Narcissistic personality disorder: Symptoms, diagnosis, and treatments

Narcissistic personality disorder is a diagnosable condition characterized by impulsivity, volatility, attention-seeking, and a lack of empathy. As it can lead to problems with relationships and health, it is important to know the symptoms and treatments for this condition.

What is narcissistic personality disorder?

Narcissistic personality disorder (NPD) is a mental health condition in which a person may show a pattern of behavior or inner experience that may include:

• a need for admiration from others
• a grandiose or excessive sense of self-importance
• a sense of entitlement
• a preoccupation with themselves
• a lack of empathy for others.

NPD may occur in up to 5% of the US population. The condition is 50% to 75% more common in males than females. Narcissistic personality disorder affects all areas of life, and can harm a person's physical and mental health and lead to problems in social and work relationships. People with NPD are also at a higher risk for completing suicide.

Narcissistic personality disorder symptoms

Narcissistic personality disorder is categorized as a type of personality disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which lists nine criteria to diagnose the condition. According to the DSM-5, a person with NPD may display or possess:

• a grandiose sense of self-importance
• a preoccupation with fantasies of success, power, beauty, or perfect love
• a belief that they are "special" and can only be understood by other special people
• a need for excessive admiration
• a sense of entitlement, which may include an unreasonable expectation to be treated favorably or for others to comply with their demands and expectations
• behavior that is exploitative and takes advantage of others to achieve their own ends
• a lack of empathy or an unwillingness to identify with the needs of others
• a tendency to be envious of others or a belief that others are envious of them
• arrogance, haughty behaviors, and attitudes.

Causes of narcissistic personality disorder

Researchers are trying to understand the causes of NPD. Experts believe that a combination of family history of NPD, as well as certain early life experiences, may be key factors leading to the condition.

Some early childhood experiences thought to contribute to NPD include:

• being rejected as a child
• excessive praise by parents or caregivers
• excessive judgement by parents or caregivers
• trauma or abuse.

Types of narcissistic personality disorder

While the DSM-5 does not describe different types of narcissistic personality disorder, research suggests there may be different subtypes of NPD.

• Grandiose: This subtype is described as attention-seeking, entitled, arrogant, exploitive, lacking empathy, and charming.
• Vulnerable: This subtype is described as shy, hypersensitive to criticisms or "thin-skinned," and chronically envious. However, this individual may secretly harbor grandiosity.
• High-functioning: This subtype is described as grandiose, competitive, attention-seeking, and sexually provocative. NPD is often misdiagnosed in a person with this subtype, as they may not appear to have a personality disorder.

Both grandiose and vulnerable subtypes are exceedingly self-absorbed.

Diagnosing narcissistic personality disorder

Many people with NPD do not think there is anything wrong with them. They may not seek treatment, or if they do it's often for another condition like depression or substance use. If you do see a mental health professional, he or she will ask you about your symptoms, including their severity and duration. They will also likely conduct a psychiatric interview to understand more about your personality, coping skills, and interpersonal relationships.

Making a diagnosis of narcissistic personality disorder can be challenging because, more often than not, NPD is present along with other mental health disorders such as:

• substance use disorders
• depression
• anxiety
• bipolar disorder
• other personality disorders, such as antisocial personality disorder, borderline personality disorder, histrionic personality disorder, or schizotypal personality disorder.

Narcissistic personality disorder treatments

Treatment for narcissistic personality disorder typically involves psychotherapy (talk therapy) with a mental health professional. This form of therapy may be done individually or with your partner or family, and can help you relate to other people in a more positive way.

There are no FDA-approved medications for the treatment of NPD. However, some medications, such as antidepressants, mood stabilizers, and antipsychotic medications, may relieve the symptoms associated with co-existing disorders including anxiety, depression, and other mood disorders.