Insights on Narcissistic Personality Disorder
Learn more about the complexities of narcissistic personality disorder (NPD), its causes, symptoms, diagnosis, treatment options and its impact on relationships.
Written by Dr.Sonia Bhatt
Last updated on 3rd Jul, 2025
Narcissism is a personality trait that involves an excessive sense of self-importance, a need for constant admiration and a lack of empathy. It exists on a spectrum, with some level of self-love and confidence considered normal. However, in its extreme form, it manifests as Narcissistic Personality Disorder (NPD). Individuals with NPD may often struggle with relationships, as their behaviour can get manipulative and self-serving.
What is Narcissistic Personality Disorder (NPD)?
Narcissistic personality disorder is one of the many personality disorders such as antisocial, dependent, borderline, paranoid, schizoid, schizotypal, histrionic, and obsessive-compulsive. People with NPD have an inflated idea of themselves, and they need a lot of attention from others. They may also find it challenging to understand the emotions and feelings of others. People with NPD may not have high self-esteem. Their NPD may be more related to feelings of entitlement. They may want to seek the help of a therapist to treat the condition. Individuals who are too self-absorbed are typically called narcissists. However, there is a difference between being self-absorbed and having narcissistic personality disorder. According to experts, narcissism is a trait, and on the other hand, NPD is a mental illness.
Difference between Healthy and Pathological Narcissism
Healthy narcissism allows individuals to maintain self-esteem and assert themselves appropriately. In contrast, pathological narcissism involves an extreme preoccupation with one’s own image and a deep-seated need for validation, often at the expense of others. People with NPD typically react poorly to criticism and may become defensive or aggressive when their self-image is threatened.
Symptoms of Narcissistic Personality Disorder
Symptoms of narcissistic personality disorder and how severe they can be can vary. People with NPD can:
Feel that they deserve privileges and special treatment.
Make achievements and talents look bigger than they are.
Have an unreasonably high sense of self-importance and require constant, excessive admiration.
Believe that they are superior to others and can only spend time with or be understood by equally special people.
Be preoccupied with fantasies about power, brilliance, success, beauty or the perfect mate.
Expect to be recognised as superior even without achievements.
Be critical of others and look down upon them.
Take advantage of others to get what they want.
Expect special favours and others to do what they want without questioning them.
Be envious of others and believe others envy them.
Have an inability or unwillingness to recognise the needs and feelings of others.
Behave arrogantly, brag a lot and come across as conceited.
Insist on having the best of everything in life.
People with narcissistic personality disorder face trouble handling anything they view as criticism. They can:
React with rage or contempt and even try to belittle others to make themselves appear superior.
Have difficulty in managing their behaviour and emotions.
Become impatient or angry when they do not get special treatment or recognition.
Experience major problems dealing with stress and adapting to change.
Have problems interacting with others and easily feel insulted.
Feel depressed and moody because they fall short of perfection.
Have secret feelings of shame, insecurity, humiliation, and fear of being exposed as a failure.
Avoid situations in which they might fail.
Causes and Risk Factors in NPD
Though the exact cause may not be known, like most mental and personality disorders, it is likely due to a complex combination of factors, which include:
Environmental Factors
In parent-child relationships, kids often imitate the behaviours of their parents. Therefore, overprotective parenting styles may inadvertently foster habits that can contribute to NPD.
Genetic Factors
NPD is believed to also arise from genetic predisposition. Certain inherited traits, such as emotional regulation and temperament, may contribute to the development of narcissistic traits.
Neurological Factors
Neurological factors, including structural and functional differences in the brain regions responsible for self-regulation and empathy, may also play a pivotal role.
Culture
NPD seem to be more common in individuals who grow up in cultures that value personal independence. It is less likely to affect those who live in cultures that stress the importance of community.
Childhood Experiences
Early childhood experiences significantly impact personality development. Common contributing factors may include:
Emotional neglect or inconsistent parenting.
Childhood trauma such as abandonment or abuse.
Excessive praise or criticism from parents.
Growing up in environments that emphasise achievement and external validation over emotional support.
Diagnosis of Narcissistic Personality Disorder
NPD is diagnosed using criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). To be diagnosed, a person must exhibit at least five of the following traits:
Envy of others or belief that others envy them.
A grandiose sense of self-importance.
Preoccupation with fantasies of unlimited success and power.
Sense of entitlement.
Lack of empathy.
Exploitative behaviour.
Need for constant and excessive admiration and praise.
Arrogant behaviours and attitudes.
The belief that they are superior and unique to others.
Diagnosis, however, may get challenging as people with NPD may not recognise or acknowledge their condition. Many may seek therapy only when they experience other mental health issues, such as anxiety or depression, or after significant relationship breakdowns.
Impact of Narcissistic Personality Disorder on Relationships
NPD can impact a person’s personal as well as professional life.
Effects on Family: People with NPD often have strained relationships due to their need for control, manipulative tendencies and lack of empathy. Family members and friends may feel undervalued, emotionally drained, or even abused.
Effects on Professional Life: Narcissistic behaviour can lead to conflicts with colleagues, difficulties in teamwork and power struggles. People with NPD may be charismatic socially but struggle to maintain meaningful relationships due to their self-centred nature.
Treatment Options
Therapy may help in treating narcissistic personality disorder. The goal is to build up the person’s poor self-esteem and foster more realistic expectations of others. Treatment of NPD usually centres on talk therapy, which sometimes is also called psychotherapy. With talk therapy, a person with NPD may relate to other people better and understand their feelings and behaviours. Talk therapy can help a person with NPD to:
Recognise their strengths and weaknesses.
Accept and maintain relationships with other people, including co-workers.
Develop more realistic goals.
Let go of unrealistic goals and desires.
Learn to accept criticism or failures.
A few types of talk therapy may include:
Cognitive Behavioural Therapy (CBT): It helps identify and change negative thoughts and behaviours.
Dialectical Behavioural Therapy (DBT): This is a type of psychotherapy that helps people manage their emotions and improve their relationships. It is based on cognitive behavioural therapy (CBT) and is often used in treating people with borderline personality disorder (BPD).
Metacognitive Therapy: This is a type of CBT that specifically helps in stopping unhealthy beliefs and thinking.
Couple or Family Therapy: Couples therapy addresses issues within a romantic relationship, while family therapy focuses on helping family members work on dynamics and conflicts within the entire family unit.
Group Therapy: This therapy involves multiple patients receiving care from one or more healthcare professionals at the same time.
Conclusion
Narcissistic personality disorder is a complex condition that impacts the emotions, well-being, relationships, and people's quality of life overall. Hence, it is essential to understand the symptoms, causes and treatment options, essential in addressing the challenges it presents. Education and compassion are vital in managing NPD. For individuals living with NPD and their loved ones, professional help, supportive communities, and self-awareness can facilitate growth and improved relationships.
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