Narcissistic Personality Disorder Explained

It's not uncommon to display (at least) some narcissistic characteristics every so often — too much, however, and it might make you (or those around you) question if you have narcissistic personality disorder (per PyschCentral). And a report published in The Recovery Village shows that for every 200 people in the United States, at least one has the disorder. And often it tags along other troubling disorders including bipolar disorder, depression, eating disorders, substance abuse disorder, and paranoid personality disorder.

If you consider how destructive the condition can become in the long term — ruining friendships and romantic relationships and having a hard time keeping a job, for instance — it's easy to see how important it is to get diagnosed. Figuring out if you have narcissistic personality disorder might help you overcome some of the challenges when faced with this condition, and a diagnosis could inspire you to create a more peaceful, happy and fulfilling life (via the Mayo Clinic). 

Here, we're going to learn all about narcissistic personality disorder, so you can be sure about the nuances involved and take the necessary precautions.

Causes and major risk factors for narcissistic personality disorder

The specific cause of narcissistic personality disorder is still a mystery. However, several risk factors like parenting style, genes, and environment make an individual more likely to develop the disorder (per PsychCentral). When it comes to parenting style, the extremes of over-parenting — which get highlighted by being overly involved in your child's life and doing things for them which they can easily handle by themselves, or being less strict and too free with them — can make kids lean toward the disorder. On the flip side, if you mistreat your child and show coldness and lack of care and concern, it may also fuel the development of narcissistic personality disorder. This is because it may help them cope, and to fill in the void you created in their life as a parent.

As for genes, certain aspects of narcissistic personality disorder (a sense of entitlement, for example) and a feeling of grandiosity can get passed down to newer generations — although not in all cases. You can also cultivate them through your thinking patterns (via the Mayo Clinic). Regarding environment, there is research that "suggests that narcissism scores were higher in individualistic cultures (which focus more on each person's rights and goals) compared with collectivistic cultures (which focus more on what's best for the group)," according to PsychCentral. And gender as another risk factor — the condition is more prevalent in men than women.


The signs and symptoms of narcissistic personality disorder may include wanting to get acknowledged as the person who has the finest things — for instance, the type of automobile you own. And they may boast about their achievements and might even have a desire for being overly praised. Some may want to manipulate other people for their own gain while others could be super obsessed about how powerful, intelligent, attractive, or successful they are. You'll often find them belittling other people's opinions to promote their own, and expecting others to go out of their way for them. Some people with the condition may even want you to strictly "obey" their orders yet you hold the same position at work (per the Mayo Clinic).

Others may want to be constantly admired and approved by everyone and will go to any lengths to achieve that. When they get some criticism — even constructive criticism — they don't handle it too well and will often direct blame for their shortcomings to other people. It may also be hard for them to relate to other people's feelings because they want their own feelings to always be recognized ahead of others. Close friends may describe them as people who fall short of empathy, and who come across as heartless and conceited because "you can't put yourself in other people's shoes and empathize with their experiences. You might belittle others or even bully people to feel better about yourself." (via Psycom).

Narcissism vs. narcissistic personality disorder

From afar, narcissism and narcissistic personality disorder may appear to be the same thing. However, PsychCentral explains there's a visible fine line between the two. Narcissism is a characteristic in your personality that gives off the vibe of self-importance, selfishness, arrogance, and lack of empathy. For some, the characteristic presents itself moderately — in others it's extreme and defines almost every aspect of their lives. Narcissism itself is a trait of narcissistic personality disorder, and everyone who has the disorder has narcissistic features. However, not all people who have narcissism can be strictly said to have narcissistic personality disorder.

Narcissism becomes narcissistic personality disorder when the trait causes continuous havoc in your life. If it affects every aspect of your life including relationships, friendships, and work, and you experience consistent suffering — to the point where you need medical help — you may end up getting diagnosed with narcissistic personality disorder. In many cases, other health conditions such as antisocial personality disorder, borderline personality disorder, histrionic personality disorder, anxiety, and depression, may co-exist with the condition and the affected person may indulge in alcohol and drug use. It's also not a surprise for people with narcissistic behavior to have eating disorders like bulimia nervosa (where you have extended eating periods and then take extreme measures to prevent weight gain) and anorexia nervosa (where you starve yourself to avoid being or appearing to have excess weight) so that people can find them to match the common perception of beauty (per The Recovery Village).

Types of narcissism

In the grand scheme of things, narcissism can go one of two ways: self-improving and constructive narcissism or destructive narcissism (via PsychCentral). In constructive narcissism, people who show this trait tend to use the narcissism to their favor. You'll find them to have an admirable sense of confidence, independence, and a self-cheering attitude that gets them through tough times. This kind of narcissism helps people move ahead in life and take up big positions in different organizations. However, the destructive kind tends to break down the person with it. It frails their social fabric and negatively impacts their work and personal life. Unlike constructive narcissism, destructive narcissism makes it very difficult for people to advance in their careers or even keep their jobs for long.

According to PsychCentral, destructive narcissism presents itself in five types: Overt (where someone is full of themselves, combative, feels they deserve way more than they're getting, and has a strong urge for recognition and admiration), malignant (where someone wants to feel and get recognized as more worthy than others, finds pleasure in other people's suffering, vengeful and paranoid), covert (where someone shows low self-esteem, looks depressed and anxious, keeps to themselves and appears to be the victim in almost all situations), communal (where someone perceives themselves as compassionate but want the attention, power, and status that comes with being socially compassionate), and antagonistic (where someone is argumentative, highly competitive, haughty, and manipulative). 

Careers in Psychology also mentions other narcissism types based on a popular American Psychologist — Theodore Millon — namely: Amorous, elitist, unprincipled, and compensatory narcissism.

Subtypes of narcissistic personality disorder

Narcissistic personality disorder can be further categorized into three groups: Grandiose, exhibitionist, and fragile (per Cadabam's). In the grandiose category, people display one major narcissistic feature — grandiosity — among other mild ones. They tend to feel unrealistically higher in terms of status than other people and they aren't shy in letting people know that — mainly through the way they carry themselves around people. Due to this "superior" feeling, they find it hard to relate to people and many people tend to avoid their company. The possibility of having the disorder existing together with drug and alcohol abuse or other types of personality disorders is very high in this category. Nonetheless, a small percentage of people in this group actually seek out medical help.

The exhibitionist gets recognized well when they anticipate failure or meet sudden issues they weren't prepared for like when they get dismissed at work or when they have a personal issue in their relationships. On the outside, they may look like they're doing well and will still display traits like entitlement, selfishness, lack of empathy, and mistreating other people for their own gain — however, those with this type of narcissistic personality disorder are suffering within. 

People in the fragile category — for the most part — also deal with anxiety, depression, and similar disorders. Sometimes, they'll look confident, composed, and eloquent while on other occasions, they may look shy, confused and unsure of themselves. During diagnosis, narcissistic personality disorder may get dismissed in people in the fragile category, because traits like grandiosity and lack of empathy aren't present (via Psychology Today).

Narcissistic personality disorder and romantic relationships

Generally, other people who get into romantic relationships with people with narcissistic personality disorder say that they feel weighed down by them over time. Although all relationships have their ups and downs, in this particular case, the problems tend to be on the extreme. In the initial stages of the relationship, someone with the disorder may appear and sound adorable and even irresistible. They may shower you with compliments on your intelligence and beauty, and for a moment, you may feel like you're in a different, special and exciting world. You may also have a reputation for being attractive or intelligent and they may feel you're best suited for them. Nedra Glover Tawwab, who founded the Charlotte-based Kaleidoscope Counseling told Healthline, "Narcissists think that they deserve to be with other people who are special, and that special people are the only ones who can appreciate them fully."

However, as time passes, things take a turn for the worse. They may start becoming the center of all your talks and constantly keep praising themselves. You may also note that they get you to compliment them a lot, and they don't tend to keep friends for a long period. Their ways of communicating may even advance to the level of making you doubt your morality and sanity, because "narcissists are often drawn to individuals who are prone to feeling guilty. Such individuals are typically emotionally sensitive and they may doubt or second-guess themselves in emotionally complex situations" (via Psychology Today). If you're an empathetic person who feels guilty easily, like protecting other people's image and goes to extreme lengths of giving up your needs for others, you're a high target for people with narcissistic traits and narcissistic personality disorder.

The diagnosis

According to the Mayo Clinic, when diagnosing narcissistic personality disorder, the healthcare provider pays close attention to the symptoms. They will most likely carry out a physical exam to look for potential physical issues that could be paving the way for associating symptoms — in other words, a physical exam will "make sure you don't have a physical problem causing your symptoms." Your doctor may even perform psychological assessments which use questionnaires to thoroughly understand your problem. They will also refer to and apply the guidelines outlined in the DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders) which highlights the symptoms, accurate descriptions, and the methodology for diagnosing mental disorders (per the American Psychiatric Association). Personality disorders, including narcissistic personality disorder, tend to share several features and it's quite easy to mistake one disorder for another. In many cases, a person may also have two personality disorders at once. That's why doctors are keen on the diagnosis to make sure they identify all the issues a person is having.

During the assessment, your doctor may tell you to describe your situation, and several interview-like questions may follow to provide more light on your case. In the interview, the doctor may ask you to describe your partner. As you speak, they may look for indicators of narcissistic personality disorder like belittling words, a sense of grandiosity, and a shallow relationship with them. Other signals may be in how you relate with the doctor. The doctor can then assess and identify signs and symptoms of the disorder via the way you respond to their questions (per the American Journal of Psychiatry).

Treating narcissistic personality disorder

After the confirmation of the disorder's presence, you may get several therapy-based treatment recommendations (per PsychCentral). The first is supportive psychotherapy. Here, you may bring your partner along. You get to learn how to control negative emotions, better your social relationships, and regulate destructive thoughts. If you also have depression and anxiety, you'll receive treatment for that too. The second is gestalt therapy, which focuses on the past's effect on your current experiences to promote self-awareness and discovery of the real cause that drives your condition. Gestalt therapy can also include guided imagery. The third is metacognitive interpersonal therapy which seeks to identify emotions and their triggers, and recognizing "unhelpful relationship patterns." It involves two steps: "stage setting" and "change promoting."

The fourth is transference-focused psychotherapy which aims to help you break the positive and negative prejudice you may be having toward people. It helps paint a more reasonable and realistic picture of the world which is a mixture of good and not-so-good traits and helps you apply it successfully. To be effective, this therapy requires a deep relationship between you and your therapist. The fifth is dialectical behavior therapy which trains you in mindfulness to regulate your emotions and present-moment experiences. The sixth is mentalization-based therapy which helps boost your reasoning skills to increase understanding and insight into your daily experiences and "understand how thoughts and feelings affect behavior" (via PsychCentral).

The Mayo Clinic explains that thoughts of abandoning your treatment may visit you frequently as you go for therapy and advises that you stay strong and focused to the end.

Long-term complications

When narcissistic personality disorder persists and medical assistance is not sought, it may develop and become fatal with time. According to the National Library of Medicine, you may slowly get other health issues that accompany narcissistic personality disorder — for example, unstable moods, depression, and substance and drug abuse. These tendencies and health problems begin when you fail to understand why people don't see life the way you do or appreciate your naturally "elevated" status. When you begin quarreling with people at school or work and receive multiple warnings from the organizations you're in, which then leads to dismissal, you may get into a downward spiral that may increase the chances of these other conditions and personality disorders.

After a while, you may contemplate suicide. Most deaths of people with narcissistic personality disorder are from suicide — especially for men (via the Journal of Affective Disorders). The Mayo Clinic further insists that people with narcissistic personality disorder have long-term problems in their romantic relationships. It's quite difficult for almost anyone to stay in a relationship with someone who constantly belittles them, manipulates them, and who can't connect deeply and emotionally — which are common traits of people with narcissistic personality disorder.

Prevention and management

Since most people with narcissistic personality disorder tend to cultivate the traits (that define the condition) at a tender age, you can prevent the traits by ensuring you give your children a balanced upbringing. This means avoiding excess pampering as well as neglect and abuse. Also, training your child to build deep and meaningful relationships that consider every party involved can go a long way in avoiding selfishness and self-centeredness. Moreover, teaching them to understand other people's pain and suffering, and aiming to ease them from it and helping them learn to take responsibility for their own actions and shortcomings can help minimize the risk of developing the disorder (via Psychology Today).

In terms of management, one of the most rewarding skills a person with narcissistic personality disorder can develop is mindful self-compassion. This is where you train yourself to engage your awareness in the here and now — with all its experiences — and aim to use it to be more kind to yourself and others. When you combine mindfulness with emotional and mental regulation, along with treatment, it becomes far simpler for you to manage the negative impact the condition has on your life (per PyschCentral).

Coping with narcissism and narcissistic personality disorder

Mary Shull, licensed therapist in Pipersville, PA, explains that if you're in a relationship with someone who has narcissistic traits or narcissistic personality disorder, it can be hectic to endure the treatment you get from your partner. However, you can train yourself to cope and actually live a fulfilling life with them. Some of the things you should keep in mind include learning more about narcissistic traits and the disorder as a whole, determining the actions to react to and the ones to overlook, motivating your partner to get therapy, and managing your emotions and helping them talk about theirs too. 

"Learn as much as you can about narcissism," Shull says. "It is a complicated mental illness centering on an individual's inflated sense of self-importance accompanied by a lack of empathy for other people."

When things get too heated between the two of you and you can't seem to have a good handle on yourself, look for ways to release the tension and frustration. Having some alone time and engaging in your preferred method of peace and calming can ease the built-up tension.

If you're the one living with narcissistic personality disorder, you can also learn to cope with the condition emotionally, mentally, and even physically by slowly making a few changes in your life. Some things to consider include becoming aware of your triggers, choosing the actions and reactions you want to improve, visualizing how you'd like to be as opposed to how you currently are, taking your time before acting and reacting, analyzing how you're applying the new resolutions, and looking for more opportunities to get even better (via Psychology Today).