Now we will review another Cluster B personality disorder: narcissistic personality disorder.

Narcissistic personality disorder (NPD) is characterized by the personality traits of persistent grandiosity, an excessive need for admiration, and a personal disdain and lack of empathy for other people. As such, an individual with narcissistic personality disorder (NPD) usually displays arrogance and a distorted sense of personal superiority and seeks to establish abusive power and control over others. Self-confidence (a strong sense of self) is a personality trait different from the traits of narcissistic personality disorder; thus, people with narcissistic personality disorder (NPD) typically value themselves over others, to the extent of openly disregarding the wishes and feelings of anyone else, and expect to be treated as superior, regardless of their actual status or achievements. Socially, the person with NPD usually exhibits a fragile ego (self-concept), intolerance of criticism, and a tendency to belittle other people in order to validate their own superiority.

The DSM-5 indicates that a person with NPD possesses at least five of the following nine criteria, typically without possessing the commensurate personal qualities or accomplishments for which they demands respect and status:

• has a grandiose sense of self-importance (e.g. exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
  

  Figure 1. Individuals with NPD typically value themselves over anyone else.

• is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
• believes that they are special and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
• requires excessive admiration.
• has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with their expectations).
• is interpersonally exploitative (i.e., takes advantage of others to achieve their own ends).
• lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
• is often envious of others or believes that others are envious of them.
• shows arrogant, haughty behaviors or attitudes.

Narcissistic Personality Disorder

NPD is a personality disorder characterized by a long-term pattern of exaggerated feelings of self-importance, an excessive craving for admiration, and struggles with empathy. People with NPD often spend much time daydreaming about achieving power and success, or on their appearance. People with the diagnosis in recent years have spoken out about its stigma in media, and possible links to abusive situations and childhood trauma. Such narcissistic behavior typically begins by early adulthood and occurs across a broad range of situations.

Epidemiology

The lifetime rates of narcissistic personality disorder are estimated at 1% in the general population; and between two to 16% in the clinical population.

Narcissistic personality disorder usually develops either in adolescence or in early adulthood, and it is common for children and adolescents to display personality traits that resemble NPD, but such occurrences are usually transient, and register below the clinical criteria for a formal diagnosis of NPD. True symptoms of NPD are pervasive, apparent in varied social situations, and rigidly consistent over time. Severe symptoms of NPD can significantly impair the person’s mental capabilities to develop meaningful human relationships, such as friendship, kinship, and marriage. The DSM-5 indicates that, in order to qualify as symptomatic of NPD, the person’s manifested personality traits must substantially differ from the cultural norms of society.

Etiology

The causes of narcissistic personality disorder are unknown, but theorized to be linked to certain types of traumas. A combination of genetic, environmental, and social factors are involved in narcissistic personality disorder. 

Narcissistic personality disorder usually develops either in adolescence or in early adulthood, and it is common for children and adolescents to display personality traits that resemble NPD, but such occurrences are usually transient and register below the clinical criteria for a formal diagnosis of NPD. True symptoms of NPD are pervasive, apparent in varied social situations, and are rigidly consistent over time. Severe symptoms of NPD can significantly impair the person’s mental capabilities to develop meaningful human relationships, such as friendship, kinship, and marriage. Generally, the symptoms of NPD also impair the person’s psychological abilities to function socially, either at work, or at school, or within important societal settings. The DSM-5 indicates that, in order to qualify as symptomatic of NPD, the person’s manifested personality traits must substantially differ from the cultural norms of society.

Treatment

Figure 2. NPD can give individuals inflated perceptions about themselves.

Narcissistic personality disorder is rarely the primary reason for which people seek mental health treatment. Therapy is difficult because people with narcissistic personality disorder usually do not consider their own issues as symptoms, despite mental distress. When people with NPD enter treatment, they usually are prompted by difficulties in their lives, or are seeking relief from some other disorder of their mental health, such as a major depressive disorder, drug addiction, or manic depression.

The reason for such an indirect path to psychotherapy is partly because an individually with NPD generally possess poor insight, and are unaware that their actions produced their mentally unhealthy circumstance, and so fail to recognize that their perceptions and behaviors are socially inappropriate and problematic, because of their very positive self-image (inflated self-concept).

Comorbidity

The occurrence of narcissistic personality disorder presents a high rate of comorbidity with other mental disorders. People with NPD are prone to bouts of psychological depression, often to the degree that meets the clinical criteria for a co-occurring depressive disorder. Moreover, the occurrence of NPD is further associated with the occurrence of bipolar disorder and substance use disorders, especially cocaine use disorder.