Narcissistic personality disorder, also known as NPD, is a personality disorder in which the individual has a distorted self image, unstable and intense emotions, is overly preoccupied with vanity, prestige, power and personal adequacy, lacks empathy, and has an exaggerated sense of superiority. NPD is closely associated with egocentrism - a personality characteristic in which people see themselves and their interests and opinions as the only ones that really matter.
People with narcissistic personality disorder are not interested in the feelings of others - they lack empathy; they are unable to feel or appreciate feelings which are not their own.
Contents of this article:
What is narcissistic personality disorder?
The US National Library of Medicine1 describes a person with narcissistic personality disorder as having an excessive sense of self-importance, an intense preoccupation with themselves, and no empathy for others.
The term comes from a character in Greek mythology, called Narcissus. He saw his reflection in a pool of water and fell in love with it.
The Cleveland Clinic2 says that narcissistic personality disorder belongs to a group of conditions known as dramatic personality disorders. Afflicted people have very unstable and intense emotions and a distorted image of "self".
However, this seeming abnormal love of self, an excessive sense of importance and superiority, combined with a preoccupation with success and power do not, in fact, reflect real self-confidence. The individual has a deep sense of insecurity. His or her self-esteem is extremely fragile.
It is common for people with narcissistic personality disorders to set unrealistic goals.
A study carried out by the National Institute on Alcohol Abuse and Alcoholism and published in the Journal of Clinical Psychiatry3 found that 7.7% of men and 4.8% of women develop narcissistic personality disorder (NDP) during their lifetime. The researchers also found that NPD rates are much higher among black men and women, Hispanic women, younger adults, and people who either never married or became divorced, widowed or separated.
Signs and symptoms
A symptom is something that the patient feels and describes, such as anger, pain, or dizziness, while a sign is something everybody, including the nurse or doctor, can see, such as a rash or swelling.
Below are the most common signs and symptoms found in people with narcissistic personality disorder:
- An insatiable appetite for the attention of other people.
- Generally prone to extreme feelings of jealousy.
- Behave is if they deserve special treatment.
- Commonly exaggerate their achievements, talents and importance.
- Extremely sensitive.
- Find it difficult to maintain healthy relationships.
- Have fantasies regarding their own intelligence, success, power and good looks.
- If they have to take advantage of others in order to get what they yearn for, they will without regret or conscience.
- It does not take much for a person with NPD to feel rejected.
- Lack empathy - empathy is the ability to understand and share the feelings of other people. People with NPD lack empathy and disregard other people's feelings.
- Many believe that only others - "special" people - are really able to understand their uniqueness.
- May consider themselves as very skilled in romance; more skilled than anybody else.
- Most people see narcissists' goals as selfish ones.
- Obsessed with themselves.
- Respond to criticism with anger.
- Respond to criticism with humiliation.
- Respond to criticism with shame.
- Seem arrogant.
- Tend to seek out praise and positive reinforcement from others.
- They may be perceived by others as tough-minded or without emotion.
- Usually expect others to agree with them or go along with what they ask for or want blindly.
- Very easily hurt.
- Whatever they crave or yearn for must be "the best".
What are the causes?
Nobody is sure why some people develop narcissistic personality disorder while others don't. Some suggest it may be associated with certain circumstances during childhood, such as very high expectations, over-pampering, neglect, and even abuse. Perhaps the individual learnt manipulative behaviors from their parents or household members during childhood.
Some experts say there may also be a genetic link, as well as the way the brain behaves, thinks and reacts to environmental stimuli.
If a child is brought up to think that vulnerability is not acceptable, their ability to tune into other people's feelings and needs may become undermined, some suggest.
The NewYork-Presbyterian Hospital4 states that recent evidence has pointed to a genetic predisposition and other biological or biochemical factors that are probably linked to NPD.
Diagnosing narcissistic personality disorder
The doctor will most likely check the patient's medical history and carry out a physical exam if some signs and symptoms are present.
Even though no specific lab tests exist which can point towards NPD, some may be ordered, such as X-rays and blood tests. The aim here is to rule out possible physical illnesses and conditions which may be causing the symptoms.
There are several different types of personality disorders, some of them overlap, and it is possible to be diagnosed with more than one type.
A NPD diagnosis must follow the criteria written in the Diagnostic and Statistical Manual of Mental Disorders, published by the APA (American Psychiatric Association).
The following must be present for a diagnosis of Narcissistic Personality Disorder to be made:
- The patient's idea and importance of self is exaggerated
- Fantasies about beauty, success and power over-dominate the patient's thoughts
- Patients think they are special, and relate only to other "special" people
- They need to be admired all the time
- They believe they are entitled to most things
- They manipulate and take advantage of other people
- They lack empathy - the ability to feel and recognize the feelings of and needs of others
- They envy other people
- Their behavior comes over as haughty or arrogant.
Recent developments on diagnosing narcissistic personality disorder from MNT news
Narcissism can be diagnosed 'with a single question' - "To what extent do you agree with this statement: 'I am a narcissist.'" Scientists believe that this question could be all researchers need to make a quick and easy diagnosis of narcissism.
There is no effective, known cure for NPD. Psychotherapy is often recommended - this is a type of counseling which aims to help the individual learn how to positively relate to other people. Psychotherapy may help the patient better understand what their problems are, which may bring about a change in their attitudes, resulting in better behavior.
Psychotherapy may involve CBT (cognitive behavioral therapy), family therapy or group therapy. CBT helps the patient identify negative beliefs and behaviors, and to replace them with healthy and positive ones.
Psychotherapy aims to help patients build up their self-esteem and acquire realistic expectations of themselves and other people.
For some of the more distressing aspects associated with NPD, the doctor may prescribe a medication. This may include, for example, an anti-depressant.
A person with untreated NPD has a higher chance of substance abuse (including drugs and/or alcohol), depression, problems with relationships, difficulties at work or school, and suicidal behaviors or thoughts.
A recent study published in PLoS One found that males with narcissistic personality disorder have higher levels of cortisol in their blood. Cortisol is a stress hormone. Even those without much stress in their lives have higher levels. High blood cortisol is linked to a greater risk of developing cardiovascular problems.
Co-author Sara Konrath, from the University of Michigan in Ann Arbor, USA, said:
"Narcissistic men may be paying a high price in terms of their physical health, in addition to the psychological cost to their relationships."
Living with somebody who has NPD
More is written and studied about the effects NPD has on the patient, rather than his/her loved ones and work colleagues. Learning to heal from the roller-coaster ride of living with somebody who has what has been described as Dr. Jekyll and Mr. Hyde traits can be nerve-wrecking and completely devastating, victims say.
Family members of somebody with NPD describe the sufferer as controlling, egotistical and forever dissatisfied with what anybody around them does. No matter what happens, the narcissist will blame others and make them feel guilty for all their problems. They are described as having short fuses, losing their tempers at the slightest provocation, or turning their backs and giving people the "silent treatment". Some can be physically and sexually abusive.
Being with a narcissistic person "can be a living nightmare", many have said. The spouse, coworker, boss, and even parent may sometimes be sucked into a relationship they find very hard to escape from. The emotional and physical damage caused by somebody with NPD can be severe. Even the health care professional might become emotionally exhausted too.
The narcissist tends not to go for strong individuals. Learning how to become more confident and assertive can help protect those living with somebody with NPD from long-term harm.
Read our article Narcissism Victim Syndrome, A New Diagnosis?