Narcissistic Personality Disorder

What is narcissistic personality disorder?

Narcissistic personality disorder (NPD) is a mental health condition that affects how you view yourself and relate to others. Having NPD means you have an excessive need to impress others or feel important. That need can be strong enough to drive harmful behaviors, negatively affecting you and those around you.

NPD gets its name from Narcissus, a hunter from Greek mythology. According to the myth, Narcissus was so obsessed with his own beauty that he couldn’t stop looking at his reflection in a pool of water. He did nothing else but stare at his reflection until he died.

While people commonly connect the term “narcissism” to physical appearance — just like in the myth — NPD isn’t just about how you look. It can also involve other traits or abilities you have, such as intelligence, charisma, artistic skill, athletic ability, wealth, power, success and more.

How common is narcissistic personality disorder?

Experts aren’t sure how common NPD is. According to research data, between 0.5% and 5% of people in the U.S. may have it. Between 50% and 75% of cases affect men and people assigned male at birth (AMAB).

However, many people hide narcissistic beliefs or behaviors (informally known as “covert narcissism”). Because of that, it’s hard to estimate how many people truly have NPD.

What are the symptoms of narcissistic personality disorder?

The symptoms of NPD all revolve around thoughts, feelings and actions. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fifth edition text revision (also known as the “DSM-5-TR™” or just “DSM-5®”) has a list of nine criteria. To others, the symptoms that fall under the criteria may look like the following:

1. Grandiose sense of self-importance.

• Overestimating their capabilities or holding themselves to unreasonably high standards.
• Bragging or exaggerating their achievements.

2. Frequent fantasies about having or deserving:

• Success.
• Power.
• Intelligence.
• Beauty.
• Love.
• Self-fulfillment.

3. Belief in superiority.

• Thinking they’re special or unique.
• Believing they should associate only with those they see as worthy.

4. Need for admiration.

• Fragile self-esteem.
• Frequent self-doubt, self-criticism or emptiness.
• Preoccupation with knowing what others think of them.
• Fishing for compliments.

5. Entitlement.

• Inflated sense of self-worth.
• Expecting favorable treatment (to an unreasonable degree).
• Anger when people don’t cater to or appease them.

6. Willingness to exploit others.

• Consciously or unconsciously using others.
• Forming friendships or relationships with people who boost their self-esteem or status.
• Deliberately taking advantage of others for selfish reasons.

7. Lack of empathy.

• Saying things that might hurt others.
• Seeing the feelings, needs or desires of others as a sign of weakness.
• Not returning kindness or interest that others show.

8. Frequent envy.

• Feeling envious of others, especially when others are successful.
• Expecting envy from others.
• Belittling or diminishing the achievements of others.

9. Arrogance.

• Patronizing behavior.
• Behaving in a way that’s snobby or disdainful.
• Talking down or acting condescendingly.

People with NPD may also show other behaviors related to the nine criteria, but still different, such as:

• Fear of or avoiding vulnerability.
• Withdrawing from others to hide feeling vulnerable.
• Perfectionism (with or without a fear of failure).
• Hypersensitivity to criticism, rejection or failure.
• Experiencing severe depression related to rejection or failure.
• Reacting with anger (or even rage) when they feel criticized or rejected.
• Faking humility to hide their feelings or protect their sense of self-importance.
• Avoiding situations where failure is possible or likely, which can limit achievements.

What causes narcissistic personality disorder?

NPD is a mental health condition, so experts aren’t exactly sure why it happens. People with NPD often have subtle differences in brain structure, but experts aren’t sure if that’s what causes NPD or happens because of NPD.

For now, the main contributing factors to NPD seem to be:

• Genetics. People with NPD are more likely to have parents or close relatives with it.
• Observation and imitation. Children can observe, imitate and learn traits and behaviors that can develop into NPD.
• Negative childhood experiences. There may be a link between negative childhood experiences. Trauma, rejection, neglect and lack of support during childhood can all contribute to developing narcissistic traits.
• Parenting style. Overindulging children and overprotective or “helicopter” parenting may lead to a child who grows to expect and demand the same treatment they received from parents or parental figures. It may also keep your child from learning to regulate their own feelings and emotions, which can contribute to trouble controlling emotions when things don’t go their way.
• Culture. Research indicates that the culture you grow up in can influence your risk of developing NPD. The risk seems to be higher in cultures where individualism and personal independence are more encouraged. People who grow up in cultures that encourage a sense of community and collective action are less likely to develop NPD.

What are the complications of narcissistic personality disorder?

It’s very common for NPD to overlap with other mental health conditions and concerns. Some of the most common overlaps or complications include:

• Mood disorders or bipolar disorder. Anxiety and depression are more likely to happen in people with NPD. Bipolar disorder is also more common in people with NPD.
• Other personality disorders. Some examples include borderline personality disorder (BPD) and antisocial personality disorder (ASPD).
• Body dysmorphic disorder. People with NPD may also have body dysmorphic disorder (also known as “body dysmorphia”). Negative feelings about their body and appearance can make this more likely to happen.
• Substance use disorders (SUDs). People with NPD may turn to alcohol or substance use to help them when reality doesn’t meet their expectations. Cocaine and other stimulants are particularly common, as they provide feelings that people with NPD might want to seek.
• Suicide. People with NPD may experience extreme depression or even despair when faced with challenges, failure or rejection. These are less likely to be impulse acts or “cries for help.” This means people with NPD are more likely to complete suicide.

How is narcissistic personality disorder diagnosed?

A healthcare provider, usually a psychiatrist or psychologist, can diagnose NPD by talking to you and asking questions about your life and interactions with others (especially family, friends or other loved ones). They may also diagnose related conditions or ask questions to rule out conditions with similar symptoms or effects.

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fifth edition text revision (also known as the “DSM-5-TR™” or just “DSM-5®”) has a list of nine criteria. You must have at least five of them to receive a diagnosis of NPD. There aren’t any diagnostic, lab or imaging tests that can help diagnose NPD.

How is narcissistic personality disorder treated?

Treating NPD usually involves some form of mental health therapy (psychotherapy).

Some of the therapy types that are most common with NPD include (but aren’t limited to) the following:

• Dialectical behavioral therapy (DBT).
• Cognitive behavioral therapy (CBT).
• Metacognitive therapy.
• Group therapy.
• Couples or family therapy.

Because there are so many therapy methods, your mental health provider is the best person to tell you more about the different types. They can answer any questions you have about how these approaches work and recommend a type that fits your needs best.

Medications that treat NPD

There aren’t any medications that treat NPD directly, but medications may treat symptoms that happen with related conditions, like anxiety or depression. Some of the medications that may help symptoms of NPD-related conditions include:

• Antidepressants.
• Antianxiety medications (anxiolytics).
• Antipsychotic medications.
• Anticonvulsant medications (these mainly treat seizures, but some, like lamotrigine, can help stabilize your mood).

Can narcissistic personality disorder be prevented, or can I lower my risk of developing it?

NPD happens for reasons that experts don’t fully understand. It also may run in families. Because of both those factors, it isn’t possible to prevent it in yourself or your child.

You may be able to reduce the risk of your child developing it with how you parent, such as finding ways to adapt your parenting style to specific situations. Your child’s pediatrician can guide you on ways to do this or may be able to recommend a provider who specializes in childhood psychological development.

What can I expect if I have narcissistic personality disorder?

People with NPD may not be aware of it. Some can go years or decades without knowing. Often, it takes some kind of stressful event or circumstance for the symptoms to appear fully. Some examples of events or circumstances include:

• Significant negative changes: Demotion, losing a job, bankruptcy, etc.
• Personal crises: Breakups or divorce.
• Other kinds of life crises: Age-related illness or changes, especially those that affect your ability to live independently, or death of a close loved one.
• Ultimatums: People with NPD may not seek help until loved ones demand it or push the issue.

What’s the outlook for narcissistic personality disorder?

The outlook for NPD depends on several factors. They include:

• Symptoms you have. Some symptoms of NPD may make you less willing or likely to ask for help. People with vulnerability-related symptoms are also less likely to draw attention that leads to them getting a diagnosis.
• How severe your NPD is. This condition can be very disruptive to your life when it’s severe. People with severe NPD are often more aggressive or confrontational, or less empathetic to the feelings and needs of others. They’re also less likely to ask for help or seek treatment.
• Other conditions you have. People with NPD who have other conditions may have greater challenges. Some examples of conditions that can make NPD a bigger problem include anxiety and depression, other personality disorders (especially antisocial personality disorder) or substance use disorders.

Because so many factors can play a role, your mental health provider is the best person to ask about the outlook for your condition. They can tell you more about what to expect and what you can do to help yourself along the way.

How do I take care of myself?

If you have NPD, you may struggle with accepting the diagnosis. The symptoms of this disease may make you want to push back against or avoid learning that you have any kind of disorder. But it’s important to recognize that treatment can help improve your life and how you relate to others. That can make it easier for you to form and build relationships, pursue personal or professional success, etc.

Some of the most important things you can do include:

• Seeing your mental health provider as recommended. People with NPD have a higher risk of “dropping out” of treatment. This can make things worse for you in the long run.
• Taking medications as prescribed. These can make it easier for you to manage and regulate your emotions and the symptoms of NPD.
• Avoiding substance or alcohol use. While they may make you feel better, that’s only temporary. They may also make things much worse for you in the long run. If you take medications, alcohol or other substances can also cause drug interactions, some of which are dangerous.

When should I see my healthcare provider, or when should I seek care?

You should see your healthcare provider as recommended. They’ll set up a schedule for treatment and follow-up visits. You should also see your provider if you notice any changes in your symptoms or how effective your medications are.

When should I go to the hospital or emergency room?

You should go to the ER or call 911 (or your local emergency services number) if you have thoughts about harming yourself, including thoughts of suicide, or about harming others. If you have thoughts like these, you can call any of the following:

• National Suicide and Crisis Lifeline (United States). This line can help you if you have suicidal thoughts or impulses, and you can also call this line even when you’re not in crisis. To call this line, dial 988. You can also get help via text message. To do so, text HELLO to 741741.
• 911 (or your local emergency services number). You should call 911 (or the local emergency services number) if you feel like you’re (or someone you know is) in immediate danger of self-harm or suicide. Operators and dispatchers for 911 lines can often help people in immediate danger because of a severe mental crisis and send first responders to assist.

Are there different types of narcissism?

The DSM-5-TR (the latest revision of the DSM-5) doesn’t describe different types of narcissism or NPD. But experts often still organize narcissism based on traits or behaviors.

Some of the traits used are:

• Grandiose (wanting admiration or recognition) vs. vulnerable (needing approval to maintain self-esteem or feeling afraid of disapproval).
• Overt (visible) vs. covert (hidden).
• Benign (harmless) vs. malignant (willing to hurt or take advantage of others).

These aren’t formal distinctions, but a mental health provider may tell you about them to help you understand your condition. You can also ask a provider about these traits if you think they apply to you.

Can I take a test to see if I have narcissistic traits?

Providers may use several diagnostic screening questionnaires to help diagnose NPD. While you might feel tempted to take a test online to see if you have it, you should remember that it isn’t a formal diagnosis. You should see a trained, qualified provider to be certain of the diagnosis.

What do I do if I think a loved one has narcissistic personality disorder?

People with NPD may be unable to see its signs and symptoms in themselves. Often, family, friends or loved ones may be the first to suspect someone has NPD. If you suspect someone you care about has NPD, you should keep in mind the following:

• You can’t change someone with NPD. The only person who can change their behavior is themselves. While you may feel frustrated by a loved one’s unwillingness to change, remember that it’s not your fault. You can encourage them to receive care, but they have to want it for this to succeed.
• Stay calm and don’t take things personally. People with NPD may try to antagonize or draw a reaction, especially when lashing out. Don’t take it personally, and don’t respond in kind.
• Set healthy boundaries. People with NPD often consciously or unconsciously try to get what they want by going to others. If you have a loved one with NPD, setting healthy boundaries may be necessary. Make sure you communicate what you’re willing and unwilling to do, and hold fast once you set boundaries. It may be difficult, but giving in to their demands won’t help (and may make things worse).
• Protect yourself. People with NPD often resort to gaslighting (trying to convince you that either you or they said or did something differently) to undermine your boundaries. Keep notes or a journal if you think you’ll need to be certain in the future about what you said or did. They may also lash out (either verbally or physically) out of anger. Be sure to protect your own health and well-being.
• Take care of your own mental health. People who have loved ones with NPD should consider seeing a mental health professional also. Doing so can help you better work through your own emotions and difficulties surrounding NPD, and better prepare you for how to deal with the effects of this condition in a loved one.
• Don’t ignore warning signs. People with NPD have a higher risk of dying by suicide. If you suspect a loved one with NPD is withdrawing or considering harming themselves, talk to them directly. Call 911 (or your local emergency services number) immediately if you think they’re in imminent danger.

A note from Cleveland Clinic

Narcissistic personality disorder isn’t a flaw or a character defect. It’s a mental health disorder. If you have it, there are things you can do to help yourself and strengthen your connections to others in a healthy way. It may be difficult to accept or admit, but this condition can seriously damage relationships and disrupt your life. You shouldn’t ignore it or avoid the reality of it.

If you know someone with NPD, learning about it can help you take care of yourself and try to help them. Sometimes, the best thing you can do is establish boundaries and not engage. Remember that you can’t force someone with NPD to change. They have to be willing to do so.