A lot of people throw around the word “narcissist,” whether it’s to describe an ex-partner or a grandstanding politician. However, there’s plenty of misinformation about what narcissism is and, on a related note, what it actually means to have the mental health condition narcissistic personality disorder (NPD). Let’s set some facts straight.
1. Narcissism is a personality trait that centers around being self-involved, and it exists on a spectrum.
Just as people vary in how spontaneous, independent, thoughtful, or protective they are, people can also vary in how narcissistic—meaning how selfish, self-absorbed, or obsessed with themselves—they are.
“Healthy self-esteem and pride in one's accomplishments [are] a good thing,” psychologist Angela Grace, Ph.D., tells SELF. “However, further along the spectrum of narcissism can be a sense of exaggerated self-importance, grandiosity to the point of exploitation, and lack of empathy for others.”
Even this doesn’t necessarily indicate a potential mental health problem. “People who don't have any ‘disorder’ can still have narcissistic tendencies,” Alice Frye, Ph.D., a licensed clinical psychologist and associate teaching professor at UMass Lowell, tells SELF. These tendencies may become more pronounced when someone is under stress or during other emotionally trying times, Frye says. However, narcissism becomes a disorder when someone experiences it so persistently that it affects their life on a regular basis.
2. Narcissistic personality disorder revolves around a prolonged, inflated sense of self, lack of empathy for others, and related symptoms.
NPD is listed as a personality disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Per the Merck Manual, people who have NPD persistently exhibit at least five of the following symptoms by early adulthood:
- An overwhelming sense of self-importance
- An obsession with fantasies about being incredibly successful, powerful, intelligent, attractive, or loved
- A belief that they are more special and unique than others
- A need for excessive admiration
- A strong sense of entitlement
- A habit of constantly taking advantage of other people
- A lack of empathy toward others
- An envy of others
- A haughty attitude
3. Experts believe NPD’s characteristic outsized self-esteem is rooted in a person’s low opinion of themselves.
As the Mayo Clinic explains, this exaggerated self-confidence seems to be a way of overcompensating for flimsy self-esteem. “An inflated sense of self … is actually a protection people with NPD use to cover up extreme hurt they are embarrassed or feel guilty about,” psychiatrist Laura Dabney, M.D., tells SELF.
This is why, as the Mayo Clinic notes, people with NPD can have a really hard time handling criticism—they’re already critical of themselves.
4. It’s not entirely clear how common NPD is.
Since there’s a pretty significant dearth of research on the subject, there are no solid numbers on how prevalent NPD is. The DSM-5 says that estimates range from 0 to 6.2 percent of the population having NPD, which is kind of confusing. Here’s the deal.
The DSM-5 cites a 2010 review of studies in Comprehensive Psychiatry for these numbers. This review looked at seven different studies published between January 1980 and August 2008 involving a total of 49,812 adults and found a mean NPD prevalence of 1.06 percent.
The 0 to 6.2 percent range comes from two of these studies that both had large, nationally representative samples and found significantly different results. In a study from 2007 that was published in Biological Psychiatry, researchers conducted face-to-face interviews with 9,282 adults and concluded that, actually, 0 percent of them met the criteria for NPD. But a 2008 study published in the Journal of Clinical Psychiatry that involved researchers conducting face-to-face interviews with 34,653 adults found that 6.2 percent of participants met the diagnostic criteria for NPD.
The takeaway? More research is needed before experts can pinpoint just how prevalent NPD really is.
5. It does seem as though narcissistic traits and NPD are more common in men than in women.
A massive 2014 review in Psychological Bulletin investigated the gender differences in narcissism to interesting results. After examining 31 years of narcissism research that included 470,846 participants, the study authors concluded that, on average, men were more likely to exhibit narcissistic traits such as entitlement and a quest for power.
To be clear, this review was looking at aspects of narcissism as a personality trait, not narcissistic personality disorder. For instance, men and women showed about the same level of self-absorption, another personality trait that is a cornerstone of NPD. With that said, it appears that this gender-based trend with narcissism as a personality trait corresponds with the actual personality disorder since the Mayo Clinic notes that NPD is more prevalent in men.
The study authors explain that a lot of these personality differences may be ingrained culturally. For instance, the outdated societal expectation is that men are more likely to be natural leaders, so they may be more inclined to seek power. More research is necessary to fully delve into possible social and biological factors behind gender differences in narcissism and NPD.
6. Experts are not sure exactly what causes NPD.
“Little is known about narcissistic personality disorder’s causal factors,” Anthony DeMaria, Ph.D., a clinical psychologist and assistant professor of psychiatry at Mount Sinai Hospital, tells SELF.
Some people may be genetically predisposed to developing NPD, the Mayo Clinic says. The condition is also likely linked to brain chemistry in some way. A small 2010 study in Journal of Psychiatric Research studied brain images from 34 people, half with NPD and half without. The researchers found that those with NPD had less gray matter in parts of the brain connected with empathy such as the left anterior insula, but there’s no definitive evidence to this link as of yet.
Kids who are already biologically predisposed to NPD might also be at an increased risk if they grow up with overprotective or neglectful parents, according to the Mayo Clinic. DeMaria offers up the examples of a parent who calls their child “a huge disappointment” for getting a B on a test, or a parent who excuses their child’s acting out by saying that’s just how they are. “Neither scenario would foster healthy and adaptive behaviors or a stable sense of self," DeMaria explains.
7. NPD can be tough to diagnose because there aren’t easy tests for it, and it shares symptoms with other disorders.
Even though NPD symptoms can appear in adolescence, experts typically wait until adulthood to make a diagnosis, DeMaria says. This helps make sure those “symptoms” aren’t just due to a person being self-involved as they grow up then becoming better adjusted as an adult.
There’s no lab test that can provide a diagnosis of NPD. Instead, a mental health professional can use interviews or questionnaires to see if someone is showing the NPD symptoms listed in the DSM-5, the Cleveland Clinic explains.
To make things trickier, NPD has symptoms in common with other mental health conditions, clinical psychologist John Mayer, Ph.D., tells SELF. For instance, antisocial personality disorder can also cause a sense of superiority and lack of empathy. That’s part of why thorough diagnostic questioning is so important.
8. Therapy can help someone with NPD, but only if they’re willing to put in the work.
DeMaria says that NPD is “one of the hardest-to-treat psych conditions.”
According to the Mayo Clinic, there are no FDA-approved medications available for treating personality disorders like NPD, likely because scientists don’t fully understand which parts of the brain or chemical imbalances may contribute. (However, people with NPD might take medication for co-occurring mental health issues like anxiety and depression.)
Instead, treatment for NPD revolves around therapy. The problem is that people who have NPD may avoid admitting that something is going on with them, let alone see a therapist. “If you believe that you deserve special treatment and are above everyone else,” Grace posits, “why on earth would you seek treatment for what you perceive to be everyone else's problem?”
Still, you don’t have to assume all hope is lost if you think a loved one has NPD. In Dabney’s experience, people with NPD seek treatment due to the ways their difficulty relating to people can manifest, like repeatedly getting fired, losing contact with their grown children, or struggling to maintain intimate relationships.
“If a loved one can stress to someone with NPD that mental health treatment can help with their relationships, that might work,” Dabney says. If the person in question is someone really close to you like a partner, Dabney suggests setting up a joint therapy appointment and saying something like, “Our relationship is in trouble, and I've made an appointment for us to see a counselor on this date and this time. I hope you'll come, because we will be talking about you, among other things.” In Dabney’s experience, this has worked every time.
NPD treatment is considered a success when a person can understand that they have strengths and weaknesses, as do other people, DeMaria says. Learning to interact with others in a healthier way is also a main goal, Dabney says. This doesn’t necessarily mean that a person with NPD will completely leave these personality traits behind, but with dedication to reframing how they view themselves and others, they may be able to live more balanced lives.
9. NPD is widely misunderstood, so educating yourself and others about what narcissism really means is important.
Mayer says that people often conflate NPD with someone who is “spoiled” or poorly socialized, but it’s much more than that. Unfortunately, the “narcissist” label is still persistently “overstated, overused and misapplied,” he says.
“Narcissistic personality disorder is a serious diagnostic label,” Frye says. “It should be used very cautiously and only by a professional.”