The hallmarks of narcissistic personality disorder are grandiosity, a lack of empathy for others, and a need for admiration. People with this condition are often described as arrogant, selfish, manipulative, and demanding. They may also have grandiose fantasies and believe they deserve special treatment. These characteristics typically begin in early adulthood and should be consistently evident in multiple contexts, such as work and relationships.
People with narcissistic personality disorder often try to relate to others who they believe are unique or gifted in some way, which can boost their self-esteem. They tend to seek excessive admiration and attention and have difficulty tolerating criticism or defeat.
Although narcissistic personality disorder is a difficult disorder to treat, treatment can help those with the condition develop a sense of self and their relationships.
Narcissistic personality disorder refers to a diagnosable mental disorder, while the term “narcissism” is a trait that varies in degree from person to person.
Symptoms
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), individuals with narcissistic personality disorder exhibit five or more of the following symptoms, which appear in early adulthood and across a variety of contexts:
Inflated sense of self-importance
Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
Belief that one is special and can only be understood or connected to by special people or institutions
Need for excessive admiration
Feelings of entitlement (to special treatment)
Exploitativeness of others
Lack of empathy
Envy of others or the belief that one is the object of envy
Arrogant and haughty behaviors or attitudes
Individuals with narcissistic personality disorder can be easily affected by criticism or defeat and may react with contempt or anger—but social withdrawal or a false appearance of humility may also follow, according to the DSM-5.
Feelings of entitlement, disregard for others, and other aspects of narcissistic personality disorder can damage relationships. While a person with narcissistic personality disorder may be a high achiever, narcissistic personality disorder can also hurt functioning (due to, for example, a person’s sensitivity to criticism).
Researchers have reported associations between narcissistic personality disorder and higher rates of substance abuse, mood disorders, and anxiety. These may be due to characteristics such as impulsivity and increased shame in people with narcissistic personality disorder.
Having narcissistic traits in adolescence does not necessarily mean that a person will have narcissistic personality disorder as an adult.
Causes
The causes of narcissistic personality disorder are not yet well understood, but biological and environmental factors play a role.
In addition to the genetic roots of the disorder, research suggests that early experiences—such as parenting styles and social and cultural environments—also influence the course of the disorder. For example, narcissism is higher in individualistic cultures than in collectivist cultures, and competitive environments like New York City are higher than in noncompetitive environments like Iowa.
In terms of parenting, an intense focus on competition and success can foster narcissism, while warmth, affection, and simply expecting children to do their best can promote healthy development.
Treatment
Treatment of narcissistic personality disorder can be challenging because people with the condition have a high level of grandiosity and defensiveness, which makes it difficult for them to acknowledge problems and weaknesses.
While change is difficult, it is not impossible. The key is to find a therapist who is trained to work with people with narcissistic personality disorder.
Therapy can help people with narcissistic personality disorder learn how to relate to themselves and others more compassionately. By exploring their experience, developing a therapeutic relationship, and focusing on relationships, community, and connection, narcissists can develop a healthy sense of self and, in turn, healthier relationships with others.
