Narcissistic personality disorder has become a controversial condition, mainly because it’s often misunderstood. It’s also been stigmatized as a personal choice of behavior, which it’s not.

People with narcissistic personality disorder (NPD) are often regarded as self-centered, lacking empathy, and having a great need for attention and recognition. But underneath this apparent sense of superiority are other important aspects at play.

People with NPD can face challenges in their relationships because of how they’re perceived and how they act.

Counseling and professional support can sometimes help them find a different way to connect to others and manage the shifts in mood that may characterize this personality disorder.

Help is available if you or someone you love is exploring an NPD diagnosis. You might find this article and the resources listed at the end a good starting point.

NPD is a formal mental health diagnosis and not just a type of personality or a personal choice.

Understanding this difference is key to managing the formal symptoms of narcissism and supporting someone who’s received this diagnosis.

A mental health condition, including a personality disorder, affects how someone feels, thinks, and behaves.

In turn, this can deeply affect day-to-day living and how people function in their relationships, at work, and in general.

Researchers have found that, specifically, someone with NPD may have a lower ability than others to acknowledge and understand how and why they think and behave the way they do.

Similarly, they may have a difficult time relating to what other people feel or do.

As a cluster B personality disorder, NPD is mainly characterized by behaviors that are:

  • dramatic and exaggerated
  • emotional and intense
  • erratic and unpredictable

Not everyone with narcissistic personality behaves in the same way. This is, in part, because there are different types of narcissism.

Most of us will display at least one narcissistic trait at some point in our lives. These may be considered narcissistic behaviors or attitudes, but they differ from a personality disorder in severity, frequency, and duration.

There are many personality traits, such as generosity and discretion, for example. They show to a greater or lesser degree in all of us. The same thing happens with a narcissistic trait.

Narcissism, or at least some aspects of it, could be a personality trait in some people.

In others, the severity and intensity of these narcissistic traits is such that it permanently affects and hurts how they relate to others and themselves.

Narcissism as a personality trait might occasionally appear in some of our behaviors or thoughts.

For example, you could have an ongoing rivalry with a co-worker. This might lead you to make snarky comments around them or exaggerate the praise you received from your boss when they’re around. Maybe you even give them an unfairly poor review at some point.

But this is an occasional reaction related to this specific co-worker instead of a generalized attitude toward everyone else all the time.

On the other hand, narcissism in someone with NPD is a persistent and characteristic trait.

For example, you have an ongoing rivalry with all your co-workers and even your boss. You think you’re more intelligent and capable than them, and you should be the one in a higher role.

This happened to you in your last two jobs. In general, you feel you’re far superior to the people you encounter at school, work, and other places.

Remember that NPD is a mental health condition. It doesn’t refer to someone:

  • having high self-esteem
  • displaying social confidence
  • being assertive
  • being proud of their real accomplishments
  • taking care of their physical appearance
  • being competitive
  • disliking you

NPD is one of 10 personality disorders. These are a group of mental health conditions characterized by persistent thoughts, emotions, and behaviors that may be harmful to the person with the disorder or to others.

In general, a mental health professional diagnoses a personality disorder if at least these two criteria are met:

  1. Personality traits make it difficult for that person to relate and connect to other people or themselves. For example, how they control their own behavior or how they respond emotionally to other people.
  2. Pathological personality traits keep showing up and across many different situations.

“Pathological,” in mental health terms, refers to thoughts, emotions, or behaviors that negatively affect how a person sees, relates, and adapts to the world around them.

Pathological may also refer to traits caused by a mental or physical condition that aren’t expected or accepted in the culture they live in.

Not all personality disorders show the same symptoms or pathological personality traits. This is why they’re classified into three different groups, or clusters.

This classification is based on their most representative personality traits:

  • Cluster A: odd and eccentric
  • Cluster B: dramatic and erratic
  • Cluster C: fearful and anxious

NPD is part of the cluster B personality disorders.

More specifically, doctors diagnose narcissism when a person shows five or more specific symptoms.

These NPD symptoms have been established by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association. It’s a handbook mental health professionals use as a classification reference for making accurate diagnoses.

Not everyone with narcissistic personality will have these symptoms in the same degree or intensity, but five of them need to be present over time and across different situations for a diagnosis to be made.

Even though there’s still no consensus, some experts believe that fragility, fear, and low self-esteem could explain some NPD symptoms.

Grandiosity and self-importance

Exaggeration is often the basis for grandiosity. This means that people with NPD tend to have an inflated sense of self-importance. They may feel they’re more powerful, intelligent, capable, and charming than they really are and more than other people in general.

To reaffirm this sense of superiority, someone with narcissistic personality may exaggerate or lie about their accomplishments, skills, and talents.

For some people with NPD, this sense of superiority isn’t as evident in how they behave. Some may be shy or withdrawn, but they may still firmly believe they’re superior in one or many aspects compared to other people.

Fantasies of perfection and superiority

People with narcissistic personality may constantly fantasize about having unlimited power, intelligence, beauty, acceptance, or love. They often believe they deserve it more than others.

Sense of specialness and uniqueness

People with NPD may have the need to highlight how special and unique they are in comparison to everyone else.

This also leads them to believe they can only be understood by or associate with other special and unique people and groups.

If someone doesn’t “get them,” it’s because they’re not as smart, special, or unique.

Need for praise and attention

People with narcissistic personality may have a constant need to be admired and praised. They might seek constant attention and might not take well to any form of criticism.

They may also resent others who don’t think what they’re doing and saying is exceptional.

Strong sense of entitlement

Someone with NPD may be convinced they deserve special treatment and have the right to all the available privileges.

Similarly, people with NPD might feel everyone should comply with their expectations and demands.

A tendency to exploit others

Manipulation and exploitation tactics are very common in many people with narcissistic personality. This means they may take advantage of others to achieve their own goals because there’s a need for personal gain above everything else.

People with NPD might also use strategies such as spreading lies about others in order to get ahead.

In many instances, a person with NPD may turn to cruelty when they feel their needs aren’t met, or if someone doesn’t treat them the way they expect.

Lack of empathy

Someone with NPD might be unable to connect with the needs of others or put themselves in someone else’s shoes. This is one of the main reasons why they might behave in a cruel or exploitative way.

This lack of empathy might also show as selfishness, disregard, and lack of compassion for what others are experiencing or feeling.

Jealousy, envy, and distrust

People with this personality disorder usually believe others are competing with them or are envious of who they are. In the same way, they may often compete with others or feel envious of their accomplishments.

Arrogance and scorn

Some people with narcissistic personality may disregard others as worthless, ridiculous, or despicable. This belief may lead them to display an attitude of arrogance and scorn.

It’s now accepted that there are different levels and types of narcissism.

Mainly, experts focus on two different subtypes of NPD.

Overt narcissism

This subtype of narcissism, also called grandiose narcissism, is the most recognized. It’s mainly characterized by attitudes and behaviors that are:

  • arrogant
  • pretentious
  • dominant
  • exhibitionist
  • aggressive
  • self-assured

Covert narcissism

This other subtype of narcissism refers to people whose attitudes and behaviors are more typically:

  • anxious
  • overly sensitive, particularly in regard to criticism
  • insecure
  • defensive
  • depressive
  • withdrawn

Even if this type of narcissism is less obvious, someone with covert narcissism will still exhibit self-absorbed behaviors, secretly believe they’re superior to everyone else, and have a decreased ability to put themselves in other people’s shoes.

Narcissistic personality is one of the least studied personality disorders. This makes understanding its causes and treatment options more difficult.

There’s little agreement within the medical community regarding what really causes someone to develop NPD.

Most researchers believe NPD is a response to a combination of two or more of these factors:

  • environmental and cultural influences
  • early life experiences and the parent-child bond
  • genetics

In other words, someone may have developed narcissistic traits as a response to the specific situations they’ve experienced since very early in life, like:

  • a traumatic event
  • negligence and abandonment
  • excessive criticism from a loved one
  • living with a parent or guardian with a mental health condition
  • abuse of any kind
  • discrimination
  • excessive pampering and praising
  • a medical history of NPD in the family
  • growing up in an individualistic culture

Not everyone will respond in the same way to these events. That’s why it’s difficult for researchers to determine the exact causes of a personality disorder.

Also, these same reasons might lead someone to behave in a certain way that may be perceived as narcissistic, even if it’s not NPD.

The diagnosis of NPD should be left to a mental health professional only.

It might be tempting to evaluate someone you know based on this information, but in reality, narcissism goes far beyond a few behaviors or attitudes. It’s impossible for someone not formally trained and educated to make a proper diagnosis.

A psychiatrist, psychologist, or another mental health professional typically makes an NPD diagnosis after having direct access to the person and their medical history.

Even for a mental health professional, it might not be as easy in some instances to diagnose NPD. This is because it’s rare for someone with NPD to commit to seeking help, openly talk about their thoughts, or even attend a therapy session.

A mental health professional might follow the DSM-5 model to diagnose NPD. They’ll then observe and measure the following:

  • individual personality traits
  • how the person functions in the world (relationships, jobs, etc.)
  • sense of identity
  • self-esteem and changes related to their self-image over time
  • if the person is capable of empathy

The mental health professional will try to identify five or more of the symptoms of NPD. If they do, they’ll be able to make a diagnosis and recommend treatment accordingly.

Even though teenagers may display early signs of the disorder, NPD is usually diagnosed in adulthood.

This is because children and adolescents are still under constant physical and mental development. These ongoing personality changes at an early age might make it difficult to recognize lasting patterns of behavior.

If an NPD diagnosis is made during adolescence, it’s because there’s a clear pattern of behavior that’s been evident for more than 1 year.

There’s been some controversy regarding how NPD is diagnosed.

This is mostly because many mental health professionals have focused on the most visible interpersonal behaviors of those with NPD and not enough on the inner struggles, vulnerabilities, and challenges they live with. This sometimes leads to judgment instead of understanding.

Experts estimate that about 5.3% of the U.S. population has NPD. It’s an estimate because a diagnosis depends on many factors, including how willing a person is to seek a diagnosis and treatment. This might not be the case for many people with the disorder.

NPD diagnoses are more common among men than women. Fifty to 75% of people diagnosed with NPD are male.

Therapy has the potential to help someone with NPD develop skills and strategies that can help them change the way they relate to others and themselves.

The challenge is that many people with personality disorders don’t often seek treatment until the disorder starts to significantly interfere or otherwise impact their lives.

People with NPD are sometimes more likely to develop other mental health conditions, such as:

In many cases, they might seek help to treat these conditions and not NPD itself.

Sometimes, a person with NPD may seek treatment for reasons other than believing they have an issue. For example, when they feel conflicted because their relationships or way of living isn’t up to their own high standards. Or when they feel they’re losing someone’s admiration or interest.

When someone with NPD comes to therapy for these reasons, they’re not aware these difficulties might come from their own personality traits. They might blame others for their issues and may see therapy as a place to vent, not wanting to accept any responsibility.

Even when NPD treatment is sought, clinical case studies suggest people with NPD have difficulty staying in therapy long enough to lead to long-term changes in behavior.

For one, people with NPD may face challenges interacting with other people in general, which shows in the therapist-client setting. Also, they may not often recognize they have a problem.

Sometimes when a person with NPD stays in therapy, they may show slow progress and be reluctant to change because of the disorder’s core personality traits. Since they might not accept responsibility, they may find no valid reason to change.

In any case, long-term psychotherapy seems to be the most effective treatment for NPD.

When the person commits to long-term treatment, a therapist may be able to help them:

  • regulate and understand their own emotions
  • identify behaviors and attitudes that may lead to conflict with other people
  • develop the ability to prevent and change these behaviors
  • manage reactions to criticism and feedback
  • develop skills to build more intimate and stable relationships
  • develop adaptive coping mechanisms
  • explore, tolerate, and understand other people’s perspectives

These goals are specific to every case and vary according to the person’s needs and the therapist’s approach.

Many psychotherapy approaches have been used to treat NPD. The most common ones include:

  • psychoanalytic psychotherapy
  • cognitive behavioral therapy
  • schema-focused psychotherapy
  • metacognitive interpersonal psychotherapy
  • dialectical behavior therapy

Whether you or someone you love wants to explore treatment for NPD, many resources are available to help you find support. The following organizations can point you in the right direction:

Narcissistic personality disorder (NPD) is a formal mental health diagnosis. It’s not a personal choice of behaviors. It requires a proper diagnosis by a mental health professional.

Although there are different subtypes of NPD, the most common symptoms are a strong sense of entitlement and superiority, need for attention, and lack of empathy.

These symptoms can have a direct impact on how the person relates to others and themselves.

People can manage NPD symptoms when they’re committed to staying in therapy long term. Treatment can help regulate emotions and change hurtful behaviors to healthy ones.