When someone is so self-focused that their relationships and working life begin to deteriorate, they may be experiencing something called narcissistic personality disorder (NPD). NPD is a mental health condition that effects someone’s sense of self-worth, their ability to control their emotional state, and their relationships with others. People living with NPD often feel excessively self-important and superior to those around them. They may rely on praise and admiration to feel good, belittle those who challenge their sense of superiority, and struggle to empathise with other peoples’ experiences.
NPD differs from the type of narcissism that most people feel from time to time. People living with NPD have a constant need to feel superior to those around them and will often behave in ways that are overly self-aggrandising. However, although they may appear incredibly confident, this presentation usually hides a deeper feeling of insecurity.
This type of behaviour can be difficult for others to tolerate, yet it is important to remember that NPD seriously harms those who experience it first-hand. This fact sheet will give an overview of NPD, how many people experience it, and where to find support.
Signs and symptoms
What are the signs and symptoms that someone may be experiencing NPD? Here are the most common ones to look out for are:
- Displays a heightened sense of self-importance (exaggerates achievements and talents; expects to be seen as superior regardless of circumstances)
- Has an obsession with fantasies of power, wealth, success, beauty
- Believes they deserve special treatment, that they need the best of everything, and should only be friends with other equally ‘special’ people
- Relies on constant admiration to maintain relationships with other people
- Has unrealistic expectations towards others about how they should be treated (needs automatic compliance with expectations)
- Exploits others for personal gain; only interacts with people to achieve individual goals
- Is unable to empathise with others or understand how someone else might be feeling
- Is envious of others or believes that others are envious of them
- Displays an arrogant attitude towards others
In times of distress, people living with NPD may display the following behaviours:
- Responds with anger and frustration when they don’t receive special treatment
- Struggles to cope with stress and change in their life, and takes this stress out on other people
- Feels depressed because they fall short of perfection
- Reacts with anger if their superiority is challenged by others
There is also another side of NPD known as ‘vulnerable narcissism’. Vulnerable narcissism occurs when someone can no longer maintain their narcissistic self-perception, and they retreat into a state of low self-esteem.
Signs of vulnerable narcissism include:
- Hypersensitivity to others
- Low self-esteem and self-belief
- Feeling inferior to other people
- Retreating to a place of isolation
The sooner the person seeks help from a mental health professional, the sooner they can manage their symptoms.
Causes of narcissistic personality disorder
The root cause of narcissistic personality disorder is unclear. The latest research suggests that people develop NPD from a mixture of genetic factors and childhood experiences. These childhood experiences could be dysfunctional or distant parenting styles, or exposure to abuse or neglect. Studies suggest that when certain genetic traits mix with these formative experiences, someone may be more likely to develop NPD as they get older.
How is narcissistic personality disorder diagnosed?
There is no formal way of diagnosing NPD. A treating psychologist or psychiatrist may notice NPD signs during conversation and form a diagnosis from there. These signs could be:
- Difficulty processing emotions
- Being quick to blame others (including the therapist) for things that happen in their life
- Struggling to see things from another person’s perspective.
This process could take weeks or months of therapy and is very dependent on the patient’s willingness to participate. A therapist may choose not to tell the patient about the possibility of NPD until they feel the time is right. That said, it is always okay to ask a therapist about NPD.
How is narcissistic personality disorder treated?
The most effective treatment for NPD is long-term psychological therapy. There are psychologists and psychiatrists who specialise in NPD treatment and have treated NPD in the past. They may encourage someone living with NPD to reflect on their behaviour, the impact their behaviour has on themselves and others, and create strategies to implement behavioural change.
A psychologist or psychiatrist may reappropriate treatments used for other personality disorders. These treatments are mentalisation therapy, transference-focused therapy and schema-focused therapy as described below.
Mentalisation therapy helps someone reflect and improve on their behaviour in moments of conflict or emotional distress. With their psychologist or psychiatrist, someone may discuss an incident where they ‘acted-out’ emotionally towards themselves or others. They may be encouraged to retrace exactly what happened in that situation, both internally and externally, and reflect on whether their response was appropriate. Through repetition, mentalisation therapy increases someone’s capacity to stop and consider their behaviour, before making impulsive (and potentially harmful) decisions.Find a professional practitioner
Transference therapy is also aimed at helping someone manage their emotions in social situations. At points of distress or conflict, a psychologist or psychiatrist may help the client reflect on how they act-out emotionally towards other people, and what is motivating their behaviour in that moment. Transference therapy can help reveal the underlying fears and anxieties that cause someone to enter the ‘all-or-nothing’ state of mind, which may have previously led to interpersonal conflict and relationship breakdown.Find a therapy
A ‘schema’ describes the way someone thinks and feels during a specific life situation. If someone has a ‘maladaptive schema’, they often have endured harmful experiences during their childhood and adolescence, which means they react differently to others in certain situations. For example, someone with an ‘abandonment schema’ may be hypersensitive to other people, and quickly lose their sense of self-worth if triggered in a specific way. Schema therapy heals the maladaptive schema by working through the negative associations attached to certain life situations (e.g. a social gathering). This can help someone cope better with a triggering environment, and replace their ‘maladaptive’ coping techniques with healthier behaviour patterns.Find a professional practitioner
Medication for other symptoms
There is no medication to treat NPD. However, a doctor may prescribe medication to treat symptoms for other mental health problems, like anxiety or depression. Ultimately, the most important aspect of treatment is the commitment from the patient. Approaching treatment with a strong willingness to participate is the most vital part of recovery.Find a GP
Help & Support
Because the diagnostic process can be very complicated, the true number of people living with NPD is unclear. Different studies have suggested that within the adult population, numbers could range from 1% to 6%. People experiencing NPD can get support and treatment.
NPD is frequently comorbid with other mental health issues. This means that NPD can lead to things like anxiety, depression, or bi-polar disorder. These other conditions can disguise an underlying case of NPD, so it is very important that treatment continues until the patient and therapist understand what is really going on. If the underlying case of NPD is understood, it is more likely that other life issues will be alleviated. This will give someone the best chance of improving their life and achieving their goals.
If symptoms of NPD are ignored, it can cause serious consequences, such as family breakdown or loss of employment. Because NPD can make it difficult for someone to acknowledge their own problems, it is often family members that lead them to treatment. It may be difficult for someone living with NPD to maintain interest in treatment – statistics show that 40% of people drop out of therapy. However, with continued support from a therapist that specialises in treating NPD, there is always hope for improvement.
A clinical psychologist or psychiatrist is the best place to receive treatment for narcissistic personality disorder. They have the training and experience to help someone to recovery. To find a suitable psychologist or psychiatrist, it is often best to speak directly to local mental health organisations. They will already know who the best clinicians are in the local area.
Once you know which psychologist or psychiatrist you want to see, visit your local GP to get a referral. They will give you the right paperwork so you can book an appointment with your chosen psychologist or psychiatrist.