Disorder deep dive

Narcissistic Personality Disorder

Also known as NPD

What is it?

Personality disorders are deeply ingrained patterns of behavior that violate social norms and cause problems in interpersonal relationships. They are broken into three categories — Cluster A, B and C. 

Personality disorders are previously known as axis two disorders — a group of conditions that impact a person’s function in relation to others. They are ego-syntonic, meaning a person with a personality disorder often doesn’t believe they have a problem. The disorder is consistent with their world view, perception of others and perception of themselves. They usually begin during a person's teenage years or early adulthood, and in some cases, become less obvious in middle age. It is common for people with one personality disorder to have symptoms of another.

Narcissistic personality disorder, also called NPD, is a Cluster B disorder. Cluster Bs are characterized by dramatic, emotional or erratic behavior. People with NPD have an inflated sense of self and lack empathy for others. But behind this mask of confidence, lies a fragile self-esteem that’s vulnerable to even the slightest of criticism. NPD causes problems in many areas of life including work, relationships, school and financial affairs. People with NPD may be unhappy and disappointed when they’re not given what the attention and opportunities they think they deserve, and may find their personal relationships unfulfilling.

NPD frequently occurs alongside other mental health conditions, including depression, eating disorders, substance use disorders and other personality disorders like histrionic, borderline and paranoid. It’s estimated that up to 6.2% of the U.S. population has NPD, and it’s more common in men than women.

What are the symptoms?

People with NPD think they are superior and unique, and often look down on others for being less intelligent, talented or interesting than them. They are often obsessed with success and the validation of others. They do not handle criticism well, and may struggle in their relationships at work, school, home and in their romantic life. 

Additional symptoms include: 

  • Having an exaggerated sense of self-importance
  • Feeling entitled and worthy of constant admiration 
  • Expecting to be recognized as superior without having done anything to warrant it
  • Exaggerating their achievements and talents
  • Being preoccupied with fantasies about success, power or beauty
  • Only wanting to associate with other successful people 
  • Belittling people they consider inferior 
  • Taking advantage of others to get what they want 
  • Lacking empathy for others and refusing to acknowledge their feelings 
  • Being envious 
  • Coming across as conceited, boastful and pretentious
  • Wanting the “best” of everything, such as the best phone, clothes or car

NPD is often comorbid with other mental illnesses including depression, substance abuse and eating disorders. 

What are some common warning signs?

NPD is characterized by boisterous and self-centered tendencies. Because of this, a loved one with NPD might display noticeable symptoms at home, at work or in social settings. Pay attention to their emotional reactions, social habits and relationships with others. Ask yourself the following questions: 

  • Do they get down when they aren’t complimented or held in high regard? 
  • Do they speak over people or act more intelligent during conversations? 
  • Do they brag about common accomplishments, such as beating a game or finishing a book?   
  • Do they ask validation-based questions? 
  • Do they act petty or make low blows when offended? 
  • Do they criticize other people’s hobbies, interests or accomplishments? 
  • Do they get jealous easily? 

None of these behaviors confirm an NPD diagnosis, but they do hint at one. If you feel comfortable doing so, talk to your loved one about this behavior and why you’re concerned. Keep in mind that symptoms aren’t always obvious. People battling chronic mental health conditions often learn to hide their pain from others. It’s possible to appear outwardly fine, while facing mental difficulties in secrecy.

What causes NPD?

The exact causes of NPD are unknown. Doctors believe a range of factors play a role in its development, including being genetically predisposed (i.e. other family members struggle with NPD or other mental disorders), having brain abnormalities in the insular cortex and frontal lobes, and having been raised by parents that either over-congratulated them or were hyper-critical.

How is it treated?

The primary treatment method for all personality disorders, NPD included, is psychotherapy (aka talk therapy). However, people with NPD often refuse help because they don’t see their behavior as problematic. Instead, they may seek out solutions for co-occurring disorders like depression.

Medications are not commonly used to treat personality disorders. However, they may be recommended to address severe cases or symptoms that stem from co-occurring conditions.  

Common medications include anti-depressants such as SSRIs or SNRIs, and anti-anxiety medications (aka Benzodiazepines).

It’s important to remember that treatment plans are personalized. If you’re seeking help, make sure you work one-on-one with a doctor to create a plan that fits your needs. Just because a medication or therapy helps someone else recover, doesn’t mean it’ll be the right solution for you. Don’t ever feel guilty about asking for help, taking meds or going to therapy. Addressing your mental health is a productive and courageous thing to do.

How can I help a loved one with NPD?

Caring for someone with NPD is not easy. They might speak over you, discount your feelings or deny your concerns. It’s important to remember that their behaviors are not a reflection of your self-worth. 

It can also be hard to know how to support them. Do they want to talk about their behavior? Will they push you away if you try to help? There are no easy answers to these questions. Every person handles their mental health differently. That said, we all want to feel loved and supported. Showing someone that you’re invested in their wellbeing can make a world of difference. 

Here are some ways to do so: 

  • Educate yourself: Read up on symptoms, treatment options, and healthy living recommendations. Try and understand what your loved one is going through so you are better equipped to talk to them about it. This will also make you a valuable resource when it comes time to find treatment. 
  • Advocate treatment: Asking for help can be hard. Societal stigma often keeps people from opening up to others about their symptoms. Support your loved one by helping them research different treatment methods, or doctors in their area. If they’d like, go to a few sessions with them. Remind them that there’s nothing weird about getting help, and that you’re proud of them for following through. Remember that people with NPD often refuse help and may resent the recommendation. 
  • Set boundaries: You want to be understanding of their symptoms, but that doesn’t mean you have to put up with everything. Make rules for what you will and won’t tolerate. Stick to these boundaries and follow through on consequences when they’re broken. 
  • Be patient: Don’t take it personally if they lash out at you. They are battling something that’s very hard to overcome. Their distance has nothing to do with who you are as a person. Keep showing up for them even when it feels like it’s not helping. The act alone lets them know that they have people in their life who care.

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