What is Narcissistic Personality Disorder?

Katie Tyrrell, MS, LPCC
July 29, 2020

People often use the term narcissist to describe someone who is overconfident, desperate for attention, and manipulative. However, a person with narcissistic personality disorder (NPD) is not just being rude, selfish, and egotistical. Narcissistic personality disorder is a serious mental health disorder defined as a pervasive pattern of grandiosity, need for admiration, and lack of empathy.

narcissistic personality disorder

These patterns and symptoms can make life difficult both for individuals with NPD and the people around them. They will experience significant self-esteem issues with very little ability to tolerate criticism without their image, ego, or integrity being challenged.

The need to develop and display a grandiose, important, and successful persona to the outside world emerges to cover internal feelings of inadequacy. When this image is threatened, the person may experience extreme emotional responses of inadequacy, rage, fear, and destruction.


The symptoms of narcissistic personality disorder vary in intensity, and from person to person. Here are some possible symptoms:

  • Grand sense of self-importance
  • Preoccupation with power, success, beauty, and intelligence
  • Belief in being chosen, special, divine, or unique
  • Need for excessive admiration
  • Sense of entitlement
  • Lack of empathy toward others
  • Arrogant behaviors or attitudes
  • Jealousy of others
  • Belief that others are jealous of you
  • Taking advantage or manipulating others


Narcissistic personality disorder falls into the personality disorder category in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM5), which means the symptoms typically emerge in adolescence or early adulthood and remain present throughout the person’s life. Like many mental health disorders, especially personality disorders, the causes of NPD are unknown.

Researchers have evaluated the root causes for many years without conclusive results. Some patterns have emerged, suggesting that parenting styles, early childhood trauma, genetics, and neurobiology may all play a role in NPD development.

Statistics indicate that males are more likely to be diagnosed with NPD, as 50-75% of people diagnosed with NPD are males. Symptoms of narcissistic personality disorder typically emerge in adolescence; however, many children and adolescents who show symptoms of NPD (likely due to development or environment) do not go on to develop NPD in adult life.


  • Individuals with narcissistic personality disorder are often unaware of their symptoms or do not experience distress as a result. One study found that the pain and suffering associated with narcissistic personality disorder were more consistent and predictably experienced by the significant people in the narcissistic person’s life.
  • Complications of NPD can emerge when the person feels that their image or ego is being threatened, and is disappointed by others for their behavior and perceived lack of admiration. Narcissistic individuals can experience anger outbursts or counterattacks toward the person responsible for the ego damage.
  • People with NPD can experience other mental health issues such as anxiety, depression, suicidal ideation, and anger issues.
  • A person with NPD is more likely to have substance use issues and an increased risk of anger and aggression when using substances.
  • Statistics suggest a higher risk of death by suicide for people with NPD than individuals with other personality disorders.


Diagnosis of a narcissistic personality disorder requires an assessment by a trained mental health or medical professional. There are no approved medications for people with narcissistic personality disorder. Some medications can reduce distress related to other mental health issues, which may occur with NPD, such as anxiety, depression, or bipolar disorder.

Many individuals with narcissistic personality disorder do not believe there is anything wrong or that they need help. As a result, many don’t seek treatment. When people with NPD do receive treatment, it is often for other reasons, such as court-ordered therapy or relationship issues.

Treatment for NPD is challenging as there is limited data suggesting the efficacy of any particular type of psychotherapy. Different types of therapy are used to manage the symptoms since there is no cure. Some therapy modalities include:

  • Cognitive Behavioral Therapy (CBT) – CBT techniques can be useful in reframing thoughts, changing dysfunctional thoughts and beliefs, and modifying dysfunctional behaviors.
  • Psychodynamic Therapy – Psychodynamic therapy aims to explore the narcissistic person’s anger, relational patterns, defensiveness, and grandiosity.
  • Dialectical Behavioral Therapy (DBT) – DBT was developed for individuals with a borderline personality disorder but has been used with people with narcissistic personality disorder too. The therapy focuses on reducing the shame associated with criticism and increasing distress tolerance, mindfulness, and interpersonal effectiveness.

Regardless of the specific treatment, professional counseling is advisable as NPD can put a major strain on one’s relationships, and navigating through possible solutions can be very helpful.

Katie Tyrrell, MS, LPCC

Katie is a licensed professional clinical counselor (LPCC). She has a passion for healing trauma using body-based somatic therapy. Katie believes that healing trauma and restoring physical and emotional health comes from healing the body and nervous system.

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