Narcissistic personality disorder has become a controversial condition, mainly because it is often misunderstood. It has also been stigmatized as a personal choice of behavior, which it is not.
People with narcissistic personality disorder (NPD) are often viewed as selfish, lacking empathy, and having a high need for attention and appreciation. But beneath this apparent sense of superiority there are other important aspects.
People with narcissistic personality disorder can experience challenges in their relationships because of how they are perceived and how they act.
Counseling and professional support can sometimes help them find a different way to relate to others and manage the changes in mood that may characterize this personality disorder.
Help is available if you or someone you love is exploring a diagnosis of borderline personality disorder. You may find this article and the resources listed at the end a good starting point.
What is narcissistic personality disorder?
Narcissistic personality disorder is an official mental health diagnosis and not just a personality type or personal choice.
Understanding this difference is key to managing the formal symptoms of narcissism and supporting the person who has received this diagnosis.
A mental health condition, including a personality disorder, affects how a person feels, thinks, and acts.
This, in turn, can profoundly impact daily life and how people function in their relationships, at work, and in general.
Researchers have found that a person with borderline personality disorder, specifically, may have a lesser ability than others to recognize and understand how and why they think and act the way they do.
Likewise, they may have difficulty dealing with what others feel or do.
As a Cluster B personality disorder, narcissistic personality disorder is mainly characterized by the following behaviors:
Dramatic and exaggerated
Emotional and intense
Irregular and unpredictable
Not everyone with a narcissistic personality behaves the same way. This is partly because there are different types of narcissism.
What a narcissistic personality is not
Most of us will display at least one narcissistic trait at some point in our lives. These behaviors or attitudes may be considered narcissistic, but differ from a personality disorder in their severity, frequency, and duration.
There are many personality traits, such as generosity and discretion, for example. It appears to a greater or lesser degree in all of us. The same thing happens with the narcissistic trait.
Narcissism, or at least some aspects of it, can be a personality trait in some people.
In other cases, the severity and intensity of these narcissistic traits is such that they permanently affect and harm how they relate to others and to themselves.
Narcissism as a personality trait may sometimes appear in some of our behaviors or thoughts.
For example, you could have an ongoing competition with a coworker. This may lead you to make snide comments about him or exaggerate the praise you receive from your boss when he is around. Maybe even give them an unfairly bad review at some point.
But this is a casual reaction related to that specific coworker rather than the general attitude toward everyone else all the time.
On the other hand, narcissism in someone with narcissistic personality disorder is a constant and distinct trait.
For example, you have constant competition with all of your co-workers and even your boss. You think you are smarter and more capable than them, and should be the one in a higher position.
This has happened to you at your last two jobs. In general, you feel much superior to the people you meet at school, work, and other places.
Remember that narcissistic personality disorder is a mental health condition. Does not refer to someone:
Have high self-esteem
Show social confidence
Be firm
Proud of their true achievements
Paying attention to their physical appearance
Being competitive
He hates you
What is a personality disorder?
NPD is one of 10 personality disorders. This is a group of mental health conditions characterized by persistent thoughts, emotions and behaviors that may be harmful to the person with the disorder or to others.
In general, a mental health professional diagnoses a personality disorder if at least two of these criteria are met:
Personality traits make it difficult for this person to relate and communicate with others or with themselves. For example, how they control their behavior or how they respond emotionally to others.
Pathological personality traits continue to appear across many different situations.
The word “pathological”, in mental health terminology, refers to thoughts, emotions or behaviors that negatively affect how a person sees, relates to and copes with the world around them.
Pathology may also refer to traits resulting from a mental or physical condition that is not expected or accepted in the culture in which they live.
Not all personality disorders show the same symptoms or personality traits. For this reason, they are classified into three different groups or groups.
This classification is based on their most representative personality traits:
- Group A: Strange and eccentric
- Group B: Dramatic and irregular
- Group C: Scared and anxious
- NPD is part of Cluster B personality disorders.
Symptoms of narcissistic personality disorder
More specifically, doctors diagnose narcissism when a person shows five or more specific symptoms.
These symptoms of narcissistic personality disorder are defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association. It is a guideline used by mental health professionals as a classification reference to make accurate diagnoses.
Not everyone with a narcissistic personality will experience these symptoms to the same degree or severity, but five of them must be present over time and across different situations for a diagnosis to be made.
Although there is no consensus yet, some experts believe that vulnerability, fear, and low self-esteem can explain some of the symptoms of borderline personality disorder.
Greatness and self-importance
Exaggeration is often the basis of greatness. This means that people with narcissistic personality disorder tend to have an exaggerated sense of self-importance. They may feel that they are stronger, smarter, more capable, and more charming than they really are and more so than others in general.
To reaffirm this feeling of superiority, a person with a narcissistic personality may exaggerate or lie about his or her accomplishments, skills, and talents.
For some people with narcissistic personality disorder, this feeling of superiority is not evident in their behavior. Some may be shy or withdrawn, but they may still firmly believe that they are superior in one or more aspects compared to other people.
Delusions of perfection and superiority
People with a narcissistic personality may constantly fantasize about possessing unlimited power, intelligence, beauty, acceptance, or love. They often think they deserve it more than others.
Feeling special and unique
People with BPD may need to highlight how special and unique they are compared to everyone else.
This also leads them to believe that they can only be understood or related to by special and unique people and groups.
If someone doesn’t “get” them, it’s because they’re not smart, special, or unique.
The need for praise and attention
People with a narcissistic personality may have a constant need for admiration and praise. They may seek constant attention and may not accept any form of criticism.
They may also resent others who do not think what they do or say is exceptional.
A strong sense of entitlement
A person with BPD may be convinced that he or she deserves special treatment and is entitled to all available privileges.
Likewise, people with narcissistic personality disorder may feel that everyone must conform to their expectations and demands.
- The tendency to exploit others
Manipulative and exploitative tactics are very common among many people with a narcissistic personality. This means that they may exploit others to achieve their own goals because there is a need for personal gain above all else.
People with BPD may also use strategies such as spreading lies about others in order to get ahead.
In many cases, a person with BPD may resort to cruelty when they feel that their needs are not being met, or if someone does not treat them the way they expect.
Lack of empathy
A person with borderline personality disorder may be unable to relate to the needs of others or put themselves in someone else’s shoes. This is one of the main reasons why they may behave in a cruel or exploitative manner.
This lack of empathy may also manifest as selfishness, disregard, and lack of empathy for what others feel or feel.
Jealousy, envy, and distrust
People with this personality disorder usually believe that others are competing with them or envious of their identity. In the same way, they may often compete with others or feel jealous of their achievements.
Pride and contempt
Some people with a narcissistic personality may dismiss others as worthless, ridiculous, or despicable. This belief may lead them to display an attitude of arrogance and contempt.
Overt narcissism versus covert narcissism
It is now accepted that there are different levels and types of narcissism.
Experts mainly focus on two different subtypes of narcissistic personality disorder.
Overt narcissism
This subtype of narcissism, also called grandiose narcissism, is the most well-known. It is mainly characterized by attitudes and behaviors that are:
arrogant
sonorous
dominant
exhibitionist
violent
Self-confident
Covert narcissism
This other subtype of narcissism refers to people whose attitudes and behaviors are more common:
anxiety
- Excessive sensitivity, especially regarding criticism
Unsafe
defensive
My depression
It has been withdrawn
Even if this type of narcissism is less obvious, a person with covert narcissism will still exhibit self-absorbed behaviors, secretly believe they are superior to everyone else, and have a low ability to put themselves in other people’s shoes.
Causes and factors contributing to narcissistic personality disorder
Narcissistic personality is one of the least studied personality disorders. This makes understanding its causes and treatment options more difficult.
There is not much agreement within the medical community as to what exactly causes someone to develop borderline personality disorder.
Most researchers believe that narcissistic personality disorder is a response to a combination of two or more of these factors:
Environmental and cultural influences
Early life experiences and the parent-child bond
Genetics
In other words, someone may have developed narcissistic traits in response to specific situations they experienced from very early in life, such as:
Traumatic event
Neglect and abandonment
Excessive criticism from a loved one
Living with a parent or guardian who has a mental health condition
Abuse of any kind
discrimination
Excessive pampering and praise
Medical history of narcissistic personality disorder in the family
Originates in an individualistic culture
Not everyone will respond the same way to these events. For this reason, it is difficult for researchers to determine the exact causes of personality disorder.
These same reasons may also cause someone to behave in a certain way that may be viewed as narcissism, even if it is not narcissistic personality disorder.
How is narcissistic personality disorder diagnosed?
Diagnosis of borderline personality disorder should be left to a mental health professional only.
It may be tempting to evaluate someone you know based on this information, but in reality, narcissism goes beyond just certain behaviors or attitudes. It is impossible for an untrained and formally educated person to make a proper diagnosis.
A psychiatrist, psychologist, or other mental health professional usually diagnoses narcissistic personality disorder after having direct access to the person and their medical history.
Even for a mental health professional, BPD may not be easy to diagnose in some cases. This is because it is rare for someone with BPD to commit to seeking help, talking openly about their thoughts, or even attending a therapy session.
A mental health professional may follow the DSM-5 model to diagnose narcissistic personality disorder. They will then monitor and measure the following:
Individual personality traits
How a person functions in the world (relationships, jobs, etc.)
Sense of identity
Self-esteem and self-image changes over time
If a person is capable of empathy
The mental health professional will try to identify five or more symptoms of borderline personality disorder. If they do, they will be able to make a diagnosis and recommend treatment accordingly.
Although teens may show early signs of the disorder, borderline personality disorder is usually diagnosed in adulthood.
This is because children and adolescents are still in a stage of continuous physical and mental development. These persistent personality changes at an early age may make it difficult to recognize permanent patterns of behavior.
If BPD is diagnosed during adolescence, it is because there is a clear pattern of behavior that has been evident for more than one year.
There has been some controversy about how to diagnose borderline personality disorder.
This is mostly because many mental health professionals have focused on the more obvious interpersonal behaviors of those with BPD and have not focused enough on the internal conflicts, vulnerabilities, and challenges they live with. This sometimes leads to judgment rather than understanding.
How common is a diagnosis of narcissistic personality disorder?
Experts estimate that about 5.3% of the U.S. population has borderline personality disorder. It is an estimate because prognosis depends on many factors, including how willing a person is to seek a diagnosis and treatment. This may not be the case for many people with this disorder.
A diagnosis of borderline personality disorder is more common among men than among women. Between fifty and 75% of people diagnosed with borderline personality disorder are male.
Treatment of narcissistic personality disorder
Therapy has the potential to help someone with BPD develop skills and strategies that can help them change the way they relate to others and themselves.
The challenge is that many people with personality disorders often do not seek treatment until the disorder begins to significantly interfere or affect their lives.
People with borderline personality disorder are sometimes more likely to have other mental health conditions, such as:
Anxiety disorders
depression
Substance abuse disorder
In many cases, they may seek help for these conditions and not the BPD itself.
Sometimes, a person with borderline personality disorder may seek treatment for reasons other than believing they have a problem. For example, when they feel conflicted because their relationships or lifestyle do not live up to their high standards. Or when they feel like they are losing someone’s admiration or interest.
When someone with BPD comes to therapy for these reasons, they don’t realize that these difficulties may come from their personality traits. They may blame others for their problems and may see therapy as a place to vent, not wanting to accept any responsibility.
Even when treatment for NPD is sought, clinical case studies indicate that people with BPD have difficulty staying in treatment long enough to result in long-term changes in behavior.
For one thing, people with BPD may have challenges interacting with others in general, which is evident in the therapist and client environment. They may also often not realize that they have a problem.
Sometimes, when a person with BPD continues in treatment, they may show slow progress and be reluctant to change because of the disorder’s core personality traits. Since they may not accept responsibility, they may not find any good reason to change.
However, long-term psychotherapy appears to be the most effective treatment for BPD.
When a person commits to long-term treatment, a therapist may be able to help them:
Regulate and understand their own emotions
Identify behaviors and attitudes that may lead to conflict with others
Develop the ability to prevent and change these behaviors
Manage reactions to criticism and feedback
Develop the skills necessary to build more intimate and stable relationships
Develop adaptive coping mechanisms
Explore, tolerate and understand other people’s points of view
These goals are case-specific and vary depending on the person’s needs and the therapist’s style.
Many psychotherapeutic approaches have been used to treat narcissistic personality disorder. The most common include:
Analytical psychotherapy
Cognitive behavioral therapy
Schema-focused psychotherapy
Interpersonal metacognitive psychotherapy
Dialectical behavioral therapy
