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Narcissistic Personality Disorder: Traits, Symptoms, Subtypes, Causes, Diagnosis And Treatment

It is cardinal to love yourself and who you are. However, it is also important to be considerate of the people around you. You may have come across people who are solely focused on themselves that nothing and no one around them matter. And, when a person is extremely engorged in oneself, it is never positive.

This type of behaviour is medically termed as a narcissistic personality disorder (NPD). An individual with NPD has a magnified sense of self-image and self-importance. The mental condition causes the person to have an extreme need for excessive attention and admiration [1] ]. NPD usually appears in early adulthood.

NPD is associated with egocentrism, a personality characteristic in which people consider aspects concerned to them as the only thing that matters. An individual with NPD are mostly uninterested in the feelings of other people and lack empathy [2] . They find it impossible to appreciate the feelings and emotions that are not concerned with them.

Some researchers have mentioned narcissism to be genetic, suggesting that it is one of the most common inherited personality type and NPD has a genetic component [3] . A narcissistic individual is often mistaken for being self-obsessed, arrogant and tough-minded.

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Traits Of Narcissistic Personality Disorder

The signs and symptoms which indicate that an individual has NPD are mentioned below [4] [5] .

  • Extreme feelings of jealousy
  • Extreme sensitivity and tendency to be easily hurt and to feel rejected with little provocation
  • Difficulty maintaining healthy relationships
  • Insists on having the best of everything
  • Be envious of others and believe others envy them
  • Belittles others and look down on people they perceive as inferior
  • Believe they are superior and can only associate with people of the 'same kind'
  • Have concealed feelings of insecurity, shame, vulnerability and humiliation
  • Feels depressed and lack any motivation

And doctors use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association to diagnose NPD. The DSM-5 diagnostic criteria for NPD are as follows [5] :

  • An exaggerated sense of self-importance and a sense of entitlement
  • The need to require constant and excessive admiration
  • An expectation of special treatment due to perceived superiority
  • Exaggerates achievements and talents
  • Preoccupied with fantasies about power, success and beauty
  • Takes advantage of others to get what they want
  • Responds to criticism with anger and humiliation
  • Lack of empathy and inability to understand and share the feelings of others
  • Behaves in an arrogant manner

Symptoms Of Narcissistic Personality Disorder

Individuals with NPD may not recognise that they have the condition. However, the following signs indicate that you may have NPD [6] .

  • Constant issues at work or school
  • Unfulfilling relationships
  • Sudden bursts of anger, unhappiness and confusion when things fail to go your way
  • Constant financial problems
  • Alcohol and drug abuse

Subtypes Of Narcissistic Personality Disorder

According to DSM-5, narcissistic personality disorder is a homogeneous syndrome but there are variations in its interpretation[7] .

According to Theodore Millon, NPD can be classified as:

  • Unprincipled narcissist
  • Amorous narcissist
  • Compensatory narcissist
  • Elitist narcissist
  • Normal narcissist
  • Fanatic narcissist
  • Hedonistic narcissist
  • Malignant narcissist

According to Will Titshaw, NPD can be classified as:

  • Pure narcissist
  • Attention narcissist
  • Beyond the rules narcissist

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Causes Of Narcissistic Personality Disorder

There lacks clarity in the understanding of what causes NPD. It is associated with aspects such as high parental expectations, over-pampering, abuse etc.

Some of the possible causes of NPD are as follows [8] :

  • Genetics (inherited characteristics)
  • Environmental factors (such as a lack of connection or excessive adoration in parent-child relationships)
  • Sexual promiscuity
  • Cultural influences

Complications Of Narcissistic Personality Disorder

With an individual being extremely self-centred and oblivious to the emotions of others, it is bound to create some complications [9] .

  • Depression and anxiety
  • Relationship difficulties
  • Physical health problems
  • Problems at work or school
  • Suicidal thoughts or behaviour
  • Drug or alcohol misuse

Diagnosis Of Narcissistic Personality Disorder

There are no lab tests available for the diagnosis of the mental condition. The doctor will carry out X-ray and blood tests to rule out other conditions. Some features exhibited by the condition are similar to that of other personality disorders.

The diagnosis may point out that the individual is suffering from more than one personality disorder at the same time, making the diagnosis a bit challenging [10] [11] .

The diagnosis for the condition will be based on the

  • signs and symptoms,
  • a psychological evaluation that may include filling out questionnaires and
  • the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Treatment For Narcissistic Personality Disorder

As there is no 'cure' for NPD, the treatment involves talk therapy which is also defined as psychotherapy.

Psychotherapy: It attempts to help the person relate better with others so that the relationships become more enjoyable and rewarding. The therapy also helps in understanding the cause of emotions and what drives the individual to compete, cause distrust and despise [12] .

It can help the individual in accepting and maintaining real personal relationships and collaboration with co-workers, recognise and accept one's competence and potential so criticisms or failures can be tolerated, improve one's ability to understand and regulate feelings, tolerate the impact of issues related to one's self-esteem and consequently, let go of the unattainable goals and ideal conditions.

Psychotherapy includes cognitive behavioural therapy (CBT), family therapy, or group therapy [13] .

Medications: There are no medications specifically used to treat NPD. But, if the symptoms are linked with that of depression, anxiety or other conditions, antidepressants or anti-anxiety drugs can be beneficial [14] .

On A Final Note...

Narcissistic personality disorder can pose limitations and problems in your life. It can negatively affect your work, school and relationships. These individuals have a lack of self-esteem and mental fragility, veiled behind the extreme confidence and self-worth which can get maimed by the slightest criticism.

The personality disorder is not incurable and as aforementioned can be managed with therapy and lifestyle shifts. Make sure to avoid alcohol, drugs, and other substances that can trigger negative behaviour. Engage in soothing and relaxation methods such as yoga or meditation.

Infographics by Sharan Jayanth

View Article References
  1. [1] Rothstein, A. (2018). The narcissistic pursuit of perfection. Routledge.
  2. [2] Eaton, N. R., Rodriguez-Seijas, C., Krueger, R. F., Campbell, W. K., Grant, B. F., & Hasin, D. S. (2017). Narcissistic personality disorder and the structure of common mental disorders. Journal of personality disorders, 31(4), 449-461.
  3. [3] Kendler, K. S., Aggen, S. H., Gillespie, N., Krueger, R. F., Czajkowski, N., Ystrom, E., & Reichborn-Kjennerud, T. (2019). The structure of genetic and environmental influences on normative personality, abnormal personality traits, and personality disorder symptoms. Psychological medicine, 49(8), 1392-1399.
  4. [4] Bliton, C., Dowgwillo, E. A., Dawood, S., & Pincus, A. L. (2017). Personality disorder. Encyclopedia of Personality and Individual Differences, Springer International Publishing, 1-19.
  5. [5] Pincus, A. L., Dowgwillo, E. A., & Greenberg, L. S. (2016). Three cases of narcissistic personality disorder through the lens of the DSM-5 alternative model for personality disorders. Practice innovations, 1(3), 164.
  6. [6] Smits, M. L., Feenstra, D. J., Bales, D. L., de Vos, J., Lucas, Z., Verheul, R., & Luyten, P. (2017). Subtypes of borderline personality disorder patients: a cluster-analytic approach. Borderline personality disorder and emotion dysregulation, 4(1), 16.
  7. [7] Aslinger, E. N., Manuck, S. B., Pilkonis, P. A., Simms, L. J., & Wright, A. G. (2018). Narcissist or narcissistic? Evaluation of the latent structure of narcissistic personality disorder. Journal of abnormal psychology, 127(5), 496.
  8. [8] Coleman, D., Lawrence, R., Parekh, A., Galfalvy, H., Blasco-Fontecilla, H., Brent, D. A., ... & Oquendo, M. A. (2017). Narcissistic personality disorder and suicidal behavior in mood disorders. Journal of psychiatric research, 85, 24-28.
  9. [9] Hörz-Sagstetter, S., Diamond, D., Clarkin, J. F., Levy, K. N., Rentrop, M., Fischer-Kern, M., ... & Doering, S. (2018). Clinical characteristics of comorbid narcissistic personality disorder in patients with borderline personality disorder. Journal of personality disorders, 32(4), 562-575.
  10. [10] Caligor, E., Levy, K. N., & Yeomans, F. E. (2015). Narcissistic personality disorder: diagnostic and clinical challenges. American Journal of Psychiatry, 172(5), 415-422.
  11. [11] Ronningstam, E. (2016). Pathological narcissism and narcissistic personality disorder: Recent research and clinical implications. Current Behavioral Neuroscience Reports, 3(1), 34-42.
  12. [12] Tanzilli, A., Muzi, L., Ronningstam, E., & Lingiardi, V. (2017). Countertransference when working with narcissistic personality disorder: An empirical investigation. Psychotherapy, 54(2), 184.
  13. [13] Caligor, E., & Petrini, M. J. (2018). Treatment of narcissistic personality disorder.
  14. [14] Krizan, Z., & Herlache, A. D. (2018). The narcissism spectrum model: A synthetic view of narcissistic personality. Personality and Social Psychology Review, 22(1), 3-31.

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