Narcissistic Personality Disorder: Symptoms, Diagnosis and Treatments

a woman wearing a paper crown, evoking an inflated sense of self often seen in people with narcissistic personality disorder
by Daniel

Narcissistic Personality Disorder (NPD) is a complex mental health condition characterized by an inflated sense of self-importance, a deep need for admiration, and a lack of empathy for others. While individuals with NPD may appear confident, their self-esteem is often fragile and dependent on external validation.  

This disorder is part of the Cluster B personality disorders, a group of conditions associated with dramatic, emotional, and erratic behaviors. Understanding NPD requires a closer look at its symptoms, how it impacts individuals and those around them, how it’s diagnosed, and the treatment options available.

What is narcissistic personality disorder?

NPD is a long-term mental health condition that affects how an individual perceives themselves and interacts with others. It typically manifests in adulthood, though its traits may become evident during adolescence.  

People with NPD have an inflated sense of their own importance, believing they are superior to others and deserving of special treatment. They may believe they are uniquely talented or gifted and that others should recognize and cater to their superiority.  

These beliefs and behaviors often lead to strained relationships and difficulties in various aspects of daily life.

Symptoms

The symptoms of NPD can vary in severity, but they generally fall into several core categories:

  1. Grandiosity: Individuals with NPD often have an exaggerated sense of their own abilities and achievements. They may believe they are more talented, intelligent, or successful than others, and they expect to be recognized for these traits without necessarily having earned it. 
  2. Need for admiration: People with NPD crave constant attention and praise. They may seek out situations where they are the center of attention and feel hurt or angry if they do not receive the admiration they believe they deserve. 
  3. Sense of entitlement: Individuals with NPD often feel entitled to special treatment and may become frustrated or angry when they do not receive it. This entitlement can manifest in personal and professional relationships, where they expect others to cater to their needs and desires. 
  4. Exploitation of others: People with NPD may take advantage of others to achieve their own goals. They may not be concerned about their actions’ impact on others if it serves their interests. 
  5. Lack of empathy: A hallmark of NPD is the inability to empathize with others. Individuals with NPD may have difficulty understanding or caring about the feelings and needs of those around them, which can strain relationships. 
  6. Envy: Individuals with NPD may feel envious of others who they perceive as more successful, admired, or talented. At the same time, they may believe that others are envious of them. 
  7. Arrogance and superiority: People with NPD may come across as arrogant, boastful, or condescending. They often believe they are better than others and may look down on people they perceive as inferior.

NPD in relationships and daily life

NPD often leads to difficulties in maintaining healthy relationships due to the individual’s self-centeredness, lack of empathy, and exploitative behavior.

In personal relationships

People with NPD may have troubled relationships with family members, friends, and romantic partners. Their need for admiration and entitlement can lead to conflicts and resentment. Partners of individuals with NPD often feel unappreciated, manipulated, or emotionally drained. The narcissistic individual may be controlling, dismissive of their partner’s feelings, or prone to emotional outbursts if their expectations are not met. 

Additionally, the lack of empathy seen in NPD can make it difficult for the individual to connect emotionally with others. They may struggle to understand or respond to the emotional needs of their loved ones, leading to feelings of isolation and frustration for both parties.

In professional settings 

In the workplace, individuals with NPD may seek leadership roles or positions of power, driven by their desire for recognition and admiration. While they may initially appear charismatic and confident, their inability to collaborate effectively, take criticism, or empathize with colleagues can lead to professional difficulties. Their entitlement may lead them to expect special treatment, which can cause friction with coworkers and supervisors. 

NPD can also impact job performance, as individuals with the disorder may become easily frustrated or disillusioned if they are not given the praise or status they feel they deserve. This can lead to conflicts with colleagues or even job loss.

In daily life 

NPD affects daily functioning, particularly in how the individual interacts with others. Because people with NPD are often focused on their own needs and desires, they may neglect the feelings or needs of those around them. This can lead to strained social interactions, isolation, and difficulty maintaining long-term friendships. 

Their sensitivity to criticism and perceived slights can result in mood swings, anger, or withdrawal. People with NPD may also experience episodes of depression or anxiety when they feel that their grandiose self-image has been challenged or undermined.

How NPD is diagnosed 

Diagnosing NPD involves a comprehensive psychological evaluation. Mental health professionals, such as psychologists or psychiatrists, use specific criteria outlined in the DSM-5 to assess whether an individual meets the diagnostic requirements for the disorder. 

To be diagnosed with NPD, an individual must exhibit at least five of the following criteria:

  1. A grandiose sense of self-importance 
  2. Preoccupation with fantasies of unlimited success, power, brilliance, or beauty 
  3. Belief that they are “special” and can only be understood by, or associate with, other high-status individuals or institutions 
  4. A need for excessive admiration 
  5. A sense of entitlement 
  6. Exploitative behavior in relationships 
  7. A lack of empathy 
  8. Envy of others or belief that others are envious of them 
  9. Arrogant or haughty behaviors or attitudes 

The diagnostic process typically involves an in-depth interview, self-assessment questionnaires, and observation of the individual’s behavior and interactions with others. It is important for clinicians to differentiate NPD from other personality disorders, such as borderline personality disorder or antisocial personality disorder, as these conditions can share overlapping symptoms.

Narcissistic personality disorder treatments 

Treating NPD can be challenging, as individuals with the disorder may not recognize that their behavior is problematic or that they need help. They may resist treatment or become defensive if they feel their self-image is being criticized. However, with appropriate interventions, people with NPD can make progress in managing their symptoms and improving their relationships.

The most effective treatment for NPD is psychotherapy, also known as talk therapy. The goal of therapy is to help individuals develop a healthier self-image, improve their empathy, and learn to build more satisfying relationships. Cognitive-behavioral therapy (CBT) is often used to help individuals recognize and change distorted thinking patterns and behaviors.

Therapy

In therapy, individuals with NPD may work on: 

  • Developing a more realistic and balanced self-image 
  • Understanding the impact of their behavior on others 
  • Building better communication and interpersonal skills 
  • Managing feelings of anger, frustration, and insecurity 

Group therapy can also be beneficial, as it provides an opportunity for individuals with NPD to interact with others and receive feedback on their behavior in a supportive environment.

Medication

While there is no specific medication for NPD, individuals with the disorder may benefit from medication if they experience co-occurring conditions, such as depression, anxiety, or mood swings. Antidepressants, mood stabilizers, or anti-anxiety medications may be prescribed to help manage these symptoms.

Challenges in treatment

One of the biggest challenges in treating NPD is the individual’s resistance to acknowledging their behavior as problematic. People with NPD may see themselves as superior and may not believe they need help.

Additionally, their sensitivity to criticism can make it difficult to engage in therapy. For this reason, it is important for mental health professionals to approach treatment with empathy and patience, helping the individual to gradually build self-awareness and motivation for change. 

While the symptoms of NPD may present challenges, especially in relationships, treatment through psychotherapy and – in some cases – medication, can lead to meaningful improvements in a person’s life. Early intervention and a supportive therapeutic environment can help individuals with NPD develop greater empathy, improve their social skills, and foster healthier, more fulfilling relationships.

If you need help managing these symptoms, or coping with someone who exhibits these symptoms, contact us. We’re to help.