What Exactly Is Narcissistic Personality Disorder?

A healthy (even sometimes inflated) sense of self can be a good thing. In fact, some researchers believe those who have grandiose views of themselves are mentally tougher, less stressed, and less at risk for depression. However, narcissism exists on a spectrum: On one side, it’s craving the occasional compliment. On its darkest side, it can creep into pathological territory.

Narcissistic Personality Disorder (NPD) is one of 10 personality disorders recognized in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The hallmark signs of NPD read like laundry list of what NOT to look for in a significant other: An inflated sense of self-importance, a lack of empathy for others, and a deep need for constant attention or admiration.

While a narcissist’s self-esteem can be off the charts, ironically, it can also be super fragile, dependent on external validation, or self-deception. They’ll believe grandiose fantasies about themselves (i.e. they’re smarter, more attractive, and successful than everyone they know), easily put other people down, and generally hijack any conversation/situation to make themselves feel better or superior. Feeling “less than perfect” is very uncomfortable for a narcissist, and they’ll protect themselves from it at all costs.

A personality disorder like NPD is about disturbed relationships, says Modesto, California-based psychologist Robert Moody, PhD. “People with personality disorders, as a class, have a lifetime of struggles with intimate, interpersonal relationships with their family, friends, and co-workers—and that’s especially true for those with narcissistic personality disorder.”

The disorder affects anywhere from 0.5 to 5% 1of the general US population with a greater prevalence in men than women.2 The percentage is low because, in order to be diagnosed, someone with NPD has to admit they have issues—which they often don’t. “The real problem with a narcissistic personality disorder is that the individual lacks good insight into what’s going on,” says Dr. Moody. “They think that the problem is all about everyone else, not them.”

And it can manifest differently in men versus women. According to research, compared to males, a narcissistic female personality is more likely to include deep insecurity, martyrdom, jealousy, and competitiveness with other women, often seeing them as a “threat” (think the overbearing mother-in-law).3 Men on the other hand are more likely than women to exploit others and feel entitled to certain privileges. They’re also more apt to exhibit qualities of assertiveness or power hunger. However, when it comes to vanity and self-absorption, both sexes rate equally.

Narcissism Subtypes

When you think of a narcissist, certain people you know may come to mind: case in point, the guy at the gym in the too-tight tank who’s more concerned with how his muscles look in the mirror than actually working out; the co-worker who fills her insta feed with her face—at every angle. But narcissism isn’t just about looking pretty: There are, in fact, 4 different types of narcissists.

#1. The Covert Narcissist (or vulnerable narcissist). Basically the exact opposite of the stereotypical type, instead of craving the spotlight and constant admiration, covert narcissists tend to be shy, self-effacing, hypersensitive to how others perceive them, and chronically envious. They often think their pain or suffering is worse than everyone else’s—and may even believe they’re the ugliest person in the room.

#2. The Cerebral Narcissist. They derive their self-importance from their intellect, believing they’re smarter than everyone else.

#3. The Somatic Narcissist. Somatic narcissists get their self-worth from their bodies. They tend to obsess over physical appearance, including weight, and criticize others based on their appearance.

#4. The Spiritual Narcissist. They use religion or spirituality to intimidate or justify harmful behaviors to others that can creep in when an individual takes a “holier than thou” stance, overemphasizing their level of spirituality or closeness to God. Harmful behaviors can happen when, as an example, a church leader claims they had a vision from God about someone else, or that they’re in a “higher” position to use Biblical passages to control, hurt, or shame someone.

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What Are The Symptoms Of Narcissistic Personality Disorder?

Narcissism is a label that gets thrown around a lot, especially when someone seems conceited or acts out of self-interest, says psychologist Kristina Hallett, PhD, ABPP, associate professor of graduate psychology and the director of clinical training at Bay Path University in Connecticut. “But a narcissistic action every now and then isn’t the same as having a personality disorder.” With the latter, a narcissist’s self-absorbed and self-centered way of thinking and behaving surfaces in every area of their life, from work and friendships to family and love relationships.

The nine most common traits for NPD include:

  • Having an inflated sense of self-importance and entitlement. Deep down, you feel like you’re the best, most successful, competent, [insert praise here] in any situation.
  • Needing constant admiration. Your self-esteem is like a balloon without a knot, requiring a steady stream of attention, approval, and recognition to keep it inflated. No matter how much someone tells you that they love or look up to you, it feels like it’s never enough.
  • Expecting special treatment. Whether it’s favors or apologies, whatever you want, you believe you deserve to have it—because you’re superior to everyone around you, and they know it and should comply.
  • Exaggerating achievements and talents. You have no problem embellishing the facts—or even outright lying—about your life, resume, and experiences.
  • Reacting negatively to criticism. Even though you crave control and take full credit when things are going well, you’re quick to blame others whenever a situation doesn’t go as planned. It’s extremely hard to accept criticism or admit to mistakes because, naturally, it’s always someone else’s fault, not yours.
  • Being preoccupied with fantasies about power, success, and beauty. You tend to create and believe exaggerated, unrealistic narratives around your success, relationships, even how good you look to help you feel special and in control. Anything that threatens the fantasy is rationalized away or simply ignored. You also want people to feel envious of you, and you feel pretty envious of people who have what you want.
  • Taking advantage of others. You often don’t think twice about using or exploiting other people to achieve your own ends—whether maliciously or obliviously. You care about your relationships and the people in your life on a superficial level—if they elevate your social status, or make you look or feel good, for instance—and you don’t really think about how your behavior might affect them.
  • Having an inability or unwillingness to recognize the needs and feelings of others. You’re super sensitive to how people treat you and react to your needs and feelings, but on the flip side, you can’t put yourself in other people’s shoes and empathize with their experiences. You might belittle others or even bully people to feel better about yourself. You never really “go deep” in any of your relationships, either—and, frankly, it doesn’t bother you all that much.
  • Behaving in an arrogant manner. With an inflated ego and sense of superiority and entitlement, you probably insist on having the best everything—the best car, office, designer clothes—monopolize conversations, look down on people you perceive as “inferior,” and only associate with those you think are equally special, successful, and talented.

How Is Narcissistic Personality Disorder Diagnosed?

NPD is not the kind of condition that can be diagnosed with a blood test, MRI, or exact scale, and according to the DSM-5, a person needs to exhibit only 55% of the above traits, symptoms, and behaviors to be considered narcissistic. But nailing down NPD can be a little more complicated.  Since narcissists tend to think there’s nothing wrong with them, they rarely enter treatment.

This in part may explain why we might feel we know and encounter many narcissists, but only an estimated 5% of people actually have NPD. (This is also why you can’t ask your therapist to diagnose your narcissistic husband with the disorder if he doesn’t think he has a problem.)

Narcissism hinges on personality traits alone—most of which are objectively negative (it’s pretty easy to label someone with these tendencies as, well, a jerk). But psychologists want to be extremely careful about pathologizing someone’s personality.

A clinical NPD diagnosis is given to someone who’s experiencing social and occupational impairment and subjective distress—which is a fancy way of saying that their narcissistic behavior is not only messing with their work and personal lives, but they’re actually aware that it’s destructive, and it’s making them uncomfortable.

In other words, if a self-entitled, grandiose, empathy-lacking person doesn’t see a problem with the way they live their life, they’re simply just a narcissist—full stop. A clinician usually won’t diagnose a narcissist with NPD until they’re struggling with their behavior and seek help to change it.

“These individuals most frequently come to therapy to either a) get support for their perspective; or b) because a family member is insisting and it’s easier to comply,” says Dr. Hallett. Sometimes, it takes facing a serious ultimatum, failure, or loss for someone with this personality type to get help, and it’s not uncommon for them to seek treatment for another mental health problem altogether, like depression.

At that point, diagnosing NPD is a little more straightforward. Some psychologists may simply use the duck test—if it looks like a duck and quacks like a duck, it probably is a duck—based on observations of the behavior and attitudes that a person presents.

What Causes Narcissistic Personality Disorder?

There’s no single cause of NPD. But, researchers agree that both genetic and environmental causes are at play. Individuals with narcissistic personality disorder have been found to have less volume of gray matter in the left anterior insula, the part of the brain related to empathy, emotional regulation, compassion, and cognitive functioning.

It can be hard to resist the confidence, assertiveness, and excitement that surrounds a person with narcissistic personality disorder. But those same traits that drew you to that person in the first place may eventually become a turnoff when you start to notice the impact of their unemotional response to relationships, the cruelty of their lack of empathy for others, and the grandiose belief they are greatly important and should be treated as such.

“By definition, personality disorders are developed over time and through childhood experiences, genetics, and environment,” says Dr. Hallett, noting that as an adult, narcissistic traits on their own are not likely to develop into a personality disorder. Often, NPD will begin in the teenage years or early adulthood.

Personality disorders are typically diagnosed at 18 years or older, according to Dr. Hallett. The thing to keep in mind with kids is that some narcissistic traits are simply just typical of their age (teenagers by definition are self-absorbed), and it doesn’t mean they’ll go on to develop a full-blown disorder.

Scientists believe that the full onset of NPD may occur when interpersonal development is compromised, for example:

  • Being born with an oversensitive temperament
  • Learning manipulative behavior from parents or peers
  • Being excessively praised for good behaviors and excessively criticized for bad behaviors
  • Suffering from severe childhood abuse or neglect
  • Inconsistent or unpredictable parental caregiving
  • Growing up with unrealistic expectations from parents
  • Being excessively pampered or overindulged by parents, peers, or family members
  • Being excessively admired with no realistic feedback to ground you with reality
  • Receiving excessive praise from parents or others focused on your looks or abilities

[Click to Learn More: 9 Signs You are Married to a Narcissist and What to Do About It]

What Are the Treatments for Narcissistic Personality Disorder?

For those who do seek help, “psychotherapy, also called talk therapy, can help by working to increase empathy and compassion,” says Dr. Hallett. Meeting with a therapist, you’ll learn how to better relate to others, which can encourage more functional and improved interpersonal relationships, as well as gain a better understanding of your own emotions and why you feel the way you do. Along the way, your therapist might work with you on:

  • Accepting and maintaining relationships with co-workers and family
  • Tolerating criticisms and failures
  • Understanding and regulating your feelings
  • Minimizing your desire to attain unrealistic goals and ideal conditions

But don’t expect a personality adjustment overnight: Treatment for NPD can be a long, slow-going, uphill battle—and just as with other personality disorders, patients may need to be more motivated than a typical therapy client to make progress and resolve their issues.

While in treatment, those with this personality type tend to be mistrusting and reluctant, exhibit negative reactions, and often drop out early. Since the work deals primarily with personality traits, which are pretty steady over time, it could take many years of psychotherapy before a breakthrough happens (as they say, you can’t teach an old dog new tricks).

The good news is, studies in intervention with those living with NPD have shown that narcissists are in fact capable of learning and feeling empathy, which is the ultimate antidote.4

And while there are no psychotropic medications to treat the disorder specifically, keep in mind that the likelihood of a co-occurring psychiatric disorder along with NPD is a possibility. If you are living with this condition and also dealing with depression, anxiety, addiction problems or substance use disorder, bipolar disorder, eating disorder, or any other illness, you may be prescribed medications that are helpful in treating these conditions.

FAQs

Q: Do narcissists have high or low self-esteem?
Narcissists have high self-esteem. The thing is, they lack a secure sense of self-esteem, having what researchers call “fragile high self-esteem.” This form of high self-esteem is extremely dependent on external validation and self-deception or having fantasies of success, power, and beauty.

Q: Can a narcissist fall in love?
Yes, but their personality will make it very difficult for a truly intimate relationship to come into full bloom, says Dr. Moody. Unfortunately, the other person in the relationship may even not notice the red flags until several months down the line, when they realize that their relationship should have naturally reached a deeper level.

Q: How do I deal with a narcissistic in my life?
Setting strong boundaries is an important way to protect yourself in any type of relationship with a narcissist. For coupled partners, participating in therapy to learn healthy ways to communicate, cope, and manage emotional distress can help. The good news is that the relationship can get better if both people are willing to stick through treatment.

Q: What are the different types of narcissists?
There are 4 types of narcissists. The covert narcissist tends to be shy, self-effacing, hypersensitive to how others perceive them, and chronically envious. They often think their pain or suffering is worse than everyone else’s—and may even believe they’re the ugliest person in the room. The cerebral narcissist derives self-importance from their intellect, believing they’re smarter than everyone else. The somatic narcissist tends to obsess over physical appearance, including weight, and criticize others based on their appearance. The spiritual narcissist uses religion or spirituality to intimidate or justify harmful behaviors to others. They might look down on anyone who is “unevolved,” “unawakened,” or “asleep” and claiming that they can’t possibly understand you because they’re not at your level of consciousness or spiritual/religious maturity.

Helpful Resources for Narcissistic Personality Disorder

There is no known way to prevent the condition, but if you suspect that you might be dealing with NPD, are in a relationship with a narcissist, or if a loved one is struggling with it, it’s important to get help as soon as possible.

  • Find a psychiatrist or psychologist who specializes in helping people with narcissism.
  • If you or a family member is dealing with narcissistic or psychological abuse, call the National Domestic Violence Hotline at 1-800-799-7233.
  • Read these tips on ending or leaving a relationship with a narcissist.
  • If you are physically threatened or abused, seek immediate help by calling 911.
  • Find more hotlines and organizations for support in our mental health resources directory.

Narcissistic Personality Disorder By The Numbers

0.5-5% – the estimated percentage of people with NPD in the US population-based on community samples.

50-75% – the percentage of people with NPD who are men.

40% – the percentage of people with NPD who also have an anxiety disorder.

[Read This Next: What is Empathy and Why We Need It]

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Last Updated: Sep 15, 2020