Narcissistic personality disorder

Learn about NPD, signs to look for, treatment options and supporting recovery.
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Found in: Mental Health Conditions
Date: September 2022

About narcissistic personality disorder (NPD)

Narcissistic personality disorder, or narcissism, is a pattern of thinking and feeling that can make it difficult for people to get on with others. They may appear to others to be feeling very self-important, needing admiration, and having little feeling for others. 

If you experience narcissistic personality disorder, you may come across to others as conceited or boastful. In reality, though, this behaviour masks how you are really feeling inside, which can sometimes be very insecure and lonely. With treatment, you can learn new strategies to relate better to others and to improve your relationships and your enjoyment of life.

Just as we have physical features that make us who we are, we also have our own distinct personality features. Personality refers to the lifelong patterns in the way we see, think about, and relate to ourselves, other people, and the wider world – whether we see ourselves as good or bad, trust or mistrust others, or see the world as a good or bad place. 

A diagnosis of personality disorder is only made where the person’s problems result in significant difficulty in their day-to-day activities and relationships, and cause significant distress.

NPD is one of the 10 different types of personality disorder that have been identified. You can find out more about personality disorders in this article. You may want to read it first and then come back here for NPD in particular. The article explains that a personality disorder does not mean there is something wrong with your personality. It just means that some of the patterns you have learned to use in your life are causing you difficulties with others.

Who is likely to have a narcissistic personality disorder?

A personality disorder such as NPD will often show up by late adolescence or early adulthood. It remains relatively stable throughout adult life and can gradually improve with increasing age. This is in contrast to other mental health conditions, which come and go over time, with periods of illness interspersed with periods of wellness. For people with NPD, learning new strategies will be key to recovery – see the “treatment” section below.

People who experience a personality disorder have a tendency to develop other mental health conditions, particularly if stressed. These include psychotic illnesses, depression and drug and alcohol abuse. It is important for people with personality disorders to learn ways of coping with stress, and to seek help early should any of these other conditions arise.

The risk of suicide in people who experience a personality disorder is significant. It is important that if you are having any suicidal thoughts you seek help immediately.

Early diagnosis and treatment is best, but you can start to make changes at any stage in your life. The evidence shows that with good treatment over a period of time, people with NPD can enjoy rewarding and satisfying lives.

If you think you have a personality disorder, or you are worried about a loved one, it’s important to talk to your doctor or counsellor, or someone else you can trust, as a first step to getting the important help you or they need.

What causes a personality disorder such as narcissism?

There has been considerable debate in the past regarding whether personality is determined by nature (genes) or nurture (your environment). There is now good evidence that personality development occurs as a result of both genetic and environmental influences. 

Trauma, or difficult experiences in childhood or early life, can contribute to the development of a personality disorder. Often the patterns of behaviour and feeling may have been formed as coping mechanisms for difficult circumstances, such as abuse, neglect or other experiences.

It's important to remember that it is not your fault you experience a mental health problem and that you can learn new ways of navigating life. 


Signs to look for (symptoms)

People who live with NPD often find it difficult to recognise the following symptoms in themselves – they will often think the characterisation is quite wrong. It’s important to understand that these are not value judgements. As a person living with NPD, you are not a bad person or failing morally in some way. Instead, you experience a set of challenges you need some extra help with, to make sure you can thrive and live a fulfilled life.

People with narcissism may exhibit characteristics such as these:

  • grandiose/pretentious sense of self-importance (in fantasy or behaviour)
  • difficult-to-shift preoccupation with fantasies of success, power, beauty, or ideal love
  • strong belief in being unique, and in only being able to be understood by people or institutions they feel are also unique
  • obsessional need for admiration
  • sense of entitlement
  • behaviour that seems to be taking advantage of other people
  • difficulty empathising with others
  • feeling envious of others or believing others are envious of them
  • behaviour that comes across as arrogant or dismissive of others
  • difficulty in taking criticism constructively.

How the clinician determines if you have narcissistic personality disorder (diagnosis)

People experiencing a personality disorder such as NPD often do not seek out treatment. You may, however, decide to see your doctor about depression, often due to feeling upset by what you suspect others think of you. Some people with NPD find that stress makes symptoms such as relationship difficulties more intense, and they may become paranoid and fixated when highly stressed. 

Once you have spent some time talking to your doctor, they will refer you to a mental health professional qualified to diagnose and treat people with this condition. A diagnosis is made after talking with you about what you have been experiencing, especially around your level of personal functioning and personality traits that may suggest a particular personality disorder.

For this reason, it’s important the mental health professional gets a full picture, from you and (if possible) your family/whānau or others who know you well.

Usually, for a person to be diagnosed with NPD they must meet five or more of the symptoms listed above. Sometimes, people exhibit some of the traits of NPD without fitting the full criteria for a diagnosis.

Accessing help

People with NPD and other personality disorders are faced with stigma in life. This unfortunately also happens when accessing health care. It can be challenging to access support, especially when in crisis. You may find that some people don’t believe what you are experiencing – this can be frustrating.

Many people find it useful to prepare an information sheet that they can show the health care professional to explain their diagnosis and what they need to get better. Understanding support from whānau and friends is also invaluable, to help you access support. 

Treatment options

Treatment can involve a number of aspects, each of which will be tailored to meet your individual needs. Psychological therapies or counselling are generally seen as the treatment of choice for personality disorders, with medication if required for other mental health conditions/co-morbidities. Therapy could include individual, couple, family/whānau and/or group therapy.

Therapy, such as talking therapies

These therapies involve a trained professional who uses clinically researched techniques to assess and help people to make positive changes in their lives. 

They may involve the use of specific therapies such as Dialectical Behaviour Therapy (DBT) or Cognitive Behavioural Therapy (CBT), which largely focus on overcoming unhelpful beliefs and learning helpful strategies.

Counselling may include some techniques, e.g. anger management, but is mainly based on supportive listening, practical problem-solving and information-giving.

DBT and CBT approaches are the most effective, and must be continued over a significant period of time, often for a year or more.

You can find out more about therapy approaches in this article on personality disorders in general. 

All types of therapy/counselling should be provided to you and your family/whānau in a manner that is respectful of you and that helps you feel comfortable and free to ask questions.

It should be consistent with and incorporate your cultural beliefs and practices.


Medication is generally used for treating any other mental health condition that you may be experiencing, such as depression. It may also be useful as a short-term strategy to help with coping in times of extreme stress or distress.

If you are prescribed medication, you are entitled to know:

  • the names of the medicines
  • what symptoms they are supposed to treat
  •  how long it will be before they take effect
  • how long you will have to take them for and what their side effects (short- and long-term) are
  • what the process of stopping medication might look like.

Before making any decisions about taking medication at this time, you should talk with your doctor about the potential benefits and problems. Even if you are pregnant or breastfeeding, medication might be an option. It is best to discuss with your health provider what might be on offer for you.

Other strategies to support recovery

Complementary therapies

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and that may be used to complement and support it.

Certain complementary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress. 

Physical health

It’s really important to look after your physical wellbeing. Make sure you get an annual check-up with your doctor, and do what you can to reduce stress, get enough sleep, eat a balanced diet and exercise. Being in good physical health will also help your mental health. 

Important strategies to support someone in their recovery

Family, whānau and friends of someone with a personality disorder have found the following strategies important and useful:

  • Remember that people with these conditions tend to easily take words and actions very personally and may misunderstand what you mean to say. It’s important to be clear in what you say, and to be willing to clarify your meaning or intention if you are misunderstood. It’s also important not to take these reactions personally but to see them as a result of the person’s misinterpreting you.
  • Learn what you can about the condition, its treatment, and what you can do to assist the person.
  • Take the opportunity, if possible, to contact a family or whānau support, advocacy group or culturally appropriate organisation. For many, this is one of the best ways to learn about how to support the person, deal with difficulties, and access services when needed.
  • Encourage the person to continue treatment and to avoid alcohol and drug abuse.
  • Find ways of getting time out for yourself and feeling okay about this. It’s important to maintain your own wellbeing.
  • Keep safe, and access counselling or therapy for your own support if needed.

Thanks to Jenni Beckett, clinical psychologist, for reviewing this content. Date last reviewed: September, 2022.

Thanks also to Sutherland Self-Help Trust for making the 2022 updates possible.