Narcissistic personality disorder
We all have the capacity to display some degree of grandiosity, yet some people will have a disorder that gives them a permanently inflated sense of importance, as well as a preoccupation with power, personal adequacy, prestige and vanity.
These characteristics are typical signs of narcissistic personality disorder - one of several types of personality disorder that means individuals behave in ways that are not considered socially 'normal'. This makes it difficult for them to function in relationships and other aspects of life such as work and education.
On this page we will look into narcissistic personality disorder in more detail - exploring the symptoms and causes of acute narcissism as well as treatment options designed to help sufferers learn how to manage their disorder and build healthier relationships.
What is narcissistic personality disorder?
Narcissistic personality disorder (NPD) is a rare psychological disorder where people have a distorted self-image and believe they are of great importance and superior to others. More prevalent in men than women, NPD makes sufferers feel like their opinions, feelings and interests are more important than other people's, and they often find it difficult to empathise with others.
Furthermore, there is a tendency for sufferers to exaggerate talents and accomplishments - sometimes to the point of lying. They are also obsessed with the idea of success and power. Other traits of acute narcissism include patronising and snobbish behaviour, an overwhelming need for admiration and sudden bursts of rage when people considered inferior contradict or confront them.
Yet underneath this hard and insensitive exterior is thought to be a very fragile core. People with NPD are assumed to put on a mask of ultra confidence to hide their low self-esteem and insecurities. However, new research suggests a number of people with this kind of narcissism are secure and grandiose on all levels. Any defensiveness on their part is merely aggression rather than a retaliation when someone threatens their self-esteem.
Either way, narcissistic personality disorder reflects a continuing pattern of behaviour and experience that deviates from what is considered normal. Sufferers will show signs of their disorder across a wide range of social and personal situations. There is a possibility that narcissistic personality disorder symptoms decrease in intensity as people age, but all sufferers experiencing severe problems should seek help. There is no cure, but counselling and psychotherapy are highly recommended forms of narcissistic personality disorder treatment. They can help people with acute narcissism to learn how to change their behaviours and positively relate to others.
Narcissistic personality disorder symptoms
Characterised primarily by dramatic, emotional behaviour, narcissistic personality disorder symptoms are wide ranging and can differ between individuals. However it is generally believed that if someone has NPD, they will show five or more of the following symptoms:
- Believe that they are better than others.
- Have an insatiable appetite for the attention of others.
- Fantasise about their intelligence, success, power and attractiveness.
- Constant exaggerating and boasting about talents and achievements.
- Set unrealistic goals.
- Manipulate and take advantage of others to get what they want.
- Prone to extreme jealousy.
- Highly sensitive - particularly to rejection and criticism.
- Find it difficult to maintain healthy relationships.
- Believe that others are jealous of them.
- Behave like they deserve special treatment.
- Quick to anger if they do not receive special treatment.
- Expect others to go along with their ideas and plans.
- Fail to show empathy for others.
- Expect constant admiration and praise.
- Consider themselves to be skilled in romance.
- Respond to criticism with anger, humiliation or shame.
- Self-absorbed and self-centred.
- Want the 'best' of everything.
It is important to note that while strong self-esteem and confidence are core elements of NPD, there is a fine line between someone who is naturally confident and someone who consistently places their self-worth above others.
What causes narcissistic personality disorder?
It is unknown what specifically causes NPD. There are many theories that suggest the condition is shaped by a combination of biological, genetic, psychological, environmental and social factors. This is considered by many experts to be a 'biopsychosocial model of causation'. It is unlikely one single factor is responsible.
People with narcissistic personality disorder tend to develop the condition in early adulthood. This could be linked to factors such as individual personality and an oversensitive temperament, but generally it is thought experiences during childhood are the most significant risk factors. These may include:
- insensitive parenting
- over praise and excessive pampering - particularly when parents focus on a specific thing (i.e. looks, talents)
- lack of affection or praise
- neglect and emotional abuse
- unpredictable or negligent caregiving from parents
- extremely high expectations
- excessive criticism.
The egotistical behaviour of people with acute narcissism is considered to be largely influenced by extreme parenting methods. Some children learn from their parents that vulnerability is unacceptable. As a result they will be focused on masking their emotional needs and deep sensitivities with grandiose behaviour that makes them seem bulletproof. Parenting issues may also be the reason why sufferers lose the ability to empathise with others and adopt manipulative tactics. They have not been taught 'normal' levels of interaction and thus find it difficult to connect with others on a healthy level.
When is it time to seek help for narcissistic personality disorder?
As with all personality disorders, experts agree that seeking help as soon as possible is essential for effective recovery. It will also help to ensure that people living with NPD do not go on to develop severe complications. These may cause further distress in their relationships and everyday life. Although the severity of narcissistic personality disorder will differ between individuals, generally all sufferers are considered to be at risk of developing the following if their disorder is left untreated:
- alcohol abuse
- substance abuse
- suicidal thoughts or behaviour.
Due to the nature of NPD it is very rare for sufferers to actively seek help. Often people with acute narcissism do not recognise they have a problem. Many may only consider treatment if their disorder starts to significantly impact their lives. Some sufferers will visit their GP when they develop symptoms of depression - usually because of a build-up of perceived rejections or criticisms. From here they will be officially diagnosed. This could lead onto potentially life-changing narcissistic personality disorder treatment.
How is narcissistic personality disorder diagnosed?
Visiting your GP is typically the first port of call when seeking help for narcissistic personality disorder. Here you will undergo an initial mental health assessment, which will involve physical examinations to ensure your symptoms of narcissism are not the result of a physical illness.
From here your doctor will refer you to a psychiatrist or psychologist who will conduct a more in-depth assessment. This will take a bit longer - around a couple of weeks or months. It is necessary to ensure your mental health professional gets to know you thoroughly as a person in order make an effective psychological evaluation. This process will typically involve special assessment tools and a questionnaire to cover the severity of your symptoms.
The key criteria for a diagnosis of NPD are outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This examines a person for five or more of the common narcissistic personality disorder symptoms. To improve this diagnosis process, you should consider making a note of all your symptoms as they occur beforehand. This will help your mental health provider to know what kinds of events are likely to make you feel defeated or angry. This may show key insights into how your history has shaped your narcissism.
Narcissistic personality disorder treatment
Counselling and psychotherapy are primary forms of narcissistic personality disorder treatment. Medication can be provided to individuals showing signs of other conditions such as depression or anxiety. Because it can be difficult to change inherent personality traits, therapy may take several years. Over time however, individuals with narcissism can learn to develop new patterns of thinking to help shake off their distorted self-image. This will help them to identify with healthier and more positive behaviours.
Typically, cognitive behavioural therapy (CBT) is used to promote these changes, yet family therapy is another valuable approach. Family therapy sessions aim to bring the whole family together so someone with acute narcissism can explore with their loved ones any conflicts and communication problems that need to be resolved.
Group therapy can also be provided. In these settings, NPD sufferers can come together to share their stories and learn how to relate to others more effectively. It is an environment where they must listen to, and consider the needs and feelings of other people. They will also learn more about themselves and how to make the most of the support available.
This process of learning to relate to others can also be pursued in psychotherapy. The aim is to help ensure that future relationships of people with NPD are more intimate, long-lasting and enjoyable. This approach encourages the exploration of emotions and delves into what drives sufferers to compete with others, distrust and sometimes despise those closest to them.
The ultimate aim of narcissistic personality disorder treatment is to help sufferers change patterns of thinking that lead to a distorted self-image and unhealthy relationships. By learning to see themselves and others in a more realistic light, sufferers can begin to adopt behaviours that foster life fulfilment and well-being.
It is not uncommon for individuals with narcissistic personality disorder to feel defensive about treatment. They may feel that therapy sessions are a waste of time and effort - for both them and the therapist. Although it may be tempting to quit, if you have NPD it is important to stay committed to your recovery and ensure that your lifestyle reinforces the changes you are gradually making. In order to help you stay focused on your goal, here are some simple lifestyle tips to consider:
- Stick to your treatment programme - Make sure you attend all therapy sessions and take any medications as requested. Recovery won't be easy and you are bound to experience setbacks, but sticking to your recovery plan will keep you on the right track.
- Learn relaxation and stress management techniques - Stress reduction exercises such as deep breathing, meditation, yoga or tai chi can be very soothing and calming and will ultimately help you to feel less tense and thus less driven by your emotions to behave in a way that is not encouraged by treatment.
- Learn about your disorder - In order to better understand the risk factors, symptoms and necessity of treatment for narcissistic personality disorder, you should make an effort to educate yourself about your condition. This may help you to see your behaviour and ways of thinking in a different light, and this can be highly motivating for your recovery.
What should I be looking for in a counsellor or psychotherapist?
Whilst there are currently no official regulations in place that stipulate what level of training and experience a counsellor needs to treat narcissistic personality disorder, we do recommend that you check your therapist is experienced in the area for which you are seeking help.
The NHS recommends psychotherapy as a form of treatment for personality disorders.
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