Just about all of us show some narcissistic traits, some of the time—we crave attention, put our own needs first, or think we are special. Teenagers in particular can be narcissistic—it’s part of their growth process.
But most of the time, most of us can empathize with others, admit our mistakes, and keep our achievements in perspective. This is not the case with people who have narcissistic personality disorder (NPD) —they are excessively self-involved, and they disregard other people’s needs.
Srinivas Dannaram, MD, a psychiatrist with Banner Thunderbird Medical Center in Glendale, AZ, said that in people with NPD, you’ll see these personality traits, which are listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM):
- They think highly of themselves (inflative sense of self-importance), exaggerate achievements, and expect to be recognized as superior.
- They fantasize about their own success, power, brilliance, beauty or perfect love.
- They believe they are special and can only be understood by other special people (or institutions).
- They demand admiration.
- They have a sense of entitlement and expect favorable treatment.
- They take advantage of others to achieve their goals.
- They lack empathy and don’t try to identify with the needs of others.
- They envy others, or believe others envy them.
- They are arrogant.
In a subtype categorized as “vulnerable narcissism,” people can be hypersensitive and defensive. “The vulnerable subtype is often easy to miss,” Dr. Dannaram said.
Signs of narcissism
Get together a group of 16 people and, odds are, one of them is a narcissist. One study found that 6.2% of people in the U.S. have narcissistic personality disorder at some point in their lives.
If you know someone who’s a narcissist, you’ll probably see that they struggle in their relationships. “People with this disorder want their way,” Dr. Dannaram said. “They can make others furious by the refusal to obey conventional rules of behavior.”
It’s common for them to exploit the people they’re close to, through manipulative behavior. They aren’t capable of empathy, but they can feign sympathy, and will sometimes do so to get what they want. They expect special treatment, because they consider themselves superior to others. They handle criticism poorly, so they might get enraged when someone criticizes them, or they might act indifferent to criticism. They can be ambitious; striving for the fame or fortune they believe they deserve.
They may appear confident, secure and have high self-esteem, but underneath that façade they are fragile, so they can be susceptible to depression, anxiety, self-harm, and substance abuse. And their narcissistic behavior can lead to interpersonal difficulties, problems at work, rejection and loss.
Who’s likely to be a narcissist?
Narcissism is more common in men than in women, and genetics may play a role in who develops the disorder. Persons with NPD tend to show some signs as young children: They can be aggressive, tolerate distress poorly, struggle to regulate their emotions and have fragile egos.
Being rejected as a child, or being excessively praised as a child, could also lead to narcissistic personality disorder.
Treatment of narcissistic personality disorder
“According to the American Journal of Psychiatry, there’s no standardized pharmacological or psychological treatment for NPD,” Dr. Dannaram said. And many narcissists don’t seek treatment since they don’t recognize their behavior as a problem. Those who do look for support might try:
- Transference-focused therapy, which is twice-a-week therapy where a person with narcissism expresses their emotions toward the therapist. Since people with narcissistic personality disorder can be provoked by how they feel others’ treat them, it’s essential for them to examine their own feelings towards other people, according to the International Journal of Psychoanalysis.
- Schema-focused therapy, a relatively new therapy that focuses on alternate forms of cognitive-behavioral therapy, including activating emotional senses, according to the German Journal Progress in Neurology-Psychiatry.
- Treatment of other conditions, including anxiety, depression, disproportionate mood highs and lows, transient psychosis, and impulse control issues.
- Medications including antidepressants, antipsychotics, and mood stabilizers.
The bottom line
Narcissistic personality disorder is common, and people with it often struggle with their relationships and with other mental health conditions. If you think you or someone you love may show symptoms of NPD, a mental health professional can help. To connect with a behavioral health specialist, visit bannerhealth.com.
For more mental health information, check out:
- Impostor Syndrome: What Happens When You Feel Like a Fraud
- How to Strengthen Your Empathy Muscle, and Why It’s Important
- Do I have Anxiety, Depression, or Both? Here’s How to Tell
- What Can Happen When You Have Borderline Personality Disorder