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Narcissistic Personality Disorder

The term “Narcissistic Personality” is currently popping up a lot in the news, so I thought it would be a good subject for an article. Any time a mental health diagnosis begins to surface regularly in popular culture, distortions and misunderstandings occur about what it means.

Let’s start with a definition of “personality disorder.”

What is a personality disorder?

Here’s a definition from the American Psychiatric Association:

A personality disorder is a way of thinking, feeling and behaving that deviates from the expectations of the culture, causes distress or problems functioning, and lasts over time.

In plain English, this means that someone develops a pattern of personality traits (ways of thinking, feeling, and behaving) that are not in line with what our culture sees as normative or okay.

These patterns are considered pathological or abnormal and appear in a person’s self-image, character (distorted or lacking), relationships, social interactions, and work behavior.

Personality disorders are generally not diagnosed until late adolescence, usually 18 years of age. That’s because we’re still developing and solidifying our identities, character, and personality traits during adolescence.

You can sometimes see precursors of an enduring personality disorder during adolescence, especially for teens who engage in sociopathic behavior regularly. However, the diagnosis is made later in early adulthood when it appears that the dysfunctional personality traits are fixed across time and show up in the main areas of a person’s functioning.

Personality Disorders are not mutually exclusive, which means someone may have characteristics of more than one personality disorder. This is true of what’s called Malignant Narcissism which I’ll discuss a little further on.

Characteristics of a Narcissistic Personality Disorder (NPD)

Here are the main characteristics or personality traits that are seen in people who are diagnosed with Narcissistic Personality Disorder:

Lack of Empathy

An inability to empathize with others is a hallmark trait of this personality disorder.

NPDs can’t and don’t recognize others’ feelings, needs, desires, or experiences. When interacting with anyone, the prime objective is always to cater to oneself, sometimes at the other person’s expense.

All conversations or interactions will focus on or veer back to the NPD. They’re not interested in how someone else is doing or what they think or feel. Their focus is on what the other person has to offer that’s flattering or useful in meeting their goals.

If you ask a narcissist for something, voice a need, or express a genuine feeling, they’ll see you as weak and respond in a way that makes you feel insignificant or dismissed.

NPDs are famous for one-upping.


NPDs are highly grandiose and have a wildly exaggerated sense of themselves and their worth.

They use big words, big numbers, extreme adjectives, and expansive gestures, all of which point back to how great they are.

The words “the best” often appear regarding themselves, their accomplishments, or who they know.

Constant Need for Admiration

Narcissists need excessive and constant admiration and adoration. They’ll require it from those around them and verbalize it themselves.

They see themselves as having excessive talent, intelligence, looks, popularity, and power.

Conversely, they’re highly envious of those others admire and may openly attack or try and sabotage them. They need to feel superior.

Entitlement and Special Treatment

NPDs feel entitled to have things others don’t.

They have different rules or are above the rules.

They expect to be treated with high regard at all times and to receive favorable consideration. They’re often quite cocky and brag about their ability to get away with more than others. They like to show off and see themselves holding a special place at the top of the hierarchy.

They can be manipulative, arrogant, and quite self-centered.

Blame Others for Mistakes or Failures

When a narcissist makes a mistake, he blames it on someone else. He doesn’t take responsibility for his failures and generally won’t admit them. He’ll find a scapegoat or completely rearrange the facts of a situation to release himself from responsibility.

Preoccupation with Unlimited Power, Success, Status, Beauty, and Ideal Love

NPDs seek power and outward success and align themselves with others in powerful positions. Conversely, they can also be envious of those who threaten their self-view as being better than everyone else.

They may seek ideal love but, in actuality, are not really capable of love.

They become infatuated temporarily until the other person has served their purpose, which is to make the NPD feel special.

Exploitative, Manipulative, and Vengeful

Any hint of criticism will bring on revenge of some sort or a cold dismissal.

Distort Reality

NPDs are highly emotional, even if they appear in some cases to be very cool and dismissive. Their main goal is always to preserve and enhance their grandiose self-image. As a result, they don’t use executive functions.

That means they can’t take in information and analyze facts to make reality-based decisions. They distort facts and often scoff at them.

In general, they:

  • Don’t learn from experience and so make repetitive mistakes.
  • Are unable to observe themselves objectively or critically.
  • Don’t consider the consequences of their actions or choices.
  • Use words to provoke emotions in others rather than effectively communicate.

Conversations with them can be cut short without explanation or feel very twisted and muddy.


In general, there are more men with NPD than women. Between 50 and 75 percent of NPDs are men.

NPDs and Relationships

It’s very challenging to be in a relationship with a Narcissistic Personality. These folks don’t have real and abiding attachments to others.

They see others as either an extension of themselves, a means for self-gratification, or a vehicle to achieve something they want.

If you become involved with someone who has this type of disorder, you’ll note that they rewrite history as they go. They distort whole conversations held previously, and any attempt on your part to remind them of something that was said or done will be met with anger, a counterattack, and usually a flat-out denial.

If they do something for you, it isn’t out of genuine love or concern but rather because it will get them something or add to their need for admiration.

NPDs can sometimes pose as pillars of the community by participating in charitable events. However, their participation is a vehicle to point out how wonderful they are rather than a feeling for the charity itself or the recipients of the charity.

They view their spouses and children as extensions and commentaries on themselves.

“I have the most beautiful wife and the most accomplished kids.”

As soon as the spouse or child does something disappointing that will not reflect well on the narcissist, he will turn away icily and emotionally abandon them.

Worse, many NPDs are envious of their children. They demand that their children achieve and reflect well on them but simultaneously become jealous that their kids may surpass them.

If they become too threatened by a child’s success, they will subtly or not so subtly sabotage it. They often compete with their kids and involve them in contests where they will win, leaving the child feeling small and inept.

When you meet a Narcissist, you may have one of two experiences:

  1. He sees you as having exceptional beauty, power, status, or importance, so he places you on a pedestal and showers you with accolades.
  2. The second is that you’ll immediately feel insecure, less than, dismissed, or put down.

Narcissists gravitate towards influential figures and will ingratiate themselves to win over those people to feel powerful. If they experience you as less powerful than themselves, they’ll dismiss you, often with haughtiness, condescension, or disdain.

A note about the pedestal: It never lasts. You’ll eventually fall off or, in most cases, be thrown off. Narcissists don’t have real and lasting attachments. They ultimately become abusive. Involvement with them long-term can be emotionally damaging.

Work and Public Image

NPDs can succeed in a work setting. You’ll find them leading companies, in positions of political power, professors in university settings, attorneys, entertainers, and even innovators.

In whatever setting you find them, they’ll likely have problems relating to others and will be described as arrogant, abusive, unbending, and authoritarian.

They see themselves as above the grade, and if you work alongside them, you’ll always be in a subordinate position. If you oppose or criticize them, they can turn on you in a heartbeat. Everyone is dispensable.

In many cases, NPDs sabotage their work relationships and are not successful. They’re ultimately self-destructive because they can’t use previous history or foresee the consequences of their actions. They don’t realize that others will eventually see through them.

They have no fundamental ideology or values other than promoting their grandiose self.

In positions of power, they can be quite dangerous.

Malignant Narcissism

“Malignant Narcissism” is a more extreme form of narcissism because it mixes in characteristics of other personality disorders, especially Antisocial Personality Disorder. Wikipedia defines it as follows:

Malignant narcissism is a psychological syndrome comprising an extreme mix of narcissism, antisocial disorder, aggression and sadism.

Someone who fits this category has all of the characteristics of a Narcissistic Personality Disorder, as I’ve outlined above, but in addition, has traits that include extreme manipulation and usury, lack of remorse, involvement in illegal or sociopathic behaviors, and a tendency to seek sadistic pleasure in harming anyone in their way.

Outwardly charming, these people have absolutely no conscience and or attachments to others.

NPDs without sociopathic tendencies generally don’t get involved in criminal activities or have a record of such activities. They bend the rules but usually stay under the legal radar.

Those with malignant narcissism ride that bridge between narcissism and psychopathy and can become involved in illegal, aggressive, and sadistic activities with no remorse whatsoever.

The main difference is that a narcissist’s goal is to feed his grandiose self and garner admiration. In contrast, the focus of an Antisocial Personality is his power and gratification without any genuine concern for how anyone sees him.

The combo is a person concerned first and foremost with the grandiose self but also involves himself in illegal and often criminal ties, especially to gain power. He also engages in sadistic actions that will harm others, especially those he considers needy and weak or in his way.

Is treatment possible?

Some people have “narcissistic trends” rather than a full-blown personality disorder and are good candidates for treatment. In these circumstances, this person can learn to be more empathetic and maintain a real attachment to another person.

Someone with a full-blown Narcissistic Personality Disorder with well-entrenched patterns usually is not treatable. NPDs may change as they age, become less challenging to deal with, and even soften, but their personality structure remains intact.

Treatment for malignant narcissism is almost always unsuccessful.

NPDs don’t initiate treatment because they don’t see themselves as having problems. If they do enter into treatment, it’s usually because someone else initiates it, often a spouse or a child. In both cases, the NPD will use therapy to point out what’s wrong with everyone else, and they won’t continue if there’s a push for them to make changes.


The interesting thing about NPDs is that they’re highly dependent, although they would never admit or recognize this.

Because they need a continuous feed of admiration, they seek out others. They also often can’t run their lives well because they don’t foresee the consequences of their actions, can’t think objectively, have low frustration tolerance, and don’t regulate their emotions.

They become attached to those who will care for them even as they abuse them. Their attachment is need-fulfilling, meaning it’s focused on getting what they need without regard for giving back. Over time they alienate everyone close to them. As they age, they can find themselves alone and feel empty and depressed.

Successful psychiatric treatment requires a thorough recognition of dysfunctional personality traits and a desire and commitment to stay in therapy.

Sometimes someone who has aged or has suffered a severe loss may enter treatment. If they remain in therapy with a knowledgeable therapist long enough, treatment can have a positive effect. It requires an ongoing attachment to the therapist and rebuilding basic trust typically acquired in the first years of life.

What are the Causes?

There’s some controversy about this, and in general, researchers disagree. The two causes most often noted are related to parenting and early environment.

  1. One is that a child is raised with excessive pampering, permissiveness, doting, and admiration while also being rescued from having to live with the consequences of their actions with few limits on behavior. Parents enable and consistently transmit the message that they are better than others without having to work for anything.
  2. On the other side is the child raised with significant emotional neglect or who is harshly abused and criticized. Early emotional neglect is particularly harmful and inhibits the development of attachment and trust.

All of these factors can certainly play a role, but as is always the case, two children can be raised in the same circumstances and turn out differently.

There may be some bio-genetic predispositions, such as a particular temperament or a parent who is also narcissistic.

In my experience, I’ve found early and continuing emotional neglect to be one of the most significant factors in the development of NPD.

The development of a healthy sense of self arises through the positive, consistent, and affectionate interactions between the infant and his mother (or primary parent).

This nurturing, empathetic, and abiding love given consistently over the early years of a child’s life is responsible for foundational developments in personality, self-image, self-worth, brain development, cognition, and the nervous system.

Infants who consistently experience emotional remoteness and neglect do not form normal, healthy attachments. Later, as adults, they create a pseudo-self that insulates and replaces the maladaptive and fragmented self. Children who are consistently physically and emotionally abused by a harsh, critical, and punishing parent can also have the same outcome.

Normal Narcissism

We all have some degree of narcissism. Healthy narcissism helps us maintain a positive regard for ourselves. Yet, we’re able to hold ourselves accountable and incorporate humility into our outlook and dealings with others while performing well and achieving our goals.

Narcissism also appears to a greater degree during specific developmental periods. In particular, the budding teen can be noticeably self-centered, however, this is normal and almost a necessary development to assist the teen in exploring and building his identity.

As teens move toward early adulthood, narcissism decreases and is incorporated into a healthy self-image characterized by positive self-regard and the ability to empathize with others

For all of us, it’s always a good idea to take a personal inventory and examine the balance between positive self-regard and regard for others. Moving too far on either side of the scale is problematic. The aim is to:

  • Feel good about yourself, yet be able to assess areas that need improvement.
  • Show compassion and empathy for others, but maintain proper boundaries that inhibit being taken advantage of or coerced into actions that reach outside your values.
  • Act in prosocial ways, which means behaving in ways that are for the good of all.
  • Feel remorse when causing harm to someone and taking action to make reparations.
  • Taking responsibility for yourself and your behavior.
  • Learn from experience and make corrections when indicated.

Ultimately, we’re all connected, and everything we think, do or feel impacts the whole. Keeping that in mind will help steer you away from unhealthy personality traits and create a more fulfilling and gratifying life.

Revised January 8, 2023

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