What is a Narcissistic Personality Disorder?

Narcissistic personality disorder (NPD) is a mental health condition and is one of the subtypes of the broader category of personality disorders. NPD is currently not very well recognised in the UK. It is estimated that between 1% and 5% of the UK population has a narcissistic personality disorder.

What is a narcissistic personality disorder?

A narcissistic personality disorder is one of ten personality disorders as recognised in the World Health Organization’s International Classification of Diseases (ICD). It is a mental health condition in which people display a lack of empathy for others, have an inflated sense of their own importance, have difficulties in forming and maintaining relationships and have a deep need for excessive attention and admiration from others.

Narcissism is an extreme form of self-involvement which makes a person ignore the needs of those around them. They are not able to understand the effect that their behaviour has on others, and they will be able to easily disregard the feelings of others.

Not every narcissist will have narcissistic personality disorder as someone can have narcissistic traits but not have narcissistic personality disorder. All people may show the occasional narcissistic trait, but true narcissists will continuously disregard others and their feelings, and do not understand the impact their actions will have on other people. People who are diagnosed with NPD are at the highest end of the spectrum of narcissists.

Personality disorders usually present themselves in late teens and early adulthood. Personality disorders in general can make people think, feel and behave in ways that can hurt themselves and others. People who have narcissistic personality disorder can have difficulties in other areas of their life and other conditions may develop alongside it, including:

• Depression and anxiety.
• Suicidal thoughts.
• Drug and alcohol misuse.
• Relationship difficulties.
• Physical health problems.
• Difficulties maintaining employment or difficulties in the workplace.

If you are interested in reading further about different types of personality disorders, you can find these by visiting our knowledge base where you can read about Dissociative Identity Disorder (split personality disorder) and Borderline Personality Disorder.

What are the signs and symptoms of a narcissistic personality disorder?

People who show signs of narcissism can often, initially, be very charming and will not immediately behave negatively, especially in romantic relationships. This can make it difficult for people to spot the signs. A common trait of narcissism is displaying manipulative and controlling behaviour. They may initially try to impress you and appear to treat you well; however, their own needs will always come first.

People with narcissistic traits often like to surround themselves with people who feed into their ego; however, often these relationships will be superficial and one-sided. They will expect the people around them to cater for their every need. They may keep people at a distance in order to maintain control and they may even exploit other people for their own gains. Sometimes this exploitation can be malicious and other times it is simply that they are oblivious to their own actions and the impact of their behaviour on other people.

The symptoms of NPD can vary between people as can the severity of symptoms.

Symptoms can include:

• Having a sense of entitlement. This can require constant and excessive admiration from others. They believe that others should be obedient to their wishes and that the rules don’t apply to them.
• Manipulative and/or controlling behaviour.
• An exaggerated sense of self-importance.
• An expectation to be treated as superior to others, that they should receive special treatment above others and have the best of everything.
• Consumed with fantasies about success and power.
• Only wanting to associate with high status people.
• Taking advantage of others to get what they want.
• Being envious of others or believing that others are envious of them.
• An inability to recognise or understand the feelings or needs of others.
• Feelings of extreme self-importance.
• Believing people to be inferior to them.
• An expectation that other people should unquestionably comply with their requests.
• Can display boastful or pretentious behaviour.
• Significant difficulties in building and maintaining relationships.
• Attempt to belittle other people in order to make themselves appear superior.
• Feelings of depression and sudden mood changes.
• The inability to cope with stress.
• Having feelings of insecurity and shame and humiliation which they conceal from others.

Since reality doesn’t often fit with the person with their view of themselves, a person with NPD can often live in a fantasy world. Their fantasies can help to avoid their inner feelings of worthlessness and shame. Anything that challenges this fantasy can be met with extreme defensiveness and even rage. People around them can therefore feel like they are walking on eggshells trying not to upset them and may go along with their fantasies in order to achieve this.

What are the types of narcissistic personality disorder?

There are different types of narcissistic personality disorder.

Grandiose or overt narcissism

Grandiose narcissistic personalities are typically charming and well liked. People with grandiose narcissism usually overestimate their capabilities and have very high self-esteem. People with grandiose narcissism can be dominant and aggressive and view themselves as being more important than others. They are very self-confident and self-assured and tend to brag about themselves. This type of narcissist was most likely treated as if they were superior and above others when they were children and therefore continue to have these expectations as adults.

Experts believe that there are two types of grandiose narcissists:

• Adaptive narcissism – this causes people to build up their self-confidence in order to protect themselves. They are often attracted to careers where they will have a leadership role as they are natural leaders who crave authority.
• Maladaptive narcissism – this means that someone will have naturally high self-esteem and they believe that they are entitled to take advantage of other people in order to benefit themselves. This means that they can be controlling and manipulative. They can be angry or aggressive with people around them.

Vulnerable narcissism

Most people assume that narcissism causes people to desire to be the centre of attention; however, vulnerable narcissism usually results in people behaving in a withdrawn or introverted manner. Vulnerable narcissism can be referred to as closet or covert narcissism, where a person usually has a low sense of self-worth and needs people to admire and praise them in order for them to feel better about themselves. They can go back and forth between feeling superior and inferior to others and can become easily offended when other people don’t give them special treatment.

Vulnerable narcissistic personalities can have elaborate fantasies about being successful and a lack of recognition from others can lead them to feel angry and enraged. A vulnerable narcissist is more likely to experience negative emotions. People living with this type of narcissism are more likely to have feelings of depression and paranoia. People with this behaviour are much more sensitive and narcissistic behaviour serves as a protection for them against feelings of inadequacy and failure. It is thought that this type of narcissism usually occurs in people who were neglected or abused as children.

People may also fluctuate between grandiose and vulnerable narcissism.

Communal narcissism

People with communal NPD perceive themselves as being very generous and caring whilst behaving in the complete opposite way. They may be outspoken and outraged when they see someone being mistreated; however, when they mistreat people themselves, they do not view their own behaviour in the same way. Their actions often don’t match their beliefs.

Antagonistic narcissism

Many narcissistic personality types are competitive in nature; however, this is especially noticeable in antagonistic NPD. Often mistrusting other people, it is common to see everyone around them as a rival and treat most social interactions as a competition. This leads them to be aggressive and hostile and unwilling to forgive others.

Malignant narcissism

The symptoms of malignant narcissism can be severe and can interfere with a person’s quality of life. They can display severely hostile and vindictive behaviour towards others. They are often paranoid about perceived threats.

Seductive narcissism

People with seductive NPD crave positive attention. They will often shower people with compliments; however, when they are not getting the attention they require, they will easily move on to a new target.

How to deal with someone who has a narcissistic personality disorder

Someone with a narcissistic personality disorder may come across as being charming and friendly. As they are often living in a fantasy world they can often convince others initially that this is who they really are. Their confidence in themselves may be an attractive quality initially and often people with a low self-esteem may be more likely to be drawn in by them. It is important to remember that they may be out of touch with reality and you will need to avoid allowing them to convince you that your reality is wrong.

It is important to observe the way a narcissist treats other people. You may see them manipulating, lying or treating other people badly and they may try to convince you that it is the other person’s fault and that they will treat you differently; however, it is likely that, in time, they will go on to treat you in the same way.

Try not to internalise the way a narcissist is treating you as this is never your fault. If they are treating you negatively, this is due to their narcissistic traits and not because of anything you have done wrong. If they are blaming or criticising you, try not to take this personally or let this impact negatively on you. Their reality is not the same as anyone else’s, so if they are being critical of you, this is likely to be unjustified and a version of reality that only exists in their head.

There is little point arguing with a narcissist or trying to reason with them in any way, as they will not have the ability to see things from your point of view.

Be confident in your own self-worth and do not allow the narcissist to convince you that you are any less.

It is important to remember that although it is possible for someone with NPD to change their behaviour, this can only be achieved through intensive therapy with a professional. There is likely nothing that you can do to change their behaviour. Do not try to manage the situation on your own and expect that you can change them, as the condition is too complex for this to be the case.

Someone with NPD who hasn’t sought help will be truly incapable of having a healthy, two-way relationship with another person. They will regularly violate the boundaries of others and they cannot see you or your needs as being important. You will need to be clear and firm in your boundaries and you may need some help with this. If you feel that a situation is ever becoming unsafe, or if you are ever concerned for your safety or the safety of anyone else, it is important to seek help immediately. You can contact the police by calling 999 or alternatively you can contact the National Domestic Abuse helpline if you feel that you are a victim of domestic abuse. Specialist trained operators will be able to offer advice and support relevant to your situation.

If you want to leave the relationship but you are finding this difficult, it can be completely normal to feel this way. Ending a relationship is never easy and particularly an abusive relationship. If the person you are in a relationship with has NPD, this can make it even more difficult.

You may wish to:

• Educate yourself about NPD.
• Seek support from a domestic abuse support service, a refuge or the police.
• Seek support from friends and family.
• Be clear about the reasons you are leaving.

Women’s Aid offers advice and support for victims of domestic abuse. They discuss how to leave, the support available, safety planning and other useful resources.

If you are in a relationship with someone with narcissistic personality disorder, it is important that you are honest with yourself about what you can expect from the relationship.

You may also wish to:

• Look for support elsewhere, particularly emotional support.
• Spend time with people who value you and give you an honest reflection of who you are.
• Make new friends that are completely separate from the person you are in a relationship with.
• Have interests and fulfilment away from the relationship. This may be hobbies, work or volunteering.
• Learn about healthy relationships.

What causes a narcissistic personality disorder?

The exact causes of narcissistic personality disorder are unknown; however, it is thought that the disorder may result from a combination of factors that include:

• Childhood trauma (this may be physical, sexual or emotional abuse).
• Genetics (how certain qualities or traits are passed from parents to offspring as a result of changes in DNA sequence).
• Early relationships with relatives and friends.
• Temperament and personality.
• Hypersensitivity to textures, noise or light in childhood.

As with other personality disorders, the cause is not always clear and there is likely to be a complex set of circumstances involved. Scientists believe that the full onset of NPD may occur when interpersonal development is compromised, for example:

• Learning manipulative behaviour from parents, family members or peers.
• Being excessively praised or excessively criticised.
• Being born with an over-sensitive temperament.
• Unrealistic expectations from parents.

Can a narcissistic personality disorder be prevented?

As there isn’t a clear, known cause for developing a narcissistic personality disorder, it is therefore difficult to say for sure how it can be prevented. As with any mental health condition, there are steps that can be taken and it may help to:

• Seek support and treatment for any childhood mental health conditions.
• Seek family therapy which can provide ways to cope with conflict and distress and learn healthy ways to communicate with other people.
• Speak to your GP with any concerns you have with your own or your child’s mental health.

The NHS provide some helpful guidance on how to look after your mental health for both yourself and your children and where you can access support if needed.

How is a narcissistic personality disorder diagnosed?

Healthcare providers can diagnose NPD when you have at least five of the following characteristics:

• Consuming thoughts about being more successful, powerful, smart, loved and attractive than others.
• Feelings of superiority.
• A desire to only associate with people with a high status or power.
• A sense of entitlement.
• A need for excessive admiration.
• Arrogant behaviours and attitudes.
• Willingness to take advantage of others to achieve goals.
• Lack of understanding and consideration for other people’s needs and feelings.

A mental health professional, such as a psychologist or psychiatrist, can determine if you have symptoms of NPD. The focus will be on long-term patterns of thinking, feeling, behaving and interacting with other people. Other mental health conditions can also be ruled out as the symptoms can sometimes be similar to other mental health conditions.

Can a narcissistic personality disorder be treated?

People with NPD may not believe that anything is wrong as they may have little insight into their behaviour. They are often extremely resistant to changing their behaviour and they will often blame others for their actions or blame other people for provoking them into acting that way. This may make it unlikely that they will seek treatment for their condition as they may not have the insight needed to access support and make changes.

When it comes to treating NPD, the primary form of treatment is psychotherapy or other types of talking therapy. Talking therapies are psychological treatments for mental and emotional problems like stress, anxiety, depression and other mental health difficulties. There are many types of talking therapy, but they all involve working with a trained therapist. This may be one to one, in a group, online, over the phone or with your family members or partner. The therapist can help you understand and cope with the problems you are having. You can find details of which talking therapies are available and what you can access on the NHS on their talking therapies information page.

A therapist can help people learn how to deal with NPD, improve their relationships with other people and become more empathic and compassionate. Therapy can also help people to build their self-worth without the need for constant recognition from others. It can also teach you how to better relate to others, encourage more functional interpersonal relationships, as well as help you to gain a better understanding of your own emotions. It is possible for someone with NPD to learn to recognise their own behaviour with the right treatment which can improve their lives and the lives of those around them.

A therapist can also help you to:

• Accept and maintain relationships with family and co-workers.
• Understand and regulate emotions.
• Tolerate criticism and failure.
• Minimise a desire to attain unrealistic goals.

This could be done through cognitive behaviour therapy (CBT). CBT is a tool to help manage mental health problems by changing the way people think and behave.

People with NPD can also benefit from a combination of both therapy and medication such as anti-depressants or mood stabilisers. All of the different narcissistic personality disorder types can benefit from receiving professional help. People with NPD often aren’t aware of their harmful behaviours towards themselves and other people and psychotherapy can teach coping skills as well as offer some awareness of their behaviour.

Although treatment of NPD can be slow in terms of progress, studies have shown that narcissists are capable of learning and feeling empathy and ultimately making changes.

If you recognise narcissism in yourself you can take steps in order to change the way you think about yourself. Instead of comparing yourself to others you can focus and grow your own good qualities and lower your need to be praised by others.