Introduction

Having a strong sense of self can be beneficial. Interestingly, according to certain researchers, individuals who possess a somewhat inflated sense of self may exhibit greater mental resilience, experience lower levels of stress, and have a reduced risk of depression.

However, narcissism exists on a spectrum. On one end, it involves craving the occasional compliment. At its most extreme, it can cross into pathological territory.

Understanding NPD can help improve relationships and mental health. Narcissistic personality disorder can cause problems in various areas of life, including relationships, work, school, and finances. 

This blog will explore the complexities of Narcissistic Personality Disorder, offering insights into its symptoms, causes, diagnosis, and treatment.

Understanding Narcissistic Personality Disorder

Narcissistic Personality Disorder (NPD) is one of 10 recognized personality disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the standards used by mental health professionals to diagnose conditions.

NPD is characterized by an inflated opinion of oneself and an intense need for admiration and attention from others. 

Those with NPD may feel generally unhappy and disappointed when they don't receive the special treatment or admiration they believe they deserve.

This can lead to unhappy and unfulfilling relationships and others may perceive them as snobbish and conceited, and may not enjoy their company.

They have high self-esteem and believe that they are special or superior to other people. They need excessive praise and consideration and react poorly to perceived criticism.

Individuals with strong self-esteem are typically humble, whereas those with NPD rarely are.

NPD tends to be more prevalent among males and typically manifests during the teenage years or early adulthood. 

It is common for children to display narcissistic traits, which is a normal part of their development and does not necessarily indicate the development of Narcissistic Personality Disorder.

Different Types of Narcissistic Personality Disorder

There are two types of Narcissistic Personality Disorders:

Adaptive Narcissism

Adaptive Narcissism occurs when an individual with this disorder embraces positive traits, like self-reliance and self-assurance, that can be beneficial. These traits may assist someone in setting high goals at work, for instance, or in experiencing fulfilling relationships without becoming excessively reliant on a partner.

Maladaptive Narcissism

Maladaptive narcissism is defined by toxic traits, including a sense of entitlement and a willingness to exploit others.

The different forms of maladaptive narcissism include:

Overt or grandiose narcissism: Overt narcissists are typically extroverted but also uncooperative, selfish, and overbearing. Their exaggerated self-image and high self-esteem enable them to be confident and assertive

Covert or vulnerable narcissism: Covert narcissists are introverts. They tend to be extremely sensitive to criticism and suffer from low self-esteem.

Communal narcissism: Communal narcissists tend to view themselves as altruistic and claim to care deeply about fairness. They present themselves to others as supportive and selfless.

Antagonistic narcissism: Antagonistic Narcissists have a zero-sum mindset. They think there is a winner and a loser in every situation. This makes them aggressive and hostile toward others. They are quick to criticize others. They are slow to forgive.

Malignant narcissism: Malignant narcissism is an extremely harmful form of personality disorder. A malignant narcissist may exhibit aggressive, paranoid, or sadistic tendencies, deriving pleasure from the suffering of others.

Symptoms of Narcissistic Personality Disorder

The most common symptoms of NPD include:

Grandiose sense of self-importance: Individuals with NPD may feel they are exceptional and deserving of special treatment. They may overstate their accomplishments or abilities and anticipate admiration for them.

Need for admiration: They seek admiration from others, often resorting to manipulation or exploitation to fulfill their craving for attention.

Lack of empathy: They struggle to comprehend and empathize with the emotions of others. They may display insensitivity or even cruelty towards others without fully grasping the hurtful impact of their behavior.

Envy of others: They may envy those who possess the things they desire, such as achievement, riches, or fame, and attempt to undermine others or hinder their accomplishments.

Arrogant or haughty behavior: They may appear arrogant or haughty, looking down on others and believing themselves to be superior.

Difficulty with relationships: They frequently struggle to sustain positive relationships, often displaying controlling, manipulative, or abusive behaviors.

Sensitivity to criticism: They are extremely sensitive to criticism, often responding with anger, rage, or even violence when they feel criticized.

Causes of Narcissistic Personality Disorder

The exact causes of Narcissistic Personality Disorder (NPD) are still unclear, but it's likely a complex interplay of genetic, environmental, and psychological factors.

Here's a breakdown of the main contributors:

Genetics

Research indicates a genetic predisposition to NPD. Individuals with family members who have the disorder are more likely to develop it themselves.

However, genes do not guarantee the development of NPD, and environmental factors also play a significant role.

Early Childhood Experiences: 

Certain childhood experiences can increase the risk of NPD, including:

Excessive praise or admiration: This can inflate a child's sense of self-importance and make them crave constant attention.

Neglect or abuse: On the other hand, neglect or abuse can cause feelings of worthlessness and insecurity, which exaggerated self-importance in NPD can mask.

Unrealistic expectations: Setting impossibly high standards for a child can create pressure to be perfect, leading to narcissistic traits.

Lack of empathy or boundaries: Children raised in environments with little empathy or clear boundaries may struggle to understand and respect others' feelings and needs.

Psychological Factors: 

Some psychological factors may also contribute to NPD, such as:

Low self-esteem: Despite their outward appearance of confidence, people with NPD often have underlying feelings of inadequacy and insecurity.

Difficulty with emotion regulation: They may struggle to manage their emotions, leading to outbursts of anger or grandiosity.

Poor coping mechanisms: Unhealthy coping mechanisms like manipulation or blaming others can perpetuate narcissistic patterns.

It's crucial to keep in mind that there isn't a single cause of NPD and that each person's experience is different.

While these are some of the known contributors, more research is needed to understand the causes of NPD.

How is NPD Diagnosed?

A psychiatrist, psychologist, or other mental health professional typically diagnoses NPD after having direct access to the individual and their medical history.

Even for a mental health professional, diagnosing NPD may not be easy in some cases. This is due to the rarity of individuals with NPD seeking help, openly discussing their thoughts, or attending therapy sessions.

A mental health professional may use the DSM-5 model to diagnose NPD.

Treatment Options of NPD

Here are some treatment options for NPD:

• Psychotherapy, which includes cognitive-behavioral therapy (CBT) and dialectical behaviour therapy (DBT)
• Medications may be prescribed to alleviate symptoms such as depression or anxiety in some cases. 
• Group therapy can provide support and feedback from others who may be experiencing similar challenges. 
• Self-help strategies, such as journaling and mindfulness, can also aid in managing symptoms. 
• Family therapy may help address relationship dynamics that may be contributing to the problem.

Conclusion

Narcissistic Personality Disorder (NPD) is a complicated and difficult mental health condition. People with NPD often experience difficulties maintaining healthy relationships and may struggle in various aspects of their lives. 

Although therapy, such as Cognitive-Behavioral Therapy, can be helpful, treating NPD can be complicated due to the inherent resistance to acknowledging and addressing the core issues.

It is crucial for individuals affected by NPD and their loved ones to seek professional help and support to manage the condition effectively and improve their well-being.

FAQs

How do you know when someone is narcissistic?

Individuals with narcissistic personality disorder exhibit a consistent pattern of self-centered thinking and behavior, displaying a lack of empathy and consideration for others, as well as an excessive need for admiration. Others often describe people with NPD as confident, influential, self-assured, and assertive.

Do narcissists have high or low self-esteem?

Narcissists have a very high level of self-confidence. The thing is, they lack a secure sense of self-esteem, having what researchers call “fragile high self-esteem.” External validation and self-deception, or fantasies of success, power, and beauty, are extremely important factors in this form of high esteem.

How do I deal with a narcissist in my life?

Setting clear boundaries is a crucial method to protect oneself in any interaction with a narcissist. Therapy can help couples find healthy methods to communicate, cope, and manage emotional pain. The good news is that if both people are willing to go through treatment, their relationship may improve.

Are narcissists bad people?

Narcissists aren't bad people; it's their behavior that's problematic. They've been conditioned to think they're special and deserve to be treated better than others, and they're approaching the world accordingly.

References

• National Library of Medicine (2023). Stinson FS, Dawson DA, Goldstein RB, Chou SP, Huang B, Smith SM, Ruan WJ, Pulay AJ, Saha TD, Pickering RP, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. 2008 Jul;69(7):1033-45. (Accessed 16/01/2024).
  
• Mayo Clinic (2023). Narcissistic personality disorder. Available at https://www.mayoclinic.org/diseases-conditions/narcissistic-personality-disorder/diagnosis-treatment/drc-20366690 (Accessed 16/01/2024).
• PsychCentral (2021) All About Narcissistic Personality Disorder. Available at https://psychcentral.com/disorders/narcissistic-personality-disorder (Accessed 16/01/2024).
• Medical News Today (2022). All about Narcissistic Personality Disorder. Available at https://www.medicalnewstoday.com/articles/covert-narcissist (Accessed 16/01/2024).
• Cleveland Clinic (2023). Narcissistic Personality Disorder. Available at https://my.clevelandclinic.org/health/diseases/9742-narcissistic-personality-disorder (Accessed 16/01/2024).
• WebMD (2023). Narcissism: Symptoms and Signs. Available at https://www.webmd.com/mental-health/narcissism-symptoms-signs (Accessed 16/01/2024). 
• Psycom (2023). Tell Me All I Need to Know About Narcissistic Personality Disorder. Available at https://www.psycom.net/personality-disorders/narcissistic (Accessed 16/01/2024).