What is Narcissistic Personality Disorder?

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Main Category: Psychology / Psychiatry
Also Included In: Mental Health
Article Date: 29 Feb 2012 - 0:00 PDT


Narcissistic personality disorder, also known as NPD, is a personality disorder in which the person 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 the individual sees himself/herself and his/her interests and opinions as the only ones that really matter.

People with narcissistic personality disorder are not particularly interested in other people's feelings - they have a lack of empathy; they are unable to feel or appreciate feelings which are not their own.

However, their apparent self-confidence is really a mask, which hides a brittle and fragile self-esteem. People with NPD are overly sensitive to criticism, even if it is very slight.

NPD is a personality disorder. Personality disorders are kinds of personality types and persistent behaviors that are linked to significant distress or disability. The individual's behavior veers from normal social expectations, especially the way the person relates to other people.

According to Medilexicon's medical dictionary, Narcissistic personality disorder is :

1. a pervasive pattern in adulthood of self-centeredness, self-importance, lack of empathy for others, sense of entitlement, and viewing others largely as objects to meet one's needs, manifested in a variety of contexts.

2. a DSM diagnosis that is established when the specified criteria are met."

What are the signs and symptoms of narcissistic personality disorder?

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.

A person with narcissistic personality disorder will typically have some of the signs and symptoms below:

• Responds to criticism with anger
• Responds to criticism with humiliation
• Responds to criticism with shame
• Their own talents, achievements and importance are frequently overstated
• They have exaggerated fantasies regarding their own good looks, power, intelligence and success
• They may believe their skills in romance are superior to anybody else's
• They are generally jealous people and may be suddenly affected with intense jealousy
• They seek out and demand positive reinforcement from other people
• They have an insatiable appetite for attention from others
• They lack empathy and disregard other people's feelings
• They are obsessed with themselves
• Most of their goals are considered by others as selfish
• They have problems maintaining healthy relationships
• They are very sensitive and easily hurt
• They may easily feel rejected
• Whatever they have or yearn for, it must be "the best"
• They come over as unemotional or tough-minded
• They may seem arrogant
• They act as if they have a right for special treatment
• If others have to be taken advantage of in order to achieve goals, they will do so
• They may believe that only other "special" people really understand their uniqueness
• They often expect others to go along with what they desire or ask for, blindly

What are the causes of narcissistic personality disorder?

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.

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 tests may be ordered, such as X-rays and blood tests. The aim here is to rule out some 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

What are the treatment options for Narcissistic Personality Disorder (NPD)?

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.

What are the complications related to narcissistic personality disorder (NTD)?

A person with untreated NTD 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 higher 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 narcissistic personality disorder (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?

Written by Christian Nordqvist
Original article date: 21 April 2004. Article updated: 28 February 2012.
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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