Overview

What is a narcissist?

A narcissist is a common catchphrase describing someone who acts self-absorbed or vain. What many people don’t know is that narcissism, or narcissistic personality disorder (NPD), is actually a serious condition.

If you have a NPD diagnosis, others may see you as only concerned about your wants and needs or having a never-ending need for compliments. But inside, you may feel insecure, less-than and empty. Having NPD makes it hard to relate to others or have genuine self-worth. It can affect relationships with your family, friends and co-workers.

How common is narcissistic personality disorder?

Experts estimate that up to 5% of people have NPD. Narcissism is one of 10 personality disorders. These disorders cause people to think, feel and behave in ways that hurt themselves or others. Signs of personality disorders usually appear in the late teen years and early adulthood.

Symptoms and Causes

What causes narcissistic personality disorder?

The exact cause of NPD is not known. The disorder may result from a combination of factors that include:

Childhood trauma (such as physical, sexual and verbal abuse).
Early relationships with parents, friends and relatives.
Genetics (family history).
Hypersensitivity to textures, noise or light in childhood.
Personality and temperament.

What are narcissistic traits (characteristics)?

Healthcare providers diagnose NPD when you have at least five of the following characteristics:

Overinflated sense of self-importance.
Constant thoughts about being more successful, powerful, smart, loved or attractive than others.
Feelings of superiority and desire to only associate with high-status people.
Need for excessive admiration.
Sense of entitlement.
Willingness to take advantage of others to achieve goals.
Lack of understanding and consideration for other people’s feelings and needs.
Arrogant or snobby behaviors and attitudes.

Diagnosis and Tests

How is narcissistic personality disorder diagnosed?

A mental health professional such as a psychologist or psychiatrist (psychotherapist) can determine if you have key symptoms of NPD. Your psychotherapist will give you questionnaires and then talk with you.

You’ll go over what’s causing you distress. The focus will be on long-term patterns of thinking, feeling, behaving and interacting with others. Your psychotherapist will also identify and rule out any other mental health conditions.

Can I take a test to see if I have narcissistic traits?

Your psychotherapist may give you personality tests to see if you have narcissistic traits. The tests are just questions you answer honestly. They give your psychotherapist better insight into how you think and feel. Tests include:

Personality diagnostic questionnaire-4 (PDQ-4).
Millon clinical multiaxial inventory III (MCMI-III).
International personality disorder examination (IPDE).

Management and Treatment

Is there a treatment for narcissism?

Long-term counseling is the primary treatment for NPD. It helps you gain greater insight into your problems and learn what changes you can make to:

Relate to others in a positive and rewarding way.
Develop healthy self-esteem.
Have more realistic expectations of others.

Your psychotherapist may also recommend medications to treat symptoms like anxiety and depression. Medications include:

Antidepressants: These medications treat depression. Healthcare providers commonly prescribe selective serotonin reuptake inhibitors (SSRIs). This class of drugs has fewer side effects than other antidepressants. SSRI medications include fluoxetine, sertraline and paroxetine.
Mood stabilizers: To reduce mood swings, your provider may prescribe a mood-stabilizing drug such as lithium.
Antipsychotic drugs: This type of medication can help with symptoms of depression and anxiety. Aripiprazole and risperidone are two kinds of antipsychotic drugs.

What are the complications of narcissistic personality disorder?

Without treatment for NPD, you can have trouble maintaining positive relationships at work and home. You might also be more vulnerable to abusing drugs and alcohol to cope with difficult emotions. Also, feeling alone can lead to deep depression and suicidal thoughts.

Prevention

How can I avoid becoming a narcissist?

If one of your parents had NPD, you have a slightly higher risk of developing it. But experts believe heredity is just one of a combination of factors that lead to NPD. If you’re concerned you or a loved one may have NPD, talk to a mental health professional.

Outlook / Prognosis

Can people with narcissistic personality disorder get better?

Starting counseling is half the battle with NPD. When you have the disorder, your self-esteem is fragile, and criticism hurts you easily. Fear of criticism can keep you from getting the help you need.

Willingness to change is vital. With counseling, you can start to change your thought patterns, which changes your behavior. Over time, those changes can improve the quality of your relationships and life.

Living With

What can my family do to help?

Living with or having a close relationship with someone who has NPD is challenging. Learning about the disorder can be eye-opening for your friends and family. They may have more compassion once they realize the source of your behavior. They should also know that it’s going to take time to see noticeable changes in your behavior.

Other steps your loved ones can take to understand NPD and how it affects them include:

Couples therapy.
Family counseling.
Individual counseling.
Support groups.

A note from Cleveland Clinic

Remember, NPD isn’t a personality flaw. It’s a mental health condition. When you have NPD, you do or say things that rub others the wrong way and damage relationships. Usually, this isn’t on purpose. It’s driven by deep-seated insecurity — feeling like you’re not good enough — and the need for people to think that you’re worthy. With treatment, you can learn healthy ways to boost your self-esteem and get along better with others.

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Narcissistic Personality Disorder