What is Narcissistic Personality Disorder?

Do you know someone who requires constant attention, excessive admiration, and lacks empathy? These personality traits could potentially mean that you are dealing with someone who has narcissistic personality disorder–especially if this behavior is disruptive and getting in the way of their day-to-day life and relationships. 

Many people throw around the term “narcissist,” but it’s relatively rare for someone to truly be diagnosed with narcissistic personality disorder, or NPD. It’s estimated that anywhere from 0.5% to 5% of people in the U.S. have this unique personality disorder. 

So, if you think your loved one, family member, or friend could be a narcissist, it’s important to be aware of the symptoms of narcissistic personality disorder so you can keep an eye out for narcissistic behavior and help them get the treatment that they need to better their lives and relationships.

Here’s what you need to know about what narcissistic personality disorder is, its symptoms, common co-occuring mental health conditions, and treatment. 

What is narcissistic personality disorder?

First, let’s discuss what a “personality disorder” is in the first place. According to the American Psychiatric Association, in order for someone to be diagnosed with a personality disorder, they must have ways of thinking, feeling, or behaving that are outside of the “expectations of culture.” This behavior is long-lasting and causes “distress or problems functioning.” Personality disorders can also cause troubled relationships, whether with friends, family, or romantic partners. The worrisome behaviors typically begin to show up in the teenage or young adult years, and progress from there.

There are three types or Clusters of personality disorders, and NPD falls into what’s known as Cluster B personality disorders. Aside from narcissistic personality disorder, the other Cluster B personality disorders are: 

• Antisocial personality disorder
• Borderline personality disorder
• Histrionic personality disorder

Essentially, what all of these disorders have in common is that the person may be very emotional, erratic and dramatic. It’s also common for them to act unpredictably in various situations. 

While many people can exhibit narcissistic tendencies once in a while, it doesn’t necessarily mean the person has narcissistic personality disorder. You can distinguish the personality trait from the personality disorder because the disorder will involve pathological narcissism that severely affects the person’s life, functioning, and relationships. For someone who just exhibits narcissistic behavior or seems self-absorbed from time to time, this is likely not the case. 

So, what are the symptoms of narcissistic personality disorder? The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, has specific diagnostic criteria.

The DSM-5 says NPD is, “A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts.” In order to be diagnosed with narcissistic personality disorder, someone must meet at least five of the below criteria from the DSM-5 that are narcissistic personality disorder symptoms: 

• Is very “grandiose,” having inflated self-importance and feeling superior to others, often embellishing their talents or achievements 
• Often fantasizes about things like power, success, and beauty 
• Feels like they are one-of-a-kind and that only other special or high-power people can understand them
• Needs constant admiration 
• Unreasonably feels entitled to special treatment 
• Exploits others and takes advantage of them for their own benefit 
• Is not empathetic and doesn’t consider other people’s needs or emotions
• Gets jealous of other people, and thinks other people are jealous of them
• Is arrogant and egotistical 

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Researchers and doctors are not sure of the specific causes of narcissistic personality disorder. However, they think that some potential causes of NPD include:

• Being genetically predisposed (for example, having a narcissistic parent)
• Experiencing trauma or abuse early in life
• Sensory hypersensitivity early in life 
• Having an upbringing where one’s parents were either overly critical or overly adoring

Additionally, males are more likely to have narcissistic personality disorder. It’s estimated that men make up 50%-75% of diagnosed cases of NPD. 

What are the different types of narcissistic personality disorder?

Among people with narcissistic personality disorder, there are different types of narcissism. These are determined based on the specific narcissistic traits that an NPD patient exhibits. The subtypes simply provide more insight and understanding of how a narcissist acts and thinks, but they are not distinct diagnoses. There is only one official formal diagnosis: narcissistic personality disorder.

The main two subtypes are overt narcissism and covert narcissism. Overt narcissism is sometimes referred to as grandiose narcissism, and covert narcissism is sometimes referred to as vulnerable narcissism. 

Since both overt narcissists and covert narcissists must meet diagnostic criteria for NPD, there is plenty of overlap in general symptoms. However, there are some major differences, too. 

Here is a breakdown of the ways that the different forms of narcissism can present:

Traits of overt/grandiose narcissists:

• Tend to be the more outwardly obvious type of narcissist to outsiders
• Are very grandiose, thinking they’re special and better than everyone else 
• Constantly seek out attention and admiration 
• Are outwardly self-absorbed, arrogant, and entitled 
• Exploit other people
• Ignore other people’s needs, lacking empathy
• Can be aggressive 

‍Traits of covert/vulnerable narcissists:

• Tend to be less obviously a narcissistic to outsiders 
• Are hypersensitive to criticism 
• Are often jealous of others
• Compare themselves to other people
• May come across as anxious or shy
• Still grandiose, but more inwardly 

The most severe and harmful type of narcissism is malignant narcissism. This type of narcissist is potentially dangerous to others, and can be quite difficult to treat. 

On top of the typical NPD symptoms, some signs of malignant narcissism are:

• Exhibiting antisocial behavior 
• Being paranoid
• Being overly aggressive
• Being sadistic (enjoying inflicting pain on others)
• Lying often
• Having psychopathic traits

This type of narcissist will typically be very manipulative, conniving, and take pleasure in hurting other people –– putting those around them in danger of emotional or physical harm. 

Which mental health conditions co-occur with narcissistic personality disorder?

It’s common for someone with NPD to have more than one personality disorder. For example, they may also be likely to be diagnosed with:

• Antisocial personality disorder
• Borderline personality disorder
• Histrionic personality disorder
• Schizotypal personality disorder 

Additionally, it’s common for someone with narcissistic personality disorder to experience other mental health conditions, including:

• Major depressive disorder
• Bipolar disorder
• Substance use disorder/substance abuse 
• Anxiety disorder

Furthermore, experts say that compared to other personality disorders, NPD comes along with the highest suicide risk. The risk is even higher if a narcissist also struggles with depression. However, even if a narcissist doesn’t have depression, they can still be at risk of death by suicide. This can be the case due to their intense emotions, troubled relationships, or hits to their self-esteem.  

The symptoms and challenges of any co-occurring disorders can feed off each other. That’s why it’s so important to get these mental health conditions under control so they do not continue to impair functioning and quality of life.

Symptoms of various mental health conditions may overlap. A mental health professional can help someone understand what condition or conditions they might have based on symptoms, history, and official diagnostic criteria.

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What is the treatment for narcissistic personality disorder? 

Oftentimes, people with narcissistic personality disorder do not think that they have any problems or need any kind of mental health treatment. Due to their inflated sense of self and arrogance, they might think that it’s everyone else around them who has the problem.

Therefore, people with NPD typically do not seek out treatment on their own. Usually, people with NPD only end up getting treatment if they seek mental health care for a co-occurring mental health condition, such as depression. From there, when a mental health professional like a therapist, psychologist, or psychiatrist evaluates them, they may see signs of NPD and make the diagnosis of narcissistic personality disorder.

Alternatively, a loved one such as a family member, partner, or friend may intervene if they notice a narcissist’s behavior worsening and causing negative impacts. However, even if you truly believe that your loved one is a narcissist and urge them to seek therapy, they still may not believe there’s anything wrong with them, and may be offended. For these reasons, it can be very tricky to get a narcissist to actively admit their behavior is a problem and agree with you –– however, treatment is certainly available and helpful if a narcissist will comply and stick with it.  

There is no one-size-fits-all treatment plan for narcissistic personality disorder. However, in many cases, narcissistic personality disorder treatment involves long-term therapy. While talk therapy or cognitive behavioral therapy (CBT) are commonly used for treatment of many mental health conditions, personality disorders often require more specialized treatment.  

Some specific types of therapy used to help a narcissist include: 

• Mentalization-based therapy
• Transference-focused psychotherapy
• Schema-focused psychotherapy
• Dialectical behavior therapy (DBT)

Medications may also be prescribed to a narcissist, although there isn’t a medication that is specifically prescribed for narcissistic personality disorder. Rather, medications are used to treat symptoms of any co-occurring conditions ––– like depression, anxiety, or bipolar disorder ––so they can improve overall mental health. For example, someone with NPD may be prescribed antidepressants, mood stabilizers, or antipsychotic medications. 

Treatment for someone with narcissistic personality disorder will be highly individualized based on how someone’s narcissism presents and what other personality disorders or mental health conditions they have. Oftentimes, a team of mental health professionals may work together to treat a narcissist. For example, someone with NPD may see a psychologist, social worker, or counselor for their therapy, and a psychiatrist for their medication management. The therapist and psychiatrist will collaborate to come up with the best course of treatment for the individual. 

Ultimately, much more research is needed surrounding NPD and narcissistic personality disorder treatment. While the concept of narcissism has been around for centuries, even making appearances in ancient Greek mythology, this personality disorder was only formally recognized and added to the Diagnostic and Statistical Manual of Mental Disorders in 1980. Hopefully, as NPD continues to be researched and better understood by mental health professionals, new innovations in treatment will be available. 

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How can Charlie Health help young adults with narcissistic personality disorder?

If you think a young adult in your life is a narcissist and/or struggles with any other mental health conditions, Charlie Health may be able to help. 

We know that every individual has their own unique mental health journey depending on what symptoms they have and the difficulties they face. Our personalized intensive outpatient program provides mental health treatment for teens, young adults, and families dealing with a variety of struggles, including narcissistic personality disorder and any other co-occurring conditions.

At Charlie Health, every client is matched with a therapist who fits their specific needs, and will also be matched with a group of peers who are from similar backgrounds with similar struggles. 

Coping with narcissistic personality disorder can be very difficult, but it is certainly possible for people with NPD to experience a healthier, higher quality of life and improved mental health –– help is here now. Get started.