Narcissistic personality disorder

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at April 5, 2016
StartDiseasesNarcissistic personality disorder

Narcissistic personality disorder (NPD) is one of ten conditions classified by the American Psychiatric Association as a personality disorder. Individuals with NPD frequently have unusually strongly positive opinions about themselves. As a result, the disorder interferes with their ability to find success in many areas of life including relationships, careers, or finances. In addition, their inflated sense of entitlement leaves them unable to recognize the need for improvement.


Definition & Facts

The Diagnostic and Statistical Manual of Mental Disorders (DSM) has identified the same nine characteristics of the NPD patient for almost 20 years. It is rare that a patient of NPD shows all 9 symptoms, so diagnosis relies on the individual exhibiting 5 of the 9 identified characteristics.

On the surface, NPD is a mental disorder in which one has a distorted understanding of his or her own importance. A need for the admiration of others and a complete lack of empathy for others are also present. Beneath the surface, however, a lack of self-esteem drives the suffering individual. Many people have mild narcissism, but it's estimated that 1 to 3 percent of the population has the disorder.

Symptoms & Complaints

Those with NPD will not recognize the disorder in themselves, so it is up to friends, family, and medical professionals to recognize the symptoms of this disorder. Some of the symptoms might include:

  • Exaggerating abilities and accomplishments
  • An obsession with power, intelligence, wealth, success, looks, etc.
  • Expecting continuous admiration of associates
  • Having an over-inflated sense of self
  • Pursuing a continuous drive to find excitement
  • Lack of empathy with regard to others’ needs, feelings, and emotional expectations.
  • Disproportionate sense of conceit
  • Aloofness.

Individual with NPD may be at a loss with how to function in life due to severe feelings of emptiness and inadequacy. They seek approval, but the possibility of not receiving it is so frightening that they adopt narcissistic attitudes and behaviors to overcompensate, protecting oneself from rejection.


The precise cause of NPD is not known. Some experts believe, as with other disorders, that genetic factors play a role. Dysfunctions in the brain and cognition may also contribute. Environmental factors likely play a role as well.

Extremes in parenting such as parents who indulge the whims of their children, incessantly praising them, and raising them with the understanding that they are perfect may contribute to the development of NPD. On the other hand, parents who are hypercritical of their children may also play a role.

Diagnosis & Tests

Diagnosis and testing for NPD include observing signs and symptoms, a physical examination, and a thorough psychological evaluation. A careful analysis of signs and symptoms as well as a psychological examination is necessary as symptoms can often be indicative of other personality disorders, and sometimes personality disorders overlap.

Frequently, the psychological exam will include the use of questionnaires that evaluate how the individual sees himself or herself in relation to society, relationships with others, and to oneself. A physical exam is also essential to rule out a physical ailment as a possible cause of symptoms.

Treatment & Therapy

Treatment programs that involve psychotherapy are the primary means of treating NPD. The goal is to help the individual better relate to society and the workplace, while having more successful, rewarding, and fulfilling relationships. Additional therapy addresses the driving force behind NPD behavior. Other issues that sometimes overlap with NPD such as drug abuse will also need to be treated. The hope of the therapist is that the NPD patient develops a more realistic sense of self and a healthy understanding of goals for success. Treatment and therapy can take many years.

Prevention & Prophylaxis

Family therapy may provide tools for families to learn how to communicate more effectively, as well as empower individuals with better tools for dealing with stress and emotions of life. Not only should individuals with NPD seek counseling, but their loved ones should as well. The parents, the husband and wives, the children, etc. of those with NPD find themselves suffering as they struggle to deal with these individuals. With a recognized diagnosis, a quality treatment program, and strong family or social support, there is hope.