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 1 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 2.
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 3 . 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 4 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 5 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 6 .
Narcissistic Personality Disorder (NPD)
NPD is one of the ten personality disorders 7 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 8 .
People with this psychological condition possess and exhibit traits of narcissism—such as an intense sense of self-importance, and a lack of empathy 9 , 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 10 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.
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 11 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 12 .
In fact, researchers 13 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 14 that are colored by their anxiety related to personal adequacy, control, and personal image and status 15 .
Studies 16 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:
- An extremely inflated sense of self-importance, and self-absorption
- A sense of entitlement and grandiosity
- A strong need for excessive and constant attention and admiration
- Feelings of superiority even without any significant achievement
- An inclination to associate only with high-status individuals
- A willingness to manipulate and exploit others for personal gain
- A lack of empathy
- Fantasies about unlimited power, success, beauty, love, and brilliance
- Considering others as inferior and monopolizing company
- Pretentious, conceited, arrogant, and boastful behavior
- Feelings of victimization
- An aggressive reaction to being ‘ignored’ or ‘mistreated’
- Being exploitative, toxic, and superficial in interpersonal relationships
- A fragile self-esteem and low self-confidence
- An exaggeration of talents and accomplishments
- Feelings of jealousy
- A strong belief in being envied by others
- Exceptionally charming and charismatic when it’s beneficial
- Undermining others’ achievements
- Reacting negatively and aggressively to criticism
- An emotional disconnection or detachment from others
- A lack of intimacy or attachment in relationships
- Social withdrawal
- Emotional dysfunction 17
- Internalized feelings of insecurity, shame, humiliation, emptiness, and vulnerability
- Extreme suspiciousness
- 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 18 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 19 , “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:
- 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 20 . Individuals with this NPD subtype tend to be:
- 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:
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 21 .
There may be some neurobiological factors 22 at play as well. For instance, studies 23 show that subclinical narcissism is associated with variations in regional brain volumes in insular and prefrontal areas.
Studies 24 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 25 , and other negative developmental experiences and having fragile egos during childhood can be risk factors.
A 2006 study 26 elaborates “childhood experiences may help to explain the paradoxical combination of grandiosity and fragility in adult narcissism.”
3. Excessive praise
Research 27 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 28 , 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 29
- Extremely high and unrealistic parental expectations
- Neglect or lack of care
- Parental overindulgence 30
- Oversensitive temperament
- Growing up with narcissistic, manipulative, or toxic parents
- Cultural and social influences
What Are The Comorbidities Associated With Narcissism?
A 2017 study 31 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 32 mental health conditions, such as:
- Anorexia nervosa
- Bulimia nervosa
- Antisocial personality disorder
- Borderline personality disorder (BPD 33 )
- Generalized anxiety disorder (GAD)
- Social anxiety disorder
- Panic disorder
- Substance abuse 34 (like alcoholism or drug addiction)
- Physical health issues like cardiovascular problems 35 , coronary disorders, etc.
- Self-harm and suicidal tendencies
According to a 2009 study 36 , “in general, patients with NPD showed similar co-occurring disorders as patients with BPD, or with the co-diagnosis NPD and BPD.” Further studies 37 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 38 . Moreover, narcissism is found 39 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 40 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 41 )
- Millon clinical multiaxial inventory III (MCMI-III 42 )
- Personality diagnostic questionnaire-4 (PDQ-4 43 )
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:
Psychotherapy or talk therapy is considered the most effective treatment 44 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 45 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 46
- Dialectical behavior therapy (DBT 47 )
- Mentalization therapy 48
- Cognitive-behavioral therapy (CBT 49 )
- Transference-focused therapy 50
- Schema-focused therapy 51
- Psychoanalytic psychotherapy 52
- Psychoanalysis 53
- Supportive psychotherapy 54
- Group psychotherapy 55
- Couple therapy 56
- Family therapy 57
- In-patient treatment 58
A 2000 study 59 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 9 have found that therapy can enable narcissists to develop empathy.
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 60 , eating disorders, etc.).
For instance, antidepressants 61 (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 62
- Practice deep breathing 63 and other relaxation exercises, like mindfulness meditation 64 , yoga 65 , massage 66 , and aromatherapy 67 , to reduce stress anxiety and depressive symptoms
- Avoid alcohol and other substances to better manage your thoughts, emotions, and behavior
- Try volunteering 68 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
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
- Narcissism is excessive self-overvaluation that causes a distorted sense of self-worth and reduces a person’s empathic receptivity.
- Its pathological form, narcissistic personality disorder (NPD), is a mental disorder.
- A narcissistic individual seeks gratification from egotistic admiration of his/her own idealized traits and self-image.
- People with NPD often fail to realize that they have a personality disorder and hence do not typically seek help or treatment.
- Around 6.2% of the global population has a lifetime prevalence of NPD.
- The symptoms of NPD include a sense of self-importance, grandiosity, or lack of intimacy or empathy that impair the narcissist’s everyday functioning.
- NPD can be easily addressed with therapy and/or medication.
Frequently Asked Questions (FAQs)
1. Is narcissism genetic?
Genetics and neurobiology might play a role in the development of narcissistic personality disorder. However, research contends that environmental factors are primarily associated with narcissism.
2. Is narcissism a mental illness?
Narcissism is a fundamental personality trait. However, when a person develops a clinical condition in which he/she harbors an inflated sense of self, a lack of empathy, and an obsession for attention—the person is said to suffer from a narcissistic personality disorder (NPD).
3. Can narcissism be cured?
There is no cure for narcissism because it is a fundamental personality trait. However, narcissistic personality disorder (NPD) can be addressed with psychotherapy, medication, and self-help strategies.
- 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
- 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.
- 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
- Ellis, Lee & Farrington, David & Hoskin, Anthony. (2019). Handbook of Crime Correlates, 2nd Edition. Available from: https://www.researchgate.net/publication/333842967
- Palmowski B. (1989). Uber Narzissmuskonzepte bei S. Freud [Freud’s narcissism concept]. Zeitschrift fur Psychosomatische Medizin und Psychoanalyse, 35(2), 101–116.
- Kris A. O. (1994). Freud’s treatment of a narcissistic patient. The International journal of psycho-analysis, 75 ( Pt 4), 649–664.
- Fariba, K. A., Gupta, V., & Kass, E. (2022). Personality Disorder. In StatPearls. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556058/
- 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
- 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
- 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
- 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
- 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
- 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/pr0.19220.127.116.11
- 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
- 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
- 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
- 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
- Mitra, P., & Fluyau, D. (2022). Narcissistic Personality Disorder. In StatPearls. StatPearls Publishing. Available From: https://www.ncbi.nlm.nih.gov/books/NBK556001/
- 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
- Goldner-Vukov, M., & Moore, L. J. (2010). Malignant Narcissism: from fairy tales to harsh reality. Psychiatria Danubina, 22(3), 392–405.
- 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
- 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
- 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
- Zvelc G. (2010). Object and subject relations in adulthood–towards an integrative model of interpersonal relationships. Psychiatria Danubina, 22(4), 498–508.
- 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
- 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
- Mitra, P., & Fluyau, D. (2022). Narcissistic Personality Disorder. In StatPearls. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556001/
- 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
- Bleiberg E. (1994). Normal and pathological narcissism in adolescence. American journal of psychotherapy, 48(1), 30–51. https://doi.org/10.1176/appi.psychotherapy.1918.104.22.168
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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.1922.214.171.124
- 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
- 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
- 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.
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- Jones S. A. (1987). Family therapy with borderline and narcissistic patients. Bulletin of the Menninger Clinic, 51(3), 285–295.
- 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
- Gabbard G. O. (2000). Psychotherapy of personality disorders. The Journal of psychotherapy practice and research, 9(1), 1–6.
- Saito, S., Kobayashi, T., & Kato, S. (2013). Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica, 115(4), 363–371.
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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