Narcissism

Narcissism refers to excessive self-overvaluation that causes a distorted sense of self-worth and reduces a person’s empathic receptivity. Although most of us tend to be narcissistic at times, repeated ignorance of others’ needs and extreme self-importance can be a sign of narcissistic personality disorder (NPD).

What Is Narcissism?

Narcissism is marked by an inflated sense of self-involvement, self-absorption, self-importance, and self-image. It also involves a strong need for admiration and attention, a lack of empathy, a chronic disregard for other people, and toxic, unhealthy interpersonal relationships.

A narcissistic individual seeks gratification from egotistic admiration of his/her own idealized traits and self-image. A 2018 study [mfn] Hyatt, C. S., Sleep, C. E., Lamkin, J., Maples-Keller, J. L., Sedikides, C., Campbell, W. K., & Miller, J. D. (2018). Narcissism and self-esteem: A nomological network analysis. PloS one, 13(8), e0201088. https://doi.org/10.1371/journal.pone.0201088 [/mfn] states “Narcissism is a personality construct typically characterized by grandiosity, vanity, entitlement, and exploitativeness.”

Narcissism is a fundamental personality trait. However, sometimes, an individual with narcissism traits may suffer from its chronic and clinical counterpart: Narcissistic personality disorder (NPD). It is a mental condition characterized by an elevated sense of self-fixation, entitlement, and grandiosity [mfn] Jonason, P.K., & Middleton, J.P. (2015). Dark Triad: The “Dark Side” of Human Personality. International Encyclopedia of the Social & Behavioral Sciences. 10.1016/B978-0-08-097086-8.25051-4. [/mfn].

However, despite self-absorption, narcissists tend to be highly insecure. They have low self-esteem as they constantly worry about how they are perceived by others.

“Narcissistic patients are desperately attempting to manage their vulnerability,” explains a 2016 study [mfn] Gabbard, G. O., & Crisp-Han, H. (2016). The many faces of narcissism. World psychiatry : official journal of the World Psychiatric Association (WPA), 15(2), 115–116. https://doi.org/10.1002/wps.20323 [/mfn] . This can adversely affect how the individual thinks, behaves, reacts, and relates to his/her loved ones and others.

A person with NPD may tend to manipulate and exploit others and take their loved ones for granted. Narcissists tend to consider themselves superior and behave mostly in a “self-centered” manner. They may also possess exploitative traits used predominantly for achieving goals.

A recent study [mfn] Ellis, Lee & Farrington, David & Hoskin, Anthony. (2019). Handbook of Crime Correlates, 2nd Edition. Available from: https://www.researchgate.net/publication/333842967 [/mfn] elaborates that “genuine concern for the feelings and needs of others is almost completely absent. Instead, narcissistic individuals seem to view other persons as little more than objects for manipulation.”

History Of Narcissism

The term “narcissism” is derived from the name of Narcissus, a young hunter and god in Greek mythology, who falls in love with his own reflection and beauty in a pool of water.

The legend goes that he gazes at his reflection for the rest of his life. The pathological form of narcissism was initially identified by the English physician and writer Havelock Ellis in 1898—who also declared it a disorder.

Austrian neurologist and founding father of psychoanalysis, Sigmund Freud, believed [mfn] Palmowski B. (1989). Uber Narzissmuskonzepte bei S. Freud [Freud\’s narcissism concept]. Zeitschrift fur Psychosomatische Medizin und Psychoanalyse, 35(2), 101–116. [/mfn] that it is primarily a common stage in child development. However, when such traits are exhibited after puberty, it can be considered a personality disorder [mfn] Kris A. O. (1994). Freud\’s treatment of a narcissistic patient. The International journal of psycho-analysis, 75 ( Pt 4), 649–664. [/mfn] .

Narcissistic Personality Disorder (NPD)

NPD is one of the ten personality disorders [mfn] Fariba, K. A., Gupta, V., & Kass, E. (2022). Personality Disorder. In StatPearls. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556058/ [/mfn] identified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). “Narcissistic Personality Disorder (NPD) is characterized by a persistent pattern of grandiosity, fantasies of unlimited power or importance, and the need for admiration or special treatment,” explains one 2018 study [mfn] Kacel, E. L., Ennis, N., & Pereira, D. B. (2017). Narcissistic Personality Disorder in Clinical Health Psychology Practice: Case Studies of Comorbid Psychological Distress and Life-Limiting Illness. Behavioral medicine (Washington, D.C.), 43(3), 156–164. https://doi.org/10.1080/08964289.2017.1301875 [/mfn] .

People with this psychological condition possess and exhibit traits of narcissism—such as an intense sense of self-importance, and a lack of empathy [mfn] Baskin-Sommers, A., Krusemark, E., & Ronningstam, E. (2014). Empathy in narcissistic personality disorder: from clinical and empirical perspectives. Personality disorders, 5(3), 323–333. https://doi.org/10.1037/per0000061 [/mfn] , and an extreme need for attention and admiration.

A narcissistic personality disorder is marked by self-centered thoughts and arrogant behavior. But narcissists are extremely vulnerable to criticism, due to their fragile self-esteem. They appear to be extremely confident to cover up their inherent feelings of insecurity.

Research [mfn] Ronningstam E. (2011). Narcissistic personality disorder: a clinical perspective. Journal of psychiatric practice, 17(2), 89–99. https://doi.org/10.1097/01.pra.0000396060.67150.40 [/mfn] shows that people with NPD are hypersensitive, shy, and insecure. Moreover, they experience a sense of inadequacy, anxiety, pain, fear, interpersonal vulnerability, internal emotional distress, and even depression.

Yet they may appear extremely confident, demanding, patronizing, selfish, and manipulative to others. However, such patterns of thought and behavior can cause significant psychological distress and adversely affect different aspects of their lives, including career, social life, and interpersonal relationships.

Understanding Narcissism

Narcissistic personality disorder or narcissism is a cluster B personality disorder.

As narcissistic people harbor extremely positive self-concepts, they may become very disappointed and even depressed when they are unable to get the desired admiration and attention which they think they deserve. As a result, they may often feel unsatisfied in relationships—making them toxic partners, spouses, friends, coworkers, or bosses.

People with NPD often fail to realize that they have a personality disorder and hence do not typically seek help or treatment. As they refuse to acknowledge or change their toxic behavioral patterns, they look for others to blame [mfn] Lambe, S., Hamilton-Giachritsis, C., Garner, E., & Walker, J. (2018). The Role of Narcissism in Aggression and Violence: A Systematic Review. Trauma, violence & abuse, 19(2), 209–230. https://doi.org/10.1177/1524838016650190 [/mfn] for their unfulfilled and unrealistic needs.

They can often be hostile and react aggressively to others when faced with criticisms or negative feedback. “Narcissistic individuals are sensitive to insults and prone to react to such criticism with anger and hostility,” says a 2002 study [mfn] Witte, T. H., Callahan, K. L., & Perez-Lopez, M. (2002). Narcissism and anger: an exploration of underlying correlates. Psychological reports, 90(3 Pt 1), 871–875. https://doi.org/10.2466/pr0.2002.90.3.871 [/mfn] .

In fact, researchers [mfn] McCann, J. T., & Biaggio, M. K. (1989). Narcissistic personality features and self-reported anger. Psychological reports, 64(1), 55–58. https://doi.org/10.2466/pr0.1989.64.1.55 [/mfn] have observed that males with NPD are more likely to express anger in a physically violent manner than females. Narcissists often experience fluctuating and intense emotions [mfn] Svrakić D. M. (1985). Emotional features of narcissistic personality disorder. The American journal of psychiatry, 142(6), 720–724. https://doi.org/10.1176/ajp.142.6.720 [/mfn] that are colored by their anxiety related to personal adequacy, control, and personal image and status [mfn] Grapsas, S., Brummelman, E., Back, M. D., & Denissen, J. J. A. (2020). The “Why” and “How” of Narcissism: A Process Model of Narcissistic Status Pursuit. Perspectives on Psychological Science, 15(1), 150–172. https://doi.org/10.1177/1745691619873350 [/mfn] .

Studies [mfn] Stinson, F. S., Dawson, D. A., Goldstein, R. B., Chou, S. P., Huang, B., Smith, S. M., Ruan, W. J., Pulay, A. J., Saha, T. D., Pickering, R. P., & Grant, B. F. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions. The Journal of clinical psychiatry, 69(7), 1033–1045. https://doi.org/10.4088/jcp.v69n0701 [/mfn] show that, in the United States, around 6.2% of the population have a lifetime prevalence of NPD—with about 7.7% being men and almost 4.8% being women. With treatment and therapy, one can learn to manage their narcissistic traits.

Read More About Cluster B Personality Disorder Here

Symptoms Of Narcissism

Some of the most common traits and signs of narcissism may include:

1. An extremely inflated sense of self-importance, and self-absorption
2. A sense of entitlement and grandiosity
3. A strong need for excessive and constant attention and admiration
4. Feelings of superiority even without any significant achievement
5. An inclination to associate only with high-status individuals
6. A willingness to manipulate and exploit others for personal gain
7. A lack of empathy
8. Fantasies about unlimited power, success, beauty, love, and brilliance
9. Considering others as inferior and monopolizing company
10. Pretentious, conceited, arrogant, and boastful behavior
11. Feelings of victimization
12. An aggressive reaction to being ‘ignored’ or ‘mistreated’
13. Being exploitative, toxic, and superficial in interpersonal relationships
14. A fragile self-esteem and low self-confidence
15. An exaggeration of talents and accomplishments
16. Feelings of jealousy
17. A strong belief in being envied by others
18. Exceptionally charming and charismatic when it’s beneficial
19. Undermining others’ achievements
20. Reacting negatively and aggressively to criticism
21. An emotional disconnection or detachment from others
22. A lack of intimacy or attachment in relationships
23. Social withdrawal
24. Emotional dysfunction [mfn] Weinberg E. (2006). Mentalization, affect regulation, and development of the self. Panel report. Journal of the American Psychoanalytic Association, 54(1), 251–270. https://doi.org/10.1177/00030651060540012501 [/mfn]
25. Internalized feelings of insecurity, shame, humiliation, emptiness, and vulnerability
26. Extreme suspiciousness
27. Mental disorders like anxiety, depression, mood disorders, etc.

Read More About Generalized Anxiety Disorder Here

Types Of Narcissism

Narcissism is widely regarded as a trait that exists as a spectrum. There is no specific or established number of subtypes of NPD. However, certain types have been identified by researchers [mfn] Mitra, P., & Fluyau, D. (2022). Narcissistic Personality Disorder. In StatPearls. StatPearls Publishing. Available From: https://www.ncbi.nlm.nih.gov/books/NBK556001/ [/mfn] while others have become informally popular. Some of the most common narcissistic subtypes include:

1. Grandiose narcissism

The grandiose or overt type of NPD typically refers to what most people understand as a narcissistic personality. According to a 2018 study [mfn] Zajenkowski, M., Maciantowicz, O., Szymaniak, K., & Urban, P. (2018). Vulnerable and Grandiose Narcissism Are Differentially Associated With Ability and Trait Emotional Intelligence. Frontiers in psychology, 9, 1606. https://doi.org/10.3389/fpsyg.2018.01606 [/mfn] , “grandiose narcissism is characterized by high self–esteem, interpersonal dominance, and a tendency to overestimate one’s capabilities.” ‘Grandiose’ narcissists have:

• An unrealistic and inflated sense of superiority
• An excessive overestimation of their own abilities
• Exhibitionistic behavioral tendencies
• A constant need to seek attention
• Other behavioral traits that border on authoritarian, entitled, exploitative, unempathetic, self-absorbed, aggressive, and abusive tendencies

2. Vulnerable narcissism

Also known as the covert subtype, vulnerable narcissism is characterized by inhibition, shyness, and distress. It “is also associated with lower levels of self-esteem, extraversion and agreeableness, [and] higher neuroticism,” elaborates a 2018 study. Vulnerable narcissists are also associated with a “more realistic self-perception of emotional abilities.” People with vulnerable NPD are:

• Self-effacing
• Constantly envious of others
• Hypersensitive to criticism
• Extremely defensive when criticized
• Constantly seeking validation and recognition from others
• Avoidant, insecure, and vigilant

3. Malignant narcissism

The malignant narcissism subtype is believed to be at the extreme end of the NPD continuum. “Malignant Narcissism is described as a core narcissistic personality disorder, antisocial behavior, ego-syntonic sadism, and a paranoid orientation,” explains a 2010 study [mfn] Goldner-Vukov, M., & Moore, L. J. (2010). Malignant Narcissism: from fairy tales to harsh reality. Psychiatria Danubina, 22(3), 392–405. [/mfn] . Individuals with this NPD subtype tend to be:

• Psychopathic
• Immoral
• Highly malicious
• Extremely manipulative
• Mildly neurotic or grandiose
• Sadistic, paranoid, cruel, and aggressive

4. Other types

Other common types of narcissistic personality are:

• Healthy narcissist
• High-Functioning or exhibitionist narcissist
• Primordial narcissist
• Somatic narcissist
• Sexual narcissist
• Communal narcissist
• Cerebral or intellectual narcissist
• Spiritual narcissist
• Conversational narcissist

Read More About Psychopath Here

What Causes Narcissism?

Although no specific causes of narcissism have been identified yet, certain risk factors influence the development of narcissistic personality disorder. Some of the influencing factors that contribute to NPD include:

1. Genetics

It has been observed that biology and genetics may play a role in the etiology of NPD. Although the causes are multifaceted, there may be a genetic predisposition at the onset, according to a study [mfn] Jang, K. L., Livesley, W. J., Vernon, P. A., & Jackson, D. N. (1996). Heritability of personality disorder traits: a twin study. Acta psychiatrica Scandinavica, 94(6), 438–444. https://doi.org/10.1111/j.1600-0447.1996.tb09887.x [/mfn] .

There may be some neurobiological factors [mfn] Jankowiak-Siuda, K., & Zajkowski, W. (2013). A neural model of mechanisms of empathy deficits in narcissism. Medical science monitor : international medical journal of experimental and clinical research, 19, 934–941. https://doi.org/10.12659/MSM.889593 [/mfn] at play as well. For instance, studies [mfn] Jauk, E., & Kanske, P. (2021). Can neuroscience help to understand narcissism? A systematic review of an emerging field. Personality neuroscience, 4, e3. https://doi.org/10.1017/pen.2021.1 [/mfn] show that subclinical narcissism is associated with variations in regional brain volumes in insular and prefrontal areas.

2. Trauma

Studies [mfn] Zvelc G. (2010). Object and subject relations in adulthood–towards an integrative model of interpersonal relationships. Psychiatria Danubina, 22(4), 498–508. [/mfn] have found that abuse and traumatic experiences—particularly in childhood or developing years—can contribute to the development of narcissistic personality disorder.

Adverse childhood experiences like abuse, abandonment, rejection, maltreatment [mfn] van Schie, C. C., Jarman, H. L., Huxley, E., & Grenyer, B. (2020). Narcissistic traits in young people: understanding the role of parenting and maltreatment. Borderline personality disorder and emotion dysregulation, 7, 10. https://doi.org/10.1186/s40479-020-00125-7 [/mfn] , and other negative developmental experiences and having fragile egos during childhood can be risk factors.

A 2006 study [mfn] Otway, L. J., & Vignoles, V. L. (2006). Narcissism and childhood recollections: a quantitative test of psychoanalytic predictions. Personality & social psychology bulletin, 32(1), 104–116. https://doi.org/10.1177/0146167205279907 [/mfn] elaborates “childhood experiences may help to explain the paradoxical combination of grandiosity and fragility in adult narcissism.”

3. Excessive praise

Research [mfn] Mitra, P., & Fluyau, D. (2022). Narcissistic Personality Disorder. In StatPearls. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556001/ [/mfn] also shows that “excessive praise, including the belief that a child may have extraordinary abilities, may also lead to NPD.”

According to a 2015 study [mfn] Brummelman, E., Thomaes, S., Nelemans, S. A., Orobio de Castro, B., Overbeek, G., & Bushman, B. J. (2015). Origins of narcissism in children. Proceedings of the National Academy of Sciences of the United States of America, 112(12), 3659–3662. https://doi.org/10.1073/pnas.1420870112 [/mfn] , parents often give special attention and exceptional treatment to children to boost their self-esteem.

However, overvaluing a child can lead to the development of narcissism in children. Contrarily, overly criticizing parents can also result in the onset of narcissism.

4. Other causes

Other environmental causes and risk factors contributing to the development of NPD may include the following:

• Unstable or inconsistent parenting
• Lack of validation during childhood and adolescence [mfn] Bleiberg E. (1994). Normal and pathological narcissism in adolescence. American journal of psychotherapy, 48(1), 30–51. https://doi.org/10.1176/appi.psychotherapy.1994.48.1.30 [/mfn]
• Extremely high and unrealistic parental expectations
• Neglect or lack of care
• Parental overindulgence [mfn] Wetzel, E., & Robins, R. W. (2016). Are Parenting Practices Associated with the Development of Narcissism? Findings from a Longitudinal Study of Mexican-origin Youth. Journal of research in personality, 63, 84–94. https://doi.org/10.1016/j.jrp.2016.05.005 [/mfn]
• Oversensitive temperament
• Growing up with narcissistic, manipulative, or toxic parents
• Cultural and social influences

What Are The Comorbidities Associated With Narcissism?

A 2017 study [mfn] Eaton, N. R., Rodriguez-Seijas, C., Krueger, R. F., Campbell, W. K., Grant, B. F., & Hasin, D. S. (2017). Narcissistic Personality Disorder and the Structure of Common Mental Disorders. Journal of personality disorders, 31(4), 449–461. https://doi.org/10.1521/pedi_2016_30_260 [/mfn] states that NPD “shows high rates of comorbidity with mood, anxiety, substance use, and other personality disorders.” A person with narcissistic personality disorder often develops several other comorbid [mfn] Kacel, E. L., Ennis, N., & Pereira, D. B. (2017). Narcissistic Personality Disorder in Clinical Health Psychology Practice: Case Studies of Comorbid Psychological Distress and Life-Limiting Illness. Behavioral medicine (Washington, D.C.), 43(3), 156–164. https://doi.org/10.1080/08964289.2017.1301875 [/mfn] mental health conditions, such as:

• Anorexia nervosa
• Bulimia nervosa
• Antisocial personality disorder
• Borderline personality disorder (BPD [mfn] Hörz-Sagstetter, S., Diamond, D., Clarkin, J. F., Levy, K. N., Rentrop, M., Fischer-Kern, M., Cain, N. M., & Doering, S. (2018). Clinical Characteristics of Comorbid Narcissistic Personality Disorder in Patients With Borderline Personality Disorder. Journal of personality disorders, 32(4), 562–575. https://doi.org/10.1521/pedi_2017_31_306 [/mfn] )
• Generalized anxiety disorder (GAD)
• Social anxiety disorder
• Panic disorder
• Depression
• Substance abuse [mfn] Parmar, A., & Kaloiya, G. (2018). Comorbidity of Personality Disorder among Substance Use Disorder Patients: A Narrative Review. Indian journal of psychological medicine, 40(6), 517–527. https://doi.org/10.4103/IJPSYM.IJPSYM_164_18 [/mfn] (like alcoholism or drug addiction)
• Physical health issues like cardiovascular problems [mfn] Reinhard, D. A., Konrath, S. H., Lopez, W. D., & Cameron, H. G. (2012). Expensive egos: narcissistic males have higher cortisol. PloS one, 7(1), e30858. https://doi.org/10.1371/journal.pone.0030858 [/mfn] , coronary disorders, etc.
• Self-harm and suicidal tendencies

According to a 2009 study [mfn] Ritter, K., Roepke, S., Merkl, A., Heuser, I., Fydrich, T., & Lammers, C. H. (2010). Komorbiditäten bei Patienten mit einer Narzisstischen Persönlichkeitsstörung im Vergleich zu Patienten mit einer Borderline-Persönlichkeitsstörung [Comorbidity in patients with narcissistic personality disorder in comparison to patients with borderline personality disorder]. Psychotherapie, Psychosomatik, medizinische Psychologie, 60(1), 14–24. https://doi.org/10.1055/s-0028-1102943 [/mfn] , “in general, patients with NPD showed similar co-occurring disorders as patients with BPD, or with the co-diagnosis NPD and BPD.” Further studies [mfn] Schoenleber, M., Sadeh, N., & Verona, E. (2011). Parallel syndromes: two dimensions of narcissism and the facets of psychopathic personality in criminally involved individuals. Personality disorders, 2(2), 113–127. https://doi.org/10.1037/a0021870 [/mfn] show that a person with narcissism can also develop a psychopathic personality.

“Although antisocial personality disorder is associated with psychopathy, it also seems common in individuals with narcissistic personality traits,” explain researchers [mfn] Martínez-López, J., Medina-Mora, M. E., Robles-García, R., Madrigal, E., Juárez, F., Tovilla-Zarate, C. A., Reyes, C., Monroy, N., & Fresán, A. (2019). Psychopathic Disorder Subtypes Based on Temperament and Character Differences. International journal of environmental research and public health, 16(23), 4761. https://doi.org/10.3390/ijerph16234761 [/mfn] . Moreover, narcissism is found [mfn] Coleman, D., Lawrence, R., Parekh, A., Galfalvy, H., Blasco-Fontecilla, H., Brent, D. A., Mann, J. J., Baca-Garcia, E., & Oquendo, M. A. (2017). Narcissistic Personality Disorder and suicidal behavior in mood disorders. Journal of psychiatric research, 85, 24–28. https://doi.org/10.1016/j.jpsychires.2016.10.020 [/mfn] to be closely associated with a greater risk of suicidal death than any other personality disorder.

Read More About Panic Disorder Here

How To Diagnose Narcissistic Personality Disorder?

Typically, narcissists don’t seek treatment as they don’t believe that they are suffering from a mental condition or a personality disorder. However, they may seek treatment for comorbid conditions like anxiety, depression, substance abuse disorders, etc.

This is why narcissism diagnosis can be challenging for mental health professionals. However, a diagnosis of NPD can be made by a qualified healthcare professional.

Certain symptoms of narcissism—such as a sense of self-importance, feelings of grandiosity, or a lack of intimacy or empathy—impair the narcissists’ normal daily functioning. Their personality traits and functional impairments must be stable across a variety of circumstances, over a period of time.

Moreover, the personality traits must not be socially or culturally acceptable or caused by developmental stages, substance use, and other psychiatric or medical disorders.

Narcissism can be diagnosed medically [mfn] Ronningstam E. (2010). Narcissistic personality disorder: a current review. Current psychiatry reports, 12(1), 68–75. https://doi.org/10.1007/s11920-009-0084-z [/mfn] when the symptoms lead to subjective distress and functional impairment in the patient’s occupational, social, and personal life. So even if they may not admit to having a condition or personality disorder, they are aware that their thoughts and behaviors cause them severe distress.

A psychiatrist, psychologist, or therapist can ask the patient to fill out certain questionnaires or undergo specific personality tests to determine if they have NPD. Common screening tools used in narcissism diagnosis include:

• International personality disorder examination (IPDE [mfn] Loranger, A. W., Sartorius, N., Andreoli, A., Berger, P., Buchheim, P., Channabasavanna, S. M., Coid, B., Dahl, A., Diekstra, R. F., & Ferguson, B. (1994). The International Personality Disorder Examination. The World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration international pilot study of personality disorders. Archives of general psychiatry, 51(3), 215–224. https://doi.org/10.1001/archpsyc.1994.03950030051005 [/mfn] )
• Millon clinical multiaxial inventory III (MCMI-III [mfn] Caparrós, B. C., & Hoz, E. V. (2013). Millon clinical multiaxial inventory III (MCMI-III) and communication styles in a sample of university students. The Spanish journal of psychology, 16, E85. https://doi.org/10.1017/sjp.2013.85 [/mfn] )
• Personality diagnostic questionnaire-4 (PDQ-4 [mfn] Fossati, A., Maffei, C., Bagnato, M., Donati, D., Donini, M., Fiorilli, M., Novella, L., & Ansoldi, M. (1998). Brief communication: criterion validity of the Personality Diagnostic Questionnaire-4+ (PDQ-4+) in a mixed psychiatric sample. Journal of personality disorders, 12(2), 172–178. https://doi.org/10.1521/pedi.1998.12.2.172 [/mfn] )

Mental health professionals (MHPs) may also conduct lab tests, physical exams, and psychological evaluations for differential diagnosis of NPD.

How To Treat Narcissism?

Narcissism, being a personality trait, cannot be permanently cured. However, a clinical narcissistic personality disorder can be addressed by a combination of therapy and medication.

Such treatment for narcissism can help relieve the symptoms of the disorder and improve certain negative thoughts and behaviors. Medications can help treat comorbid symptoms (such as anxiety and depression), but there are no particular medications for NPD.

Some of the commonly available options in treatment for narcissism include:

1. Psychotherapy

Psychotherapy or talk therapy is considered the most effective treatment [mfn] Maillard, P., Berthoud, L., Kolly, S., Sachse, R., & Kramer, U. (2020). Processes of Change in Psychotherapy for Narcissistic Personality Disorder. Journal of personality disorders, 34(Suppl), 63–79. https://doi.org/10.1521/pedi.2020.34.supp.63 [/mfn] for NPD. Such therapy is targeted at addressing the thoughts, beliefs, emotions, and behaviors related to narcissism.

Therapists work with the patients to make them realize how their behaviors are driven by their emotions and help them set goals associated with behavioral change. Psychotherapy can enable [mfn] Kiliç, N., & Eryilmaz, A. (2019). Investigating Narcissistic Personality Traits in the Context of Positive Psychotherapy. Noro psikiyatri arsivi, 56(1), 40–46. https://doi.org/10.29399/npa.22794 [/mfn] a narcissist to:

• Identify the origin of emotions that lead to narcissistic behavior
• Better regulate emotions
• Accept criticism by acknowledging actual potential and competence
• Identify and better self-esteem issues
• Relate to and connect better with others to build more intimate relationships

Some of the most helpful and widely recommended forms of therapy for the treatment of narcissism typically include:

• Psychodynamic psychotherapy [mfn] Wilczek, A., Weinryb, R. M., Gustavsson, P. J., Barber, J. P., Schubert, J., & Asberg, M. (1997). Symptoms and character traits in patients selected for long-term psychodynamic psychotherapy. The Journal of psychotherapy practice and research, 7(1), 23–34. [/mfn]
• Dialectical behavior therapy (DBT [mfn] Neacsiu, A. D., & Tkachuck, M. A. (2016). Dialectical behavior therapy skills use and emotion dysregulation in personality disorders and psychopathy: a community self-report study. Borderline personality disorder and emotion dysregulation, 3, 6. https://doi.org/10.1186/s40479-016-0041-5 [/mfn] )
• Mentalization therapy [mfn] Drozek, R. P., & Unruh, B. T. (2020). Mentalization-Based Treatment for Pathological Narcissism. Journal of personality disorders, 34(Suppl), 177–203. https://doi.org/10.1521/pedi.2020.34.supp.177 [/mfn]
• Cognitive-behavioral therapy (CBT [mfn] Matusiewicz, A. K., Hopwood, C. J., Banducci, A. N., & Lejuez, C. W. (2010). The effectiveness of cognitive behavioral therapy for personality disorders. The Psychiatric clinics of North America, 33(3), 657–685. https://doi.org/10.1016/j.psc.2010.04.007 [/mfn] )
• Transference-focused therapy [mfn] Diamond, D., & Hersh, R. G. (2020). Transference-Focused Psychotherapy for Narcissistic Personality Disorder: An Object Relations Approach. Journal of personality disorders, 34(Suppl), 159–176. https://doi.org/10.1521/pedi.2020.34.supp.159 [/mfn]
• Schema-focused therapy [mfn] Dieckmann, E., & Behary, W. (2015). Schematherapie: Ein Ansatz zur Behandlung narzisstischer Persönlichkeitsstörungen [Schema Therapy: An Approach for Treating Narcissistic Personality Disorder]. Fortschritte der Neurologie-Psychiatrie, 83(8), 463–478. https://doi.org/10.1055/s-0035-1553484 [/mfn]
• Psychoanalytic psychotherapy [mfn] Kernberg O. F. (2014). An overview of the treatment of severe narcissistic pathology. The International journal of psycho-analysis, 95(5), 865–888. https://doi.org/10.1111/1745-8315.12204 [/mfn]
• Psychoanalysis [mfn] Higgitt, A., & Fonagy, P. (1992). Psychotherapy in borderline and narcissistic personality disorder. The British journal of psychiatry : the journal of mental science, 161, 23–43. https://doi.org/10.1192/bjp.161.1.23 [/mfn]
• Supportive psychotherapy [mfn] Zalman, H., Doorn, K. A., & Eubanks, C. F. (2019). Alliance challenges in the treatment of a narcissistic patient: the case of Alex. Research in psychotherapy (Milano), 22(2), 351. https://doi.org/10.4081/ripppo.2019.351 [/mfn]
• Group psychotherapy [mfn] Macaskill N. D. (1980). The narcissistic core as a focus in the group therapy of the borderline patient. The British journal of medical psychology, 53(2), 137–143. https://doi.org/10.1111/j.2044-8341.1980.tb01428.x [/mfn]
• Couple therapy [mfn] Links, P. S., & Stockwell, M. (2002). The role of couple therapy in the treatment of narcissistic personality disorder. American journal of psychotherapy, 56(4), 522–538. https://doi.org/10.1176/appi.psychotherapy.2002.56.4.522 [/mfn]
• Family therapy [mfn] Jones S. A. (1987). Family therapy with borderline and narcissistic patients. Bulletin of the Menninger Clinic, 51(3), 285–295. [/mfn]
• In-patient treatment [mfn] Hinrichs J. (2016). Inpatient Therapeutic Assessment With Narcissistic Personality Disorder. Journal of personality assessment, 98(2), 111–123. https://doi.org/10.1080/00223891.2015.1075997 [/mfn]

A 2000 study [mfn] Gabbard G. O. (2000). Psychotherapy of personality disorders. The Journal of psychotherapy practice and research, 9(1), 1–6. [/mfn] states “Psychoanalysis and psychoanalytic therapy have long been used in the treatment of patients with personality disorders (PDs).” Therapy helps to replace harmful beliefs and negative behaviors with positive ones by helping the patient identify them in the first place.

It can help them develop a more realistic and healthier self-image. In fact, studies [mfn] Baskin-Sommers, A., Krusemark, E., & Ronningstam, E. (2014). Empathy in narcissistic personality disorder: from clinical and empirical perspectives. Personality disorders, 5(3), 323–333. https://doi.org/10.1037/per0000061 [/mfn] have found that therapy can enable narcissists to develop empathy.

2. Medications

A mental health professional may prescribe certain medications to address symptoms of narcissism and other comorbid conditions (such as bipolar disorder, substance use disorder or addiction, anxiety, depression [mfn] Saito, S., Kobayashi, T., & Kato, S. (2013). Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica, 115(4), 363–371. [/mfn] , eating disorders, etc.).

For instance, antidepressants [mfn] Dunlop, B. W., DeFife, J. A., Marx, L., Garlow, S. J., Nemeroff, C. B., & Lilienfeld, S. O. (2011). The effects of sertraline on psychopathic traits. International clinical psychopharmacology, 26(6), 329–337. https://doi.org/10.1097/YIC.0b013e32834b80df [/mfn] (like selective serotonin reuptake inhibitors (SSRIs), mood stabilizers, antipsychotics, or anti-anxiety drugs) are commonly prescribed to NPD patients.

3. Lifestyle changes

Apart from psychotherapies and medications, experts suggest that lifestyle changes and coping strategies can also help treat clinical narcissism.

This can be especially important, as a person with narcissism may believe that treatment may not be worth it and is more likely to quit. The following strategies can help a narcissist to recover successfully:

• Follow the doctor’s instructions, stick to the treatment plan, and attend therapy sessions regularly
• Stay physically active and exercise regularly as it boosts your mood and self-esteem [mfn] Sharma, A., Madaan, V., & Petty, F. D. (2006). Exercise for mental health. Primary care companion to the Journal of clinical psychiatry, 8(2), 106. https://doi.org/10.4088/pcc.v08n0208a [/mfn]
• Practice deep breathing [mfn] Ma, X., Yue, Z. Q., Gong, Z. Q., Zhang, H., Duan, N. Y., Shi, Y. T., Wei, G. X., & Li, Y. F. (2017). The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults. Frontiers in psychology, 8, 874. https://doi.org/10.3389/fpsyg.2017.00874 [/mfn] and other relaxation exercises, like mindfulness meditation [mfn] Goyal, M., Singh, S., Sibinga, E. M., Gould, N. F., Rowland-Seymour, A., Sharma, R., Berger, Z., Sleicher, D., Maron, D. D., Shihab, H. M., Ranasinghe, P. D., Linn, S., Saha, S., Bass, E. B., & Haythornthwaite, J. A. (2014). Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA internal medicine, 174(3), 357–368. https://doi.org/10.1001/jamainternmed.2013.13018 [/mfn] , yoga [mfn] Shohani, M., Badfar, G., Nasirkandy, M. P., Kaikhavani, S., Rahmati, S., Modmeli, Y., Soleymani, A., & Azami, M. (2018). The Effect of Yoga on Stress, Anxiety, and Depression in Women. International journal of preventive medicine, 9, 21. https://doi.org/10.4103/ijpvm.IJPVM_242_16 [/mfn] , massage [mfn] Nazari, F., Mirzamohamadi, M., & Yousefi, H. (2015). The effect of massage therapy on occupational stress of Intensive Care Unit nurses. Iranian journal of nursing and midwifery research, 20(4), 508–515. https://doi.org/10.4103/1735-9066.161001 [/mfn] , and aromatherapy [mfn] Toda, M., & Matsuse, R. (2020). Endocrinological effect of lavender aromatherapy on stressful visual stimuli. Contemporary clinical trials communications, 17, 100547. https://doi.org/10.1016/j.conctc.2020.100547 [/mfn] , to reduce stress anxiety and depressive symptoms
• Avoid alcohol and other substances to better manage your thoughts, emotions, and behavior
• Try volunteering [mfn] Han, S. H., Kim, K., & Burr, J. A. (2020). Stress-Buffering Effects of Volunteering on Daily Well-Being: Evidence From the National Study of Daily Experiences. The journals of gerontology. Series B, Psychological sciences and social sciences, 75(8), 1731–1740. https://doi.org/10.1093/geronb/gbz052 [/mfn] and pursuing interests and hobbies to counter self-absorbing negative thoughts
• Seek support from family members and friends
• Join local support groups in your community or online
• Learn positive conflict resolution strategies

Read More About Psychotherapy Here

Coping Strategies For Loved Ones

Living with a narcissist can be challenging, especially when they are your family member or friend. If you have a loved one with narcissistic personality disorder, here are a few tips that can help you cope better:

• Identify the signs and symptoms of narcissism
• Encourage them to seek treatment for NPD
• Set strong and healthy personal boundaries
• Don’t take their behavior personally
• Practice self-care and do things that you enjoy
• Be compassionate and respond to them calmly
• Seek support from others and talk to friends and family
• Consult a therapist, if needed

Takeaway

Although a person with narcissism may appear to be highly selfish and manipulative, we need to realize that it is a mental health condition that requires treatment and support.

With effective treatment, an individual can reduce the symptoms of narcissistic personality disorder, learn to be more empathic, build stronger self-esteem, reduce insecurities, and build better interpersonal relationships.

Narcissism At A Glance

1. Narcissism is excessive self-overvaluation that causes a distorted sense of self-worth and reduces a person’s empathic receptivity.
2. Its pathological form, narcissistic personality disorder (NPD), is a mental disorder.
3. A narcissistic individual seeks gratification from egotistic admiration of his/her own idealized traits and self-image.
4. People with NPD often fail to realize that they have a personality disorder and hence do not typically seek help or treatment.
5. Around 6.2% of the global population has a lifetime prevalence of NPD.
6. The symptoms of NPD include a sense of self-importance, grandiosity, or lack of intimacy or empathy that impair the narcissist’s everyday functioning.
7. NPD can be easily addressed with therapy and/or medication.

Frequently Asked Questions (FAQs)