All about narcissistic personality disorder

What is NPD? Traits Diagnosis Treatment Causes Complications Living with someone with NPD

Narcissistic personality disorder involves a distorted self-image. Emotions can be unstable and intense, and there is excessive concern with vanity, prestige, power, and personal adequacy. There also tends to be a lack of empathy and an exaggerated sense of superiority.

Narcissistic personality disorder (NPD) is closely associated with egocentrism, a personality characteristic in which people see themselves and their interests and opinions as the only ones that really matter.

People with NPD have limited interest in the feelings of others. They lack empathy and are unable to feel or appreciate feelings that are not their own.

According to the United States' National Library of Medicine, a person with NPD has an excessive sense of self-importance, an intense preoccupation with themselves, and a lack of empathy for others.

Fast facts on NPD:

• The term comes from a character in Greek mythology, called Narcissus.
• It is characterized by an extreme sense of self-worth.
• Other features include being quick to anger and prone to irritation.
• For a diagnosis, the symptoms must be persistent and chronic.

What is narcissistic personality disorder?

Narcissistic personality disorder (NPD) is characterized by an extreme sense of self-worth.

The term comes from a character in Greek mythology, called Narcissus. He saw his reflection in a pool of water and fell in love with it.

NPD is one of a group of conditions known as dramatic personality disorders. The person will have unstable and intense emotions and a distorted self image.

An unusual love of self, an excessive sense of importance and superiority, and a preoccupation with success and power can indicate a lack of self-confidence. NPD often involves a deep sense of insecurity and a lack of self esteem.

A study carried out by the National Institute on Alcohol Abuse and Alcoholism, published in the Journal of Clinical Psychiatry, found that 7.7 percent of men and 4.8 percent of women develop NPD during their lifetime.

The researchers also found that NPD rates are much higher among black men and women, Hispanic women, younger adults, and people who either never married or became divorced, widowed, or separated.

Traits

Below are the most common traits found in people with NPD:

• An insatiable appetite for the attention of others
• Extreme feelings of jealousy
• An expectation of special treatment
• Exaggerating achievements, talents, and importance
• Extreme sensitivity and a tendency to be easily hurt and to feel rejected with little provocation
• Difficulty maintaining healthful relationships
• Fantasizing about their own intelligence, success, power, and appearance
• An ability to take advantage of others to achieve a goal, without regret or conscience
• A lack empathy, or ability to understand and share the feelings of others, and a tendency to disregard others' feelings
• A belief that only certain people can understand their uniqueness
• A tendency to consider themselves as skilled in romance
• Responding to criticism with anger, humiliation, and shame
• Seeking out praise and positive reinforcement from others
• An expectation that others will agree with them and go along with what they want
• Whatever they crave or yearn for must be "the best"

Others may see narcissists' goals as selfish ones. They may describe the person as self-obsessed, arrogant, tough-minded, and lacking emotion.

Diagnosis

A thorough range of criteria need to be met before a diagnosis of NPD can be made.

No specific lab tests exist that can diagnose NPD, but X-rays and blood tests may help rule out other conditions that may be causing the symptoms.

There are several different types of personality disorder, some of them overlap, and it is possible to be diagnosed with more than one type.

An NPD diagnosis must follow the criteria written in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the APA (American Psychiatric Association).

The following must be present for a diagnosis of NPD to be made:

• The patient's idea and importance of self is exaggerated.
• Fantasies about beauty, success, and power dominate the individual's thoughts.
• The person thinks they are special, and relate only to other "special" people.
• They need to be admired all the time.
• They believe they are entitled to most things.
• They manipulate and take advantage of others.
• They lack empathy, the ability to feel and recognize the feelings and needs of others.
• They envy other people.
• Their behavior appears haughty or arrogant.

Treatment

There is no known cure for NPD. With psychotherapy, the individual may come to understand what causes their problems and learn how to relate more positively to others.

This may bring about a change in attitudes, resulting in more constructive behavior. It can help the person build up their self-esteem and acquire realistic expectations of themselves and others.

Cognitive behavioral therapy (CBT), family therapy, or group therapy are types of psychotherapy. CBT helps the patient identify negative beliefs and behaviors, in order to replace them with healthful, positive ones.

Medication may help with some of the more distressing aspects of the condition.

Causes

It is unclear what causes NPD. It may be associated with circumstances during childhood, such as very high parental expectations, over-pampering, neglect, or abuse.

An individual may have learned manipulative behaviors from their parents or household members while growing up.

If a child learns that vulnerability is not acceptable, this may undermine their ability to tune into other people's feelings and needs.

The NewYork-Presbyterian Hospital points to recent evidence that a genetic predisposition and other biological or biochemical factors may be linked to NPD.

Complications

A person with untreated NPD has a greater chance of abusing drugs and alcohol, of having depression, relationship problems, difficulties at work or school, and suicidal behaviors or thoughts.

A study published in PLoS One found that males with NPD have higher levels of cortisol in their blood. Cortisol is a stress hormone. A person with NPD may have higher levels even when stress levels are low. High blood cortisol is linked to a greater risk of developing cardiovascular problems.

Living with somebody who has NPD

Living with someone who has NPD can be challenging.

Family members have described their loved one as:

• controlling
• egotistical
• frequently dissatisfied with the actions of others
• prone to blaming others and making them feel guilty for all their problems
• losing their temper at the slightest provocation
• turning their back and giving people the "silent treatment"
• being physically and sexually abusive

The emotional and physical impact of working with or living with a person with NPD can be severe. Learning how to become more confident and assertive can help a person cope with the effects.