Narcissistic personality disorder

Written by Ellen Lees
Ellen Lees
Counselling Directory Content Team

Last updated 18th July 2024 | Next update due 18th July 2027

We all display some degree of narcissism from time to time. For some, however, it is a permanent fixture. Narcissistic personality disorder (NPD) gives those with the condition an inflated sense of importance, as well as a preoccupation with power and personal adequacy. Here we look at how this can affect those with the condition as well as loved ones.

We recognise that the system of personality disorder diagnosis can be considered controversial. It is completely your choice which term, if any, you want to use, knowing that your doctor or care team may use another. 

The terms used on Counselling Directory are those that are generally used in the UK, currently. We refer to these terms throughout, with the hope of reaching and supporting as many people as possible.

What is narcissistic personality disorder?

Narcissistic personality disorder occurs when people have a distorted self-image. They often believe they are superior to others. More prevalent in men than women, NPD makes those with the condition feel like their opinions, feelings and interests are more important than others. They may also find it difficult to empathise with others.

There is a tendency to exaggerate talents and accomplishments - sometimes to the point of lying. They may also be preoccupied with the idea of success and power. Other traits include patronising behaviour, an inherent need for admiration and anger when others contradict them.

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 confidence to hide their low self-esteem and insecurities. They often find criticism and rejection very difficult to take.  

Those with the condition are likely to show signs of narcissism across a wide range of social situations. There is a possibility that narcissistic personality disorder symptoms decrease in intensity with age, but if it is affecting a person’s life, it’s important to reach out for support. Counselling and psychotherapy are recommended treatments. These approaches can help people with NPD learn how to change behaviours and positively relate to others.

Therapists who can help with narcissistic personality disorder

Narcissistic personality disorder symptoms

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.
  • Require constant attention from others.
  • Preoccupied with intelligence, success, power and ideal romance.
  • Believe they are special and that only other special people/institutions will understand them.
  • Believe they should be given preferential treatment.
  • Lack of empathy and disregard feelings of others.
  • Takes advantage of others to reach their own goals.
  • Often envious of others and/or believe others are envious of them.
  • Displays arrogant behaviours and attitudes.

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 is covert narcissism?

Covert narcissism (also known as vulnerable narcissism) is another kind of narcissism. A covert narcissist is someone with narcissistic personality disorder who does not display a sense of self-importance often associated with NPD. A covert narcissist might have traits not typically associated with more overt narcissism. These can include:

  • shyness
  • introversion
  • insecurity
  • defensiveness
  • being self-conscious
  • being sensitive about what others may think of them
  • high sensitivity to criticism
  • passive aggression
  • be self-deprecating 

A covert narcissist may be able to hide more obvious signs of NPD, making it more difficult to recognise. Both covert and overt narcissists can display a sense of self-importance and may fantasise about success and grandeur. 

Hope Therapy & Counselling explain more about how counselling can help with dealing with covert narcissism

What causes narcissistic personality disorder?

It is unknown what specifically causes NPD. Some theories suggest the condition is shaped by a combination of factors.

People with narcissistic personality disorder tend to develop the condition in early adulthood. This could be linked to factors such as individual personality, but generally, it is thought experiences during childhood are the most significant risk factors. These may include:

  • overpraise - 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
  • trauma
  • extremely high expectations
  • excessive criticism

Some children learn from their parents that vulnerability is unacceptable. As a result, they learn to mask their emotional needs with grandiose behaviour that makes them seem bulletproof. The way someone with NPD has been parented may also explain why they lose the ability to empathise with others and adopt manipulative tactics. They may not have been taught how to interact in a ‘normal’ way and thus find it difficult to connect with others.

When is it time to seek help for narcissistic personality disorder?

As with many mental health concerns, experts agree that seeking help as soon as possible is key. Although the severity of narcissistic personality disorder will differ between individuals, generally all those with the condition are considered to be at risk of developing the following if their disorder is left untreated:

Due to the nature of NPD, it is rare for those with the condition to actively seek help themselves. Often they do not recognise that they have a problem and may only consider treatment if their disorder starts to significantly impact their lives.

Often those with NPD will visit their GP for a different reason; for example, if they develop symptoms of depression (which may happen because of a build-up of perceived rejections or criticisms). From here they are likely to be officially diagnosed and offered support.  

I think I have narcissistic personality disorder, how do I get diagnosed?

Visiting your GP is 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. These will ensure there is no physical underlying cause for the behaviour.

From here your doctor will refer you to a psychiatrist or psychologist who will conduct a more in-depth assessment. This process will typically involve special assessment tools and a questionnaire.

To assist the diagnosis process, you should consider making a note of all your symptoms as they occur beforehand. This will help your mental health provider 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 behaviour.  

Narcissistic personality disorder treatment

Counselling and psychotherapy are primary forms of narcissistic personality disorder treatment. Medication may also be provided to those 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 behaviours.  

Typically, cognitive behavioural therapy (CBT) is used to promote these changes, however, family therapy is another valuable approach. Family therapy sessions aim to bring the whole family together so someone with NPD can explore with their loved ones any conflicts and communication problems that need to be resolved.

Group therapy may also be offered. In these settings, those with the condition can come together to share their stories and learn how to relate to others more effectively. It’s an environment where they must listen to, and consider the needs and feelings of other people which makes for good practice. Those with NPD also have the opportunity to learn more about themselves and how to make the most of the support available.

The healing journey takes courage and I find myself deeply respectful of those who are prepared to take that road. Pushing past the thorny bushes of guilt and self-doubt, they are willing to truly grieve the losses they incurred, to overcome their inner critic, to take note of and assert their own emotional and physical needs and to address ‘fleas’ caught from the narcissist.

- Counsellor Lorna Slade MBACP (Reg) MNCS (Accred) MNHS (Accred)

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 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.

Family members of those with narcissistic personality disorder

If you have someone with NPD in your life, and especially if they are a family member, their behaviour can have an impact on you. While family therapy can often be helpful, don’t be afraid to seek out support for yourself.

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