What Is A Narcissist? Signs And Symptoms Of Pathological Narcissism

Medically reviewed by Andrea Brant, LMHC and Julie Dodson, MA, LCSW
Updated October 23, 2024by BetterHelp Editorial Team
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In recent years, the terms “narcissist” and “narcissistic personality” have become commonly used in casual conversation. This widespread use has led to some misconceptions about what exactly these labels mean and when they may apply. Here, we’ll explore the answer to the question, “What is a narcissist?,” covering key signs and symptoms of narcissistic personality disorder, notes on terminology, and treatment options.

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What are personality disorders?

According to the American Psychological Association, a personality disorder is when “one's way of thinking, feeling and behaving deviates from the expectations of the culture, causes distress or problems functioning, and lasts over time.” Personality disorders are considered to be a type of diagnosable mental illness. There are several different types of personality disorders, such as borderline personality disorder, paranoid personality disorder, schizotypal personality disorder, and narcissistic personality disorder, among others.

Can personality disorders be cured?

Personality disorders are generally thought of as conditions that require long-term treatment and management rather than conditions that can be “cured,” though this may be possible in some cases. Treatment for personality disorders usually consists of some form of individual talk therapy, which often aims to help the individual learn to develop self-awareness of their behaviors and coping tools for their symptoms. In some cases, medication, lifestyle changes, and family or couples therapy might also be recommended.

What is a narcissist? 

Although the term “narcissist” has become common in popular culture, many clinicians avoid using it. Instead, they may prefer language like a person having narcissistic tendencies, or qualifying for a diagnosis of narcissistic personality disorder, or NPD (sometimes referred to as pathological narcissism).

Terminology: What is a narcissist vs. someone with narcissistic personality disorder?

Again, “narcissist” as a label is viewed as an outdated and potentially offensive term by many mental health experts. It’s possible for someone to display some narcissistic traits but not qualify for an official diagnosis of narcissistic personality disorder. In this case, they may be referred to clinically as a person showing narcissistic traits or tendencies. Or, a person may display enough of these tendencies to qualify for a clinical diagnosis of narcissistic personality disorder, or NPD, in which case they’d be referred to as a person with NPD.

Using the correct terminology for this type of condition can be important. NPD is a diagnosable mental health condition, just like depression or bipolar disorder. While individuals can take steps to learn to better manage their symptoms, the development of the disorder is not a choice. Research has demonstrated differences in gray matter in the brains of those with NPD, further highlighting the fact that this NPD is an illness like any other. The harm that a person with this disorder can cause to those around them is real as well, but referring to this condition using nonjudgmental terminology may help reduce the stigma around it and encourage those experiencing symptoms to seek treatment.

About narcissistic personality disorder

In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), personality disorders are divided into categories, or “clusters.” Narcissistic personality disorder is classified as a cluster B personality disorder, along with antisocial personality disorder, borderline personality disorder, and histrionic personality disorder. The disorders in this cluster are typically characterized by behaviors that can be seen as “dramatic/erratic.”

It’s estimated that around 6% of US adults live with narcissistic personality disorder, though there’s some uncertainty with statistics on this illness. That’s because many people with NPD or other personality disorders don’t realize that their behaviors may indicate a diagnosable disorder and, therefore, may not seek help.

Symptoms of narcissistic personality disorder

The DSM-5 lists nine different criteria that mental health professionals can use to identify whether a person may have narcissistic personality disorder. In order for this diagnosis to be considered, the individual must display at least five of the following nine symptoms.

1. An inflated/grandiose sense of self-importance

A grandiose sense of one’s own importance is often a key symptom of NPD. The individual may believe that they are more important than others, which could lead them to behave selfishly or act in ways that put their needs or feelings above those of others.

2. A preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love

People with NPD may fixate on certain expectations for their own future, often relating to having high levels of power, beauty, intelligence, or other forms of success. They may firmly believe that they will achieve and/or deserve these things.

3. A belief that they are special and unique and can only be understood by, or should associate with, other special or high-status people or institutions

As discussed above, people with narcissistic personality disorder might believe that they’re more important than other people. As a result, they could reject spending time with people or in places that they don’t deem to be “high-status.”

4. A need for excessive admiration

A person with narcissistic personality disorder will often feel the need to receive frequent and glowing praise for who they are and what they’ve done. Since low self-esteem is often associated with this condition, the person may feel insecure or lost without frequent reassurance that they are worthy and impressive.

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5. A sense of entitlement

A sense of entitlement is related to a sense of inflated self-importance and the belief that one is particularly special or unique. As a result of these beliefs, an individual with NPD might expect to receive privileges or praise, regardless of whether they’ve done anything to deserve or earn them. 

6. Interpersonally exploitative behavior

It’s not uncommon for a person living with NPD to exploit others for their own gain, since they tend to believe that their needs and desires are more important than anyone else’s. As a result, they may experience the impulse to intentionally lie, deceive, or manipulate in order to exploit others and get what they want.

7. A lack of empathy

It’s often harder for those with this type of personality disorder to feel a sense of empathy for others. The symptom of an exaggerated sense of self-importance may cause them to focus on themselves and their own needs without considering the effects of their actions on others.

8. Envy of others, or a belief that others are envious of them

Because they often believe they are uniquely talented and important, people with NPD symptoms may assume that others are envious of them. Or, upon seeing the successes or admiration of others, they may be more likely to feel strongly envious themselves.

9. Arrogant and haughty behaviors or attitudes

This final criterion is another that’s related to an inflated sense of self-importance and entitlement. Those symptoms may make a person with pathological narcissism behave in an arrogant way, because they often believe that they are more important or worthy than those around them.

How pathological narcissism or narcissistic personality disorder can affect mental health

NPD is categorized as a mental health condition, so its symptoms are closely linked to mental health. First, some experts believe that it may be caused by past trauma like abuse in some cases. Trauma can affect mental health in many different ways, from contributing to the development of depression, post-traumatic stress disorder, or substance use disorders to causing chronic stress and problems in relationships.

Whether it’s linked to other mental health challenges like trauma or not, NPD itself can impact the overall mental health of an individual living with it. It’s important to note that NPD symptoms can significantly impact the mental health and well-being of those around the individual with this condition too, such as family members, partners, friends, and coworkers.

Commonly co-occurring mental health conditions with pathological narcissism, or narcissistic personality disorder

Another way NPD can affect a person’s mental health is by increasing the likelihood of developing other co-occurring, or comorbid, mental health conditions. Research suggests that anorexia nervosa, depressive disorders, and other personality disorders are commonly comorbid with NPD.

It’s also worth noting that many people with NPD actually live with shame, deep insecurity, and low self-esteem. Although their behaviors may seem to indicate the opposite, their symptoms may sometimes be attempts to control and enhance their own self-image and perception. 

How NPD can affect relationships

NPD can also affect mental health by impacting a person’s relationships. Symptoms like exploitative behavior and a lack of empathy can strain and damage relationships with partners, friends, and family members. This can lead to stress, loneliness, and related health problems for both the individual living with NPD and their loved ones. 

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Seeking support for an inflated sense of self-importance, low self-esteem, and other NPD symptoms

The symptoms of narcissistic personality disorder can cause significant challenges for a person’s daily functioning and overall well-being, and it can deeply affect the lives and health of those around them as well. That’s why seeking treatment for signs of NPD can be so important. With professional treatment over time, a person may be able to learn to better recognize and adjust their behaviors and how they affect others.

Types of therapy for NPD

Talk therapy is one of the most common treatment methods for personality disorders of various types. Through any of a number of talk therapy methods, a therapist may help an individual with NPD learn to better manage their emotions, raise their self-esteem, and find healthier ways of interacting with other people. Some types of therapy that are often used for NPD symptoms may include:

  • Cognitive behavioral therapy
  • Dialectical behavioral therapy
  • Schema therapy
  • Transference-focused psychotherapy

If you’re experiencing signs of narcissistic personality disorder or another mental health condition, it’s usually recommended that you meet with a licensed mental health professional for evaluation and personalized treatment advice. Those who aren’t displaying signs of this disorder but whose mental or emotional health has been affected by someone with this disorder may also benefit from seeking support from a healthcare professional like a therapist.

Online therapy for NPD 

In many cases, talk therapy can be equally effective when done online or in person, as research suggests. That means that individuals can often choose the format that works best for them without worrying about differences in quality of care. For example, those with busy schedules may choose online therapy because it usually offers a wider range of appointment times and doesn’t require time spent commuting to an office. Online therapy can also be preferable for those facing financial constraints, since virtual sessions tend to be more affordable than in-person sessions.

Takeaway

The term “narcissist” is considered outdated by many mental health experts, but it generally either refers to a person who demonstrates some narcissistic tendencies but hasn’t been diagnosed with a disorder, or a person who is living with clinical narcissistic personality disorder (NPD). An NPD diagnosis requires the presence of at least five of nine core symptoms, such as a lack of empathy and an inflated sense of self-importance. Treatment for NPD usually involves some form of talk therapy. Those who have been harmed by someone demonstrating NPD symptoms may also benefit from the support of a therapist.
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