Narcissistic Personality Disorder: Diagnosis, Signs, Causes, and Treatment

Selfish. Arrogant. Insensitive. People frequently use these characteristics and other similar traits to describe individuals with narcissistic personality disorder (NPD).

In general, individuals with personality disorders display enduring patterns of behaviors that are markedly different from the expectations and norms of their society and culture in at least two of the following key areas:

Cognition
Affectivity
Interpersonal Functioning
Impulse Control

This course examines the unique characteristics and clinical features of narcissistic personality disorder and how its range of signs and symptoms impact each area.

NPD: Cluster B

Personality disorders like NPD are classified by the Diagnostic Statistical Manual of Mental Disorders 5, Text Revision (DSM-5-TR) into three categories, known as clusters. The DSM-5-TR classifies narcissistic personality disorder as a Cluster B personality disorder. Cluster B also includes antisocial, histrionic, and borderline personality disorders.

Signs and Symptoms of Narcissistic Personality Disorder

Diagnostic criteria define narcissistic personality disorder as consisting of dramatic symptoms and behaviors like a pervasive pattern of grandiosity, need for constant admiration, and a lack of empathy.

To receive a clinical diagnosis of narcissistic personality disorder, individuals must exhibit at least five signs, symptoms, and behavioral characteristics, including but not limited to:

Arrogant, haughty behaviors
Preoccupation with fantasies of success, power, brilliance, etc.
Beliefs that he/she is superior, “special,” or “unique”
Interpersonal exploitation and manipulation
Reactivity to insults, ego threats, or unmet needs
Devaluation of other’s contributions

While individuals typically receive a diagnosis of narcissistic personality disorder in adulthood, symptoms are often present in childhood and peak in adolescence.

In this course, learners will also explore the ‘soft symptoms’ of narcissistic personality disorder and how each symptom fits into the personality disorder areas of cognition, affectivity, interpersonal functioning, and impulse control.

While treating narcissistic personality disorder is often tricky, an individualized, collaborative, and flexible treatment approach can help. More research into treating narcissistic personality disorder is needed, as there are currently no medications found to be significantly useful for this condition. Patients with narcissistic personality disorder may be prescribed medicines to treat co-existing psychiatric symptoms or co-morbid conditions, such as affective deregulation and anxiety. A combination of psychotherapy, education, and medication may assist clients in improving functioning and interpersonal relationships.

A critical intervention for treating narcissistic personality disorder is risk assessment and management. Mental health professionals should assess all patients with narcissistic personality disorder for suicide and violence risk, including any substance use that can increase these risks.

Prevalence and Etiology

As many as 50-75% of those affected by narcissistic personality disorder are men, though its overall prevalence remains poorly understood. Like many other psychiatric conditions, environmental and genetic factors play a role in the cause of narcissistic personality disorder. However, research suggests that genes and hereditary factors may play a larger role in NPD development.

For everyone suffering from NPD, this complex and difficult to treat condition can severely inhibit normal social functioning and interpersonal relationships. More research is needed to identify the most effective treatment for narcissistic personality disorder to help mental health professionals care for these individuals. Education, support, and awareness of this disorder will hopefully improve outcomes for those suffering from NPD.

Discover more details, including a full list of clinical features and symptoms, and learn about the etiology of narcissistic personality disorder while receiving CME & CNE credit in our online course.

Written by Jessica Dzubak, MSN, RN

References

American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed, text revision). American Psychiatric Publishing, Inc. https://doi.org/10.1176/appi.books.9780890425596.

Coleman, D., Lawrence, R., Oquendo, M. (2017) Narcissistic Personality Disorder and Suicidal Behavior in Mood Disorders. Journal of Psychiatric Research. February; 85:24-28.

Lowenstein, J., Purvis, C.M. and Rose, K. (2016). A systematic review on the relationship between antisocial, borderline and narcissistic personality disorder and risks of violence to others in a clinical and forensic sample. Borderline Personal Disord Emot Dysregul. 3: 14. Published online 2016 Oct 13. https://doi: 10.1186/s40479-016-0046-0

Bateman. A.W., Gunderson, J., Mulder, R. (2015) Treatment of personality disorder. Lancet. 385 (9969): 735-43

Luo, Y.L.L., Cai, H. (2018). Distinguishing between adaptive and maladaptive narcissism. In: Hermann A, Brunell A, Foster J. (eds) Handbook of Trait Narcissism. Springer, Cham.

Luo YLL, Cai, H. (2018). The Etiology of Narcissism: A review of Behavioral Genetic Studies. In: Hermann A, Brunell A, Foster J. (eds) Handbook of Trait Narcissism. Springer, Cham.

Thomaes, S. & Brummelman, E. (2018). Parents’ socialization of narcissism in children. In: Hermann A, Brunell A, Foster J. (eds) Handbook of Trait Narcissism. Springer, Cham.

Torgersen S., Lygren S., Oien, P.A., Skre, I., Onstad, S., et al. (2000). A twin study of personality disorders. Comprehensive psychiatry 41: 416-425.

Jessica Dzubak, MSN, RN, is the Director of Nursing Practice for the Ohio Nurses Association. She is also a freelance writer specializing in the healthcare industry. She enjoys her two dogs, which add commentary to her articles by laying their heads across the keyboard while she’s writing. Visit her website at www.nursejessicawrites.com.