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

Myth

Narcissistic personality disorder is the same as acting narcissistic

Fact

Acting narcissistic is a part of the human condition. On the other hand, narcissistic personality disorder is classed as a disorder because it is marked by extreme narcissistic symptoms.

Myth

I am pretty sure (insert famous person or someone you know) has narcissistic personality disorder.

Fact

It is incredibly dangerous to diagnose at a distance. Someone exhibiting some narcissistic behaviours does not mean they have narcissistic personality disorder. Narcissistic personality disorder is characterised by a rigid consistency and symptoms that are manifested in a variety of social situations.

Myth

Narcissistic personality disorder is very common.

Fact

While the term narcissism regularly enters common conversation , narcissistic personality disorder is not that common. It only affects between 0.5% and 1% of the general population, with few studies suggesting an upper bound 6% of the population have narcissistic personality disorder.

Myth

Individuals with narcissistic personality disorder are inherently bad

Fact

People with narcissistic personality disorder live with a complex mental health problem. Their behaviours and symptoms make life hard for them and the people around them. It is a symptom or a mental illness, not a moral failing.

How to deal with a narcissist

What to do with a narcissist
What not to do with a narcissist

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.