Narcissistic personality disorder is a mental disorder in which people have an inflated sense of their own importance, a deep need for admiration and a lack of empathy for others. But behind this mask of ultraconfidence lies a fragile self-esteem that's vulnerable to the slightest criticism.

A narcissistic personality disorder causes problems in many areas of life, such as relationships, work, school or financial affairs. You may be generally unhappy and disappointed when you're not given the special favors or admiration you believe you deserve. Others may not enjoy being around you, and you may find your relationships unfulfilling.

Narcissistic personality disorder treatment is centered around talk therapy (psychotherapy).

Narcissistic personality disorder is one of several types of personality disorders. Personality disorders are conditions in which people have traits that cause them to feel and behave in socially distressing ways, limiting their ability to function in relationships and other areas of their life, such as work or school.

If you have narcissistic personality disorder, you may come across as conceited, boastful or pretentious. You often monopolize conversations. You may belittle or look down on people you perceive as inferior. You may feel a sense of entitlement — and when you don't receive special treatment, you may become impatient or angry. You may insist on having "the best" of everything — for instance, the best car, athletic club or medical care.

At the same time, you have trouble handling anything that may be perceived as criticism. You may have secret feelings of insecurity, shame, vulnerability and humiliation. To feel better, you may react with rage or contempt and try to belittle the other person to make yourself appear superior. Or you may feel depressed and moody because you fall short of perfection.

Many experts use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, to diagnose mental conditions. This manual is also used by insurance companies to reimburse for treatment.

DSM-5 criteria for narcissistic personality disorder include these features:

  • Having an exaggerated sense of self-importance
  • Expecting to be recognized as superior even without achievements that warrant it
  • Exaggerating your achievements and talents
  • Being preoccupied with fantasies about success, power, brilliance, beauty or the perfect mate
  • Believing that you are superior and can only be understood by or associate with equally special people
  • Requiring constant admiration
  • Having a sense of entitlement
  • Expecting special favors and unquestioning compliance with your expectations
  • Taking advantage of others to get what you want
  • Having an inability or unwillingness to recognize the needs and feelings of others
  • Being envious of others and believing others envy you
  • Behaving in an arrogant or haughty manner

Although some features of narcissistic personality disorder may seem like having confidence, it's not the same. Narcissistic personality disorder crosses the border of healthy confidence into thinking so highly of yourself that you put yourself on a pedestal and value yourself more than you value others.

When to see a doctor

When you have narcissistic personality disorder, you may not want to think that anything could be wrong — doing so wouldn't fit with your self-image of power and perfection. People with narcissistic personality disorder are most likely to seek treatment when they develop symptoms of depression — often because of perceived criticisms or rejections.

If you recognize aspects of your personality that are common to narcissistic personality disorder or you're feeling overwhelmed by sadness, consider reaching out to a trusted doctor or mental health provider. Getting the right treatment can help make your life more rewarding and enjoyable.

It's not known what causes narcissistic personality disorder. As with other mental disorders, the cause is likely complex. Narcissistic personality disorder may be linked to:

  • Mismatches in parent-child relationships with either excessive pampering or excessive criticism
  • Genetics or psychobiology — the connection between the brain and behavior and thinking

Narcissistic personality disorder is rare. During childhood and teen years, children may show traits of narcissism, but this may simply be typical of their age and doesn't mean they'll go on to develop narcissistic personality disorder.

Narcissistic personality disorder affects more males than females, and it often begins in the teens or early adulthood.

Although the cause of narcissistic personality disorder isn't known, some researchers think that in biologically vulnerable children, parenting styles that overemphasize the child's specialness and criticize fears and failures may be partially responsible. The child may hide low self-esteem by developing a superficial sense of perfection and behavior that shows a need for constant admiration.

Complications of narcissistic personality disorder, if left untreated, can include:

  • Relationship difficulties
  • Problems at work or school
  • Depression
  • Drug or alcohol abuse
  • Suicidal thoughts or behavior

You may start by seeing your doctor, or your doctor may immediately refer you to a mental health provider, such as a psychiatrist.

What you can do

Before your appointment, make a list of:

  • Any symptoms you're experiencing and for how long, to help determine what kinds of events are likely to make you feel angry or defeated
  • Key personal information, including traumatic events in your past and any current major stressors
  • Your medical information, including other physical or mental health conditions with which you've been diagnosed
  • Any medications, vitamins or other supplements you're taking and the dosages
  • Questions to ask your mental health provider so that you can make the most of your appointment

Take a trusted family member or friend along, if possible, to help remember the details. In addition, someone who has known you for a long time may be able to ask helpful questions or share important information with the mental health provider.

Some basic questions to ask your mental health provider include:

  • What exactly is narcissistic personality disorder?
  • Could I have other mental health conditions?
  • What is the goal of treatment?
  • What treatments are most likely to be effective for me?
  • How much do you expect my quality of life may improve with treatment?
  • How frequently will I need therapy sessions, and for how long?
  • Would family or group therapy be helpful in my case?
  • Are there medications that can help?
  • I have these other health conditions. How can I best manage them together?
  • Are there any brochures or other printed materials that I can have? What websites do you recommend?

Don't hesitate to ask questions at any time during your appointment.

What to expect from your mental health provider

The mental health provider is likely to ask you many questions to gain an understanding of your symptoms and how they're affecting your life. He or she may ask:

  • What are your symptoms?
  • When do these symptoms occur, and how long do they last?
  • How do your symptoms affect your life, including school, work and personal relationships?
  • How do you feel — and act — when others seem to criticize or reject you?
  • Do you have any close personal relationships? If not, how do you explain that lack?
  • What are your major accomplishments?
  • What are your major goals for the future?
  • How do you feel when someone needs your help?
  • How do you feel when someone expresses difficult feelings, such as fear or sadness, to you?
  • How would you describe your childhood, including your relationship with your parents?
  • Have any of your close relatives been diagnosed with a mental health problem, such as a personality disorder?
  • Have you been treated for any other mental health problems? If yes, what treatments were most effective?
  • Do you use alcohol or illegal drugs? How often?
  • Are you currently being treated for any other medical conditions?

Narcissistic personality disorder is diagnosed based on:

  • Signs and symptoms
  • A thorough psychological evaluation that may include filling out questionnaires
  • A physical exam to make sure you don't have a physical problem causing your symptoms

Some features of narcissistic personality disorder are similar to those of other personality disorders. Also, it's possible to be diagnosed with more than one personality disorder at the same time.

Psychotherapy

Narcissistic personality disorder treatment is centered around talk therapy, also called psychotherapy. Psychotherapy can help you:

  • Learn to relate better with others so your relationships are more intimate, enjoyable and rewarding
  • Understand the causes of your emotions and what drives you to compete, to distrust others, and perhaps to despise yourself and others

Because personality traits can be difficult to change, therapy may take several years. Areas of change are directed at helping you accept responsibility and learning to:

  • Accept and maintain real personal relationships and collaboration with co-workers
  • Recognize and accept your actual competence and potential so you can tolerate criticisms or failures
  • Increase your ability to understand and regulate your feelings
  • Understand and tolerate the impact of issues related to your self-esteem
  • Release your desire for unattainable goals and ideal conditions and gain an acceptance of what's attainable and what you can accomplish

Medications

There are no medications specifically used to treat narcissistic personality disorder. However, if you have symptoms of depression, anxiety or other conditions, medications such as antidepressants or anti-anxiety drugs may be helpful.

You may feel defensive about treatment or think it's unnecessary. The nature of narcissistic personality disorder can also leave you feeling that therapy is not worth your time and attention, and you may be tempted to quit.

However, it's important to:

  • Keep an open mind. Focus on the rewards of treatment.
  • Stick to your treatment plan. Attend scheduled therapy sessions and take any medications as directed. Remember, it can be hard work and you may have occasional setbacks.
  • Learn about it. Educate yourself about narcissistic personality disorder so you can better understand symptoms, risk factors and treatments.
  • Get treatment for substance abuse or other mental health problems. Your addictions, depression, anxiety and stress can feed off each other, leading to a cycle of emotional pain and unhealthy behavior.
  • Learn relaxation and stress management. Try stress-reduction techniques, such as meditation, yoga or tai chi. These can be soothing and calming.
  • Stay focused on your goal. Recovery from narcissistic personality disorder takes time. Stay motivated by keeping your recovery goals in mind and reminding yourself that you can work to repair damaged relationships and become happier with your life.

Because the cause of narcissistic personality disorder is unknown, there's no known way to prevent the condition. However, it may help to:

  • Get treatment as soon as possible for childhood mental health problems
  • Participate in family therapy to learn healthy ways to communicate or to cope with conflicts or emotional distress
  • Attend parenting classes and seek guidance from therapists or social workers if needed
Nov. 18, 2014