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.
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.
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.
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 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.