Narcissistic personality disorder
Narcissistic personality disorder
Narcissistic personality disorder is a mental disorder in which people have an inflated sense of their own importance and a deep need for admiration. Those with narcissistic personality disorder believe that they're superior to others and have little regard for other people's feelings. But behind this mask of ultra-confidence lies a fragile self-esteem, vulnerable to the slightest criticism.
Narcissistic personality disorder is one of several types of personality disorders. Personality disorders are conditions in which people have traits that cause them to feel and behave in socially distressing ways, limiting their ability to function in relationships and in other areas of their life, such as work or school.
Narcissistic personality disorder treatment is centered around psychotherapy.
Narcissistic personality disorder is characterized by dramatic, emotional behavior, in the same category as antisocial and borderline personality disorders.
Narcissistic personality disorder symptoms may include:
Although some features of narcissistic personality disorder may seem like having confidence or strong self-esteem, it's not the same. Narcissistic personality disorder crosses the border of healthy confidence and self-esteem into thinking so highly of yourself that you put yourself on a pedestal. In contrast, people who have healthy confidence and self-esteem don't value themselves more than they value others.
When you have narcissistic personality disorder, you may come across as conceited, boastful or pretentious. You often monopolize conversations. You may belittle or look down on people you perceive as inferior. You may have a sense of entitlement. And when you don't receive the special treatment to which you feel entitled, you may become very impatient or angry. You may insist on having "the best" of everything — the best car, athletic club, medical care or social circles, for instance.
But underneath all this behavior often lies a fragile self-esteem. You have trouble handling anything that may be perceived as criticism. You may have a sense of secret shame and humiliation. And in order to make yourself feel better, you may react with rage or contempt and efforts to belittle the other person to make yourself appear better.
When to see a doctor
If you notice any of these problems in your life, consider reaching out to a trusted health care provider or mental health provider. Getting the right treatment can help make your life more rewarding and enjoyable.
It's not known what causes narcissistic personality disorder. As with other mental disorders, the cause is likely complex. Some evidence links the cause to a dysfunctional childhood, such as excessive pampering, extremely high expectations, abuse or neglect. Other evidence points to genetics or psychobiology — the connection between the brain and behavior and thinking.
Narcissistic personality disorder is rare. It affects more men than women. Narcissistic personality disorder often begins in early adulthood. Although some adolescents may seem to have traits of narcissism, this may simply be typical of the age and doesn't mean they'll go on to develop narcissistic personality disorder.
Although the cause of narcissistic personality disorder isn't known, researchers continue to learn more about the factors that may increase the risk of developing the condition. In the past, experts believed excessive praise, admiration and indulgence from parents may lead to a pathologically inflated sense of self. Today, however, psychiatrists believe parental neglect is more likely responsible.
Risk factors for narcissistic personality disorder may include:
Children who learn from their parents that vulnerability is unacceptable may lose their ability to empathize with others' needs. They may also mask their emotional needs with grandiose, egotistical behavior that's calculated to make them seem emotionally "bulletproof."
Complications of narcissistic personality disorder, if left untreated, can include:
Preparing for your appointment
People with narcissistic personality disorder are most likely to seek treatment when they develop symptoms of depression — often because of perceived criticisms or rejections. If you recognize that aspects of your personality are common to narcissistic personality disorder or you're feeling overwhelmed by sadness, talk with your doctor. Whatever your diagnosis, your symptoms signal a need for medical care.
When you call to make an appointment, your doctor may immediately refer you to a mental health provider, such as a psychiatrist.
Use the information below to prepare for your first appointment and learn what to expect from the mental health provider.
What you can do:
For narcissistic personality disorder, some basic questions to ask your mental health provider include:
In addition to the questions that you've prepared to ask your mental health provider, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your mental health provider
Tests and diagnosis
Narcissistic personality disorder is diagnosed based on signs and symptoms, as well as a thorough psychological evaluation that may include filling out questionnaires.
Although there's no laboratory test to diagnose narcissistic personality disorder, you may also have a physical exam to make sure you don't have a physical problem causing your symptoms.
Some features of narcissistic personality disorder are similar to those of other personality disorders. It's possible to be diagnosed with more than one personality disorder at the same time.
To be diagnosed with narcissistic personality disorder, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
Criteria for narcissistic personality disorder to be diagnosed include:
Treatments and drugs
Narcissistic personality disorder treatment is centered around psychotherapy. There are no medications specifically used to treat narcissistic personality disorder. However, if you have symptoms of depression, anxiety or other conditions, medications such as antidepressants or anti-anxiety medications may be helpful.
Types of therapy that may be helpful for narcissistic personality disorder include:
Because personality traits can be difficult to change, therapy may take several years. The short-term goal of psychotherapy for narcissistic personality disorder is to address such issues as substance abuse, depression, low self-esteem or shame. The long-term goal is to reshape your personality, at least to some degree, so that you can change patterns of thinking that distort your self-image and create a realistic self-image.
Psychotherapy can also help you learn to relate better with others so that your relationships are more intimate, enjoyable and rewarding. It can help you understand the causes of your emotions and what drives you to compete, to distrust others and perhaps to despise yourself and others.
Lifestyle and home remedies
Whether you decide to seek treatment on your own or are encouraged by loved ones or a concerned employer, you may feel defensive about treatment or think it's unnecessary. The nature of narcissistic personality disorder can also leave you feeling that therapy or the therapist is not worth your time and attention, and you may be tempted to quit. Try to keep an open mind, though, and to focus on the rewards of treatment.
Also, be sure to:
There's no known way to prevent narcissistic personality disorder with any certainty. Getting treatment as soon as possible for childhood mental health problems may help. Family therapy may help families learn healthy ways to communicate or to cope with conflicts or emotional distress. Parents with personality disorders may benefit from parenting classes and guidance from therapists or social workers.
Last Updated: 2009-11-19
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