Narcissistic Personality Disorder - Mental Health Disorders - Merck Manuals Consumer Version (2024)

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Causes of Narcissistic Personality Disorder

Genes and environmental factors may contribute to the development of narcissistic personality disorder. One theory suggests that caregivers may have interacted with the child in a way that did not help the child develop a stable sense of self. For example, caregivers may have been overly critical of or praised, admired, or indulged the child too much.

Some people with narcissistic personality disorder have special gifts or talents and become used to associating their self-image and sense of self with the admiration and esteem of others.

Symptoms of Narcissistic Personality Disorder

Grandiosity

People with narcissistic personality disorder overestimate their abilities and exaggerate their achievements (called grandiosity). They think they are better than others, unique, or special. When they overestimate their own worth and achievements, they often also underestimate the worth and achievements of others.

Fantasies of specialness

People with this disorder are preoccupied with fantasies of great achievements—of being admired for their overwhelming intelligence or beauty, of having prestige and influence, or of experiencing a great love. They feel they should associate only with others as special and talented as themselves, not ordinary people. They use this association with extraordinary people to support and enhance their self-esteem.

Need for admiration

Because people with narcissistic personality disorder need to be excessively admired, their self-esteem depends on being thought well of by others. Thus, their self-esteem is usually very fragile. They are often watching to see what others think of them and evaluating how well they are doing.

People with narcissistic personality disorder are sensitive to and bothered by criticism by others and by failure, which makes them feel humiliated and defeated. They may respond with rage or contempt, or they may viciously counterattack. Or they may withdraw or outwardly accept the situation in an effort to protect their sense of self-importance. They may avoid situations in which they can fail.

Diagnosis of Narcissistic Personality Disorder

A doctor's evaluation, based on standard psychiatric diagnostic criteria

Doctors usually diagnose personality disorders based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th ed, Text Revision (DSM-5-TR Classification and Diagnosis of Mental Illness In 1980, the American Psychiatric Association published the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), marking the first attempt to approach... read more ), the standard reference for psychiatric diagnosis from the American Psychiatric Association.

For doctors to diagnose narcissistic personality disorder, people must persistently have an inflated view of self-worth, a need for admiration, and a lack of empathy, as shown by at least 5 of the following:

They have an exaggerated, unfounded sense of their own importance and talents (grandiosity).
They are preoccupied with fantasies of unlimited achievements, influence, power, intelligence, beauty, or perfect love.
They believe that they are special and unique and should associate only with people of the highest caliber.
They need to be unconditionally admired.
They feel entitled.
They exploit others to achieve their own goals.
They lack empathy.
They envy others and believe that others envy them.
They are arrogant and haughty.

Also, symptoms must have begun by early adulthood.

Treatment of Narcissistic Personality Disorder

Psychotherapy

The general principles for treatment Treatment Personality disorders are mental health conditions that involve long-lasting, pervasive patterns of thinking, perceiving, reacting, and relating that cause the person significant distress and/or... read more of narcissistic personality disorder are the same as those for all personality disorders.

Psychodynamic psychotherapy Psychodynamic psychotherapy Extraordinary advances have been made in the treatment of mental illness. As a result, many mental health disorders can now be treated nearly as successfully as physical disorders. Most treatment... read more can be effective. This type of psychotherapy focuses on underlying conflicts.

Some approaches developed for borderline personality disorder may be adapted and used to treat people with narcissistic personality disorder. They include

Mentalization-based treatment Psychotherapy , which helps people reflect on and understand their own state of mind (what they are feeling and why) and the state of mind of others
Transference-focused psychotherapy Psychotherapy , which centers on the interaction between the person and the therapist

These approaches focus on disturbances in the ways people emotionally experience themselves and others.

Cognitive-behavioral therapy Psychotherapy Extraordinary advances have been made in the treatment of mental illness. As a result, many mental health disorders can now be treated nearly as successfully as physical disorders. Most treatment... read more may appeal to people with narcissistic personality disorder. Their need for praise may enable a therapist to shape their behavior.

Drugs Mentioned In This Article

Generic Name	Select Brand Names
cocaine	GOPRELTO, NUMBRINO

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