All About Narcissistic Personality Disorder

A healthy (even sometimes inflated) sense of self can be a good thing. In fact, some researchers believe those who have somewhat grandiose views of themselves are mentally tougher, less stressed, and less at risk for depression.

However, narcissism exists on a spectrum: On one side, it’s craving the occasional compliment. On its darkest side, it can creep into pathological territory.

Narcissistic Personality Disorder (NPD) is one of 10 personality disorders recognized in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The hallmark signs of NPD read like laundry list of what NOT to look for in a significant other: An inflated sense of self-importance, a lack of empathy for others, and a deep need for constant attention or admiration.

While someone with NPD’s self-esteem can be off the charts, ironically, it can also be super fragile, dependent on external validation, or self-deception. They’ll believe grandiose fantasies about themselves (i.e. they’re smarter, more attractive, and more successful than everyone they know), easily put other people down, and generally hijack any conversation or situation to make themselves feel better or superior. Feeling “less than perfect” is very uncomfortable for a narcissist, and they’ll protect themselves from it at all costs.

A personality disorder like NPD is about disturbed relationships, says Modesto, California-based psychologist Robert Moody, PhD. “People with personality disorders, as a class, have a lifetime of struggles with intimate, interpersonal relationships with their family, friends, and co-workers—and that’s especially true for those with narcissistic personality disorder.”

The disorder affects anywhere from 0.5 to 5% ¹of the general US population with a greater prevalence in men than women.² The percentage is low because, in order to be diagnosed, someone with NPD has to admit they have issues—which they often don’t. “The real problem with a narcissistic personality disorder is that the individual lacks good insight into what’s going on,” says Moody. “They think that the problem is all about everyone else, not them.”

And it can manifest differently in men versus women. According to research, compared to males, a narcissistic female personality is more likely to include deep insecurity, martyrdom, jealousy, and competitiveness with other women, often seeing them as a “threat” (think the overbearing mother-in-law).³ Men on the other hand are more likely than women to exploit others and feel entitled to certain privileges. They’re also more apt to exhibit qualities of assertiveness or power hunger.

However, this is not to say these traits are exclusive to either sex. When it comes to vanity and self-absorption, both sexes rate equally.

When you think of a narcissist, certain people you know may come to mind: the guy at the gym in the too-tight tank who’s more concerned with how his muscles look in the mirror than actually working out; the co-worker who fills her Insta feed with her face—at every angle.

But narcissism isn’t just about looking pretty: There are, in fact, a few different types of narcissists.

#1. The Covert Narcissist (or vulnerable narcissist)

Basically the exact opposite of the stereotype, instead of craving the spotlight and constant admiration, covert narcissists tend to be shy, self-effacing, hypersensitive to how others perceive them, and chronically envious. They often think their pain or suffering is worse than everyone else’s—and may even believe they’re the ugliest person in the room.

#2. The Cerebral Narcissist

They derive their self-importance from their intellect, believing they’re smarter than everyone else.

#3. The Somatic Narcissist

Somatic narcissists get their self-worth from their bodies. They tend to obsess over physical appearance, including weight, and criticize others based on their appearance.

#4. The Spiritual Narcissist

They use religion or spirituality to intimidate or justify harmful behaviors to others that can creep in when an individual takes a “holier than thou” stance, overemphasizing their level of spirituality or closeness to God. Harmful behaviors can happen when, as an example, a church leader claims they had a vision from God about someone else, or that they’re in a “higher” position to use Biblical passages to control, hurt, or shame someone.

Other types mentioned in NPD research include grandiose, or “overt”—that stereotypical over-the-top, attention-seeking type—and high-functioning, meaning those who may use traits such as competitiveness and exploitation to succeed in a profession or endeavor.

However, it should be noted that there is a broad spectrum of presentable traits with NPD, each with varying levels of severity, so subtypes should be used as guides rather than hard-and-fast rules.

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Narcissism is a label that gets thrown around a lot, especially when someone seems conceited or acts out of self-interest, says psychologist Kristina Hallett, PhD, ABPP, associate professor of graduate psychology and the director of clinical training at Bay Path University in Connecticut. “But a narcissistic action every now and then isn’t the same as having a personality disorder.” With the latter, a narcissist’s self-absorbed and self-centered way of thinking and behaving surfaces in every area of their life, from work and friendships to family and love relationships.

The nine most common traits for NPD include:

• Having an inflated sense of self-importance and entitlement. Deep down, you feel like you’re the best, most successful, competent, [insert praise here] in any situation.
• Needing constant admiration. Your self-esteem is like a balloon without a knot, requiring a steady stream of attention, approval, and recognition to keep it inflated. No matter how much someone tells you that they love or look up to you, it feels like it’s never enough.
• Expecting special treatment. Whether it’s favors or apologies, whatever you want, you believe you deserve to have it—because you’re superior to everyone around you, and they know it and should comply.
• Exaggerating achievements and talents. You have no problem embellishing the facts—or even outright lying—about your life, resume, and experiences.
• Reacting negatively to criticism. Even though you crave control and take full credit when things are going well, you’re quick to blame others whenever a situation doesn’t go as planned. It’s extremely hard to accept criticism or admit to mistakes because, naturally, it’s always someone else’s fault, not yours.
• Being preoccupied with fantasies about power, success, and beauty. You tend to create and believe exaggerated, unrealistic narratives around your success, relationships, even how good you look to help you feel special and in control. Anything that threatens the fantasy is rationalized away or simply ignored. You also want people to feel envious of you, and you feel pretty envious of people who have what you want.
• Taking advantage of others. You often don’t think twice about using or exploiting other people to achieve your own ends—whether maliciously or obliviously. You care about your relationships and the people in your life on a superficial level—if they elevate your social status, or make you look or feel good, for instance—and you don’t really think about how your behavior might affect them.
• Having an inability or unwillingness to recognize the needs and feelings of others. You’re super sensitive to how people treat you and react to your needs and feelings, but on the flip side, you can’t put yourself in other people’s shoes and empathize with their experiences. You might belittle others or even bully people to feel better about yourself. You never really “go deep” in any of your relationships, either—and, frankly, it doesn’t bother you all that much.
• Behaving in an arrogant manner. With an inflated ego and sense of superiority and entitlement, you probably insist on having the best everything—the best car, office, designer clothes—monopolize conversations, look down on people you perceive as “inferior,” and only associate with those you think are equally special, successful, and talented.

There’s no single cause of NPD. But, researchers agree that both genetic and environmental causes are at play. Individuals with narcissistic personality disorder have been found to have less volume of gray matter in the left anterior insula, the part of the brain related to empathy, emotional regulation, compassion, and cognitive functioning.

When NPD Develops

“By definition, personality disorders are developed over time and through childhood experiences, genetics, and environment,” says Hallett, noting that as an adult, narcissistic traits on their own are not likely to develop into a personality disorder. Often, NPD will begin in the teenage years or early adulthood.

Personality disorders are typically diagnosed at 18 years or older, according to Hallett. The thing to keep in mind with kids is that some narcissistic traits are simply just typical of their age (teenagers by definition are self-absorbed), and it doesn’t mean they’ll go on to develop a full-blown disorder.

Scientists believe that the full onset of NPD may occur when interpersonal development is compromised, for example:

• Being born with an oversensitive temperament
• Learning manipulative behavior from parents or peers
• Being excessively praised for good behaviors and excessively criticized for bad behaviors
• Suffering from severe childhood abuse or neglect
• Inconsistent or unpredictable parental caregiving
• Growing up with unrealistic expectations from parents
• Being excessively pampered or overindulged by parents, peers, or family members
• Being excessively admired with no realistic feedback to ground you with reality
• Receiving excessive praise from parents or others focused on your looks or abilities

Living with NPD can be challenging for the individual with the disorder, as well as their family members and the people around them. If you have the disorder, you may frequently experience emotional dysregulation (trouble keeping calm), particularly when other people threaten or contradict your thoughts and ideas about yourself. You may have difficulty maintaining personal and professional relationships as a result.

People with NPD are typically capable of completing the necessary activities of daily life. Consistent support from a trained therapist can also enhance your productivity and quality of life if you have NPD. With therapy, you can learn to recognize and own your actions, cultivate healthy relationships, empathize, and communicate effectively with others. This can be a slow process in some instances, but with openness and strong motivation, you are likely to see significant progress.

If you are living with someone who has NPD, you may find yourself feeling confused and frustrated much of the time. You will probably have to deal with their changing moods and behavior, their need to intimidate and exert control, a sense of entitlement, and gaslighting.

People with NPD lack empathy and may completely disregard your needs, concerns, and feelings. Once the love bombing phase is over, your relationship with them can leave you walking on eggshells around them, feeling constantly anxious, and always waiting for the other shoe to drop.

Living with someone who has NPD can take a serious toll on your mental health and well-being. It can damage your self-esteem. You may quickly begin to feel worthless and question your perception and sanity.

It can be hard to resist the confidence, assertiveness, and excitement that surrounds a person with narcissistic personality disorder. But those same traits that drew you to that person in the first place may eventually become a turnoff when you start to notice the impact of their unemotional response to relationships, the cruelty of their lack of empathy for others, and the grandiose belief they are greatly important and should be treated as such.

Healthy Ways to Communicate with Someone Who Has NPD

Conversations with people who have a NPD can be tricky. They are usually one-sided, manipulative, and superficial. However, healthy communication is possible in some cases

Here are some healthy ways to communicate with someone who has NPD:

• Use a calm, respectful tone.
• Don’t use statements beginning with “you never…” or “you always…” These may be triggering and make them feel defensive.
• Use “I” statements to share how you feel and what you want.
• Know your boundaries and stand up for them.
• Try “gray rocking”: be as uninteresting as possible when the person with NPD tries to pick a fight, gaslight you, or otherwise trigger an emotional reaction.

Managing Emotional Distress

It’s easy to get overwhelmed if you live with someone with NPD. So, regularly carve out some “me time” to recharge. Self-care can include practicing relaxation techniques like meditation, taking a nature walk, running a warm bath, and eating healthy foods. Engaging in these activities can build resilience and foster self-esteem and confidence, making it easier to cope with someone with NPD.