Narcissistic Personality Disorder

It’s human nature to be selfish and boastful now and then, but true narcissists take it to an extreme. They don’t just have extra self-confidence, they don’t value others’ feelings or ideas and ignore others’ needs.

But there’s a difference between being self-absorbed, often called a narcissist, and having narcissistic personality disorder, which is a mental illness.   

If you can recognize a few of the traits below, that’s someone who’s self-absorbed. If he has most of them, he might have the disorder. A therapist can get to the bottom of it.

What You Might See

The word comes from a Greek myth in which a handsome young man named Narcissus sees his own reflection in a pool of water and falls in love with it.

Sound like someone you know? Are people often upset with him? Is it hard for him to keep relationships? Does he tend put himself first and think he knows the only “right” way? He might also:   

  • Think about himself most of the time and talk about himself a lot
  • Crave attention and admiration
  • Exaggerate his talents and achievements
  • Believe he’s special
  • Set unrealistic goals
  • Have wide, fast mood swings
  • Have a hard time taking others’ feelings seriously
  • Strive to win, whatever it takes
  • Fantasize about unlimited success, money, and power

Someone like this may appear to have high self-esteem, but the opposite is probably true. There’s a deep sense of insecurity underneath that grand exterior. He wants others to be envious, but often he’s the jealous one. He’s competitive and threatened by others’ achievements. His relationships are often stormy and short-lived. He leaves a trail of hurt feelings in his wake.

He’s easily hurt, but either chooses to not show it or overreacts in rage. He can’t stand criticism. He makes excuses and refuses to take responsibility for his flaws and failures. He sees himself as a natural leader who can easily sway others. He doesn’t listen and often interrupts. It’s a one-way street -- all take, no give.

Someone can be a narcissist and not have the disorder. For example, Bill Gates has been called a narcissist, but not to the extent that it disrupts his daily life.

It’s proven that most people are drawn to narcissists and find them attractive, likeable, and exciting. Confidence is charming. And successful leaders are often more assertive and demanding.

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Diagnosis

There are no lab tests to confirm a mental disorder. If there’s a noticeable change in someone’s personality, a doctor might do a physical exam, blood tests, or brain scans to rule out a physical illness. If there’s no clear cause, a psychiatrist or psychologist will ask a set of targeted questions to gauge personality.

Many professionals use the Narcissistic Personality Inventory, a list of 40 questions that measures things such as how much attention and power someone craves.

Traits usually start popping up during pre-teen or teenage years, when personality is better formed. But it can come to light as early as age 8, when children start to become more aware of how people react to them.

A recent study at Ohio State University says many people readily admit to being a narcissist. Researchers say they’re probably proud of it and don’t see looking out for No. 1 as a flaw.

Causes

The exact cause is not known, but there are several theories. Many think it’s a mix of things, from how the person handles stress to how he was raised. Parents who put their children on a pedestal and shower them with endless praise can plant a seed of narcissism, a recent study found. There’s a line between being nurturing and supportive and inflating an ego.

Then again, the opposite is true, too. Children who are ignored or abused tend to be self-centered almost as a survival instinct. They feel they need to look out for themselves because no one else will.

Treatments

There is no cure, but therapy can help. The goal is to build up the person’s poor self-esteem and have more realistic expectations of others.

There aren’t drugs to treat this mental disorder, but depression and anxiety sometimes go hand in hand with narcissism, and there are helpful drugs for those conditions.

If the narcissist abuses alcohol or drugs, which is common, it’s important to get treatment for the addictions, too.

With children, experts suggest that parents who give too much praise cut back, while those who don’t pay enough attention step up.

Narcissists can learn how to relate to others in more positive ways, but it depends on how open they are to critical feedback and how willing they are to change.

WebMD Medical Reference Reviewed by Joseph Goldberg, MD on March 28, 2015

Sources

SOURCES:

MedlinePlus: "Narcissistic Personality Disorder."

American Psychological Association: "Personality."

PsychCentral: “Narcissistic Personality Quiz.”

Konrath, S. PLOS One: Aug. 5, 2014.

Bushman, B. Proceedings of the National Academy of Sciences: Feb. 12, 2015.

Thomas, S. Journal of Personality Assessment, 2008.

Psychologia: “Malignant Narcissism vs. Narcissism vs. Narcissistic Personality Disorder.”

Harvard Business Review: “Narcissistic Leaders: The Incredible Pros, the Inevitable Cons.”

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