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Narcissistic personality disorder (NPD) is best described as a paradox. People with NPD may act superior and confident, but are often fragile and lack self-esteem. They crave attention and praise yet are unable to form close relationships. NPD causes great distress to both the person with the disorder and those around them.
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:
There’s criticism that this clinical set of symptoms concentrates too much on how people with NPD relate to others, and not enough on internal symptoms, including:
Narcissism is the human experience of feeling important, needing admiration and attention, 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 what would be classed as a disorder.
A person whose personality is strongly characterised by narcissistic traits may act obnoxious and difficult, but still not have a disorder.
Think of NPD as narcissistic personality traits taken to extremes: looking excessively to others for praise, feeling exceptional and superior, having low empathy, craving attention and having only superficial relationships.
NPD is an extreme form of narcissism that can cause great distress and functional impairment, and last a long time.
The exact causes of NPD are unknown. Because NPD can be inherited, a genetic link is suspected. There are also theories that excessive praise or judgment by parents, early trauma and abuse may contribute to NPD.
NPD is not caused by a medical condition, drugs, or a person’s developmental stage in life.
Because NPD often causes feelings of superiority, entitlement and arrogance, people living with the disorder don’t always recognise that they have a mental illness or seek help – even when their patterns of behaviour cause serious problems in their lives and the lives of those around them.
For those who do seek help, diagnosis is made by a mental health professional and treatment generally takes the form of psychological therapies, including:
Therapy for NPD can be long-term. Its success depends on the willingness of the person with NPD to both acknowledge their disorder and commit to change.
NPD is not treated with medication, although medications may be prescribed for associated depression, anxiety or other health issues.
People with NPD tend to be self-obsessed, believing others are the problem, so many see no reason to attend counselling. They can interpret encouragement to seek help as criticism, and respond very defensively, deflecting fault onto others.
A useful technique to encourage therapy is suggesting that a shared problem or issue exists, focussing on things you both can work through.
Related: How to manage conflict
People living with NPD can be very difficult to relate to and sympathise with. They frequently act in hurtful ways towards the people around them.
Supportive therapy is a good way for friends and carers to build strategies for coping with a loved one’s behaviour, rebuilding self-esteem and setting boundaries.
Other self-help strategies include:
This SANE resource was created with support from The Vizard Foundation.