Narcissistic Personality Disorder

Medically Reviewed by Jennifer Casarella, MD on September 04, 2022
5 min read

Narcissistic personality disorder (NPD) is one of several personality disorders. People with this condition have an inflated idea of themselves and a need for lots of attention from other people. 

It’s human nature to be selfish and boastful now and then, but true narcissists take it to an extreme. They also 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. NDP is a mental illness.

If you can recognize a few of the traits below, that’s someone who’s self-absorbed. If they have most of them, they might have the disorder. 

People with NPD may not have high self-esteem. Their NPD may be more related to feelings of entitlement. A therapist can get to the bottom of it.

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. 

Someone with narcissistic personality disorder might:

  • Upset other people often
  • Struggle to keep relationships
  • Put themself first
  • Think they know the “right” way
  • Think about themself most of the time and talk about themself a lot
  • Crave attention and admiration
  • Exaggerate their talents and achievements
  • Believe they’re 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

NPD causes problems in many areas of life and in close relationships. These interpersonal issues are often driven by symptoms of NPD, including:

  • Easily hurt
  • Overreacts
  • Can’t take criticism
  • Makes excuses for own flaws or failings
  • Refuses to take responsibility
  • Attempts to sway or manipulate others
  • Hypercompetitive
  • Only associates with people deemed to be on “their level”
  • Reacts with rage
  • Shames others
  • Emotionally neglectful
  • Doesn’t listen
  • Interrupts often

Someone like this may appear to have high self-esteem, but sometimes the opposite is true. There may be a deep sense of insecurity underneath the grand exterior. Someone can be narcissistic and not have the disorder. They may be self-absorbed and hypercompetitive, but not to the extent that it disrupts their daily life.

It’s proven that people are often drawn to narcissists and find them attractive, charismatic, and exciting. Confidence can be charming. Successful leaders often have narcissistic qualities.

There are no lab tests to confirm a mental disorder. Many professionals use the Narcissistic Personality Inventory, a list of 40 questions that measures things such as how much attention and power someone craves.

Personality disorders are longstanding, ingrained, dysfunctional patterns of thinking, behaving and relating to other people. These signs can show up as early as age 8, when children start to become aware of how people react to them. People with narcissistic personality disorder tend not to perceive that they themselves may have a mental health problem, and thus may be less likely to seek evaluation or treatment.

A recent study at Ohio State University says many people readily admit to being a narcissist. But while narcissism may be common, narcissistic personality disorder is rare.


The exact cause is not known. Like most mental and personality disorders, it’s likely due to a complex combination of factors including:

  • Genes
  • Environment, including parent-child relationships
  • Neurobiology (the connection between your behavior and your nervous system)

People whose parents put them on a pedestal and showered them with endless praise may be at higher risk for NPD, a recent study found. Then again, the opposite is true, too. Children who are ignored or abused may develop NPD almost as a survival instinct. They may feel they need to look out for themselves because no one else will.

NPD happens more in males than females. It usually shows up in teens or young adults. Keep in mind that children -- and really anyone -- can act in ways that seem narcissistic at times. This doesn’t usually mean they have NPD or will develop it later.


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. Treatment usually centers on talk therapy. Sometimes people call this psychotherapy.

Talk therapy can help a person with NPD relate to other people better and understand their feelings and behaviors. Talk therapy can help a person with NPD to:

  • Accept and maintain relationships with other people, including co-workers
  • Recognize their own strengths and weaknesses
  • Learn to accept criticism or failures
  • Develop more realistic goals

Let go of unrealistic goals and desires 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.


If you have NPD, it may be tempting not to stick with treatment. Here are tips to seeing it through:

  • Keep an open mind
  • Focus on your goals and the rewards of treatment
  • Keep your appointments and follow your doctor’s advice
  • Get help for any addictions or other mental health problems

If you are living with or in a close relationship with a person with NPD, here are tips to taking care of yourself:

  • Set boundaries
  • Don’t get caught up in their way of viewing you
  • Be prepared for the relationship to change
  • Don’t take it personally
  • Let go of any need for approval from the person with NPD
  • Look for other people who will support you
  • Look for other sources of meaning and fulfillment in your life

Show 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.”

Mayo Clinic: “Narcissistic personality disorder.” “Is narcissism common? The answer may surprise you.” “Narcissistic personality disorder.”


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