Narcissistic personality disorder is a mental health condition. It affects a person’s sense of self-esteem, identity, and how they treat themselves and others. It’s more than arrogance or selfishness. In the worst cases, people with NPD may struggle with feelings of failure or rejection, putting their own health and well-being at risk.
Narcissistic personality disorder (NPD) is a mental health condition that affects how you view yourself and relate to others. Having NPD means you have an excessive need to impress others or feel important. That need can be strong enough to drive harmful behaviors, negatively affecting you and those around you.
NPD gets its name from Narcissus, a hunter from Greek mythology. According to the myth, Narcissus was so obsessed with his own beauty that he couldn’t stop looking at his reflection in a pool of water. He did nothing else but stare at his reflection until he died.
While people commonly connect the term “narcissism” to physical appearance — just like in the myth — NPD isn’t just about how you look. It can also involve other traits or abilities you have, such as intelligence, charisma, artistic skill, athletic ability, wealth, power, success and more.
Experts aren’t sure how common NPD is. According to research data, between 0.5% and 5% of people in the U.S. may have it. Between 50% and 75% of cases affect men and people assigned male at birth (AMAB).
However, many people hide narcissistic beliefs or behaviors (informally known as “covert narcissism”). Because of that, it’s hard to estimate how many people truly have NPD.
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The symptoms of NPD all revolve around thoughts, feelings and actions. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fifth edition text revision (also known as the “DSM-5-TR™” or just “DSM-5®”) has a list of nine criteria. To others, the symptoms that fall under the criteria may look like the following:
1. Grandiose sense of self-importance.
2. Frequent fantasies about having or deserving:
3. Belief in superiority.
4. Need for admiration.
6. Willingness to exploit others.
7. Lack of empathy.
8. Frequent envy.
People with NPD may also show other behaviors related to the nine criteria, but still different, such as:
NPD is a mental health condition, so experts aren’t exactly sure why it happens. People with NPD often have subtle differences in brain structure, but experts aren’t sure if that’s what causes NPD or happens because of NPD.
For now, the main contributing factors to NPD seem to be:
It’s very common for NPD to overlap with other mental health conditions and concerns. Some of the most common overlaps or complications include:
A healthcare provider, usually a psychiatrist or psychologist, can diagnose NPD by talking to you and asking questions about your life and interactions with others (especially family, friends or other loved ones). They may also diagnose related conditions or ask questions to rule out conditions with similar symptoms or effects.
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fifth edition text revision (also known as the “DSM-5-TR™” or just “DSM-5®”) has a list of nine criteria. You must have at least five of them to receive a diagnosis of NPD. There aren’t any diagnostic, lab or imaging tests that can help diagnose NPD.
Treating NPD usually involves some form of mental health therapy (psychotherapy).
Some of the therapy types that are most common with NPD include (but aren’t limited to) the following:
Because there are so many therapy methods, your mental health provider is the best person to tell you more about the different types. They can answer any questions you have about how these approaches work and recommend a type that fits your needs best.
There aren’t any medications that treat NPD directly, but medications may treat symptoms that happen with related conditions, like anxiety or depression. Some of the medications that may help symptoms of NPD-related conditions include:
NPD happens for reasons that experts don’t fully understand. It also may run in families. Because of both those factors, it isn’t possible to prevent it in yourself or your child.
You may be able to reduce the risk of your child developing it with how you parent, such as finding ways to adapt your parenting style to specific situations. Your child’s pediatrician can guide you on ways to do this or may be able to recommend a provider who specializes in childhood psychological development.
People with NPD may not be aware of it. Some can go years or decades without knowing. Often, it takes some kind of stressful event or circumstance for the symptoms to appear fully. Some examples of events or circumstances include:
The outlook for NPD depends on several factors. They include:
Because so many factors can play a role, your mental health provider is the best person to ask about the outlook for your condition. They can tell you more about what to expect and what you can do to help yourself along the way.
If you have NPD, you may struggle with accepting the diagnosis. The symptoms of this disease may make you want to push back against or avoid learning that you have any kind of disorder. But it’s important to recognize that treatment can help improve your life and how you relate to others. That can make it easier for you to form and build relationships, pursue personal or professional success, etc.
Some of the most important things you can do include:
You should see your healthcare provider as recommended. They’ll set up a schedule for treatment and follow-up visits. You should also see your provider if you notice any changes in your symptoms or how effective your medications are.
You should go to the ER or call 911 (or your local emergency services number) if you have thoughts about harming yourself, including thoughts of suicide, or about harming others. If you have thoughts like these, you can call any of the following:
The DSM-5-TR (the latest revision of the DSM-5) doesn’t describe different types of narcissism or NPD. But experts often still organize narcissism based on traits or behaviors.
Some of the traits used are:
These aren’t formal distinctions, but a mental health provider may tell you about them to help you understand your condition. You can also ask a provider about these traits if you think they apply to you.
Providers may use several diagnostic screening questionnaires to help diagnose NPD. While you might feel tempted to take a test online to see if you have it, you should remember that it isn’t a formal diagnosis. You should see a trained, qualified provider to be certain of the diagnosis.
People with NPD may be unable to see its signs and symptoms in themselves. Often, family, friends or loved ones may be the first to suspect someone has NPD. If you suspect someone you care about has NPD, you should keep in mind the following:
A note from Cleveland Clinic
Narcissistic personality disorder isn’t a flaw or a character defect. It’s a mental health disorder. If you have it, there are things you can do to help yourself and strengthen your connections to others in a healthy way. It may be difficult to accept or admit, but this condition can seriously damage relationships and disrupt your life. You shouldn’t ignore it or avoid the reality of it.
If you know someone with NPD, learning about it can help you take care of yourself and try to help them. Sometimes, the best thing you can do is establish boundaries and not engage. Remember that you can’t force someone with NPD to change. They have to be willing to do so.
Last reviewed by a Cleveland Clinic medical professional on 08/03/2023.
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