Just about all of us show some narcissistic traits, some of the time—we crave attention, put our own needs first, or think we are special. Teenagers in particular can be narcissistic—it’s part of their growth process.
But most of the time, most of us can empathize with others, admit our mistakes, and keep our achievements in perspective. This is not the case with people who have a narcissistic personality disorder (NPD)—they are excessively self-involved and disregard other people’s needs.
Srinivas Dannaram, MD, a psychiatrist with Banner Health, said that in people with NPD, you’ll see these personality traits or symptoms of narcissistic personality, which are listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM):
- They think highly of themselves (inflated sense of self-importance), exaggerate achievements and expect to be recognized as superior—they consider themselves high-status people.
- They fantasize about their success, power, brilliance, beauty or perfect love.
- They believe they are special and can only be understood by other special people (or institutions).
- They demand admiration.
- They have a sense of entitlement and expect favorable treatment.
- They take advantage of others to achieve their goals.
- They lack empathy and don’t try to identify with the needs of others.
- They envy others or believe others envy them.
- They are arrogant.
In a subtype categorized as “vulnerable narcissism,” people can be hypersensitive and defensive. “The vulnerable subtype is often easy to miss,” Dr. Dannaram said.
Signs of a narcissist
Get together a group of 16 people; odds are, one is a narcissist. One study found that 6.2% of people in the U.S. have symptoms of NPD at some point in their lives.
If you know someone who’s a narcissist, you’ll probably see that they struggle in their relationships. “People with this disorder want their way,” Dr. Dannaram said. “They can make others furious by the refusal to obey conventional rules of behavior.”
It’s common for them to exploit the people they’re close to through manipulative behavior. They aren’t capable of empathy, but they can feign sympathy and sometimes do so to get what they want. They expect special treatment because they consider themselves superior to others. They handle criticism poorly, so they might get enraged when someone criticizes them or act indifferent to criticism. They can be ambitious; striving for the fame or fortune they believe they deserve.
They may appear confident, secure and have high self-esteem, but underneath that façade, they are fragile and suffer from feelings of insecurity, so they can be susceptible to depression, anxiety, self-harm, and substance abuse. And their narcissistic behavior can lead to interpersonal difficulties, problems at work, rejection and loss.
Who’s likely to be a narcissist?
Narcissism is more common in men than women, and genetics may play a role in who develops NPD. Persons with NPD tend to show some signs as young children: They can be aggressive, tolerate distress poorly, struggle to regulate their emotions and have fragile egos.
Being rejected as a child, or being excessively praised as a child, could also lead to narcissistic personality disorder.
Treatment of narcissistic personality disorder
“According to the American Journal of Psychiatry, there’s no standardized pharmacological or psychological treatment for NPD,” Dr. Dannaram said. And many narcissists don’t seek treatment since they don’t recognize their behavior as a problem. “They don't have insight into their behaviors, so they lack empathy. It’s very difficult to engage them in therapy or counseling,” he said.
Those who do look for support might try these types of talk therapy or medication:
- Transference-focused therapy is twice-a-week therapy where a person with narcissism expresses their emotions toward the therapist. Since people with narcissistic personality disorder can be provoked by how they feel others treat them, it’s essential for them to examine their feelings towards others, according to the International Journal of Psychoanalysis.
With transference-focused therapy, as a person with NPD projects emotions or expectations onto their therapist, the therapist and patient work together to recognize negative patterns or ideas and develop more positive alternatives.
- Schema-focused therapy is a relatively new therapy that focuses on alternate forms of cognitive-behavioral therapy, including activating emotional senses, according to the German Journal Progress in Neurology-Psychiatry.
The premise behind schema-focused therapy is that when people have emotional needs that aren’t met during childhood, they have poor methods for coping with these needs as adults. This type of therapy helps people identify and modify these poor coping methods.
- Psychodynamic therapy, which may be needed long-term. In psychodynamic therapy, counselors help people gain insight into their lives and problems by examining beliefs, thoughts, emotions and life experiences. “In psychodynamic therapy, a focus on defenses will help people with NPD,” Dr. Dannaram said.
- Medications. While there are no US Food and Drug Administration (FDA) approved medications to treat narcissism, many people may benefit from treating symptoms and other mental health conditions, including anxiety, depression, mood swings, intermittent psychosis and impulse control issues.
“More often than not, people with NPD also have other mood disorders,” Dr. Dannaram said. “They are very vulnerable to mental health issues and substance abuse, which make things worse.” Medications that can treat these symptoms include antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), antipsychotics such as risperidone, and mood stabilizers like lamotrigine.
How to cope with a narcissist in your life
Whether it’s a spouse, child, friend, colleague or boss, you’ll likely have a relationship with a narcissist at some point. And since most narcissists don’t see their attitudes or behavior as an issue, you may need to develop your own strategies for handling them.
Dr. Dannaram shares these tips:
- In conversations with a narcissist, focus on the content without reacting emotionally. “Emotional reaction is a reward for a narcissist,” he said.
- Avoid open, direct criticism, which can provoke anger. Focus on positive aspects as a way to comment on negative aspects. For example, a narcissist may get irritable when you remind them of not meeting deadlines. So, you can ask them how they handle colleagues who are not meeting deadlines. When they respond, you can paraphrase what they said, gently ask if they implement the same strategy and ask what outcome they get.
- Hold them accountable. Narcissists boost their egos by coming up with ideas and plans but fail to accomplish them. When planning a task, clearly define roles and document responsibilities, since narcissists often don’t take the blame for their inconsistencies.
- Maintain strict boundaries no matter what type of relationship you have with the person. Don't accept any behaviors you find dominating or unacceptable.
- Practice self-care and be aware of your own emotions and needs, especially if you’re in an emotional relationship with a narcissist. “People around narcissists tend to experience high levels of anxiety and issues with self-esteem and self-confidence, which can lead to depression,” Dr. Dannaram said.
The bottom line
Narcissistic personality disorder is common, and people with it often struggle with their relationships and with other mental health conditions. If you think you or someone you love may show symptoms of NPD, a mental health professional can help.
Need help diagnosing, treating or coping with narcissism?
Call the Banner Behavioral Health Appointment Line at (800) 254-4357.
