional support or validation as a child 
• Rejection or criticism from a loved one 
• Experiences of abuse or neglect 
• Excessive praise
• A lack of discipline and boundaries in childhood 
• Over-protective parenting
• Traumatic events 
  

Genetics 

Narcissism can run in families, which suggests that genetics might play a role in the development of NPD. Some research published in the American Journal of Psychiatry has found evidence of 94 genes that can increase your risk of NPD and other psychiatric disorders. Experts currently believe that inheriting a specific gene from one or both of your parents may increase the risk of NPD.

Another study found that two narcissistic traits can be inherited from your parents: grandiosity and entitlement. Keep in mind: having a family history of the disorder does not mean you will develop narcissism—but, you may be at an increased risk of experiencing symptoms.

Cultural and Environmental Factors

The culture you grow up in can influence certain personality traits, including traits of NPD. Research suggests that narcissistic traits are more common in individualistic than collectivistic cultures. Individualistic cultures emphasize the importance of self, success, power, and individualism, which may increase narcissism.

On the other hand, collectivist cultures emphasize the group's needs over the individual and value harmony, cohesion, and interdependence, which may explain why people who grow up in collectivist cultures have fewer narcissistic traits. 

Biological Factors

Certain biological factors may play a role in NPD. Research shows that people with NPD have higher levels of oxidative stress—or, an imbalance of harmful free radicals and antioxidants in the body—which can affect your physical and mental health.

People with NPD have elevated levels of a certain biomarker (a protein or molecule found in your blood) of oxidative stress that links to hypersensitivity. This may contribute to oversensitivity to criticism in people with NPD.

Brain scans of people with NPD show that they may have structural brain differences, such as a lower volume of gray matter in brain areas that are associated with empathy, emotional regulation, and compassion.

Diagnosis

In order to receive a diagnosis for NPD, you must see a mental health professional (e.g., psychiatrist or psychologist) for a proper evaluation. The evaluation may include clinical interviews and self-report questionnaires that help healthcare providers look for patterns of symptoms and behaviors consistent with NPD: grandiosity, need for admiration, and a lack of empathy. In some cases, people close to the person who is being evaluated with NPD may also give their insight to the provider.

You or a loved one may receive an NPD diagnosis if you or they meet five or more of the specific diagnostic criteria outlined in the DSM-5. These criteria include:

• Grandiose sense of self-importance, such as exaggerating achievements and talents
• Preoccupation with fantasies of success, power, brilliance, beauty, or ideal love 
• Strong belief in being "special" or unique and the need to only associate with other special or high-status people 
• Need for constant admiration 
• Feeling entitled to special treatment 
• Exploiting others for personal gain 
• Lack of empathy 
• Being envious of others or a belief that others are envious of them 
• Arrogant or haughty (snobby) attitudes and behaviors

Questionnaires and personality tests can provide insight into a person's thoughts and feelings and allow healthcare providers to identify narcissistic traits. The tests that providers most commonly use to diagnose NPD include the Narcissistic Personality Inventory (NPI) and the International Personality Disorder Examination (IPDE).

Treatment

Treating NPD can be challenging because many narcissists struggle to acknowledge their symptoms, resist feedback, and blame others for their problems and behaviors. As a result, they are likely to be hesitant about receiving treatment.

Treatment approaches for NPD typically involve a form of talk therapy (psychotherapy) to help people with NPD develop a more realistic self-image, gain insights into their behaviors, learn skills to manage behaviors better, and form healthier relationships with others. A mental health professional may use one or more of the following therapy types:

• Cognitive-behavioral therapy (CBT): Aims to identify negative thoughts and behavior patterns and replace them with positive thoughts and behaviors.
• Psychodynamic therapy: Involves working with a therapist to explore past experiences and connect them to current emotions and thoughts. This form of therapy can help people with NPD identify harmful behavior patterns and develop greater self-awareness and insight into their behaviors. It also helps people with NPD understand the emotions of others to promote empathy. However, it is a long-term treatment that can take months or even years.
• Schema therapy: Focuses on identifying and changing unstable or dysfunctional patterns of thinking and behavior that developed in childhood. In schema therapy, people with NPD work with a therapist to identify their core schemas—or, deep-seated beliefs about themselves and the world around them. Once these schemas are identified, people learn to challenge and replace unhelpful schemas with healthier beliefs and positive coping mechanisms.
  

How to Prevent Narcissistic Personality Disorder

There is no known way to prevent NPD because a complex combination of genetic, environmental, cultural, and biological factors can contribute to the onset of symptoms and behaviors. However, certain parenting approaches may help prevent the development of NPD in young children, such as:

• Providing children with consistent, nurturing, and supportive parenting: This may include positive reinforcement and modeling empathy and compassion to promote healthy emotional development. 
• Avoiding parental indulgence: Setting and holding clear boundaries and limits and assigning age-appropriate responsibilities in the home. 
• Encouraging healthy self-esteem and self-worth: You can do this by fostering a sense of accomplishment and competence, promoting independence, and encouraging your children to pursue meaningful goals and interests. 
• Asking for help: Seek treatment for mental health problems you identify in your child as early as possible. 
• Participating in family therapy: If you or your family struggle to manage emotional distress or conflicts, family therapy can help your family develop healthy ways to communicate and connect. 

Comorbid Conditions  

Many people with NPD have other mental health disorders, which can complicate your provider's ability to give you an accurate diagnosis and figure out a treatment plan. That's why a comprehensive psychiatric evaluation is needed to learn about a person's NPD symptoms and other comorbid (co-occurring) conditions they may have.

People with NPD may commonly experience the following comorbid conditions:

• Depression
• Anxiety
• Substance use disorder (e.g., drug and alcohol misuse) 
• Other personality disorders, including antisocial, borderline, histrionic, and schizotypal personality disorders
• Anorexia nervosa

Living With Narcissistic Personality Disorder  

If you have NPD, you may have distorted thoughts and behaviors and unhelpful or harmful coping mechanisms that negatively impact your relationships, work, and quality of life. Seeking treatment can help you identify and understand your unhealthy patterns and develop healthier thoughts and behaviors. Though it may take some time, change is possible and likely to benefit every part of your life. 

Living with or caring for someone with NPD can be emotionally taxing and challenging. There are ways to cope and protect yourself from harmful narcissistic behaviors. First, learn as much as possible about what drives narcissistic behaviors, and consider working with a mental health professional to process your experiences and develop healthy coping mechanisms. Secondly, put what you learn to practice by setting and holding firm boundaries, disengaging from emotional outbursts and gaslighting attempts, and leaning on other friends and family for support.