Understanding Narcissistic Personality Disorder (NPD)

What is Narcissistic Personality Disorder?

According to the Mayo Clinic, Narcissistic Personality Disorder (NPD) “…is a mental disorder in which people have an inflated sense of their own importance, a deep need for admiration and a lack of empathy for others. But behind this mask of ultraconfidence lies a fragile self-esteem that’s vulnerable to the slightest criticism.”

Based on this definition, it’s clear how NPD can be overlooked as over-confidence, sensitivity, bossy behavior, or any other number of ordinary personality traits, desirable or otherwise.

The DSM-5 lists the following as criteria for a diagnosis of NPD:

  • Having an exaggerated sense of self-importance
  • Expecting to be recognized as superior even without achievements that warrant it
  • Exaggerating your achievements and talents
  • Being preoccupied with fantasies about success, power, brilliance, beauty or the perfect mate
  • Believing that you are superior and can only be understood by or associate with equally special people
  • Requiring constant admiration
  • Having a sense of entitlement
  • Expecting special favors and unquestioning compliance with your expectations
  • Taking advantage of others to get what you want
  • Having an inability or unwillingness to recognize the needs and feelings of others
  • Being envious of others and believing others envy you
  • Behaving in an arrogant or haughty manner

According to Psych Central, NPD is often diagnosed in adults, as children and adolescents are still developing and changing. However, if children or adolescents have been displaying traits of NPD for more than a year, they should be tested for the disorder. Additionally, older adults do not typically develop NPD in the later parts of their lives, since people establish their personalities in their late 20s or early 30s. NPD occurs more commonly in males than in females and is thought to occur in about 6 percent of the general population (Psych Central).

Diagnosis and Treatment of NPD

Because Narcissistic Personality Disorder is a disorder characterized by traits and behaviors, it can often be very hard to diagnose. Most primary care doctors do not have the expertise required to diagnose or treat NPD, and as such, a psychiatrist and/or psychologist could be consulted instead.

A specialist is important when diagnosing NPD largely because it doesn’t manifest physically. Because of this, the diagnosis process consists of psychological evaluation “that may include filling out questionnaires,” as well as a physical examination to rule out any other medical issues (Mayo Clinic). If NPD is identified, the treatment is almost exclusively consists of psychotherapy or talk therapy, since no medication can alleviate the symptoms of this disorder.

The very nature of NPD can lead those who have it to believe that treatment is not necessary — from their perspective, they are fine the way they are and it’s the rest of the world that needs to catch up. If treatment begins and no change is immediately apparent, the person with NPD might get annoyed or self-conscious and decide they want to quit because they feel like a failure. The Mayo Clinic offers some suggestions for those with NPD who are resisting treatment:  “Keep an open mind. Focus on the rewards of treatment. Educate yourself about narcissistic personality disorder so you can better understand symptoms, risk factors and treatments.” and finally “Recovery from narcissistic personality disorder takes time. Stay motivated by keeping your recovery goals in mind and reminding yourself that you can work to repair damaged relationships and become happier with your life.”

If a family member of loved one is resistant to receiving help, it’s important to encourage them to start (or continue) treatment, even when they put up some resistance. If there are other problems affecting the person in treatment, such as depression, anxiety, alcohol or substance use, or any other mental health issues, encourage the person with NPD to seek treatment for those things first, as they may alleviate some of the pressure and make psychotherapy more successful (Mayo Clinic).

NPD and the Family

Having someone with NPD in your family can put a lot of pressure on them and everyone around them. Even if your family is well-adjusted and loving, with few other issues among the members, NPD can be hard to diagnose and even harder to treat. Add to that the fact that a poor family environment can actually cause NPD, and the problems become even more complex (Mayo Clinic).

Unfortunately, being in any sort of relationship with someone with NPD can be a toxic situation for all parties. People with NPD have little to no concern for the people around them, as a result of their inflated feelings of superiority. The online forum “Out of the Fog” was created “to provide information and support to the family members and loved ones of individuals who suffer from a personality disorder.” One user of this site, Aames, describes living in a family with a person who has NPD. Aames writes,

Living with or being involved with a narcissist can be mentally and emotionally exhausting. It can feel like you have to perform “mental gymnastics” from dealing with the lying (even when confronted with undeniable proof ), the gaslighting, the triangulation, the projection, the constant contradictions, the manipulation, blame-shifting, the charm they lay on, the inflated sense of self – even subtle forms of torture, such as sleep deprivation, these people inflict on their victims – appears to be conscious and calculated to push the target of their “affections” past their limits, into surrender – and ultimately into total compliance – as a source of Narcissistic Supply.

Children, spouses, friends, lovers – those closest to the Narcissist – are not considered individuals in their own right by the Narcissist – but rather extensions or, in the worst cases, the property of the Narcissist.” (Out of the Fog)

Aames goes on to explain that even though NPD is a mental disorder and the person who has it must seek treatment, if you are the victim of the relationship, you must learn to put yourself first. If you have the option, you should remove yourself from the relationship altogether until the person with NPD has been treated for their disorder.

Unfortunately, an individual with NPD can make you feel worthless, overwhelmed or overpowered in their presence. They may switch back and forth between brute psychological force to make you feel this way, and martyrdom to make you feel bad for having those feelings. They can make you feel as though you are compromising when really you are the only one giving anything up. They can revert back to childlike innocence when it suits them–whether to make themselves look weak and victimized, or to gain your affection and pity. That will end when they switch back to a power stance and deal crushing blow after crushing blow to your self-esteem and self-worth. They can even convince you to stop taking care of yourself in favor of taking care of, or wallowing in neglect with them. (Out of the Fog).

If you find yourself in a relationship with someone who has NPD, you should seek out a behavioral health provider such as a therapist or a counselor to evaluate your situation and your options. Depending on your relationship with the person, you may consider removing yourself from that relationship. Alternately, if the individual with NPD in your life is a family member, you and your provider can work to come up with ways to encourage that person to seek their own treatment. If they refuse to go on their own, you may want to offer couples or family therapy to assist in their treatment. Above all, remember to take good care of yourself regardless of how the person with NPD makes you feel. In addition to seeking out a behavioral health provider, there are numerous support groups to support loved ones of those with NPD.







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