What is narcissistic personality disorder?

Narcissistic personality disorder (NPD) is one of several personality disorders. Individuals with this condition have an inflated idea of themselves, and they require much attention from other people. They often fail to understand the feelings of other people.

People with NPD may not have high self-esteem. Their NPD might be more related to entitlement feelings. A therapist can get to the bottom of it.

What are the symptoms of narcissistic personality disorder?

Symptoms of narcissistic personality disorder and how severe they are vary. People with the disorder may:

• Have an inordinately high sense of self-importance and demand constant, excessive admiration.
• Believe that they deserve privileges and special treatment.
• Expect to be given privileges, even without achievements, based on who they are.
• Make their accomplishments and abilities appear greater than they really are.
• Obsession over fantasies of success, power, brilliance, beauty or the perfect mate.
• Feel superior and others are equally special people with whom they should only associate or with whom they can be understood.
• Criticism and looking down on people who they consider insignificant.
• Special treatment and expect others to do what they want, questioning no one
• Exploit others to get whatever they want.
• Fail to recognize the needs and feelings of others or unwilling to do so.
• Resent others' good fortune and feel that others resent their good fortune.
• Act arrogant, boast a lot, and seem conceited.
• Demand the best of everything, such as the best car or office.

At the same time, individuals with narcissistic personality disorder have difficulty tolerating anything they consider to be criticism:

• Become easily impatient or angry when they are not given special attention or treatment.
• Have severe difficulty interacting with others and become easily slighted.
• React with anger or contempt and try to belittle other people in order to make themselves appear superior.
• Have trouble controlling their feelings and behavior.
• Have severe difficulty coping with stress and changing circumstances.
• Withdraw from or avoid situations in which they may fail.
• Become depressed and moody because they cannot be perfect.
• Secret feelings of insecurity, shame, humiliation, and fear of exposure as a failure.

What is the cause of narcissistic personality disorder?

The causes of NPD are not well-understood.

Genetics play a role in many cases of NPD. Environmental contributing factors may include:

• Childhood abuse or neglect
• Overindulgence by parents
• High parental expectations

A study found mixed evidence that narcissism is more prevalent in individualistic cultures than in collectivistic cultures.

What are the complications of NPD?

It is very typical for NPD to be involved with other mental health concerns and disorders. Some of the most common overlaps or comorbidities include:

• Mood disorders or bipolar disorder, anxiety and depression, which may occur more frequently in an individual with NPD, bipolar disorder, which occurs in a higher percentage of people having NPD.
• Some of these personality disorders include borderline personality disorder (BPD) and antisocial personality disorder (ASPD).
• Body dysmorphic disorder: Patients with NPD may also experience body dysmorphic disorder, also called "body dysmorphia." This might be triggered by negative attitudes toward the body and self-image.
• Substance use disorders: People with NPD turn towards alcohol or substance abuse, to assist them when the world fails to meet the fantasies they had. More frequent than most other forms is cocaine and other stimulant usage because of the effect created, which people with NPD might wish to indulge.
• Suicide: The individual with NPD may suffer from extreme depression or despair when confronted with adversity, failure, or rejection. Such acts are less likely to be impulsive or a "cry for help." That is, the individual with NPD is more likely to commit suicide.

How is narcissistic personality disorder diagnosed?

Some characteristics of narcissistic personality disorder are similar to those of other personality disorders. It is also possible to have more than one personality disorder at once. This can make diagnosis more difficult.

Diagnosis of narcissistic personality disorder typically involves:

• Your symptoms and how they affect your life.
• A physical exam to rule out a medical condition that might be causing your symptoms.
• A comprehensive psychological analysis may also involve the use of questionnaires.
• Diagnosis criteria in the DSM-5

How is narcissistic personality disorder treated?

Treatment for NPD mainly involves talk therapy, also known as psychotherapy.

If symptoms of NPD occur with depression or another mental health condition, you may take medications to treat the other condition. There are no medications to treat NPD.

Talk therapy

Talk therapy can educate you on how to be better in relating to other people so your relationships can be more fun, intimate, and fulfilling. Positive interactions with others can definitely enhance many aspects of your life.

Talk therapy can also teach you how to:

• Improve collaboration with co-workers and peers
• Develop personal relationships
• Recognize one's strength and potential, thus be able to tolerate criticism or failures
• Understand and regulate your emotions
• Cope with any self-esteem issues
• Set realistic goals for yourself

However, due to the complexity of the brain wiring and the role that personality traits play in the hard-wiring of the brain, therapy regarding them would require several years before changes can be ascertained. One might at some point begin to feel as if therapy is a waste of time, thus considering giving up, but such nebulous clouds are necessary to be pushed aside for yourself.

Attend all therapy sessions and consume the medications prescribed for you. With time, you will begin to see transformations within you and with other people around.

Lifestyle modifications

The following lifestyle modifications may benefit you as you undergo therapy:

• Avoid drugs that may provoke problematic behaviors.
• Identify and seek healthy habits.
• Practice relaxation techniques such as yoga and meditation to help reduce stress and anxiety.

Can narcissistic personality disorder be prevented? 

NPD occurs for reasons that professionals don't fully understand. It may also be inherited. Because of both of those factors, it can't be prevented in oneself or one's child.

You might be able to limit your child's chances of acquiring it with the way you raise your child, such as making sure you find a way to change your parenting style according to particular circumstances. Your child's pediatrician will assist you in doing so, or perhaps they can direct you to a provider that can provide this kind of professional advice on childhood psychological development.

What can happen to me if I have narcissistic personality disorder?

People with NPD may not be even aware of it. There are some who may even go years or decades unaware of it. Often, such symptoms come to the front only when some kind of stressful event or circumstance occurs in life. Some examples of those events or circumstances include:

• Significant negative changes: Demotion, losing a job, bankruptcy, etc.
• Personal crises: Divorce or separation.
• Other forms of life crises: Illness or physical changes related to age, particularly those that would limit your ability to stay independent; or death of a close relative.
• Ultimatums: People with NPD may not seek help until loved ones demand it or push the issue.

What is the prognosis for narcissistic personality disorder?

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

• Symptoms you have: Some symptoms of NPD may discourage you or make you less likely to seekassistance. Individuals who have vulnerability-related symptoms are less likely to attract attention that will lead to their 
• How severe your NPD is: This can be very disruptive if the condition is really quite severe. Severe NPD often makes people much more aggressive or confrontational, or less empathetic to others' feelings and needs, as such individuals are less likely to ask for help or to get treatment.
• Other conditions you have. You have more significant challenges when NPD is combined with other conditions. Some examples of other conditions that can make NPD a bigger problem are anxiety and depression, any of the other personality disorders-especially antisocial personality disorder-or any of the substance use disorders.

Because so many factors can be involved, your mental health provider is the best one to ask about the prognosis for your condition. They will be able to tell you more about what to expect and what you can do to help yourself along the way.

When should I seek care?

You have to see your doctor as recommended. They will arrange the treatment schedule and follow-up visits. Also, when you feel new changes in symptoms or effectiveness of medications, you have to visit the doctor.

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