What Is Narcissism? Symptoms, Causes, Diagnosis, Treatment, and Prevention

The term “narcissism” is commonly used to describe anyone who is self-absorbed. Someone who exhibits narcissistic traits may have a personality disorder known as narcissistic personality disorder (NPD).

A personality disorder affects the way a person thinks, behaves, and relates to others. According to the American Psychiatric Association, the essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits.

When Is Narcissism a Personality Disorder?

Holly Crisp-Han, MD, a psychiatrist and clinical associate professor at Baylor College of Medicine in Houston and the co-author of Narcissism and Its Discontents, says everyone has narcissistic tendencies from time to time.

However, those tendencies become a personality disorder when a person’s ability to function and engage with others is affected.

“The clinical manifestation of narcissism is narcissistic personality disorder,” says Ramani Durvasula, PhD, a professor emerita of psychology at California State University in Los Angeles. “This is a persistent and pathological pattern and causes the person distress and dysfunction.”

• Considering themselves very important
• Not taking criticism well
• Having an outsized sense of their own potential success
• Having a need to be admired

“If feeling superior or having grandiose ideas about your place in the world is getting in the way of your living a happy life, it’s time to talk to a mental health professional to discuss treatment to help you live your best life,” says Dr. Crisp-Han.

Grandiose narcissism is associated with displays of superiority, entitlement, and extraverted behavior. Vulnerable narcissism also involves self-absorbed behavior, but it is associated with self-consciousness, insecurity, and introversion.

• An exaggerated sense of self-importance
• A sense of entitlement
• Requiring excessive and constant admiration
• Behaving in an arrogant manner that is perceived as conceited, boastful, or pretentious
• An exaggeration of talents and achievements
• A preoccupation with fantasies about beauty, power, and success
• Feeling superior and seeking relationships only with similarly accomplished people
• A tendency to monopolize conversations
• Looking down on and belittling people
• Taking advantage of others
• An unwillingness or inability to recognize others’ feelings and needs
• Envy of others
• A belief that others are jealous
• An insistence on having the best, in terms of property and position

• Becoming angry or impatient if they don’t get special treatment
• Feeling easily slighted
• Reacting with rage or contempt to make oneself seem superior
• Difficulty regulating emotions and behavior
• Difficulty dealing with stress and handling change
• Feeling depressed if they fall short of their own expectations
• Secret feelings of insecurity, shame, vulnerability, and humiliation

• Environmental (receiving too much adoration or criticism early in life from parents, for example)
• Genetic
• Neurobiological

Crisp-Han explains that years ago many psychiatrists thought narcissism was caused by parents not providing children with enough love or attention. Now we understand that not recognizing and helping children manage setbacks can also be problematic, she says.

Narcissism is more common in men than women. It can often begin in teenage years or early adulthood.

While children can display narcissistic tendencies, it may be more an indication of their age and stage of development.

In fact, it is normal for a very small child to be narcissistic and believe that small accomplishments are major and that they are the center of the universe. While it is good for parents to indulge this age-appropriate narcissism, it becomes developmentally important in later years to help older children recognize others’ feelings and accomplishments.

There are no lab tests to diagnose narcissism.

• An in-depth psychological evaluation
• An assessment of criteria for diagnosis based on the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

A diagnosis of NPD in the DSM-5 includes these criteria, according to PsychDB:

• Has a grandiose sense of self-importance
• Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
• Believes that they are special and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
• Requires excessive admiration
• Has a sense of entitlement
• Is interpersonally exploitative (such as taking advantage of others to achieve his or her own ends)
• Lacks empathy — is unwilling to recognize or identify with the feelings and needs of others
• Is often envious of others or believes that others are envious of them
• Shows arrogant, haughty behaviors or attitudes

A diagnosis of narcissism requires that these personality traits continue over time, are consistent in different situations, are not normal based on the person’s stage of development or their social or cultural environment, and are not the result of drug or alcohol use or a medication the person is taking.

Prognosis of Narcissism

The outcome for people with NPD might depend on different factors, such as how severe their condition is, whether they have other psychiatric disorders, and how they respond to treatment.

Psychotherapy can help someone with NPD relate to other people in a more compassionate and positive way. How effective the treatment will be depends on how severe the condition is.

Individual, couples, or group therapy can help people with NPD learn some of these new emotional skills:

• Accepting and maintaining personal and work relationships
• Recognizing and accepting what they can and can’t do, so that it’s easier to handle criticism or failures
• Understanding and regulating feelings
• Understanding and regulating issues of self-esteem
• Not pursuing goals that aren’t reachable, and embracing goals that are

Cognitive behavioral therapy (CBT) can be very helpful for people with narcissism. CBT is a type of psychotherapy that focuses on strategies and solutions to change unhelpful thoughts and harmful behavior patterns.

People with narcissism may not initially see the value in therapy or have difficulty sticking with their treatment.

Crisp-Han points out that managing the condition “can take a long time, and the person must really want treatment.”

Medication Options

• Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), sertraline (Zoloft), or paroxetine (Paxil)
• Mood stabilizers, such as lithium
• Antipsychotic medicines, such as aripiprazole (Abilify) or risperidone (Risperdal)

For parents concerned about their children developing NPD, it might be helpful to:

• Get prompt treatment for any childhood mental health issues
• Take part in family therapy sessions
• Attend parenting classes (if you have children)

The disorder is more common in men (7.7 percent) than women (4.8 percent).

The study found that NPD is much more common among younger people, as well as in people who never married or are widowed, separated, or divorced.

• Histrionic personality disorder (patients with this disorder act provocatively to gain attention)
• Borderline personality disorder
• Antisocial personality disorder

Cleveland Clinic

The Cleveland Clinic is a go-to source for Everyday Health editors, and their page on NPD provides a wealth of helpful info for understanding this mental health condition.

Mayo Clinic

Another trusted source, the Mayo Clinic covers all of the basics of NPD — symptoms, diagnosis, treatment — as well as what to expect from and what questions to ask your mental health provider.

Merck Manual

For up-to-date and in-depth coverage on just about any given medical issue, check out the Merck Manual, whether for NPD or other personality disorders. For each topic, they offer patient education materials along with a professional version on the subject for healthcare providers.

Out of the Fog

Out of the Fog is an online community for family members and loved ones of those with personality disorders. In addition to resources about personality disorders and how to cope with the challenges, it offers a discussion forum with a range of relevant topics.