Narcissism or narcissistic personality disorder is a mental health disorder. It is characterised by excessive feelings of self importance, craving for admiration and a poor ability to empathise with the feelings of others. Narcissistic personality disorder is a subtype of a broader category of health disorders known as personality disorders. Personality disorders are characterised by enduring and harmful patterns of behaviour that deviate away from norms accepted by any culture.
In an emergency
If you are concerned about suicide risk for a person with NPD, then seek medical advice urgently.
If you need help, talking to your doctor is a good place to start. If you’d like to find out more or talk to someone else, here are some organisations that can help:
- SANE Australia (people living with a mental illness) — call 1800 187 263.
- Beyond Blue (anyone feeling depressed or anxious) — call 1300 22 4636 or chat online.
- Black Dog Institute (people affected by mood disorders) — online help.
- Lifeline (anyone having a personal crisis) — call 13 11 14 or chat online.
- Suicide Call Back Service (anyone thinking about suicide) — call 1300 659 467.
Narcissistic personality disorder should possess at least five of the following:
- Grandiose sense of self-importance
- Requiring excessive admiration
- Preoccupation with fanatics of unlimited success, power, brilliance, beauty or ideal love
- Believing that they are unique and special can only be understood by or associate with other special or high-status people (or institutions)
- A sense of entitlement (unreasonable expectations of especially favourable treatment or automatic compliance with their expectations)
- Being interpersonally exploitative (taking advantage of others to achieve their own ends)
- Lacking empathy (unwilling to recognize or identity with the feelings and needs of others)
- Often being envious of others or believing that others are envious of them
- Showing arrogant, haughty behaviours or attitudes
There are two subtypes of narcissism:
Narcissism: The Numbers
In a review of 437 studies of narcissism and aggression involving a total of over 123,000 participants, narcissism was found to be related to a 21 percent increase in aggression and an 18 percent increase in violence (Kjærvik, S. L., & Bushman, B. J., 2021)
About 15% of people with narcissistic personality disorder also have depression, 13.5% have anxiety and around 17% have another mood disorder (The Journal of Clinical Psychology).
Bipolar disorder is also fairly common among people with narcissistic personality disorder. About 17% of people with pathological narcissism also have either bipolar I or bipolar II.
About 14% of people with narcissistic personality disorder also have an alcohol use disorder, while 24% misuse other types of drugs (Journal of Clinical Psychology, 2009).
Causes and Risk Factors
Environmental factors, such as culture or parenting, may contribute to the development of narcissistic personality disorder.
Research conducted in 2018 found that narcissism scores were higher in individualistic cultures than they were in collectivistic cultures. In the same study, researchers compared narcissistic traits among people who had grown up in former West Germany (an individualistic culture) to those who had grown up in former East Germany (a more collectivist culture).
Childhood experiences may also play a role in developing narcissistic personality disorder. Negative childhood experiences like rejection or neglect may contribute to narcissistic personality disorder in adulthood. At the same time, too much praise from parents could also lead to narcissistic personality disorder.
There is a link between different parenting styles and narcissistic traits in adult children. While no “one” parenting style leads to narcissism, combinations of parenting behaviours contributing factors may coalesce to cause narcissistic personality disorder.
The follow parenting factors are positively correlated with higher levels of narcissism in children:
- Overprotective or “helicopter parenting”
- Lack of warmth
- Setting few limits or boundaries (leniency)
- Praise that promotes perfection or unrealistic expectations (overvaluation)
- Maltreatment or abuse
Genetics may also play a role in contributing to Narcissistic Personality Disorder (NPD). In a 2014 study involving 304 pairs of twins, researchers found that some NPD traits were somewhat heritable. Grandiosity was 23% heritable while entitlement was 35% heritable. However, these traits seemed to exist independently of each other.
Risk factors for narcissistic personality disorder are somewhat complex. Narcissistic personality disorder has been linked to a number of things, including parenting and environmental factors, as well as genetics but all in a variety of combinations.
Certain parenting styles could be a risk factor for higher levels of narcissism in children. However, they have often been studied in isolation or in different combinations, and with mixed findings.
Furthermore, simply being male may be a slight risk factor, as narcissistic personality disorder is diagnosed more often in men.
The Fact & the Fiction
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How to deal with a narcissist
- Educate yourself: Finding out more about narcissistic personality disorder can help you better understand the narcissist’s strengths and weaknesses, as well as learn how to handle them better. Knowing how a clinically diagnosed narcissist behaves may allow you to accept the situation for what it is and have realistic emotions.
- Create boundaries: It is important to be clear about your boundaries. Even though it may upset or disappoint the narcissist, it is not your job to control that person’s emotions. Your emotions and mental well-being should be your priority.
- Speak up for yourself: When you need something, be clear and concise. It is important to make sure they understand your request well.
- Watch your wording: Narcissists do not take constructive criticism very well. You should make comments in careful and positive ways.
- Stay calm: Do not react if they try to pick a fight or gaslight you – that is make you doubt your own reality. If a narcissist lashes out, try to think of them as a child who has been told to do something they do not want to do.
- Create a support system: Living or regularly engaging with a narcissist can lead to feelings of insecurity, confusion, and self-doubt. It is important to have a core group of people in your life that can support you.
- Get Help: While therapy may not cure narcissism, a counselor may assist in approaching problem-solving with the narcissist.
- Do not argue or confront: Confronting a narcissist may cause more harm than good. While it may be difficult to constantly navigate around their needs and conditions, it can be better to manage their need to feel in charge.
- Do not try to direct them: Narcissists like to have control and often fear losing it, meaning efforts to lead or instruct a narcissist will often fail.
- Do not expect them to see your point of view: Narcissists do not like to admit that they are wrong or that they are unlovable. Therefore, trying to sway their perspective is often ineffective.
- Do not expect deep, meaningful conversations: Narcissists have very little empathy. Honest or heartfelt communication often does not get through and can create an angry outburst or shutdown response.
- Do not go over past issues: Narcissists are unable to recognise or acknowledge a long line of behaviour dating back years. Instead, stay in the present and express requests or hurt feelings
How is narcissistic personality disorder managed?
Psychotherapy, or talking to a therapist, is the most useful treatment approach, although more research is required to determine the most effective therapies. The aim is to develop a more realistic self-image and enable the person to relate to others more positively. The type of therapy used can include:
Psychodynamic therapy — long-term individual therapy that helps a person to understand their behaviours, moods and disruptive thoughts. These insights can help them find better ways to relate to others.
Cognitive behaviour therapy (CBT) — helps people identify negative, unhelpful behaviour patterns and replace them with more productive and positive ones.
Family or marital therapy — narcissistic personality disorder can affect families. Coming together for a session can help people in dealing with relationships, with problem-solving solutions and positive communication.