What To Know About Narcissistic Personality Disorder Prevalence

Many people use the term “narcissist” to refer to someone who is self-centered, has a big ego, or seeks attention. However, narcissistic personality disorder (NPD) is a much more nuanced diagnosis. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), NPD is a cluster B personality disorder, along with antisocial personality disorder, borderline personality disorder, and histrionic personality disorder. 

NPD is typically characterized by unpredictable and inappropriate behavior and emotions that display an inflated sense of self-importance and a lack of empathy. Due to the complexities of diagnosing this condition, there is some debate over its prevalence, and some believe that NPD is underdiagnosed. Individuals with narcissistic traits, as well as those who have been negatively affected by others with NPD, can often benefit from therapy.

What is narcissistic personality disorder? 

Personality disorders normally involve long-term patterns of thought, emotion, and behavior that differ from what is considered normal in a person's culture. People with NPD can exhibit symptoms that distinguish their diagnosis from other personality disorders. They may exhibit a pattern of grandiosity, a lack of empathy, a need for admiration, and an inflated sense of self-importance. Others may find them boastful or arrogant.

There are also subtypes of NPD: overt and covert. The overt subtype is usually characterized by traits that people may associate with NPD, including attention-seeking behavior, grandiosity, entitlement, and arrogance. These individuals may be perceived as charming despite not recognizing the needs of others, and they may use or manipulate other people for their own gain.

In contrast, someone with covert narcissism may appear thin-skinned or fragile, be hypersensitive to criticism, and tend to chronically compare themselves to other people. People with this subtype of NPD are often shy and extremely sensitive to perceived slights. They may outwardly seem to brush off compliments while secretly harboring a sense of grandiosity.

People with covert or vulnerable narcissism are usually more likely to experience symptoms of depression and anxiety and engage in self-injury or suicide attempts, while those with the overt or grandiose subtype may experience symptoms related to substance misuse (previously referred to as substance abuse). People with either type of NPD may appear self-absorbed, and it can be possible for them to fluctuate between being grandiose and covert, depending on what is happening in their lives. Some people may display features of both subtypes.

The challenges of diagnosing NPD

Diagnosing and treating NPD can be a complicated topic that likely requires more study. Some of the features of NPD can overlap with other mental disorders, which can make getting an accurate diagnosis challenging. 

NPD appears to be most similar to antisocial personality disorder. People with antisocial personality disorder typically display long-term patterns of exploiting, manipulating, or violating the rights of others without remorse. This behavior can be similar to the lack of empathy and selfishness seen in NPD. People with either condition may be unforgiving and tend to use others to their advantage. 

The differences can be subtle. However, NPD is not generally associated with criminality, although those with this disorder may believe that rules don’t apply to them. In addition, those with antisocial personality disorder usually do not envy others or seek their admiration. 

There can also be some overlap between NPD and histrionic personality disorder (HPD). Both disorders may involve attention-seeking behavior. People with either HPD or NPD may be shallow or superficial, and both may experience low self-esteem, although people with NPD usually try to hide this. 

There are usually differences between these disorders, but as with antisocial personality disorder, they may be subtle. For example, people with NPD or HPD may both seek attention, but the type of attention they want often differs. People with NPD usually desire recognition or admiration to reinforce their sense of self-importance. Meanwhile, those with HPD may want to be liked by others. People with HPD are often very emotional, while those with NPD may appear more reserved. 

NPD and borderline personality disorder (BPD) can also be challenging to differentiate. People with either condition can experience emotional dysregulation, but this usually occurs in response to different triggers. Someone with NPD may have a strong emotional reaction to threats to their self-esteem, while someone with BPD may react strongly to real or perceived abandonment. 

The nature of NPD can also mean that people who have it are unlikely to seek help. Many people with this condition may avoid seeking help because they may not believe that anything is wrong with them, or they may not notice or care about how their behavior affects the people around them. Asking for help generally requires some vulnerability, which can be challenging for people with NPD.

Narcissistic personality disorder prevalence

Other sources report that, in clinical samples, NPD has been reported to range from 1% to 17% of the population. Some recent studies suggest that the disorder is underdiagnosed.

Some research has also found that NPD may be more prevalent in certain populations. For example, some studies suggest that about 17% of first-year medical students have NPD, and 20% of the military population has either NPD or narcissistic traits. NPD also tends to be more common in males than females. About 75% of people diagnosed with NPD are male.

Because differentiating between NPD and other psychiatric disorders can be challenging, and many people with NPD may exhibit covert symptoms that aren’t as easy to detect, it can be challenging to determine an accurate estimate of this disorder’s prevalence. 

Treating narcissistic personality disorders

People with NPD may not recognize the ways in which their pathological narcissism affects various aspects of their lives. They may not seek treatment on their own and may only consider getting help when loved ones suggest it. Someone with NPD may also seek help due to symptoms of a coexisting disorder, like depression, anxiety, or substance use disorder.

In general, NPD is unlikely to improve without treatment. There is little evidence that medication is helpful in treating individuals with narcissistic personality disorder, although it may be prescribed to help with co-occurring conditions, like anxiety or depression. Treating NPD typically involves psychotherapy. Some types of therapy that may help with this condition include dialectical behavior therapy, cognitive behavioral therapy, metacognitive therapy, and group therapy. 

Psychotherapy can also be beneficial for friends and family members of people with NPD. Whether you have gone through narcissistic abuse or are experiencing anger or frustration due to the behavior of someone with this condition, talking to a therapist can help. If you’re interested in therapy but are concerned about not having enough time in your schedule, consider online therapy. With an online platform like BetterHelp, you can work with a licensed mental health professional from the comfort of your home at a time that fits your schedule, even if that’s outside of typical office hours. 

Research has found that online therapy can be effective for a variety of mental health concerns, and that it usually produces the same client outcomes as traditional face-to-face therapy. Both treatment options may be helpful if you’re interested in seeking professional support.