- Narcissistic Personality Disorder: Traits, Tests, Treatment
- How common is narcissistic personality disorder?
- What are narcissistic traits (characteristics)?
- Can I take a test to see if I have narcissistic traits?
- What are the complications of narcissistic personality disorder?
- Narcissistic Personality Disorder Symptoms, Treatment & Causes
- What is narcissistic personality disorder?
- What are causes and risk factors for narcissistic personality disorder?
- What are narcissistic personality disorder symptoms and signs?
- How do medical professionals diagnose narcissistic personality disorder?
- What is the treatment for narcissistic personality disorder?
- What are possible complications of narcissistic personality disorder?
- What is the prognosis of narcissistic personality disorder?
- Is it possible to prevent narcissistic personality disorder?
- Are there support groups for people with narcissistic personality disorder (NPD)?
- Narcissistic Personality Disorder Statistics — The Recovery Village Drug and Alcohol Rehab
- Narcissism Prevalence
- Diagnosing Narcissistic Personality Disorder
- Rates of Narcissism and Co-Occurring Conditions
- Statistics on Narcissistic Personality Disorder Treatment
- Is narcissism common? The answer may surprise you
- Narcissism in history
- Narcissistic personality traits on a continuum
- Normal narcissism
- Narcissistic personality type
- Pathological narcissism or NPD
- Read more . .
Narcissistic Personality Disorder: Traits, Tests, Treatment
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.
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.
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).
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 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.
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.
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 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 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.
Narcissistic Personality Disorder Symptoms, Treatment & Causes
- Narcissistic personality disorder (NPD) is a mental disorder that is characterized by an established pattern of being fixated on oneself, permeating the thoughts, feelings, and actions of the sufferer, and their relationships with other people.
- People with NPD tend to alternate between feeling omnipotent and devalued.
- Narcissistic personality disorder occurs as often as in 6% of adults, more often in men than in women.
- most mental illness, narcissistic personality disorder tends to have biological, psychological, and environmental risk factors that contribute to its development.
- Narcissists demonstrate a pervasive pattern of the external appearance of having significantly inflated self-esteem, a need for admiration, and lack of empathy for others that begins by early adulthood and manifests in a number of different aspects of their life.
- While the primary treatment for narcissistic personality disorder is talk therapy rather than medication, medication may be appropriate to address some co-occurring symptoms.
- One of the major obstacles to a good prognosis for narcissistic individuals is their perception that other people are the cause of their problems rather than their own self-centered tendencies.
Psychodynamic therapy is the assumption that a person is depressed because of unresolved, generally unconscious conflicts, often stemming from childhood. The goal of this type of therapy is for the patient to understand and cope better with these feelings by talking about the experiences. Psychodynamic therapy is administered over a period of weeks to months to years.
Learn more about psychotherapy »
What is narcissistic personality disorder?
In order to understand narcissistic personality disorder, the concept of personality is important.
As with normal personality, that of the person with narcissistic personality disorder (NPD) has a pervasive way of thinking, feeling, and interacting with other people that tends to be fairly established and fixed by the time the individual reaches adulthood.
A narcissist is someone who has therefore established a long-standing pattern of being fixated on him- or herself that permeates their thoughts, feelings, actions, and relationships.
The word narcissism comes from the story of Narcissus, a hunter in Greek mythology well known for his beauty and for being completely in love with himself. His all-consuming self-love resulted in his eventual death, caused by his becoming so attracted to his own reflection in a pool that he was unable to stop staring at his image.
People with narcissism tend to interact with others and the world in general by distorting things such that they alternate between feeling omnipotent or devalued.
Children of a narcissistic parent often feel they are never good enough. Narcissistic personality disorder has an average occurrence rate of about 1% of the population occurs as often as in 6% of adults.
Some research indicates that the incidence of NPD more than doubled from 1999 to 2009.
Medical professionals diagnose NPD more often in men than in women. It is also more often found in people who are involved with the court system compared to the public. Antisocial personality disorder is an illness that commonly co-occurs with narcissistic personality disorder.
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What are causes and risk factors for narcissistic personality disorder?
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As with most mental health disorders, narcissistic personality disorder does not have one single definitive cause. Rather, people with this illness tend to have biological, psychological, and environmental risk factors that contribute to its development. Biologically, narcissists have a tendency to have a smaller part of the brain that is related to having empathy for others.
Psychologically, individuals with narcissism tend to have trouble having opposing self-images of excessive admiration and devaluing in their minds and in their relationships. They are excessively emotionally sensitive.
Early psychoanalytic theory on the emotional motivations for the development of NPD focused on the relationship between mothers and sons.
Specifically, medical professionals believed that men develop this disorder as the result of having an excessively close relationship with their mother that is contingent upon always doing what she wants, with a resulting paranoid fear of retaliation by their father and humiliation or abandonment by their mother. Since those early theories, the social risk factors for developing NPD have been expanded to include excessive admiration or neglect by either parent.
In addition to receiving excessive, unrealistic admiration, praise, and overindulgence, or excessive criticism for misbehavior during childhood, theories about other social risk factors of narcissistic personality disorder include emotional abuse, unpredictable parental care and parent-child interactions, as well as learning manipulation from caregivers.
What are narcissistic personality disorder symptoms and signs?
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In order to be assessed with the diagnosis of narcissistic personality disorder, an individual must demonstrate a pervasive pattern of significantly inflated self-esteem (grandiosity), a need to be admired and lack of empathy for others that begins by early adulthood and is present in a number of different aspects of their life.
According to the DSM-5/DSM-V (the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), the diagnostic reference that is written and endorsed by the American Psychiatric Association, specific symptoms and signs of this illness have remained consistent from the previous edition (DSM-IV-Text Revision) and include the following:
- An excessive sense of self-importance, with an expectation of being seen as superior for no reason
- Preoccupation with self-aggrandizing fantasies: unlimited success, power, brilliance, beauty, or love
- Excessive belief that he or she is special or unique and therefore should only associate with other high-status people
- A need for excessive admiration
- A sense of entitlement to receiving especially favorable treatment or compliance with their wishes
- A tendency to take advantage of others to achieve their own ends
- Lacking empathy for the needs and feelings of people
- Frequently envious of others or thinking others are envious of him or her
- Exhibits haughty, arrogant thoughts or behaviors
Mental health professionals describe individuals who have some symptoms of narcissistic personality disorder but not enough for the full-blown diagnosis as having narcissistic personality traits.
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How do medical professionals diagnose narcissistic personality disorder?
Many providers of health care may help make the diagnosis of narcissistic personality disorder, including pediatricians, primary care providers, licensed mental health therapists, psychiatrists, psychologists, psychiatric nurses, physician assistants and social workers.
As part of this examination, the sufferer will ly undergo a full physical examination and laboratory tests in an attempt to rule out any medical condition that may contribute to the symptoms described. The person with NPD may be asked a series of questions from a standardized questionnaire or self-test to help assess the presence of the illness.
Given the low level of insight that narcissistic individuals have regarding their symptoms, there is a lower tendency for them to self-report symptoms. Therefore, mental health professionals may seek information from the family members as part of the assessment of people with NPD.
A medical professional will conduct a thorough exploration for any history or presence of mental health symptoms such that narcissistic personality disorder can be distinguished from other personality traits or disorders histrionic personality disorder, borderline personality disorder, or antisocial personality disorder.
The mental health professional will also explore whether other forms of mental illness are present, since narcissism is often also associated with depression or perfectionism.
In addition to demonstrating a pattern of grandiose thoughts or behaviors, self-absorption, need for admiration, and lack of empathy for others characterized by at least five of the previously described symptoms, other diagnostic criteria for narcissistic personality disorder include the sufferer's pattern of such behaviors being pervasive throughout the person's life, as well as stable, longstanding symptoms that are not better explained by another mental illness, the effects of a substance, or a medical condition.
What is the treatment for narcissistic personality disorder?
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The primary treatment for narcissistic personality disorder is talk therapy (psychotherapy) rather than medication. However, medication may be appropriate to address some co-occurring mental health symptoms depression, irritability, or anxiety.
Psychotherapy tends to focus on how the person with the disorder interacts with the therapist during therapy, examining and changing the individual's grandiose sense of self and excessively vulnerable thinking, teaching the sufferer ways to regulate their emotions, and correcting self-centered behaviors to more healthy self-confidence and prosocial ways of interacting with others. Some studies indicate that limited reparenting of the person with NPD by the therapist may help decrease the symptoms of the disorder. That approach, referred to as schema-focused therapy, involves accessing the aspects of the person consistent with a vulnerable child then helping the person emotionally mature to thinking and behaving a mature adult.
Providing family members of people with pathological narcissism with therapy that teaches them about the illness of their loved one as well as ways to improve their communication and problem-solving skills helps decrease symptoms in their narcissistic loved one.
What are possible complications of narcissistic personality disorder?
Compared to people without mental illness, people with narcissistic personality disorder are at higher risk of becoming depressed, anxious, and socially isolated. They tend to have problematic relationships, as well. They are also more prone to developing cardiovascular illnesses, abusing substances, becoming aggressive, and having suicidal thoughts on a long-term basis.
What is the prognosis of narcissistic personality disorder?
How well or poorly people with narcissistic personality disorder progress over time seems to be influenced by how severe the disorder is at the time that treatment starts, the state of the individual's current personal relationships, whether or not the sufferer has a history of being abused as a child, as well as whether or not the person receives appropriate treatment. Simultaneously suffering from other mental health problems, major depression, obsessive-compulsive disorder, or another personality disorder, is associated with a lower lihood of symptoms of NPD being alleviated with treatment. One of the major obstacles to treatment and therefore to a good prognosis for narcissistic individuals is the perception by these individuals that their problems are caused by others rather than by their own self-centered tendencies.
Is it possible to prevent narcissistic personality disorder?
Societal interventions prevention of child abuse, domestic violence, and substance abuse in families can help decrease the occurrence of a number of very different mental health problems, including narcissistic personality disorder.
Are there support groups for people with narcissistic personality disorder (NPD)?
Narcissistic Personality Disorder Statistics — The Recovery Village Drug and Alcohol Rehab
Many psychologists believe that narcissism is a spectrum, and narcissistic traits are often a part of other disorders. In other cases, narcissism is so extreme that it interferes with normal healthy functions. This is known as narcissistic personality disorder or NPD.
Narcissistic personality disorder exhibits some interesting trends in the population, which can be seen through facts and statistics about narcissistic personality disorder. This information can help people learn the difference between the disorder and regular narcissistic traits, discern if someone they know has NPD, and learn how to manage symptoms of the condition.
All people have narcissistic traits to some degree. In healthy individuals, a normal amount of narcissism helps them take pride in their accomplishments and find joy in their personal life. Even a high degree of narcissism is sometimes a normal occurrence. Most teenagers display narcissistic qualities as a normal and healthy part of their development and personal growth.
Narcissistic personality disorder, on the other hand, is much less common. Approximately 0.5% of the United States population, or one 1 in 200 people, has the disorder. There are significant gender differences when it comes to the prevalence of the disorder; about 75% of people with narcissistic personality disorder are men.
The prevalence of narcissistic personality disorder is higher in certain demographics, including:
- 2–6% of those seeking help from mental health clinics
- 6% of forensic analysts
- 20% of people in the military
- 17% of first-year medical students
Usually, narcissistic personality disorder first appears in early adulthood. It is not more common in any ethnicities than others.
Diagnosing Narcissistic Personality Disorder
As the name implies, mental health professionals characterize narcissistic personality disorder as a type of personality disorder. The characteristics of people with narcissistic personality disorder are fairly diverse.
However, there is a core set of features common to most people with this condition. The American Psychological Association has a set of guidelines on how to diagnose narcissistic personality disorder that psychologists refer to when they interview a patient.
These symptoms are listed in their official book Diagnosis and Statistics of Mental Disorders (DSM 5):
- A pervasive pattern of grandiosity (making themselves appear impressive)
- Need for admiration
- Fantasies about power, success, beauty or an idealized vision of love
- Sense of entitlement
- Belief of being special, unique or high-status
- Lack of empathy for others
- Tendency to exploit others
- Arrogant behavior
People with narcissistic personality disorder spend a significant amount of time comparing themselves to others. They often have fantasies about being exceptionally successful in their careers.
Some individuals with this condition consider themselves to be superior to others, while others are overly critical of their own flaws.
People with NPD may be highly resistant to criticism or highly sensitive to perceived slights.
Rates of Narcissism and Co-Occurring Conditions
other types of personality disorders, pathological narcissism frequently occurs along with other mental health conditions including depression, anxiety, eating disorders, bipolar disorder and substance use disorder.
- Depression and Anxiety. Subtypes of patients who are vulnerable to criticism from themselves or others have a higher risk of having symptoms of depression or anxiety. About 15% of people with narcissistic personality disorder also have depression, 13.5% have anxiety and around 17% have another mood disorder.
- Bipolar Disorder. Bipolar disorder is also fairly common among people with narcissistic personality disorder. About 17% of people with pathological narcissism also have either bipolar I or bipolar II.
- Eating Disorders. In some cases, people with narcissistic personality disorder obsess over their appearance. These individuals have a higher risk of developing an eating disorder because of their obsession with staying thin and meeting idealized beauty standards.
- Other Personality Disorders. Different personality disorders commonly co-occur with narcissistic personality disorder. People with the condition, especially those who have a grandiose persona, may also have paranoid personality disorder and antisocial personality disorder. Histrionic, borderline and schizotypal personality disorders also sometimes co-occur with NPD.
- Substance Use Disorders. People with narcissistic personality disorder frequently have a substance use disorder as well. They may use drugs or alcohol to self-medicate and cope with the frustration and anxiety that comes with the condition. About 14% of people with narcissistic personality disorder also have an alcohol use disorder, while 24% misuse other types of drugs.
Statistics on Narcissistic Personality Disorder Treatment
Treating narcissistic personality disorder can be challenging because people with the condition often don’t think that they have a problem.
Prognosis is often poor as a result, and there currently is not a standard protocol for treatment. However, treatment usually consists of counseling or psychotherapy.
Little research has been done on narcissistic personality disorder treatment, so its treatment success rate is not known yet.
If you believe that you or someone you love has narcissistic personality disorder along with a substance use disorder, contact us at The Recovery Village to discuss ways that we can help.
Related Topic: Personality disorder statistics
- SourcesMedscape. “Narcissistic Personality Disorder.” May 16, 2018. Accessed April 20, 2019.American Psychiatric Association. “Diagnostic and Statistical Manual of Mental Disorders.” May 2013. Accessed April 20, 2019.Caligor E, Levy KN, Yeomans FE. “Narcissistic Personality Disorder: Diagnostic and Clinical Challenges.” American Journal of Psychiatry, May 2015. Accessed April 20, 2019.Stinson FS, Dawson DA, Goldstein RB, Chou P, Huang B, Smith SM, Ruan WJ, Pulay AJ, Saha TD, Pickering RP, Grant BF. “Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Narcissistic Personality Disorder: Results From the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions.” Journal of Clinical Psychiatry, 2008. Accessed April 20, 2019.
Is narcissism common? The answer may surprise you
It’s common to label people considered self-centred or egotistical as a narcissist. But what exactly is narcissism? How common is narcissism? And how do we know when someone is living with narcissistic personality disorder (NPD)?
Narcissism is more than a personality disorder. It is believed to be a healthy developmental process in childhood, which exists in people from normal to clinical levels.
Most, if not all, of us demonstrate narcissistic tendencies over time. However, NPD is relatively rare. The estimated prevalence of NPD in the community is around 1%, although some studies say up to 6%. The data on NPD is inconclusive about whether this diagnosis is more common in men than women.
Narcissism in history
Narcissism comes from Greek mythology where the beautiful, proud young man Narcissus fell in love with his own image in a pool of water. Unable to leave, he wasted away and died. Consequently, narcissism has been considered a negative trait from ancient history to modern times.
More recently, this characteristic has attracted increased interest from psychoanalysts.
- 1911 – Otto Rank published the first psychoanalytical paper specifically concerned with narcissism, linking it to vanity and self-admiration.
- 1914 – Sigmund Freud published On Narcissism: An Introduction suggesting narcissism was a normal part of the human psyche. He called it ‘primary narcissism’ or what lies behind each person’s survival instincts.
- 1967 – Psychoanalysts Otto Kernberg and Heinz Kohut developed the concept further, with a type of narcissism called pathological narcissism (the basis for NPD).
- 1980 – NPD was officially recognised as a disorder in the third edition of the DSM and criteria established for its diagnosis.
- 2013 – NPD was initially to be removed from the DSM-5, but was later reinstated following feedback from some clinicians.
Narcissistic personality traits on a continuum
Narcissism exists on a continuum. From normal, healthy, with a few narcissistic traits, to a pathological (clinical) full blown personality disorder on the other. Our level of narcissism can vary over time, between situations and life events.
It’s important to remember that the major distinction between narcissism and narcissistic personality disorder (NPD) is that narcissism is not a mental illness or personality disorder.
Healthy narcissism is adaptive, flexible and empathic. It causes elation and joy and helps us function everyday.
Humans need admiration and attention. Everyone has a desire for success and love. But, we all occasionally experience a lack of empathy. People having power and control, and once in awhile we may feel grandiose or self-important.
So it’s not uncommon for someone displaying normal everyday narcissist traits to hurt our feelings or push our boundaries. This is normal. We may classify these experiences as someone being selfish, aggressive, egotistical or insensitive.
Narcissistic personality type
Further along the continuum is an unhealthier narcissism called narcissistic personality type. This is not a mental health issue, it’s a more-extreme form of narcissism. Whilst most or all of the characteristics of NPD may be present, this kind of narcissism is considered within the normal range of personality.
A person may appear obnoxious, because they feel superior to others. Some of the characteristics could be having little or no empathy with the feelings or situations of others. Or they could feel entitled to the best of everything, while looking down on those who show admiration for them. Men experience higher rates of this personality type than women.
Pathological narcissism or NPD
The diagnosis of narcissistic personality disorder (NPD) is usually determined through clinical evaluation of the person.
NPD was defined by the DSM-5 as significant impairments in personality functioning, such as looking excessively to others for the regulation of self-esteem, viewing oneself as exceptional, having impaired empathy, and having mostly superficial relationships and the personality traits of grandiosity and attention-seeking.
Pathological narcissism is maladaptive, rigid, persistent and causes significant distress and functional impairment. These qualities remain relatively stable over time and are not caused by a medical condition, drugs, or a person’s developmental stage.
Research shows that although people with NPD experience high self-esteem, it is also fragile and insecure. Their self-esteem fluctuates from moment to moment and day to day.
Yet people with NPD are more ly to state their self-esteem as high rather than low.
This suggests that although people with NPD describe themselves in positive terms, their nonconscious feelings are not necessarily so positive.
So, while it is common to refer to someone behaving selfishly or arrogantly as a narcissist, the psychological definition is more subtle and also relatively rare.
Read more . .
Dawhan, N., Kunik, M.E., Oldham, J., & Coverdale, J. (2010). Prevalence and treatment of narcissistic personality disorder in the community: a systematic review. Comprehensive Psychiatry, 51, 333-339.
Grijalva, E., Newman, D.A., Tay, L., Donnellan, M.B., Harms, P.D., & Robins, R.W. (2015). Gender differences in narcissism: a meta-analytic review. Psychological Bulletin, 141(20), 261-310.
Volkert, J., Gablonski, T, & Rabung, S. (2018). Prevalence of personality disorders in the general adult popultion in Western countries: systematic review and meta-analysis. The British Journal of Psychiatry, 213, 709-715.