A personality disorder affects how a person feels, thinks, and acts. In a person with narcissistic personality disorder, a high sense of self-importance can mask low self-esteem.

Someone with narcissistic personality disorder (NPD) may have intense, fluctuating emotions and an excessive concern with prestige, power, and personal adequacy.

In other’s eyes, they may:

  • act selfishly
  • seem manipulative and demanding
  • have difficulty empathizing or considering others’ needs or feelings

In reality, these behaviors often stem from a need to cover up deep feelings of insecurity.

NPD is a cluster B personality disorder. People with these disorders find it hard to manage their emotions.

NPD gets its name from a Greek myth, in which a hunter called Narcissus saw his reflection in a pool of water and fell in love with it.

A person with NPD may have an idealized self-image and an unrealistic sense of superiority. These traits can indicate a lack of self-confidence and a deep sense of insecurity, of which the person may be unaware.

The following are key features of NPD:

  • a need for admiration
  • a pattern of grandiosity
  • a lack of empathy for others

Research indicates that NPD affects 6.2% of the population, including 7.7% of males and 4.7% of females.

The way that people with NPD see themselves can be sharply different from the way others see them.

Features of the condition that may be noticeable to others include:

  • craving attention and admiration
  • having fragile self-esteem and feeling disappointed when admiration is not forthcoming
  • having an excessive feeling of superiority
  • exaggerating intimacy with others, especially those with wealth or VIP status
  • overestimating achievements and talents
  • undervaluing the achievements of others
  • having a preoccupation with success, power, brilliance, beauty, or ideal love
  • believing in their uniqueness, and that only special people can understand it
  • having a sense of entitlement to favorable treatment, for example
  • taking advantage of others to achieve their own goals
  • being unable or unwilling to identify with the feelings or needs of others
  • feeling jealous and believing that others are jealous of them
  • behaving in a way that seems arrogant or haughty to others
  • showing great charm but quickly becoming irritated or angry
  • talking at length about their own concerns but lacking interest in the concerns of others
  • showing aggression when faced with a threat to their ego

Other features may be less obviously associated with narcissism, such as:

  • a sense of shame, humiliation, and emptiness when disappointed
  • unwillingness to try something for fear of defeat
  • difficulty maintaining relationships
  • a sense of alienation emotional disconnect from others
  • high achievement due to overconfidence but disrupted performance in the face of defeat or criticism
  • suspiciousness
  • social withdrawal
  • difficulty managing emotions

Other disorders, such as depression and anorexia, can accompany NPD.

A psychiatric assessment can help, but diagnosing NPD specifically may be challenging.

First, there are several types of personality disorder and the features tend to overlap. Also, a person may have NPD alongside another condition.

In addition, a person with NPD may not recognize that problems in their life stem from their own behavior, and they may blame others instead.

Someone with this condition may be highly sensitive to perceived criticisms or slights, making it difficult for others to talk to them about their behavior and how it can be harmful.

To diagnose NPD, a doctor needs to find at least five of the following criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition:

  • A grandiose sense of self-importance.
  • A preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
  • A belief that they are unique and can only be understood by, or should only associate with, other special or high-status people or institutions.
  • A need for excessive admiration.
  • A sense of entitlement, and unreasonable expectations of receiving favorable treatment or automatic compliance with their expectations.
  • A tendency to take advantage of others to achieve their own ends.
  • A lack of empathy and unwillingness to recognize or identify with the feelings and needs of others.
  • Envy of others and the belief that others are envious of them.
  • Arrogant, haughty behaviors or attitudes.

NPD is a spectrum disorder, and the symptoms can range from mild to severe.

Experts have also proposed two subtypes:

  • The grandiose subtype: This features overt grandiosity, aggression, and boldness.
  • The vulnerable subtype: This involves hypersensitivity and defensiveness.

There is no known cure for NPD, but treatment can help a person overcome underlying issues and change some behaviors.

Medications can sometimes help if NPD occurs with another disorder, such as depression or anxiety.

The main treatment, however, is psychotherapy. This can help a person:

  • understand what underlies their behavior
  • manage their emotions more effectively
  • learn to take responsibility for their actions
  • learn to build healthier relationships
  • build up their self-esteem
  • adjust their expectations of themselves and others
  • understand the impact of their behavior on others

Cognitive behavioral therapy (CBT), family therapy, or group therapy are types of psychotherapy that may help.

CBT aims to identify unhealthful, harmful beliefs and behaviors and replace them with healthful, positive ones.

While the causes of personality disorders are unclear, they may involve a combination of genetic and environmental factors.

During childhood, for example, the following may increase the risk of developing NPD:

  • overpraising or overpampering
  • excessively high expectations
  • unpredictable care or neglect
  • trauma
  • abuse
  • rejection

Stress can worsen the symptoms of a personality disorder.

Many people with NPD have another health condition. This might be:

  • misuse of drugs or alcohol
  • depression
  • a panic disorder
  • social anxiety disorder
  • generalized anxiety disorder
  • other personality disorders
  • anorexia nervosa

Someone with NPD may also have a high risk of:

There may also be a risk of cardiovascular complications. Some research has found that males with NPD have higher levels of the stress hormone cortisol in their blood, an issue linked to a greater risk of developing cardiovascular problems.

NPD can be challenging for the individual and their loved ones, but treatment and support can improve the quality of life for everyone involved.

Anyone who suspects that they have NPD can benefit from seeing a psychotherapist. There are various ways to find a suitable therapist online, including this tool from the American Psychological Association.

For someone in any relationship with a person who has NPD, the following tips may help:

  • Maintain a network of support, including family members and friends.
  • Pursue independent interests, through work, volunteering, or hobbies.
  • Use healthful conflict resolution strategies.
  • Try to remain calm when talking about how the person’s behavior affects you.
  • Contact a support group, such as Surviving Narcissism.

Counseling services are also available for people who have experienced trauma in a relationship with a person who has NPD.