Narcissistic Personality Disorder

What is narcissistic personality disorder?

  • Narcissistic personality disorder (NPD) is a chronic (lifelong) mental condition. With NPD, your thoughts and behaviors cause problems with your relationships. You feel that you are better and smarter than everyone else. You may act out in ways that cause problems with your daily life activities, such as work and school. With NPD, you need to be the center of attention and feel that you should be loved by other people. You have trouble caring about others and their feelings. You want to control the people and events in your life.

  • With NPD, acting like you are better than others may help hide a low self-esteem. With NPD, you do not like to be told you are wrong. You may act out meanly if others do not treat you as you feel you should be treated. You only do nice things for others if you will be rewarded right away. When you have NPD, you cannot stop your behaviors even if it is hurtful to others. It is hard for you to trust others, and you have trouble asking for help.

What causes narcissistic personality disorder?

NPD commonly occurs in males between the ages of 20 to 30. You may start to show signs of NPD as a child or teenager. The exact cause of NPD is unknown. Caregivers believe you may have an increased risk for NPD if you were raised under the following conditions:

  • You grew up in a home where people had very few good things to say.

  • You had parents who did not act lovingly toward you.

  • You had parents who did everything for you, and gave you whatever you wanted.

  • You had parents who expected you to be the best at everything you did.

How is narcissistic personality disorder diagnosed?

  • Psychiatric assessment: Caregivers will ask if you have a history of psychological trauma, such as physical, sexual, or mental abuse. They will ask if you were given the care that you needed. Caregivers will ask you if you have been a victim of a crime or natural disaster, or if you have a serious injury or disease. They will ask you if you have seen other people being harmed, such as in combat. You will be asked if you drink alcohol or use drugs at present or in the past. Caregivers will ask you if you want to hurt or kill yourself or others. How you answer these questions can help caregivers decide on treatment. To help during treatment, caregivers will ask you about such things as how you feel about it and your hobbies and goals. Caregivers will also ask you about the people in your life who support you.

  • Discussion and physical exam: Your caregiver may also ask about your family's health history. Tell your caregiver about any medical conditions that you have. Your caregiver may do a physical exam. Your caregiver will ask you about your relationships with other people. Mental health testing may also be done so your caregiver can learn more about how you think and feel. Your caregiver will diagnose you with NPD if you have five or more of the following:

    • You feel that you have great self-importance. You may say you have talents or have done things that you have not. You feel people around you should praise you even if you have not done something to deserve it.

    • You often think about having great successes, power, beauty, and good relationships.

    • You feel you are very special, and should only be around people who are as special as you.

    • You need to be highly appreciated and praised by others.

    • You feel others should always agree with your way of thinking or doing things. You believe others should treat you better than anyone else.

    • You feel it is okay to use other people in order to get what you want.

    • You do not care about the needs or feelings of others around you.

    • You are jealous of others who you feel have more than you do. You believe others want to be you, or want to have what you have.

    • You act as though others are beneath you, and you are often critical of others.

What other behaviors might I have with narcissistic personality disorder?

You may have any of the following:

  • Anxiety (constant worry).

  • Depression (deep sadness).

  • Rage (severe anger).

How is narcissistic personality disorder treated?

With NPD you may not believe you have an illness. You may also feel that your caregiver is not good at what he does. You may question your caregiver about why he is worthy of caring for you. Treatment for NPD may help you learn more about your condition. Treatment may help you learn why you behave the way you do, and help you learn how change your behaviors. Treatment may also help you learn how to have good relationships with other people. You may need the following:

  • Therapies:

    • Cognitive behavior therapy: In cognitive behavior therapy (CBT), you and your caregiver will work together to learn the reasons you are narcissistic. Your caregiver will work with you to slowly change how you act. You will work with your caregiver to decrease your feelings of anger. You will learn ways to cope with what others say to you that you feel is not true. You and your caregiver will work together to help you become more sensitive to other people's feelings. Ask your caregiver for more information about CBT.

    • Psychotherapy: During psychotherapy, a caregiver will work with you to help you see your own self-worth. During this time, you and your caregiver may talk about how to cope with your illness.

    • Family therapy: During family therapy, your caregivers will meet with you and your family. You will all talk about how to cope with your illness.

    • Group therapy: During group therapy, you will attend many meetings with other patients and staff. During these meetings, patients and staff talk together about ways to cope with illness.

  • Medicines: Medicines may be needed if you have symptoms of depression, anxiety, or other problems. You may need any of the following:

    • Antianxiety medicine: This medicine may be given to decrease anxiety and help you feel calm and relaxed.

    • Anti-depressant medicine: This medicine is given to decrease or stop the symptoms of depression. It can also be used to treat other behavior problems.

    • Anti-psychotics: This medicine is usually given to decrease the symptoms of severe (very bad) agitation.

What are the risks of having narcissistic behavior disorder?

Choosing not to seek treatment for NPD may increase your risk for the following:

  • Alcohol abuse: Alcohol abuse occurs when you drink too much alcohol, too often. Alcohol includes beer, wine, whiskey, and other adult drinks.

  • Drug abuse: Drug abuse includes taking street drugs such as cocaine. Drug abuse also occurs if you are taking prescription medicines that are not yours, such as pain medicines.

  • Major depressive disorder: Major-depressive disorder occurs when you have feelings of deep sadness and emptiness. You may not want to be a part of your daily activities, and you may not feel like living.

  • Relationship problems: You are at a greater risk of having lifelong problems with intimate and other relationships. It may also be hard for you to keep a job for a long period of time.

What can I do to help myself when I have narcissistic personality disorder?

  • Keep all appointments with your caregiver.

  • Go to your follow-up visits on time.

  • Take your medicine exactly as your caregiver tells you to.

  • Talk to your family or friends about what to do if you feel like hurting yourself or others.

Where can I find support and more information?

Learning as much as you can about NPD may help you learn to cope better with your illness. Contact the following:

  • Mental Health America
    2000 N. Beauregard Street, 6th Floor
    Alexandria , VA 22311
    Phone: 1- 703 - 684-7722
    Phone: 1- 800 - 969-6642
    Web Address:

When should I call my caregiver?

Call your caregiver if:

  • You have started drinking alcohol, or are drinking more alcohol than usual.

  • You have started taking street drugs.

  • You are taking medicines that were not prescribed to you by your caregiver.

  • You have questions or concerns about your condition, treatment, or care.

When should I seek immediate help?

Seek care immediately or call 911 if:

  • You feel like hurting yourself or others.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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