Narcissistic Personality Disorder (NPD): What is it and how to treat it?

In our culture, traits such as confidence, assertiveness and a drive to succeed are generally viewed as positive. Such traits can help us to perform at our best, achieve our goals and develop successful relationships. However, these kinds of traits can sometimes be extreme.

Overconfidence, aggressiveness and the need to succeed at all costs can have negative consequences. Such extreme traits can indicate narcissistic personality disorder (NPD) which, if not managed, can cause problems in our work, education and personal relationships.

The good news is that NPD can be managed. The starting point for doing this is to understand the disorder, its impact, and the support mechanisms available to help manage it. This article provides general information about narcissistic personality disorder. However, narcissistic personality disorder is a complex disorder and for more information, support and advice, it is highly recommended that expert professional help be sought from accredited mental health practitioners.

What is Narcissistic Personality Disorder?

In everyday conversations, describing someone as narcissistic is generally intended as a negative comment with the individual being described in terms such as self-centered, egotistical, needing excessive attention and lacking empathy.

This is a rather one-dimensional view.

Narcissism is far more complex with expert literature suggesting that narcissistic traits occur on a continuum ranging from normal and beneficial to negative and problematic. Most of us have at least some behaviours (confidence, assertiveness, drive to succeed) that indicate narcissistic traits located at the normal end of the continuum. Most of us also, to some extent, at some time, display traits located towards the negative end of the continuum.

For example, it is considered normal for us to be thoughtless, selfish or self-involved once in a while. This suggests that it is possible to be slightly narcissistic.

However people with NPD manifest a consistent and ongoing pattern of negative traits. It is not the presence of narcissistic traits, but rather their constancy and intensity that is significant.

Narcissistic personality disorder has been defined as a disorder in which there is a long-term pattern of abnormal behaviour characterized by exaggerated feelings of self-importance, an excessive need for admiration, and a lack of understanding of others’ feelings (George & Short, 2018).

What are the indicators of narcissist personality disorder?

The following discussion is based on a review of the professional and academic literature. It is intended as a general overview, and does not adopt any specific theoretical or treatment perspective. There is some variation in the way traits and behaviours are named and described within the literature. However, discussions generally include the following traits:

Grandiose personality and sense of self-importance

People with narcissistic personality disorder have an inflated sense of self. They believe that they are special people and can only be recognised and understood by other high-status special people. It follows from this that they also believe they are more important than others and are entitled to special treatment. If they do not perceive you as special and talented like them, they may be arrogant, rude, even dismissive in their interactions with you. By making you feel inferior, they feel better about themselves.

Need for admiration

Individuals with narcissistic personality disorder have a need for excessive admiration. An occasional compliment isn’t enough. To gain your admiration, they exaggerate their accomplishments and abilities while at the same time pointing out what others haven’t done, or haven’t done well.  They may often seek out relationships with people who will meet this need.

Sense of entitlement

Linked to the perception of themselves as special people is a strong sense of entitlement. Individuals with narcissistic personality disorder expect others to cater to their needs. Failure to respond to this expectation can result in unpleasantness. It can also become unpleasant if you ask for something in return.

Lack of empathy

A person with narcissistic personality disorder does not acknowledge or identify with the feelings and needs of other people. This manifests in behaviours such as:  

  • Poor listening –since his/her own view is the only important one, the person with NPD does not listen to others. When others are conversing, rather than listening, he/she may be head-talking – thinking about what they are going to say next;
  • Dominating the conversation – talking about him/herself and showing no interest in other people and their ideas or experiences. They may have no interest, or feel indifferent to other people’s issues and problems;
  • Interrupting conversations: we all interrupt occasionally (normal end of the narcissistic traits continuum) but the person with NPD does so very frequently, often for the purpose of turning the focus of the discussion back on themselves.

Exploitative and manipulative

A person with narcissistic personality disorder takes advantage of others to achieve his/her own ends. He/she can be very charming as long as you are able to satisfy some of their needs. However, this charm may be switched off when you are no longer of use to them.

Low self-esteem

Despite appearing egotistical and in control, individuals with narcissistic personality disorder often have very low self-esteem. These feelings of low self-worth make them need constant reassurance, even admiration, from others.

Negative Emotions

Individuals with narcissistic personality disorder are extremely sensitive to criticism. They are easily offended by real or imagined slights. If they feel slighted, they can retaliate either aggressively or by withdrawing emotionally or physically.

Individuals may have some of these traits but they may not be severe enough or consistent enough for a diagnosis of narcissistic personality disorder. On the other hand, individuals with narcissistic personality disorder exhibit many of these traits consistently. However they do not necessarily exhibit all of them.

What causes a person to develop narcissistic personality disorder?

Current research suggests that a combination of influences, including genetic, environmental, cultural, and neurobiological factors may contribute to a person developing narcissistic personality disorder.

Genetic

Although still limited, studies have pointed to evidence that traits are inherited and that a person is more likely to develop narcissistic personality disorder if it occurs in the family medical history (Luo, Cai and Song, 2014).

Environmental

Research suggests that both childhood abuse or neglect and unrealistic expectations or excessive pampering from parents can contribute to the development of narcissistic personality disorder (Yakely, 2018).

Cultural influences

Cultural values and expectations are also considered to be involved in the development of narcissistic personality disorder . For example, as noted earlier, cultural expectations can reward both confidence and assertiveness and the more extreme traits of aggression and success at any cost. It has even been suggested that in the last few decades, the emergence of the cult of the individual, with its emphasis on self-expression, fame and personal and professional success has created a culture where more extreme traits are increasingly manifested and rewarded (Yakely, 2018).

Neurobiological factors

Research in this area is also somewhat limited, yet some studies have identified abnormalities in certain brain areas that are associated with features of narcissistic personality disorder (George and Short, 2018).

At what age does narcissistic personality disorder develop?

Traits indicating narcissistic personality disorder have been observed in children and adolescents although formal diagnosis tends to be made in young adults rather than individuals in these younger groups. This is because children and young adults are, on the whole, self-centred and often display narcissistic personality traits. However, these are generally more towards the normal end of the spectrum and moderate as children and young people learn to interact appropriately with others. Those carrying the more extreme traits into young adulthood are more likely to develop narcissistic personality disorder.

Treating narcissistic personality disorder

To fully explore treatment options for you or someone you know, a therapist or psychologist should be consulted. There are no medications to specifically treat narcissistic personality disorder. The primary approach for managing narcissistic personality disorder is psychological therapies – talking to a psychologist or therapist. Such therapies can encourage the individual to acknowledge that they have a problem, determine their behavioural traits, consider the impact of these traits on their relationships, and identify and implement strategies for behaviour change.

Consultation can be beneficial not just for people experiencing NPD, but for anyone with narcissistic traits – even those on the more normal end of the continuum. Consulting a therapist or psychologist can help identify which traits a person may have, and to discuss strategies to minimise the potential for these traits to move towards the more extreme end of the continuum. Managing out narcissistic traits can assist us to perform at our best, achieve our goals and develop successful relationships.

Information in this article is not intended as a substitute for informed professional advice. If you or someone you know is concerned about possible traits, you should consult with an appropriate mental health professional.

 

References

George FR, Short D (2018) The Cognitive Neuroscience of Narcissism. J Brain Behav Cogn Sci Vol 1:6

Yakeley, J. (2018). Current understanding of narcissism and narcissistic personality disorder. BJPsych Advances, 24(5), 305-315. doi:10.1192/bja.2018.20

Luo YL, Cai H, Song H. A behavioral genetic study of intrapersonal and interpersonal dimensions of narcissism. PLoS One. 2014;9(4):e93403. Published 2014 Apr 2. doi:10.1371/journal.pone.0093403

About the editor, Amelia Cambrell

My name is Amelia and I'm a Senior Psychologist at Counselling in Melbourne. I have over 18-years of experience in the mental health space. I am very driven to get the best outcomes for my clients which can be long lasting by using a range of modalities such as CBT. There is nothing more satisfying than helping adolescents, adults and couples who are feeling confused, frustrated, stuck or overwhelmed, to find more clarity, confidence and happiness in their lives.

Find out more about Amelia Cambrell

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