Narcissistic personality disorder

Narcissistic personality disorder is a mental health condition in which people have an unreasonably high sense of their own importance. They need and seek too much attention and want people to admire them. People with this disorder may lack the ability to understand or care about the feelings of others. But behind this mask of extreme confidence, they are not sure of their self-worth and are easily upset by the slightest criticism.

A narcissistic personality disorder causes problems in many areas of life, such as relationships, work, school or financial matters. People with narcissistic personality disorder may be generally unhappy and disappointed when they're not given the special favors or admiration that they believe they deserve. They may find their relationships troubled and unfulfilling, and other people may not enjoy being around them.

Treatment for narcissistic personality disorder centers around talk therapy, also called psychotherapy.

Narcissistic personality disorder affects more males than females, and it often begins in the teens or early adulthood. Some children may show traits of narcissism, but this is often typical for their age and doesn't mean they'll go on to develop narcissistic personality disorder.

Symptoms of narcissistic personality disorder and how severe they are can vary. People with the disorder can:

• Have an unreasonably high sense of self-importance and require constant, excessive admiration.
• Feel that they deserve privileges and special treatment.
• Expect to be recognized as superior even without achievements.
• Make achievements and talents seem bigger than they are.
• Be preoccupied with fantasies about success, power, brilliance, beauty or the perfect mate.
• Believe they are superior to others and can only spend time with or be understood by equally special people.
• Be critical of and look down on people they feel are not important.
• Expect special favors and expect other people to do what they want without questioning them.
• Take advantage of others to get what they want.
• Have an inability or unwillingness to recognize the needs and feelings of others.
• Be envious of others and believe others envy them.
• Behave in an arrogant way, brag a lot and come across as conceited.
• Insist on having the best of everything — for instance, the best car or office.

At the same time, people with narcissistic personality disorder have trouble handling anything they view as criticism. They can:

• Become impatient or angry when they don't receive special recognition or treatment.
• Have major problems interacting with others and easily feel slighted.
• React with rage or contempt and try to belittle other people to make themselves appear superior.
• Have difficulty managing their emotions and behavior.
• Experience major problems dealing with stress and adapting to change.
• Withdraw from or avoid situations in which they might fail.
• Feel depressed and moody because they fall short of perfection.
• Have secret feelings of insecurity, shame, humiliation and fear of being exposed as a failure.

When to see a doctor

People with narcissistic personality disorder may not want to think that anything could be wrong, so they usually don't seek treatment. If they do seek treatment, it's more likely to be for symptoms of depression, drug or alcohol misuse, or another mental health problem. What they view as insults to self-esteem may make it difficult to accept and follow through with treatment.

If you recognize aspects of your personality that are common to narcissistic personality disorder or you're feeling overwhelmed by sadness, consider reaching out to a trusted health care provider or mental health provider. Getting the right treatment can help make your life more rewarding and enjoyable.

It's not known what causes narcissistic personality disorder. The cause is likely complex. Narcissistic personality disorder may be linked to:

• Environment — parent-child relationships with either too much adoration or too much criticism that don't match the child's actual experiences and achievements.
• Genetics — inherited characteristics, such as certain personality traits.
• Neurobiology — the connection between the brain and behavior and thinking.

Although the cause of narcissistic personality disorder isn't known, some researchers think that overprotective or neglectful parenting may have an impact on children who are born with a tendency to develop the disorder. Genetics and other factors also may play a role in the development of narcissistic personality disorder.

Complications of narcissistic personality disorder, and other conditions that can occur along with it include:

• Relationship difficulties
• Problems at work or school
• Depression and anxiety
• Other personality disorders
• An eating disorder called anorexia
• Physical health problems
• Drug or alcohol misuse
• Suicidal thoughts or behavior

Because the cause of narcissistic personality disorder is unknown, there's no known way to prevent the condition. But it may help to:

• Get treatment as soon as possible for childhood mental health problems.
• Participate in family therapy to learn healthy ways to communicate or to cope with conflicts or emotional distress.
• Attend parenting classes and seek guidance from a therapist or social worker if needed.

Some features of narcissistic personality disorder are like those of other personality disorders. Also, it's possible to be diagnosed with more than one personality disorder at the same time. This can make diagnosis more challenging.

Diagnosis of narcissistic personality disorder usually is based on:

• Your symptoms and how they impact your life.
• A physical exam to make sure you don't have a physical problem causing your symptoms.
• A thorough psychological evaluation that may include filling out questionnaires.
• Guidelines in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Treatment for narcissistic personality disorder is talk therapy, also called psychotherapy. Medicines may be included in your treatment if you have other mental health conditions, such as depression.

Psychotherapy

Narcissistic personality disorder treatment is centered around psychotherapy. Psychotherapy can help you:

• Learn to relate better with others so your relationships are closer, more enjoyable and more rewarding.
• Understand the causes of your emotions and what drives you to compete, to distrust others, and to dislike others and possibly yourself.

The focus is to help you accept responsibility and learn to

• Accept and maintain real personal relationships and work together with co-workers.
• Recognize and accept your actual abilities, skills and potential so you can tolerate criticism or failures.
• Increase your ability to understand and manage your feelings.
• Understand and learn how to handle issues related to your self-esteem.
• Learn to set and accept goals that you can reach instead of wanting goals that are not realistic.

Therapy can be short term to help you manage during times of stress or crisis. Therapy also can be provided on an ongoing basis to help you achieve and maintain your goals. Often, including family members or others in therapy can be helpful.

Medicines

There are no medicines specifically used to treat narcissistic personality disorder. But if you have symptoms of depression, anxiety or other conditions, medicines such as antidepressants or anti-anxiety medicines may be helpful.

You may feel defensive about treatment or think it's unnecessary. The nature of narcissistic personality disorder also can leave you feeling that therapy is not worth your time and attention, and you may be tempted to quit. But it's important to:

• Keep an open mind. Focus on the rewards of treatment.
• Follow your treatment plan. Attend scheduled therapy sessions and take any medicines as directed. Remember, it can be hard work and you may have occasional setbacks.
• Get treatment for alcohol or drug misuse or other mental health problems. Addiction, depression, anxiety and stress can lead to a cycle of emotional pain and unhealthy behavior.
• Stay focused on your goals. Stay motivated by keeping your goals in mind and reminding yourself that you can work to repair damaged relationships and become more content with your life.

You may start by seeing your health care provider, or you may be referred you to a mental health provider, such as a psychiatrist or psychologist.

What you can do

Before your appointment, make a list of:

• Any symptoms you have and how long you've had them, to help determine what kinds of events are likely to make you feel angry or upset.
• Key personal information, including traumatic events in your past and any current major stressors.
• Your medical information, including other physical or mental health conditions you have.
• Any medicines, vitamins, herbs or other supplements you're taking, and the doses.
• Questions to ask your mental health provider so that you can make the most of your appointment.

Consider taking a trusted family member or friend along to help remember the details. In addition, someone who has known you for a long time may be able to ask helpful questions or share important information.

Some basic questions to ask your mental health provider include:

• What do you think may be causing my symptoms?
• What are the goals of treatment?
• What treatments are most likely to be effective for me?
• In what ways do you think my quality of life could improve with treatment?
• How often will I need therapy sessions, and for how long?
• Would family or group therapy be helpful in my case?
• Are there medicines that can help my symptoms?
• I have other health conditions. How can I best manage them together?
• Are there any brochures or other printed materials that I can have? What websites do you recommend?

Don't hesitate to ask any other questions during your appointment.

What to expect from your mental health provider

To better understand your symptoms and how they're affecting your life, your mental health provider may ask:

• What are your symptoms?
• How do your symptoms affect your life, including school, work and personal relationships?
• How do you feel — and act — when others seem to criticize or reject you?
• Do you have any close personal relationships? If not, why do you think that is?
• What are your major accomplishments?
• What are your major goals for the future?
• How do you feel when someone needs your help?
• How do you feel when someone expresses difficult feelings, such as fear or sadness, to you?
• How would you describe your childhood, including your relationship with your parents?
• Have any of your close relatives been diagnosed with a mental health disorder, such as a personality disorder?
• Have you been treated for any other mental health problems? If yes, what treatments were most effective?
• Do you use alcohol or recreational drugs? If so, what do you use and how often?
• Are you currently being treated for any other medical conditions?