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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 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.
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):
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):
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.
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).
People living with NPD may benefit from:
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):
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.
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.
1. American Psychiatric Organization. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub; 2013.
2. Ronningstam E. Narcissistic personality disorder: A current review. Curr Psychiatry Rep. 2010;12(1):68–75.
4. Volkert J, Gablonski T-C, Rabung S. Prevalence of personality disorders in the general adult population in Western countries: systematic review and meta-analysis. Br J Psychiatry. 2018;213(6):709–15.
5. Grijalva E, Newman DA, Tay L, Donnellan MB, Harms PD, Robins RW, et al. Gender differences in narcissism: a meta-analytic review. Psychol Bull. 2015;141(2):261.
6. King RM, Grenyer BF s., Gurtman CG, Younan R. A clinician’s quick guide to evidence‐based approaches: Narcissistic personality disorder. Clin Psychol [Internet]. 2020 Mar 1;24(1):91–5. Available from: https://doi.org/10.1111/cp.12214