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Narcissistic Personality Disorder

What Is Narcissistic Personality Disorder?

Narcissistic personality disorder (NPD) is a personality disorder in which people have an inflated opinion of themselves. They also have an intense need for the admiration and attention of others. People with NPD may be generally unhappy and disappointed when they’re not given the praise or special favors they believe they deserve. Others may see them as snobbish and conceited, and may not enjoy being around them.

NPD can cause problems in many areas of life, including:

  • work
  • school
  • relationships

However, the disorder can be managed with talk therapy and certain lifestyle improvements.

Identifying Narcissistic Personality Disorder Traits

People with NPD are usually described as being the following:

  • arrogant
  • self-centered
  • demanding

They often have high self-esteem and may believe they are superior or special compared to other people. However, they seem to need excessive praise and admiration, and they may react poorly to perceived criticism. Narcissists also tend to exaggerate their own talents and accomplishments, while downplaying those of others. They are usually preoccupied by power, success, and beauty. They might even engage in impulsive behaviors, such as risky sex and gambling.

Some traits of NPD may appear similar to confidence. However, healthy confidence and NPD aren’t the same thing. People who have healthy self-esteem are usually humble, while people with NPD almost never are. They tend to put themselves on a pedestal and perceive themselves as better than everyone else.

Symptoms of Narcissistic Personality Disorder

NPD usually appears in early adulthood. People with the disorder may not recognize that they have a problem since it goes against their self-image. You may have NPD if:

  • you come across as pretentious and boastful, causing others to avoid you
  • your relationships are unfulfilling
  • you become unhappy, angry, and confused when things don’t go your way
  • you have ongoing issues with:
    • work
    • school
    • relationships
    • finances
    • alcohol
    • drugs

If you believe you have NPD, schedule an appointment with your doctor or a mental health professional. They can determine whether you have this personality disorder and suggest treatments to help manage symptoms.

Doctors and mental health professionals often use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, to diagnose mental disorders, such as NPD. The DSM-5 diagnostic criteria for NPD include the following traits:

  • having an inflated sense of self-importance and entitlement
  • needing constant admiration and praise
  • expecting special treatment due to perceived superiority
  • exaggerating achievements and talents
  • reacting negatively to criticism
  • being preoccupied with fantasies about power, success, and beauty
  • taking advantage of others
  • having an inability or unwillingness to recognize the needs and feelings of other people
  • behaving in an arrogant manner

To determine whether you meet these criteria, the doctor or mental health professional may ask you to fill out a questionnaire. You may also be tested for other mental disorders and health conditions.

Causes of Narcissistic Personality Disorder

The causes of NPD aren’t well understood. However, inherited genetic defects are thought to be responsible for many cases of NPD. Contributing environmental factors may include:

  • childhood abuse or neglect
  • excessive parental pampering
  • unrealistic expectations from parents
  • sexual promiscuity
  • cultural influences

Treatment for Narcissistic Personality Disorder

Treatment for NPD primarily consists of talk therapy, also known as psychotherapy. If symptoms of NPD occur alongside depression or another mental health condition, then appropriate medications may be used to treat the other disorder. However, there are no medications to treat NPD.

Talk therapy can help you learn how to relate better to others so your relationships can become more enjoyable, intimate, and rewarding. Developing positive interactions with other people can greatly improve various areas of your life. Talk therapy can also show you how to:

  • improve your collaboration with co-workers and peers
  • maintain your personal relationships
  • recognize your strengths and potential so you can tolerate criticisms or failures
  • understand and manage your feelings
  • cope with any self-esteem issues
  • set realistic goals for yourself

Since personality traits can be difficult to change, it may take several years of therapy before you see an improvement. During this time, you may begin to see therapy as a waste of time and be tempted to quit. However, it’s important to stick with treatment. Attend all your therapy sessions and take any medications as directed. With time, you’ll begin to see a difference in yourself and your relationships with others.

The following lifestyle remedies may help you as you go through therapy.

  • Avoid alcohol, drugs, and other substances that trigger negative behaviors.
  • Exercise at least three times per week to boost mood.
  • Engage in relaxation techniques, such as yoga and meditation, to reduce stress and anxiety.

Recovery from narcissistic personality disorder takes time. Stay motivated by keeping your recovery goals in mind and reminding yourself that you can work to repair damaged relationships and become happier with your life.

What Is the Outlook for Someone with Narcissistic Personality Disorder?

The benefits of treatment may vary depending on the severity of your symptoms and your willingness to commit to treatment. In general, however, symptoms of NPD usually improve over time. If you stay motived and actively work toward change, you will likely be able to repair damaged relationships and become more satisfied with your life.

Living with Narcissistic Personality Disorder

While it can be challenging to treat narcissistic personality disorder, you can work through it. Seeing a therapist or psychologist for counseling can be very helpful, as can changing the way you think and interact with others every day. Remember that you are in charge of your behavior and you can change it at any time.

There is some debate among professionals about how to handle the person with narcissistic personality disorder. Feel free to praise them when they do something right to or well. Convey empathy when appropriate, and acknowledge when they are disappointed. Conversely, you should also feel free to point out to the person when they are acting haughty or rude. Be prepared for arguments based on your "calling them out", but recall that if the individual with NPD does not realize that their behaviors are causing problems, they are less motivated to seek help.

Even if the person with NPD does not see the problem, or chooses not to seek out therapy to modify their behavior, calling them out on their behavior may cause them to self-regulate their behavior in your presence, knowing that you will not put up with their behaviors.

Content licensed from:

Written by: Michael Kerr
Medically reviewed on: Mar 16, 2016: Timothy J. Legg, PhD, PMHNP-BC

This feature is for informational purposes only and should not be used to replace the care and information received from your health care provider. Please consult a health care professional with any health concerns you may have.
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