Narcissistic personality disorder: traits, symptoms, testing

Did you ever meet someone who seemed overly demanding or self-centered? They are so self-absorbed that when they finally stop talking about themselves, they ask, “Enough about me—what do you think about me?” Living with or working with such people can be challenging. People with such personality traits may have a personality disorder called narcissistic personality disorder.

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A person’s personality is the outward expression of their feelings, thoughts, and actions. Some people have trouble controlling their feelings, thoughts, and behaviors, causing problems with their relationships and day-to-day functioning. When these issues become overwhelming and affect every area of a person’s life, one possible cause is a personality disorder. Personality disorder symptoms aren’t caused by any underlying physical or mental health disorder or substance abuse. They are a separate condition entirely (Fariba, 2020).

There are three categories of personality disorders (Fariba, 2020):

1. Cluster A, where a person has paranoia or is always suspicious

2. Cluster B, where a person has impulsive, dramatic, and emotional reactions

3. Cluster C, where a person has anxiety and avoids most types of social situations 

A narcissistic personality disorder is in cluster B, with dramatic and emotional personality traits. 

The term narcissist comes from the classic Greek myth of Narcissus, who was so focused on his self-absorption and blinding self-love that he died when he couldn’t stop staring at his own reflection (Levy, 2011). 

Narcissism is where a person believes they are far better than other people. They need extra praise and constant admiration, and they build themselves up by exaggerating their abilities (Mitra, 2021). 

These traits may sound a lot like being confident and having high self-esteem. However, the narcissistic traits found in narcissistic personality disorder and self-confidence are not the same thing.

What is narcissistic personality disorder?

When you have self-confidence and a healthy self-esteem, you have a strong sense of who you are. You won't deliberately disregard anyone else's feelings and expect to be treated far better than anyone else.

In contrast, people with narcissistic personality disorder (NPD) have a distorted sense of who they are. They want to have abusive control and power over people they perceive as lower than them. They have an extreme need for attention and admiration from others. They may spend a lot of time and energy on their self-image, trying to look successful and influential in other people's eyes. They may act arrogant, conceited, or like "know-it-all"s. They may feel special and deserving of constant praise and act disappointed when they do not receive it (Caligor, 2015). 

According to the American Psychiatric Association, people with narcissistic personality disorder have at least five of the following nine personality traits (Mitra, 2021):

1. A grandiose sense of self-importance and self-worth—where a person exaggerates or invents their talents or achievements 

2. Being preoccupied with constant fantasies of power, brilliance, love, beauty, or unlimited success

3. Believing they are "uniquely special" and can only be with certain people who appreciate them

4. Requiring excessive admiration

5. Having a sense of entitlement or the unreasonable expectations of receiving special treatment or immediate responses to their needs

6. Exploiting others and taking advantage of others to achieve their own goals

7. Lack of empathy and unwillingness to recognize or see the needs or feelings of others

8. Feeling constant jealousy of others or believing that others are constantly jealous of them

9. Behaving or showing arrogance or haughtiness

What does narcissistic personality disorder feel like?

If you have a narcissistic personality disorder, you may not even know you have it. You may think that you are exceptional. However, if you notice that you keep having frequent issues with all your relationships, including romantic, school, or professional, and people avoid you, you may have some narcissistic traits.

It’s normal to become unhappy or upset when things don’t go the way you expected them. Still, if you have a narcissistic personality disorder, you may get irrationally upset about slights, insults, or perceived disrespectful actions. People may have told you that you are too boastful, pretentious, or selfish (Mitra, 2021). 

Narcissistic personality disorder is one of the least studied personality disorders. There is some confusion about the different ways NPD manifests in certain people, but some researchers recognize three subtypes of narcissism (Caligor, 2015):

1. The first is “grandiose” narcissism, where a person is arrogant and haughty.

2. The second is “vulnerable,” where a person is hypersensitive and defensive about themselves.

3. A third subtype is described as "high functioning," where a person may be grandiose, competitive, provocative, or attention-seeking but has learned how to act to hide their personality disorder. 

The prevalence of narcissistic personality disorder ranges from below one to six (0-6%) percent in the overall population. More men than women are diagnosed with narcissistic personality disorder  (Caligor, 2015). 

Some children and teenagers may behave with narcissistic traits, but these behaviors and attitudes are usually temporary. Most people with narcissistic personality disorder typically begin to show symptoms in early adulthood and will continue to display these traits in all interpersonal relationships (Caligor, 2015). 

Some people with NPD monopolize all conversations by focusing on their superiority. They may interrupt or act disdainfully when anyone else is speaking, especially if the narcissist feels the other person is beneath them (Caligor, 2015). 

Some are controlling and only think of themselves and their status. They may not care about other people’s feelings, thoughts, or beliefs, including their family members. They may be calculating and deliberate in demonstrating their self-proclaimed superiority. This includes devaluing and degrading other people with verbal and physical insults to keep themselves elevated (Mitra, 2021).

People with NPD often have fragile egos. They may show extreme defensiveness or hypersensitivity to even imagined criticism, becoming furious when receiving feedback that makes them feel worthless or ashamed. They may even try to seek revenge for perceived insults (Mitra, 2021). 

You may know some very successful people with narcissistic traits. Does this mean they have a narcissistic personality disorder? Not necessarily. It is only when these narcissistic traits are consistent across all relationships, profoundly interfere with a person’s life, and cause significant distress, that they can be diagnosed with NPD (Caligor, 2015).

Like borderline personality disorder or antisocial personality disorder, many personality disorders have multiple causes rather than a single cause. A narcissistic personality disorder is no exception (Mitra, 2021). Here are some of the common possible causes.

Family history

If a person’s immediate family members, like their parents or siblings, had a narcissistic personality disorder, they are more likely to develop it. 

Brain structure and function

In some people with personality disorders, parts of the brain that regulate emotions and sociability are smaller (Caligor, 2015).

Environment

If a person grew up without an emotional attachment to their parents or primary caregivers, they might feel unimportant or like they have a perceived lower value than others. Others may have had overly permissive parents. Still, others may have had parents or caregivers that were extraordinarily controlling. It is believed that these extremes of neglect to overindulgence or overvaluation can lead to a disturbed sense of self, which may manifest as a narcissistic personality disorder. 

Others may have experienced trauma in the form of physical, emotional, or sexual abuse. For others, grandiosity and a sense of superiority may be a cultural or learned societal response (Caligor, 2015).

If your loved one behaves narcissistically, they might think they are doing great. People with narcissism generally have poor insight into their behavior and may not realize that their disdain or arrogance is a problem. You may believe that there’s very little that you can do to help them and yourself. If you notice some of the symptoms of narcissistic personality disorder in yourself, you may not think of seeing a mental health provider until your symptoms profoundly interfere with your quality of life (Ronningstam, 2016). 

If you recognize any of the symptoms of narcissistic personality disorder in a loved one or yourself, seek medical advice from your healthcare provider or mental health professional. They will do a complete physical exam to rule out any underlying health problems. They will also check for other psychiatric disorders. Narcissistic personality disorder can show up alongside bipolar disorder, depression, substance use disorder, anxiety disorder, borderline personality disorder, and antisocial personality disorder, and it will be helpful to get any other condition you have addressed (Mitra, 2021). 

Your healthcare provider may ask you or your loved one to fill out a survey or questionnaire to determine the narcissistic symptoms and their impact. It takes a skilled clinician or mental health professional specializing in psychiatry to diagnose narcissistic personality disorder accurately (Caligor, 2015).

Most personality disorders, including narcissistic personality disorder, are treated with psychotherapy (Weinberg, 2020). 

Psychotherapy

There are several different types of psychotherapy to treat NPD. Except for cognitive-behavioral therapy, which is short-term, most other psychotherapy treatment is long-term. These include (Weinberg, 2020):

• Cognitive-behavioral therapy for short-term treatment only

• Transference focused therapy

• Schema therapy

• Metacognitive therapy

• Couples therapy

• Family therapy

These psychotherapy types help identify triggers for narcissistic thoughts and actions and provide tools or teach skills to help modify distressing behaviors. The overall goal is to help the person with narcissism regulate their feelings. These actions can help improve interpersonal relationships at home, school, or work. The psychotherapist, family member, and person diagnosed with NPD work together to identify clear, meaningful behavioral goals for treatment (Weinberg, 2020).

Medications

There is no single medication to treat NPD. Instead, medications treat the symptoms of depression or anxiety. Medications include antidepressants, mood stabilizers, and, if needed, antipsychotics (Mitra, 2021).

Although there is a need for more research on narcissistic personality disorder guidelines and treatments, there is some evidence that psychotherapy can help (Mitra, 2021). 

It does take a while to see an improvement in symptoms and relationships. Stay on course with treatment by going to your therapist and taking any prescribed medication as directed. Over time, you’ll be able to see a positive change in your relationships and your life!

Here are some lifestyle tips that may help you or your loved one on your journey:

• Reduce or avoid substances that trigger narcissistic behavior, including alcohol, certain drugs, or stimulants.

• Lower your stress levels by meditating, doing yoga, breathwork, or practicing other mindfulness techniques. 

• Eat nutritious food and exercise daily to keep your body healthy.

• Get enough quality sleep. 

• Remember, you can choose your reactions and response to others; you can work to repair relationships with others.

If your loved one has a narcissistic personality disorder, it can be difficult to live with. You may want to seek psychotherapy for yourself to learn how to deal with some of the more challenging behaviors. If you notice any personality traits interfering with your or your loved one’s life consistently, seek help from a mental healthcare professional. 

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

June 29, 2021

Written by

Tobi Ash, MBA, RN, BSN

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.