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Narcissistic Personality Disorder: Signs and Treatment


Narcissistic Personality Disorder (NPD) is the last Cluster B personality disorder (PD). The key characteristics of NPD are inflated self-worth, a lack of empathy for others, and a constant search for excessive admiration. It is very common for individuals with NPS to suffer from one or more comorbid conditions.

Prevalence

In the general population, the prevalence of NPD is reported to be around 6.2%. However, academic literature stresses that there is a lack of reliable reports. Research indicates that the rates of NPD are higher for men (around 7.7%) than they are for women (4.8%). Note that these rates are from a US sample, so the prevalence in other countries may be different.

The rates of NPD in this sample suggest that the prevalence is higher for black men, Hispanic women, young adults, and people who are single (separated, divorced, or never married). The rates of NPD are also significantly higher for people with other conditions, such as other PDs, substance use disorders, or mood and anxiety disorders.

As mentioned before, individuals with NPD often suffer from one or more comorbid disorders. The most common comorbidity diagnosed in individuals with NPD is major depressive disorder. The second most common comorbidity for those with NPD is bipolar disorder, which is diagnosed in around 5-11% of people with NPD.

Causes

The causes of NPD are unknown. However, as with most PDs, it is suggested that several factors play a role in the development of this condition:

  1. Genetics: Family studies suggest that individuals with a family history of NPD are more likely to develop this disorder. Twin studies support these findings, indicating that the heritability of NPD ranges from moderate to high.
  2. Environmental: Some reports suggest that individuals are at a higher risk of NPD if the relationship with their parents or caregivers has been impaired.
  3. Developmental: In some cases, it is suggested that NPD may be a result of impaired emotional development. While an individual's intellectual and physical development is intact, their emotional capacity remains childlike. This is especially the case for their ability to have feelings such as remorse, guilt, empathy, and compassion.

Symptoms

NPD is a heterogeneous disorder, meaning that it can manifest itself differently in terms of severity and symptoms. The signs and symptoms of NPD manifest in early adulthood and, if untreated, will persist across the lifespan. People with this disorder will exhibit several of the following characteristics:

  • An inflated sense of self-importance
  • Inability to take criticism
  • Feelings of entitlement
  • A constant search for excessive admiration
  • Thoughts of themselves as superior
  • Extensive bragging and exaggeration of their achievements and talents
  • Extensive daydreaming about success, power, brilliance, beauty, or the perfect mate
  • The assignment of “value” to others and refusal to socialize with people who are not worthy
  • Looking down, insulting, or ignoring people they perceive as inferior
  • Monopolizing conversations and turning them toward themselves
  • Expectations of special treatment
  • Expectations that others will agree with and obey them
  • Manipulating others for their own gain
  • Exhibiting a lack of compassion and remorse
  • The expression of exaggerated jealousy (towards others or themselves)
  • Acting in an arrogant, pretentious, or haughty manner
  • Having difficulty regulating emotions and behaviors

It is suggested that individuals with NPD experience difficulties in at least two of the following areas: individuality, self-direction, empathy, or closeness.

Treatment

Individuals with NPD rarely acknowledge their behaviors are problematic, so they primarily seek out help for comorbid conditions and not NPD.

The first line of treatment for NPD is therapy, with individual psychotherapy being the most effective for this disorder. Other therapies can be applied, such as cognitive behavioral therapy (CBT), group therapy, or family therapy. However, family and group therapies are rarely recommended as primary treatments since NPD results in the need for attention and poor interpersonal abilities.

In some cases, pharmacological treatment accompanies therapy, but this is mainly the case for patients with comorbid conditions such as depression. The treatment for NPD is primarily outpatient therapy, since studies indicate that long term inpatient care gives little to no benefit to the prognosis. Inpatient care is necessary in cases where an individual becomes a threat to themselves or others. Individuals with NPD, especially those who are suffering from depression, are at an increased risk of self-harm.

If you believe your loved one is suffering from NPD, you might want to suggest contacting a mental health professional. Given that individuals with NPD rarely recognize or admit that their behaviors are problematic, they need encouragement to seek help. With successful treatment, individuals with NPD can live a full and successful life. But, if they do not seek the appropriate help, they are at risk of having difficulties, which will affect their job as well as romantic and social relationships.

Key takeaways:

Narcissistic Personality Disorder (NPD) causes symptoms such as an inflated self-worth, lack of empathy, and the need for constant admiration.

NPD is caused by genetics, environmental factors, and impaired emotional development.

Depression is the most common NPD comorbidity, but bipolar disorder and substance use disorder may also be present in those with NPD.

Outpatient therapy is the most effective treatment for NPD, but group therapy, family therapy, and medication may also be effective in some cases.

References:

American Psychiatric Association. (2013). Personality disorders. In Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition ed.). Washington, DC: American Psychiatric Publishing Inc.

Okoye, H. Narcissistic Personality Disorder DSM-5 301.81 (F60. 81)(2022).

Pincus, A. L., & Lukowitsky, M. R. (2010). Pathological narcissism and narcissistic personality disorder. Annual review of clinical psychology, 6(1), 421-446.

Yakeley, J. (2018). Current understanding of narcissism and narcissistic personality disorder. BJPsych advances, 24(5), 305-315.

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