People who deal with Narcissistic Personality Disorder harbor an exaggerated sense of superiority and a fragile ego that demands a lot of praise and attention from others. They believe that they are exceptional and that most other people are ‘beneath’ them. They want only the best for themselves, demanding special treatment and reverence wherever they go. Despite this exterior, they are actually very insecure and constantly fight to hide it. When others fail to reinforce this elevated opinion they have of themselves, they feel embarrassed and weak. In response, they lash out at those around them and double down on their claims of greatness.
Narcissistic Personality Disorder usually first appears when people are in their early or middle 20s. Doctors need to be careful not to diagnose someone when they are much younger than this because narcissistic traits are a normal part of adolescence that subside when people enter adulthood. For the few people who retain these tendencies as a major part of their personality, life-long relationship problems plague those who do not get treatment. They have trouble maintaining friendships and intimate partnerships, as their refusal to admit fault and persistent sense of authority drive most people away. Many also abuse drugs or alcohol (often as a form of self-medication), which only adds to their problems. This disorder does not have to be a life-sentence, though. People can develop the skills they need to function better in relationships with enough therapy and practice.
Causes and Risk Factors
Gender and genes
Narcissistic Personality Disorder is quite rare, appearing in less than 1% of people in the United States. It is slightly more prevalent in men than in women, but no other major genetic links have appeared. About 45% of the tendency for the disorder is genetic, based on shared personality tendencies between parents and children. These traits include emotional sensitivity, aggression, and difficulty regulating emotions.
Worse with age
Unlike many mental disorders whose symptoms subside with age, Narcissistic Personality Disorder tends to get worse as people get older if they do not engage in treatment. These people are quite vain and put a lot of value in their own physical appearance as part of their sense of superiority over others. As they lose their looks with age, their defense mechanisms feel threatened, which leads to increasing distress.
The type of home environment that parents create for their children plays a major role in the development of this personality disorder. When parents are overwhelmingly dominating and make their children feel inferior, kids develop a protective shell of narcissistic traits. Alternatively, excessive praise or treating a child as if they are exceptionally unique and talented can also lead to the traits of narcissism. Another dangerous situation is when parents demand exceptional performance from their children, be it in school, sports, or other areas, and then criticize them for not meeting these unattainable standards. All of these parenting styles create a difficult, unsupportive environment and make narcissistic traits more likely to appear.
Although these are forms of emotional trauma, physical and sexual trauma also put people at risk for personality disorders. These events damage people’s self-esteem and make them feel shamed and humiliated. They threaten a child’s developing sense of self, creating the need for unhealthy defense mechanisms. Longer and more intense traumas like these are more likely to lead to Narcissistic Personality Disorder.
People with Narcissistic Personality Disorder usually have to deal with at least one other mental disorder during their lifetime. Substance Use Disorders are one of the most common accompanying problems and appear in about 40% of these people. These two disorders can often be hard to separate when they appear in the same person because people in the middle of a drug addiction often behave in narcissistic ways. Mood disorders, including Major Depressive Disorder and Bipolar Disorder, strike about 40% of these people as well. Anxiety and eating disorders also abound.
Diagnosing Narcissistic Personality Disorder
People with this disorder have an extremely inflated sense of their own importance.
They are convinced that they are special and that only other special people can truly appreciate their unique quality. This special status extends to what they demand from others. They want the best for themselves: the best doctors, the best restaurants, or the best schools. They firmly believe that their accomplishments and natural talents are much more impressive than those of others, yet, in fact, they are actually not far from average. Fantasies of power, wealth, fame, and beauty fill their minds, and they often compare themselves to notable people from the past or present. They are very jealous of successful people and minimize their achievements. Their extreme arrogance leads them to believe that they deserve the same praise and acclaim that other people have actually earned.
Approval and special treatment
Hidden behind this over-confident exterior is a desperate need for approval. Although these people boast about themselves, they also expect others see them the same way and feel crushed when they do not. They spend a lot of energy seeking compliments and approval from others. However, their self-esteem is shattered easily when others do not overwhelmingly admire them and their accomplishments. Coupled with this desire for attention is an expectation of special treatment. They are stunned when told they need to wait like everyone else for any sort of appointment or reservation. They expect others to prioritize their wants and needs and become angry when this fails to happen.
Disregard for others
These people are prone to exploiting others for their own gain, both intentionally and unintentionally. A boss with this disorder would be exceptionally demanding of his or her employees without any consideration about their well-being. They base their relationships with others only on how they will benefit, and they can do this because they do not empathize well and have no desire to try. While they believe their problems and desires are incredibly important, they lack any sense that other people also have their own that are equally valid. When others voice their concerns, these people brush them off as pathetic and needy.
Treating Narcissistic Personality Disorder
The first major challenge in treating Narcissistic Personality Disorder is for the individual to accept the fact they need treatment at all. To someone with this disorder, entering treatment feels like an admission of weakness, that there is something broken which needs to be fixed. Just doing this goes against the very nature of the disorder. These people operate with the ever-present goal of putting others down while building themselves up. This process builds a bubble of superiority around these people that protects their fragile egos. They desperately try to keep this fantasy of greatness alive by rejecting any evidence against it and only accepting what reinforces it.
People with Narcissistic Personality Disorder will only come to therapy when they finally accept that there is a problem in the first place. They look at their lives and realize that their relationships with others keep failing in similar ways. Patterns of problems eventually give them the insight that they could act differently to improve their lives, and they need a therapist’s help to do so. This is a major hurdle, and many people never get this far.
Connecting with a therapist
The best option for treatment is one-on-one therapy using a combination of several techniques including Cognitive Behavioral Therapy and Psychodynamic Therapy. From the beginning, creating a good relationship between a therapist and one of these people is very difficult and significantly different from treating most other disorders. Therapists need to walk a fine line to prevent people from feeling attacked and closing the door on the possibility of treatment.
These people have a deeply embedded sense of superiority and will minimize and belittle any therapist’s experience and knowledge. To keep a new person engaged in treatment, therapists need to accept the person’s grandiose self-image. Most importantly, therapists need to endure the person’s insults without any defensive response. By showing a genuine interest and not reacting negatively, the therapist creates an environment that helps people let their guard down. Once this bond is formed, they can begin the gradual process of exploring their defense mechanisms and understanding how they can change.
There are no medications that directly treat Narcissistic Personality Disorder, but several can help manage symptoms and treat co-occurring issues. Antidepressants like Selective Serotonin Reuptake Inhibitors (SSRIs) help manage the mood and anxiety symptoms that these people frequently experience. Antipsychotics and mood stabilizers reduce impulsivity and mood swings and provide a more manageable base for therapy to work.
Managing Narcissistic Personality Disorder
Engaging the family
Close family members are those hurt most by people with Narcissistic Personality Disorder. Education about the disorder is a good first step for anyone who a therapist suspects has an affected family member. In fact, family members are often more likely to reach out for help than the individual with the disorder. Children of parents with Narcissistic Personality Disorder have an especially hard time because their parents prioritized their own emotional needs over those of the kids.
Dealing with additional disorders
Narcissistic Personality Disorder rarely appears by itself, but instead is usually accompanied by substance issues, anxiety, and mood problems. Usually, it is these issues, rather than their personality disorder, that brings them to treatment. When problems are severe, people need to spend a few days in a residential treatment center. These situations are a great opportunity to treat all of an individual’s conditions together with a single, cohesive plan, and they have very positive results especially in Narcissistic Personality Disorder. This is because they offer a stable environment that lacks the social and work stresses of everyday life and helps people get started in therapy.
Many personality traits, personality disorders, and other mental issues can appear on the surface very similar Narcissistic Personality Disorder with just a few subtle differences. Antisocial Personality Disorder is similar in that they both lack empathy for others; however, narcissism lacks the aggressive characteristics of the other personality disorder. Obsessive-compulsive and narcissistic characteristics both seek high performance and perfection in their accomplishments, but only people with Narcissistic Personality Disorder truly believe they are so talented. People in the throes of a manic state or substance abuse can also behave in similar ways to this personality disorder.