Narcissistic Personality Disorder Causes and Treatments


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Narcissistic personality disorder (NPD) is one of several different types of personality disorders. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is used by many mental health professionals to diagnose this disorder, suggests that narcissistic personality disorder causes significant impairments in personality in terms of functioning and is accompanied by a number of pathological personality traits.

What Is Narcissistic Personality Disorder?

Narcissistic personality disorder is an enduring pattern of inner experience and behavior characterized by self-centeredness, lack of empathy, and an exaggerated sense of self-importance.

As with other personality disorders, this disorder negatively impacts life in various areas including social, family, and work relationships.

The National Institute of Mental Health suggests that approximately 9.1 percent of U.S. adults experience at least one type of personality disorder during any given year. Older estimates had suggested that as many as 6.2 percent of American adults experienced NPD, yet more recent figures suggest that prevalence rates are actually lower than previously believed. 

According to some current studies, narcissistic personality disorder is estimated to affect approximately 1 percent of the adult population in the United States and is more common among men than women.

Narcissistic personality disorder is thought to be less common than other personality disorders such as borderline personality disorderantisocial personality disorder, and histrionic personality disorder


Narcissism is a term commonly used to describe those who seem more concerned with themselves than with others. It is important to distinguish between those who have narcissistic personality traits and those suffering from narcissistic personality disorder. For example, narcissistic traits may be common during adolescence, but this does not necessarily mean that the teenager will go on to develop the full disorder.

Some of the symptoms associated with NPD include:

  • An exaggerated sense of one's own abilities and achievements
  • A constant need for attention, affirmation, and praise
  • A belief that he or she is unique or special and should only associate with other people of the same status
  • Persistent fantasies about attaining success and power
  • Exploiting other people for personal gain
  • A sense of entitlement and expectation of special treatment
  • A preoccupation with power or success
  • Feeling envious of others, or believing that others are envious of him or her
  • A lack of empathy for others

An official diagnosis can only be made by a qualified mental health professional and requires the individual exhibit impairments in personality functioning in various domains including the experience of a grandiose sense of self-importance as well as in interpersonal difficulties with attention-seeking, empathy, and intimacy.

Impairments in personality function and expression of personality traits must also be stable over time and across different situations, must not be normative for the individual's culture, environment, or stage of development, and must not be due to the direct influence of substance use or a general medical condition.

People with narcissistic personality disorder are typically described as arrogant, conceited, self-centered, and haughty. Because they imagine themselves as superior to others, they often insist on possessing items that reflect a successful lifestyle. Despite this exaggerated self-image, they are reliant on constant praise and attention to reinforce their self-esteem. As a result, those with narcissistic personality disorder are usually very sensitive to criticism, which is often viewed as a personal attack.


How to Identify a Malignant Narcissist


While the exact cause is unknown, researchers have identified some factors that may contribute to the disorder. Childhood experiences such as parental overindulgence, excessive praise, unreliable parenting, and a lack of an authentically validating environment are thought to contribute to narcissistic personality disorder. Genetics and biology are also thought to play a considerable role, although the exact causes are likely complex and varied.


Individual psychodynamic psychotherapy can be effectively used to treat narcissistic personality disorder, although the process can be potentially difficult and lengthy. It is important to note that people with this disorder rarely seek out treatment. Individuals often begin therapy at the urging of family members or to treat symptoms that result from the disorder such as depression.

Therapy can be especially for NPD difficult because clients are often unwilling to acknowledge the disorder. This difficulty in treatment is often compounded by the fact that insurance companies tend to pay for short-term treatments that focus only on symptom reduction, not on underlying personality problems.

Cognitive-behavioral therapy is often effective to help individuals change destructive thought and behavior patterns. The goal of treatment is to alter distorted thoughts and create a more realistic self-image. Psychotropic medications are generally ineffective for long-term change but are sometimes used to treat symptoms of anxiety or depression.

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