- Narcissistic personality disorder (NPD) is a complex and long-term mental health issue.
- People living with NPD may have a strong sense of self-importance and entitlement but, at the same time, can also experience low self-esteem and feel easily hurt by others.
- With the right support, and commitment to change, people with NPD can reduce unhelpful thinking, have better relationships, and improve quality of life.
What is narcissistic personality disorder?
Narcissistic personality disorder (NPD) is a complex mental health issue that can cause great distress, and impact relationships and wellbeing. It is a long-term condition that usually develops fairly early in life. It can impact people throughout their lives.
NPD can seem like a paradox. People with NPD may act superior and confident but are also often defensive and can struggle with self-esteem.
NPD causes great distress to both the person living with the disorder and those around them. Their behaviour can make life hard for themselves and others. It is important to note that their behaviour is the symptom of a complex mental health issue, not a moral failing.
Narcissism vs narcissistic personality disorder
Narcissism is the human experience of feeling important, needing admiration and attention, and wanting success and love. It’s normal and can even be a healthy personality trait, if it’s mild and occasional. It’s perfectly possible to feel or act a little narcissistic, even unpleasantly so, without having a disorder.
NPD involves a more extreme form of narcissism that can cause great distress and impairment over time.
Symptoms of narcissistic personality disorder
There are nine key symptoms associated with NPD. To be diagnosed with NPD, a person must be assessed by a medical professional to be experiencing least five of the following (1):
- A strong sense of self-importance.
- Excessive fantasies of unlimited success, power, brilliance, beauty, or ideal love.
- A belief that they are overly special or unique.
- An intense need for admiration.
- A sense of entitlement (that they should get whatever they want).
- A tendency to use others to achieve their own ends.
- A lack of empathy towards others (having difficulty recognising or identifying with the feelings and needs of others).
- Envy of others, or the belief that others are envious of them.
- Displaying arrogant or overconfident behaviour and attitudes.
Although the following are not required for diagnosis, many people with NPD also experience more internal or invisible symptoms, sometimes called ‘vulnerable narcissism’ – these include (2):
- low self-esteem
- harsh self-criticism, such as feeling not good enough
- feeling easily hurt by others’ criticism
- feeling inferior to others
- loneliness and isolation
- fear, rage, and shame.
Causes of narcissistic personality disorder
The exact causes of NPD are unknown, but is believed to be a combination of genetic, environmental, and psychological factors (2).
Many life experiences might contribute to the development of NPD. These can include difficult relationships with parents and caregivers, including excessive praise or excessive criticism. Early trauma and abuse may also contribute to NPD.
How common is narcissistic personality disorder?
Around 1% of adults in the general community experience NPD, although some studies estimate up to 6% (3,4). The data on NPD is unclear about whether this diagnosis is more common in men or women (5).
Managing life with narcissistic personality disorder
People living with NPD may benefit from:
- learning about narcissism and how it develops, and understanding how it impacts on thoughts, emotions and relationships
- learning strategies to manage strong emotions in a healthy way
- developing a more balanced and healthier self-image, including how to manage unhelpful thoughts
- reflecting on values, goals and desires, and seeing what is realistic and achievable
- reflecting on relationships with friends, family and co-workers.
Treatment and support for narcissistic personality disorder
Because NPD impacts a person’s view of themselves, people living with the disorder don’t always recognise their own distress, seek help, or recognise how their behaviour affects others. Sometimes people might seek help for other problems, such as life challenges (for example, relationship difficulties, or losing a job), depression, or other mental health issues.
For those who do seek help, diagnosis can be tricky. It can be difficult to accurately assess NPD, as its symptoms overlap with other disorders. Many healthcare professionals might recognise narcissistic personality traits or behaviours, but are reluctant to complete a formal assessment for NPD or give a diagnosis. This may be due to reasons like the stigma associated with the label, or concerns that a diagnosis may not be helpful or relevant.
Psychological therapies are usually recommended to help people with NPD. They can assist to reduce unhelpful thinking, have better relationships, and improve quality of life. Ideally, treatment should be provided by a healthcare professional with expertise in personality disorders.
Therapeutic approaches can include (6):
- Psychodynamic therapy
- Cognitive behavioural therapy (CBT)
- Schema therapy
- Relationship or couples therapy.
Therapy for NPD can be a long-term process. Its success depends on the willingness of the person with NPD to both acknowledge their difficulties, and commit to changing their behaviour.
NPD is not treated with medication. However, medications may be prescribed for other related issues such as depression or anxiety.
Help for family & friends
The family and friends of someone experiencing NPD need care and support too — it’s okay for family and friends to set boundaries, and to prioritise their own physical and mental health.
There are many other people out there who share similar experiences, and many services designed to help the carers of people with mental health issues. Check out our Guide for Families and Friends for more info.
Experiencing NPD can be challenging, but with support it is possible to reduce symptoms, have healthy relationships, and live a full and meaningful life.
To connect with others who get it, visit our online Forums. They’re safe, anonymous and available 24/7.
- SANE's free counselling service - 1800 187 263 (weekdays 10am-10pm AEST/AEDT)
- Project Air Strategy for Personality Disorders – Resources page
- Conflict management: SANE Blog How to Manage Conflict, Centre for Clinical Interventions Assertiveness self-help training