What is Narcissistic Personality Disorder?

What is Narcissistic Personality Disorder?

Introduction

Do you know the origins of the term narcissistic personality disorder? The character Narcissus from Greek mythology is the basis for the term narcissism. Previously known as Narcissists, people with Narcissistic personality disorder have preoccupations with themselves and their outward appearances. They also are fixated on how others perceive them.

Greek Mythology

In ancient Greek mythology, a proud hunter named Narcissus was known for his handsomeness. Narcissus was drawn to anything beautiful and thrived on admiration. He also had disdain for people who loved him. Some of his loved ones committed suicide as a way of proving their unrelenting devotion to his striking appearance.

The Sadness of Echo

Narcissus broke the heart of the wood nymph Echo, who loved him, but he did not care. She then spent the rest of her sad days wandering the woods until all that remained was only her echo sound.

Nemesis Enacts Her Revenge

The goddess of revenge, Nemesis, then retaliated for Echo’s heartbreak. She lured Narcissus to a pool where he saw his reflection in the water. Not realizing he was gazing at himself, he fell in love with the image and could not pull away. Narcissus then realized it was a love that could not be returned. As a result, his fiery passion caused him to melt away until all that was left was a narcissus flower.

Narcissistic Personality Disorder Defined

Narcissistic personality disorder (NPD) is a recognized personality disorder. NPD is listed in the DSM-5, a manual of mental disorders published by the American Psychiatric Association (APA). 1  Narcissistic personality disorder is defined as a disorder that displays:

a pattern of appearing or trying to appear more valuable than is the case

a need for admiration

a lack of empathy

Narcissistic personality disorder is a mental condition where individuals have an inflated sense of their importance. They also have a deep-seated need for lots of attention and admiration from those around them. People with narcissistic personality disorder have troubled relationships and a lack of empathy for others. They display bravado to the world but secretly struggle with self-esteem, which is frequently shattered with the slightest criticism. People with this type of disorder suffer greatly; having trouble with jobs, relationships, and social interactions.  There is no such thing as constructive criticism for a sufferer of narcissistic personality disorder; even the most friendly advice will crush their self-esteem.

Signs and Symptoms of Narcissistic Personality Disorder

Despite an inflated sense of importance and self-confidence, there are unfortunate consequences to having narcissistic personality disorder.

Harmful side effects of narcissistic personality disorder include:

Sensitivity

People with narcissistic personality disorder have extremely fragile self-esteem. They are easily injured when they meet with criticism or defeat.

Shame

People with narcissistic personality disorder may also experience higher levels of shame and humiliation from emotional instability.

Depression

A common symptom of narcissistic personality disorder is depression due to the perception of emotional injury from others and social isolation.

Symptoms of narcissistic personality disorder include:

Excessive Sense of Self-Importance

NPD sufferers feel an exaggerated sense of how important and unique they are. They also set hard to reach goals in front of others to emphasize how “special” they are so others approve of them.

Lack of Empathy

Not being able to recognize or identify with the feelings and needs of others is a major sign of narcissistic personality disorder.

Reactions to Others

People with NPD can tune in to the reactions of others, but only if they perceive them as being relevant to themselves.

Defensiveness

The defenses that people with narcissistic personality disorder throw up around them often put strains on personal relationships. These defenses often lead to isolation. Narcissists need support, love, and respect from others to maintain their inflated self-image. Thus, when their actions alienate others, they suffer immensely. Feelings of isolation and abandonment can result. Slight criticisms that others regard as harmless provoke narcissists to react, often to their detriment.

Relationship Issues

NPD causes problems in many areas of life. Relationships, work, school, or finances may suffer greatly. People with NPD are unhappy and disappointed when admiration or special treatment they believe they deserve doesn’t happen. Narcissistic personality disorder sufferers may find their relationships unfulfilling, and others may not enjoy being around them.

Narcissistic Personality Disorder Checklist

The following is a comprehensive list of narcissistic personality disorder behaviors and characteristics. Don’t be concerned if you can relate to a few of them. People with narcissistic personality disorder consistently display most of these items at different levels of severity.

Characteristics

People with narcissistic personality disorder can:

  • Possess an overstated sense of self-importance
  • Display a sense of entitlement
  • Exaggerate their talents and achievements
  • Need constant, excessive admiration
  • Believe in their superiority, so they can only socialize with special people that are their equals
  • Have expectations of special favors
  • Have expectations of people complying with their wishes without question
  • Expect recognition as being superior or special without the achievements that would call for these conclusions
  • Have a preoccupation with power, success, beauty, or the perfect partner
  • Dominate conversations
  • Look down or insult people they perceive as "unequal" or inferior
  • Be unable or unwilling to recognize or identify with the needs and feelings of others
  • Take advantage of others to get what they want
  • Come across as arrogant, self-centered, cocky, stuck-up, and pretentious
  • Show envy and feel others envy them
  • Believe they must have the best of everything

Responses

People with narcissistic personality disorder can also have problems dealing with anything perceived as disapproval or fault-finding. In response, they can:

Quickly feel slighted at things others consider harmless

Belittle others to make themselves appear more accomplished

Have a hard time controlling their emotions and behavior

React impatiently or angrily when special treatment doesn’t happen

Experience serious personal problems

Feel moody and depressed because they are not “perfect”

Strike back with extreme anger, rage, or contempt to prove they are superior to others

Have major problems dealing with stress and change

Secretly harbor feelings of shame, insecurity, humiliation, and vulnerability

Causes of Narcissistic Personality Disorder

Conditional self-love is at the core of NPD. Individuals feel that they must be important, unique, and entitled to have worth. Studies show that conditional self-love usually develops during school years and carries on through adulthood.2

Freud’s Theory

Sigmund Freud believed that people with narcissistic personality disorder suffered some sort of arrested development as infants. Freud said that all infants are naturally selfish. Infants focus on having their needs met by others. To do so, they adapt their behavior with others to have their needs met. Some children do not outgrow these types of behaviors. They can then develop NPD that persists throughout adulthood.

Kohut’s Theory

Heinz Kohut is a noted psychoanalyst. He proposed that childhood arrested development comes from a complex child-parent relationship. Specifically, it stems from parents who focus on the importance of a child’s appearance or achievements. It also involves parents who reinforce a child’s sense of self that depends on their child’s performance compared to others. In other words, to be worthy means being the best.

As these children age, they focus on how they appear to others. This focus leads to avoiding others to hide any internal weaknesses. They also avoid others to hide their low self-esteem. This emphasis causes children to be highly critical of perceived flaws in themselves and others. Low self-esteem leads to an unquenchable need to reinforce a positive self-image.

Statistics

In the United States, it is estimated that:3 Narcissistic personality disorder is more prevalent among black men and women and Hispanic women. Narcissistic personality disorder is also more prevalent among younger adults.

NPD is found more among the separated, divorced or widowed, and adults who never married. There is a high co-occurrence of substance use, mood disorders, anxiety disorders, and other personality disorders for people with NPD.

There is a relationship between narcissistic personality disorder and phobias, generalized anxiety disorder and bipolar disorder, especially for women. There is a relationship between narcissistic personality disorder and alcohol abuse and dependence, drug abuse and dependence, as well as obsessive-compulsive disorders (OCD).

About 6% of people have narcissistic personality disorder within their lifetime
Women's rates for NPD are estimated at 4.8%
One study shows that 17% of first-year medical students have narcissistic personality disorder or narcissistic traits
It is estimated 20% of those serving in the military have narcissistic personality disorder or narcissistic traits

Connection Between NPD and Addiction

There is a significant relationship between narcissistic personality disorder and addiction. One research study showed that:

People with NPD also have a co-occurring disorder

More than 40% of people with NPD also have some type of co-occurring substance use disorder.

People with NPD have a substance dependence

About 15% of people with narcissistic personality disorder also have some type of substance dependence.

People with NPD also have AUD

Approximately 22% of NPD sufferers also have an alcohol use disorder.

People with NPD also have DUD

Approximately 9% of people with narcissistic personality disorder also have a drug use disorder.

Living with or around a person with narcissistic personality disorder may not be easy. It can also have serious consequences for the NPD sufferer caught in a loop. They try to be perfect. In the process, they alienate those around them while trying to maintain an impossible image and standards.

Substance Use

The connection between substance use and narcissistic personality disorder can be from:

People with NPD attempting to restore or maintain an inflated sense of self-importance.

When narcissistic personality disorder sufferers encounter unavoidable limitations, they get depressed. Substance use could be a defensive reaction against the effects of depression.

Aging that affects one’s appearance can also cause people with NPD to become defensive.

The social isolation NPD sufferers experience can lead to substance abuse or dependence.

These factors can lead someone with narcissistic personality disorder to self-medicate. Using substances can make them feel like they can maintain a sense of superiority and invincibility. However, substance abuse frequently worsens mental health. Self-medication may also be related to blocking out feelings of sadness, depression, and guilt that come from not measuring up to impossibly high standards of perfection.

When Should a Person Seek Treatment for NPD?

People with NPD may not want to believe that anything could be wrong, so they don’t see any need for treatment. If they do seek treatment, it probably won’t be for NPD symptoms. It is more likely they will seek treatment for drug or alcohol use, depression, or another mental health problem. Treatment for addiction or other mental health problems may fail if NPD is not recognized and part of the treatment plan because when the patient perceives insults to their self-esteem, it becomes hard to accept and follow through with treatment.

If you:

recognize aspects of your personality are related to NPD

are abusing drugs or alcohol

have overwhelming feelings of sadness, isolation, or anxiety

Then consider talking to a doctor or mental health provider you trust. Getting the right treatment can help make your life easier to handle, more rewarding, and more enjoyable.

Treatment Options

There are various treatment options for narcissistic personality disorder treatment.

Psychotherapy

Psychotherapy is “talk therapy.” Therapy takes places within a client-therapist relationship built on trust. A competent therapist recognizes it is not enough to imagine what feelings a person with NPD has. Rather, they can feel what the client feels in a certain situation. 4 This understanding helps the client develop healthier ways of thinking and behaving.

Why Talk Therapy Works

Supportive psychotherapy builds a strong alliance between the client and counselor. The empathy the client receives from the therapist can help fill the void of empathy the client has. Positive experiences happening between client and counselor encourages the client to develop empathy as well.

Cognitive Behavioral Therapy (CBT)

People with NPD have persistent patterns of disturbed thinking. For example, they abnormally perceive themselves or others. They may have extreme reactions to others. They can experience social isolation and personal relationship problems.

CBT addresses these many issues by changing beliefs and behaviors that are harmful. CBT does this by using:5

Cognitive Restructuring:

Helps the client recognize thinking that leads to negative consequences

Behavior Changes:

Helps change behaviors that lead to negative experiences, relationship problems, and isolation.

Exposure:

Over time, the client is exposed to fearful situations to learn how to become less sensitive. 

Education:

The therapist provides education and information related to the mental health issues the client experiences.

Skills Training:

Social skills are learned and practiced by the client through role-playing sessions.

Why CBT Works

Clients with NPD get a better understanding of their behavior that bothers others. They also learn to identify how they act affects the quality of their relationships. Clients learn how to change their improper understandings and beliefs. This helps them become better adjusted and live more fulfilling lives.

Medications

While there are no specific drugs for NPD treatment, there are medications that can help relieve some symptoms.

Why Medication Works

Medications can help relieve symptoms related to anxiety and depression. These drugs can help put NPD sufferers in better frames of mind to work on other NPD issues.

Recognizing and Treating Narcissistic Personality Disorder

Many people who live with NPD may not be aware of how it affects their well-being or their need for treatment. Left untreated, NPD sufferers deal with limited abilities and stunted potentials. NPD has social and psychological impacts due to off-putting behaviors which damage relationships.

Despair, isolation, loneliness, or sadness may feel like the norm, but that does not have to be the case. There is hope and healing with the right treatment. Getting professional help provides the best tools and resources needed for recovery.