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Narcissistic personality disorder

Narcissistic personality disorder (NPD) is a mental health condition characterized by a pervasive pattern of grandiosity, need for admiration, lack of empathy, and distorted self-image. People with NPD often have difficulties in interpersonal relationships, work, and other aspects of life. They may also experience low self-esteem, shame, guilt, anger, or depression when their unrealistic expectations are not met. NPD is estimated to affect about 1% of the general population, and is more common in men than in women. This article discusses the causes, diagnosis and treatment of narcissistic personality disorder.

What is Narcissistic personality disorder?

Narcissistic personality disorder (NPD) is a mental disorder that affects how a person thinks, feels, and behaves. People with NPD have an inflated sense of their own importance, a deep need for admiration, and a lack of empathy for others. They often have difficulties in relationships, work, and other aspects of life because they are unable to understand or care about the feelings and needs of others. They may also exploit or manipulate others to achieve their own goals or boost their self-esteem.

People with NPD usually develop this condition in early adulthood, but the exact causes are not well understood. Some possible factors that may contribute to NPD include genetic changes, brain structure or function abnormalities, parenting styles that are either too indulgent or too harsh, and family history of mental health disorders.

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Diagnosis of narcissistic personality disorder

NPD is diagnosed based on the criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which include:

  • Having a grandiose sense of self-importance
  • Exaggerating one’s achievements and talents
  • Expecting to be recognized as superior without commensurate achievements
  • Believing that one is special and unique and can only be understood by or associate with other special or high-status people or institutions
  • Requiring excessive admiration
  • Having a sense of entitlement
  • Being interpersonally exploitative
  • Lacking empathy
  • Being envious of others or believing that others are envious of one
  • Showing arrogant, haughty behaviours or attitudes

To be diagnosed with NPD, a person must have at least five of these criteria and show significant impairment or distress in social, occupational, or other important areas of functioning.

Causes of narcissistic personality disorder

The causes of NPD are not fully understood, but they are likely to involve a complex interaction of biological and environmental factors. Some possible causes of NPD are:

  • Genetics. NPD may be influenced by inherited traits, such as certain personality characteristics or temperaments that predispose individuals to narcissism.
  • Environment. NPD may be shaped by early childhood experiences, such as parent-child relationships that are either excessively indulgent or neglectful, abusive, or inconsistent. These experiences may affect the development of self-esteem, identity, and emotional regulation in children.
  • Culture. NPD may be influenced by social and cultural norms that emphasize individualism, success, appearance, and fame. These norms may foster a sense of entitlement, superiority, or envy in some people.
Similarities with other mental health disorders

Some other mental health problems that show similarities to NPD are:

  • Bipolar disorder: This is a mood disorder that involves alternating episodes of mania and depression. mania is a state of elevated mood, energy, and activity, often accompanied by inflated self-esteem, grandiose ideas, and reduced need for sleep. Some people with bipolar disorder may exhibit narcissistic traits during manic episodes, such as arrogance, entitlement, and disregard for others. However, unlike NPD, bipolar disorder also involves depressive episodes, which are characterized by low mood, low self-esteem, and loss of interest or pleasure in activities. Moreover, bipolar disorder is not a stable personality trait, but a fluctuating mood state that can be influenced by biological factors, environmental triggers, and treatment.
  • Obsessive-compulsive personality disorder (OCPD): This is a personality disorder that involves a preoccupation with orderliness, perfectionism, and control. People with OCPD tend to have rigid and unrealistic standards for themselves and others, and may become angry or frustrated when these standards are not met. They may also have difficulty delegating tasks, expressing emotions, and being flexible or spontaneous. Some people with OCPD may show narcissistic tendencies, such as believing that they are superior or special, demanding admiration or recognition, and being intolerant of criticism or feedback. However, unlike NPD, OCPD is not driven by a fragile or inflated self-esteem, but by a compulsive need for structure and certainty. Additionally, people with OCPD are usually aware of their problems and may seek help or improvement.
  • Delusional disorder: This is a psychotic disorder that involves holding false beliefs that are not based on reality and are resistant to correction. People with delusional disorder may have delusions of various types, such as persecutory (believing that they are being harmed or harassed by others), grandiose (believing that they have exceptional abilities or achievements), erotomanic (believing that someone is in love with them), or jealous (believing that their partner is unfaithful). Some people with delusional disorder may display narcissistic features, such as exaggerating their importance or influence, expecting special treatment or favours, and lacking empathy or remorse. However, unlike NPD, delusional disorder is not a personality disorder, but a severe mental illness that impairs one’s ability to distinguish reality from fantasy. Furthermore, people with delusional disorder usually do not have a coherent or consistent sense of self, but rather a fragmented or distorted one.
Treatment of narcissistic personality disorder

Treatment options for Narcissistic personality disorder (NPD) vary depending on the individual’s needs and goals. However, some of the common approaches include:

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  • Psychotherapy: This is the main form of treatment for NPD, as it can help the person understand the causes and effects of their narcissistic traits, develop empathy and compassion for others, and improve their self-esteem and relationships. Psychotherapy can be delivered in different formats, such as individual, group, family, or couples therapy. Some of the specific types of psychotherapy that may be helpful for NPD are cognitive behavioural therapy (CBT), dialectical behaviour therapy (DBT), schema therapy, and mentalization-based therapy (MBT).
  • Medication: There is no medication specifically designed to treat NPD, but some drugs may be prescribed to address co-occurring conditions, such as depression, anxiety, or substance use. Some of the common medications used for these conditions are antidepressants, antianxiety drugs, and mood stabilizers. Medication should be used with psychotherapy and under the guidance of a qualified health professional.
  • Self-care: In addition to professional treatment, people with NPD can benefit from practising self-care strategies that can enhance their well-being and coping skills. Some of these strategies are: maintaining a healthy lifestyle, such as eating well, exercising regularly, and getting enough sleep; seeking support from trusted friends, family members, or peers; engaging in hobbies and activities that bring joy and fulfilment; avoiding alcohol and drugs that can worsen symptoms or interfere with treatment; and learning to manage stress and emotions in healthy ways.

Narcissistic personality disorder is a complex and challenging condition that requires long-term and consistent treatment. There is no cure for NPD, and the prognosis depends on the severity of the disorder, the willingness of the person to engage in treatment, and the availability of social support. However, with the right support and motivation, people with NPD can achieve positive changes and improve their quality of life.

self-transcendence for narcissistic personality disorder

Self-transcendent practices are activities that involve going beyond one’s personal ego and connecting with something greater, such as nature, spirituality, humanity, or a higher purpose. Examples of self-transcendent practices include meditation, prayer, volunteering, altruism, and awe-inducing experiences. These practices have been shown to have positive effects on psychological well-being, such as reducing stress, enhancing happiness, increasing meaning in life, and fostering prosocial behaviour.

However, whether self-transcendent practices would be beneficial for people with NPD is not straightforward. On one hand, self-transcendent practices could potentially help people with NPD to overcome their narcissistic tendencies and develop a more balanced and realistic sense of self. They could also foster a greater sense of compassion and empathy for others, which could elevate their social relationships and reduce their feelings of isolation and loneliness. On the other hand, self-transcendent practices could also pose some risks or challenges for people with NPD. For instance, they could trigger feelings of inferiority, insecurity, or shame in people with NPD who have a fragile self-esteem and a fear of being exposed as inadequate or flawed. They could also be used as a way of escaping from or avoiding their personal problems or responsibilities, or as a means of enhancing their narcissistic image or reputation by appearing more spiritual or altruistic than others.

Therefore, the answer to whether self-transcendent practices would be beneficial for people with NPD depends on several factors, such as the type, frequency, intensity, and motivation of the practice; the level of severity and insight of the disorder; the availability and quality of professional and social support; and the individual’s goals and expectations. It is important to note that self-transcendent practices are not a substitute for psychotherapy or medication, which are the main treatments for NPD. Rather, they should be considered as complementary or adjunctive interventions that may enhance the effectiveness of other therapies or facilitate the recovery process. Moreover, self-transcendent practices should be tailored to the specific needs and preferences of each person with NPD, considering their strengths and weaknesses, values and beliefs, and readiness and willingness to change.

Further reading

If you would like to learn more about narcissistic personality disorder, here are some suggested links:

Mayo Clinic. Narcissistic personality disorder – Symptoms and causes.

Mind. Types of personality disorder.

Wikipedia. Narcissistic personality disorder.

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