Narcissistic Personality Disorder: Causes, Symptoms & Treatments

What Is Narcissistic Personality Disorder?

Narcissistic Personality Disorder (NPD) is commonly defined as a persistent pattern of grandiosity (in fantasy or behavior), a need for admiration, and a lack of empathy. It is notably characterized by several key elements, including: illusions of self-importance; an obsession with fantasies of enormous success, fame, love, beauty, or wealth; a belief in being unique or special; a desire for constant praise; a sense of entitlement; manipulative behavior; lack of compassion; jealousy of others; and increasingly arrogant or egocentric attitudes (Skodol, Bender, & Morey, 2014).

Features and Symptoms of NPD

NPD is typically indicative of vulnerable self-esteem, in which attention-seeking and a desire for constant praise are prominent features, alongside overt and covert illusions of grandeur. There are also difficulties with identity, intimacy, empathy, self-direction, and certain maladaptive traits of antagonism (Skodol, Bender, & Morey, 2014). The following characteristics inform the diagnosis of NPD:

A. Moderate or significant impairment in personality functioning, manifesting in two or more of the following areas:

1. Identity: Excessive reference to others for self-definition and self-esteem regulation. Self-appraisal may be inflated or deflated, or may shift between both extremes. Emotional experience fluctuates alongside self-esteem.

2. Self-direction: Goal-setting is driven by the need for external validation. Personal standards are either excessively high — reflecting a desire to see oneself as exceptional — or unreasonably low, reflecting a sense of entitlement. The individual is largely unaware of his or her own motivations.

3. Empathy: Impaired ability to recognize or identify with the feelings and needs of others. The individual is attuned to others' reactions but only as they relate to the self; he or she may overestimate or underestimate the impact of their own behavior on others.

4. Intimacy: Interpersonal relationships are largely superficial and maintained to serve self-esteem regulation. There is minimal genuine interest in others' experiences, with relationships primarily serving personal gain.

B. Pathological personality traits in the following domain:

1. Grandiosity (a facet of Antagonism): Feelings of entitlement are pervasive, whether expressed overtly or covertly. The individual holds an inflated sense of self and may be condescending toward others.

2. Attention-seeking (a facet of Antagonism): A persistent drive to attract the attention and admiration of those around them.

The core features of NPD are a fluctuating and sensitive sense of self-esteem, combined with persistent attempts to secure approval and attention while harboring covert or overt illusions of grandeur. Impairment must reach a clinically significant threshold, and at least two of the four areas of self and interpersonal functioning must be affected. Individuals with NPD are predominantly self-focused, and their goals often exist primarily to elicit positive responses from others (Skodol, Bender, & Morey, 2014).