The other day, a friend of mine asked me a question about the age of onset of Narcissistic Personality Disorder.

I was sure I knew the answer, so I mentioned the information about the characteristics as defined in the Diagnostic and Statistical Manual of Mental Disorders, that they usually begin to appear in the late teens, but become noticeable mainly from the twenties onwards, and as a person gets older, they tend to exhibit less extreme and grandiose behaviors.

Her response to my “weird” answer was surprising and sent me back to all my favorite textbooks in a state of complete insecurity about my knowledge. Her brother-in-law described the case:

How Sam became a narcissist later in life

“Sam was a research scientist in the geology department at a university and was very successful, especially in teaching which he loved, and his students loved him. He is a bit short so he has a kind of ‘little man complex’ where he loved to perform in front of others at social gatherings or events, and you always noticed Sam. His voice was also high. Perhaps this is what made him a good lecturer in that his lectures were always a performance, whether he was talking about his passion for Quaternary fossils or his love of raising and rescuing injured raptors on his farm near the city.

He had some risk factors for a personality disorder as his mother was cold and aloof and resented having to give up her life to become a mother and always told her children about it until she died. He was also sent to boarding school and was the black sheep of the family having chosen an academic career rather than becoming a surgeon like his father and younger brothers. The fact that he had an international reputation meant nothing. If anything Motivate him.

Related : 10 Signs You Have A Narcissistic Sibling

Sam was happily married with four half-grown children when he was struck by a shock. A student who had failed her thesis accused him of sexually assaulting her. He was suspended and eventually acquitted, and it turned out she had done the same thing at school to a teacher she was friends with. But rumors spread at university and he felt he could no longer work there. He left to work for an environmental consulting firm.

Soon after, he began drinking heavily and when he got drunk he would berate his wife, his family, and everyone else. He became louder and more attention-seeking, and this perfectly nice guy as he was, seemed to fit the diagnostic criteria for Narcissistic Personality Disorder except for the age of onset. He became dysfunctional, could no longer work, and went into a downward spiral, losing his wife, family, and home. He now lives with his parents, where he rages at the world and writes angry, unpublishable essays about his former major.

Of course, Sam is not his real name.

I must admit that the story prompted me to search for any source I could find, and there wasn’t much. No, while no one is saying definitively that NPD cannot develop later in life, there is a dearth of evidence to support this.

The dominance of the medical model may be partly responsible for this. Clinically, only young people have been studied in great depth and the diagnostic criteria are focused on this age group.

There is an old saying that if you look for something, you will find it and nothing else.

This implies that no one has looked for late-onset personality disorders and NPD.

What does the research say about late-onset NPD?

I think it may be out there but hidden somewhere else.

We now have many adults who are being labelled with a variety of long-term mental health conditions, and perhaps some people with PTSD, major depressive illness, etc., may equally well qualify for a diagnosis of some form of late-onset NPD.

An academic review article supports my hunch, in which Oltman and Balsis (1) argue that:

“Compared to the literature on most forms of mental disorder, little attention has been paid to the course of personality disorders. This is especially true in midlife and beyond. Some longitudinal studies have made significant contributions to our understanding of personality disorders, but they have largely focused on the life span from childhood to adolescence and early adulthood.”

The conclusion of their article recommends that the course of personality disorders in midlife and older populations should be studied to gain a better understanding.

However, if clinicians applying this classification have preconceived notions about age of onset, finding such a sample will be as difficult as finding “hen’s teeth.”

In the less academic and clinical environment of the Internet, it is possible to find posts by many people, such as my friend’s sister, who was in a relationship with someone with late-onset personality disorder.

They are alone, questioning the diagnostic processes and criteria while their lives are being destroyed by proxy.

Related : Walk a Mile in My Shoes- The Burden of the Narcissistic Enabler

This is when the person they once knew and loved turns into someone they no longer know – a boastful, selfish, manipulative user who may or may not have a self-sabotaging streak.

From my reading of these painful posts, it seems that most of the partners have a predisposition to a personality disorder that may be Narcissistic Personality Disorder, including an abusive childhood followed by some sort of psychological trauma that caused a full-blown manifestation.

Unlike their diagnosed counterparts, they are not taken seriously in mental health treatment because they do not fit the criteria and are given inappropriate treatment such as cognitive behavioral therapy and then left to flounder with the completely mislabeled “habitual” or “alcoholic”. How many families have been destroyed in the process? Something needs to be done.

Note: Sam’s oldest daughter is now in her 20s. She had a traumatic relationship….with a narcissist!