Narcissistic Personality Disorder

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), individuals with NPD may display a range of symptoms that affect their self-perception, interpersonal relationships, and emotional responses, often resulting in consistent patterns of dysfunction and distress.

Perception of self

Below are some of the symptoms of NPD focused on perception of self: 

• Grandiosity:¹ Individuals with NPD often have an exaggerated sense of self-importance and believe they are superior and unique and can only be understood by or associated with other high-status people.
• Preoccupation with fantasies: People with NPD may harbor fantasies about unlimited success, power, brilliance, beauty, or ideal love.
• Entitlement: People with NPD may have unreasonable expectations of especially favorable treatment or automatic conformity with their expectations.

Relationship with others

People with NPD often experience turbulent relationships due to the following interpersonal symptoms: 

• Exploitation of others: People with NPD may take advantage of others to achieve their desires. They may frequently use or manipulate people around them without considering their feelings or desires. 
• Lack of empathy: While individuals with NPD may struggle with emotional empathy, not fully sharing or responding to others' feelings, they often retain cognitive empathy, understanding others' perspectives but may process them selectively. This selective attention to emotional cues can lead to perceptions of insensitivity, although their empathy mechanisms are not absent but functionally distinct and context-dependent.
• Envy of others: Individuals with NPD can believe others are envious of them and often feel envious of others.

Reactions to events

Below are some reactive symptoms of NPD: 

• Arrogance or haughty behavior: People with NPD often exhibit behaviors or attitudes that could be described as arrogant, haughty, or dismissive toward others.
• Sensitivity to criticism: Despite appearing confident, people with NPD are often sensitive to criticism, defeat, or negative realities about themselves. This negativity may lead to shame, humiliation, and thoughts of being belittled. 
• Frequent envy: People with NPD may covet others' achievements or possessions and believe others envy them.

To be diagnosed with NPD, symptoms must be consistent, long-term (chronic),² and not due to drugs, alcohol, or a medical condition. The symptoms must also cause significant distress or impairment in an individual's personal, social, or occupational life.

The exact causes of narcissistic personality disorder are not fully understood. However, they are believed to result from genetic, environmental, and psychological factors. Like some other personality disorders, a complex interplay of biopsychosocial influences contributes to their development and persistence.

Genetic and biological factors

Individuals with NPD may have a genetic predisposition to the disorder. Personality traits are often inherited, so NPD can occur more frequently in certain families.

Environmental factors

Childhood experiences can play a crucial role in the development of NPD. These factors may include excessive pampering or criticism, neglect, lack of empathy from parental figures, or emotional abuse during the formative years. Parental behavior that values a child's achievements over their character might also contribute to the development of NPD.

Psychological factors

Certain personality traits or characteristics, such as being highly ambitious or having a strong desire for power and admiration, may make a person more susceptible to developing NPD.

The risk of developing NPD may increase with exposure to certain experiences or circumstances. For example, individuals exposed to narcissistic behaviors or attitudes in their parents, or who have parents who have NPD may be at a higher risk. Similarly, individuals who receive excessive praise or criticism or have a high inherent ambition or desire for power may be more susceptible. 

Despite these potential risk factors, many people exposed to similar conditions do not develop NPD. Personality development is a complex process influenced by a multitude of factors.

Treatment for narcissistic personality disorder (NPD) primarily involves psychotherapy, also known as talk therapy, to help individuals understand and manage their symptoms, maintain a functional and satisfying life, and improve their personal and professional relationships. Individuals suspecting they might have NPD are encouraged to seek evaluation from a mental health professional, as early diagnosis and intervention can improve treatment outcomes.

Medication

While no specific drugs treat NPD directly, medications may be used to manage particular symptoms or co-occurring mental health conditions. These may include the following: 

• Antidepressants: Antidepressants might be used to help individuals manage symptoms of depression or anxiety that can co-occur with NPD.
• Antipsychotics: Antipsychotics may manage symptoms like agitation or aggression.
• Mood stabilizers: To even out mood swings or reduce irritability, impulsivity, and aggression, mood stabilizers might be prescribed. 

Medications are often most effective when used in combination with therapy. Patients with narcissistic personality disorder are often difficult to engage in treatment, underscoring the importance of alliance in patient-focused care. Consult a medical doctor before starting, changing, or stopping a medication for any condition. The above information is not a replacement for medical advice or diagnosis. 

Other treatment options

In some cases, other treatment options may be considered, especially if the person with NPD has co-occurring mental health disorders, such as borderline personality disorder (BPD), bipolar disorder, or antisocial personality disorder (ASPD).⁴ Below are two of these treatments: 

• Group therapy: Group treatment can help individuals with NPD learn to interact more effectively and productively with others. The group setting also provides a supportive environment for individuals to share their experiences and learn from others.
• Hospitalization: In severe cases, especially if there are concerns about self-harm or other risky behaviors, hospitalization may be beneficial. 

Self-care

Self-care strategies can support one’s overall treatment plan, including the following: 

• Regular exercise: Physical activity may manage symptoms of co-occurring conditions such as anxiety or depression.
• Adequate sleep: Improved sleep hygiene can support overall mood and energy levels.
• Balanced diet: Proper nutrition may support overall health and well-being.
• Stress management: Techniques like mindfulness,⁵ yoga, or other relaxation exercises can help individuals manage stress.

Treatment for NPD can be challenging as individuals with this disorder often don't recognize that they have a problem. However, with professional help and support from loved ones, individuals with NPD may learn to relate better with others and lead more fulfilling lives.

Therapy can be a crucial aspect of managing and treating narcissistic personality disorder. Online platforms like BetterHelp can connect individuals to licensed therapists specializing in personality disorders. This option can be helpful as it provides access to therapy in the comfort of one's own home, making mental healthcare more accessible and convenient.

Other resources also exist to provide further understanding and support for individuals with NPD or those who interact with them.

• The National Institute of Mental Health (NIMH) provides information on mental health disorders, including NPD.
• The American Psychiatric Association offers resources about various personality disorders and treatment options.
• The National Alliance on Mental Illness (NAMI) has resources, hotlines, and support groups for individuals and families with mental health disorders.

While addressing NPD can be challenging, help is available. Seek professional advice if you or a loved one shows signs of NPD.

For those experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7. Please also see our Get Help Now page for more immediate resources.

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357).

Emerging research sheds light on the underpinnings and potential treatments of narcissistic personality disorder.

In a 2018 study published in the Journal of Personality Disorders, researchers found that schema therapy, a form of psychotherapy that integrates elements of cognitive, behavioral, and psychodynamic therapies, could be particularly effective for individuals with NPD. Over three years, individuals undergoing schema therapy showed significant improvements in NPD symptoms and overall personality functioning. This result supports the use of long-term, integrative psychotherapeutic approaches for treating NPD.

A study from the University of Chicago indicates that there may be a biological component to NPD. The research shows that individuals with NPD exhibit differences in the volume of certain brain structures involved in processing empathy and controlling impulsive behavior, suggesting a possible neurological basis for some aspects of the disorder. The result opens new avenues of exploration for understanding the causes of NPD and, potentially, new therapeutic strategies for managing the condition.

Below are several statistics on narcissistic personality disorder: 

• According to a National Library of Medicine study, NPD affects approximately 0.5% to 1% of the general population.
• NPD is more prevalent in males than females, with an estimated 50% to 75% of those with NPD being male.
• A comprehensive review in the National Library of Medicine found that with long-term psychotherapy, many people with NPD can find relief from their symptoms and live more fulfilling lives.