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Narcissism

Narcissism refers to excessive self-overvaluation that can cause a distorted sense of self-worth and reduce 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, chronic disregard for other people and toxic, unhealthy interpersonal relationships. A narcissistic individual seeks gratification from egotistic admiration of their own idealized traits and self-image. A 2018 study 1 states “Narcissism is a personality construct typically characterized by grandiosity, vanity, entitlement, and exploitativeness.” An individual with narcissistic traits may suffer from narcissistic personality disorder (NPD), which is characterized by an elevated sense of entitlement & grandiosity. However, narcissists tend to be highly insecure and 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 2 . This can adversely affect how the individual thinks, behaves, reacts and relates to their loved ones and others.

The term narcissism is derived from the name of Narcissus, a young hunter & a god in Greek mythology, who fell in love with his own beauty while looking at a pool of water, gazing at it for the rest of his life. A person with NPD may tend to manipulate and exploit others and take their loved ones for granted. According to a research paper, narcissists tend to consider themselves as superior and behave mostly in a “self-centered” manner. They may also possess exploitative traits used predominantly for achieving goals. “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,” add the researchers. It is a form of pathological self-absorption which was initially identified by English physician and writer Havelock Ellis in 1898 as a disorder. Austrian neurologist and the founder of psychoanalysis Sigmund Freud believed 3 that it is primarily a common stage in child development, however, when such traits are exhibited after puberty then it can be considered as a personality disorder 4 .

Understanding Narcissistic Personality Disorder (NPD)

NPD is one of 10 personality disorders 5 identified in the fifth edition of 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 6 . People with this psychological condition possess and exhibit traits of narcissism, such as an intense sense of self-importance, lack of empathy 7 , extreme need for attention & admiration. 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 8 shows that people with NPD to be hypersensitive, shy, insecure and have 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 adversely affect different aspects of their lives, such as career, social life, relationships and cause significant psychological distress.

Narcissistic personality disorder or narcissism is a cluster B personality disorder. As a narcissistic person has 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 behaviors, they look for others to blame 9 for their unfulfilled, 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,” found a 2002 study 10 . In fact, researchers 11 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 12 that are colored by their anxiety related to personal adequacy, control & personal image and status 13 .

Studies 14 show that in the United States, around 6.2% of the population have a lifetime prevalence of NPD, with about 7.7% men and almost 4.8% for women. With treatment and therapy, one can learn to manage their narcissistic traits.

Signs Of Narcissism

Some of the most common traits and symptoms of narcissistic personality disorder may include the following:

  • Extremely inflated sense of self-importance & self-absorption
  • Sense of entitlement and grandiosity
  • Strong need for excessive, constant attention and admiration
  • Feelings of superiority even without any significant achievements
  • Inclination to associate only with high-status individuals
  • Willingness to manipulate and exploit others for personal gain
  • Lack of empathy or unwillingness to consider needs or feelings of others
  • Fantasies about unlimited power, success, beauty, love and brilliance
  • Considers others inferior and monopolizes conversations
  • Pretentious, conceited, arrogant & boastful behavior
  • Feels mistreated and reacts aggressively when ignored
  • Exploitative, toxic and superficial in interpersonal relationships
  • Fragile self-esteem and low self-confidence
  • Exaggeration of talents and accomplishments
  • Feelings of jealousy & strongly believes others are envious of them
  • Exceptionally charming and charismatic when it’s beneficial
  • Undermining others’ achievements
  • Reacting negatively & aggressively to criticism
  • Emotional disconnection or detachment from others
  • Lack of intimacy or attachment in relationships and social withdrawal
  • Inability to regulate emotions 15
  • Internalized feelings of insecurity, shame, humiliation, emptiness & vulnerability
  • Suspiciousness
  • Other mental disorders like anxiety and depression

Types Of Narcissism

Types Of Narcissism
Narcissism


Narcissism is widely regarded as a trait that exists on a spectrum. There are no specific or established number of subtypes of NPD. However, certain types have been identified by researchers while others have become informally popular. Here are some of the most common narcissistic subtypes:

1. Grandiose narcissism

The grandiose or overt type of NPD typically refers to what most people understand by a narcissistic personality. They have an unrealistic and inflated sense of superiority and excessively overestimate their own abilities. They may be exhibitionistic and constantly seek attention. They are usually authoritarian, entitled, exploitative, unempathetic, self-absorbed, aggressive and even abusive. “Grandiose narcissism is characterized by high self–esteem, interpersonal dominance and a tendency to overestimate one’s capabilities,” explains a 2018 study 16 .

2. Vulnerable narcissism

Also known as the covert subtype, it is characterized by inhibition, shyness and distress. People with vulnerable NPD are self-effacing, constantly envious of others and hypersensitive to criticism. These narcissists tend to become defensive when criticized as they seek validation and recognition from others. This subtype “is also associated with lower levels of self esteem, extraversion and agreeableness, higher neuroticism,” adds the 2018 study. They are often avoidant, insecure and vigilant. It is associated with “more realistic self-perception of emotional abilities.”

3. Malignant narcissism

Individuals with this NPD subtype tend to be highly malicious and manipulative. They are sadistic, paranoid, cruel, aggressive and immoral. These narcissists tend to have psychopathic traits and are not necessarily neurotic or grandiose. This 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 17 .

  • Apart from these, there may be some other common types of narcissistic personality, such as –
  • Healthy narcissist
  • High-Functioning or exhibitionist narcissist
  • Primordial narcissist
  • Somatic narcissist
  • Sexual narcissist
  • Communal narcissist
  • Cerebral or intellectual narcissist
  • Spiritual narcissist
  • Conversational narcissist

Causes Of Narcissistic Personality Disorder

Causes Of Narcissistic Personality Disorder
Narcissism


Although no specific causes for narcissism have been identified yet, there are certain risk factors which may influence the development of narcissistic personality disorder. Here are some of influencing factors that contribute to NPD:

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 to the onset, according to a 1996 study 18 . There may be some other neurobiological factors 19 at play as well.

2. Trauma

Studies 20 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 21 , negative developmental experiences and having fragile egos during childhood can be risk factors. A 2006 study 22 explains “childhood experiences may help to explain the paradoxical combination of grandiosity and fragility in adult narcissism.”

3. Excessive praise

Research 23 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 24 , parents often give special attention and exceptional treatment to children to boost children’s self-esteem. However, overvaluing a child can lead to narcissism in children. Contrarily, overly criticizing parents can also result in the onset of narcissism.

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

  • Unstable or inconsistent parenting
  • Lack of validation during childhood and adolescence 25
  • Extremely high expectations,unrealistic from parents
  • Neglect or lack of care
  • Parental overindulgence 26
  • Oversensitive temperament
  • Narcissistic, manipulative or toxic parents
  • Cultural and social influences

Complications Associated With Narcissism

A 2017 study 27 states that NPD “shows high rates of comorbidity with mood, anxiety, substance use, and other personality disorders.” A person with narcissistic personality disorder can often develop a number of other comorbid 28 mental health conditions, such as:

  • Anorexia nervosa
  • Bulimia nervosa
  • Antisocial personality disorder
  • Borderline personality disorder (BPD 29 )
  • Generalized anxiety disorder (GAD)
  • Social anxiety disorder
  • Panic disorder
  • Depression
  • Substance or alcohol abuse 30
  • Other personality disorders
  • Physical health issues like cardiovascular problems
  • Suicidal tendencies

According to a 2009 study 31 , “In general, patients with NPD showed similar co-occurring disorders as patients with BPD, or with the co-diagnosis NPD and BPD.” Further studies 32 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,” explains a 2019 study 33 . Moreover, narcissism has also found to be closely associated with greater risk of suicide death than any other personality disorder, according to research 34 .

A narcissist can also face a number of other complications in their daily life and functioning such as –

  • Education
  • Career
  • Relationships

Read More About Career Here

Diagnosis Of Narcissism

Typically, narcissists don’t usually 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 etc. This is why diagnosing narcissistic personality disorder can be challenging for mental health professionals. However, a diagnosis can be made by a qualified healthcare professional. Certain symptoms, such as a sense of self-importance, grandiosity or lack of intimacy or empathy, impairs the person’s normal daily functioning. Their personality traits and functional impairments must be stable across a variety of circumstances and over a period of time. Moreover, the personality traits must not be socially or culturally acceptable, or due to developmental stages, other psychiatric disorders, medical conditions or substance use.

Narcissism can be diagnosed medically 35 when the symptoms cause subjective distress and lead to functional impairments in the patient’s occupational, social and personal life. So even if they may not admit they have a condition or personality disorder, they are aware that their thoughts and behaviors cause them severe distress. A psychiatrist, psychologist or a therapist can ask the patient a certain question to understand their mindset and give them personality tests to determine if they have NPD. Common tests for NPD diagnosis may include:

  • International personality disorder examination (IPDE 36 )
  • Millon clinical multiaxial inventory III (MCMI-III 37 )
  • Personality diagnostic questionnaire-4 (PDQ-4 38 )

The mental health professional may also conduct lab tests, physical exams and psychological evaluations to rule out other factors.

Treatment Of Narcissism

Although there is no specific cure for narcissistic personality disorder, a combination of therapy and medication can help relieve the symptoms and improve certain negative behaviors. Medications can help to treat symptoms such as anxiety and depression but there are no particular medications for NPD. Here are some of the available treatment options:

1. Psychotherapy

Psychotherapy or talk therapy is considered to be the most effective treatment 39 for NPD. 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 to set goals associated with behavioral change. Psychotherapy can enable a narcissist to –

  • Identify the origin of emotions that lead to narcissistic behavior
  • Better regulate their emotions
  • Accept criticism by acknowledging actual potential and competence
  • Identify self-esteem issues and work on developing it
  • 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 includes:

  • Psychodynamic psychotherapy 40
  • Dialectical behavior therapy (DBT 41 )
  • Mentalization therapy 42
  • Cognitive behavioral therapy (CBT 43 )
  • Transference-focused therapy 44
  • Schema-focused therapy 45
  • Psychoanalytical psychotherapy 46
  • Psychoanalysis 47
  • Supportive psychotherapy
  • Group psychotherapy
  • Couple therapy 48
  • Family therapy
  • In-patient treatment

A 2000 study states 49 “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 50 have found that therapy can enable narcissists to develop empathy.

2. Medications

There is no specific medication for treating NPD. However, a mental health professional may prescribe certain medications like antidepressants 51 like selective serotonin reuptake inhibitors (SSRIs), mood stabilizers, antipsychotics or anti-anxiety drugs for treating symptoms and other comorbid conditions such as bipolar disorder, substance use disorder or addiction, anxiety, depression 52 , eating disorders etc.

3. Lifestyle changes

Apart from psychotherapies and medications some lifestyle changes and coping strategies can also be helpful. This can be especially important as a person with narcissism may believe that treatment may not be worth it and may be 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 can boost your mood & self-esteem 53
  • Practice deep breathing 54 and other relaxation exercises like mindfulness meditation 55 , yoga 56 , massage 57 & aromatherapy 58 to reduce stress anxiety and depression
  • Avoid alcohol and other substances to better manage your thoughts, emotions and behaviors
  • Try volunteering 59 and pursue 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

Coping Strategies For Loved Ones

Coping Strategies For Loved Ones
Narcissism


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, then here are a few things 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

Overcome Narcissistic Personality Disorder

Although a person with narcissism may appear to be extremely 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 social relationships and more intimate personal relationships.

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