Aren't I wonderful? Exploring Narcissistic Personality Disorder

The world loves to speculate on just who might be a narcissist. People hypothesize about the traits of Henry VIII, Napoleon, Hitler, Jim Jones, Joan Crawford, Madonna, Kanye West, and Donald Trump, curious how much of their personality is for show and how much is illness.

Although many people have an idea of what this personality looks like, most aren’t sure of the specifics. Narcissistic Personality Disorder (NPD) is a personality disorder in which people have a grandiose idea of their own importance and are extremely sensitive to criticism.

Otto Kernberg, a psychiatrist and psychoanalyst, believed NPD resulted from emotional neglect by a parent in early childhood. He believed when faced with a parent who was indifferent or threatening, the child created an idealized self to hide feelings of fear and deprivation.

Narcissists typically lack the ability to empathize with others, and care a great deal about appearance. They are often described as arrogant, exploitive, entitled, and in constant need of admiration. Typically this disorder appears in early adulthood.

People with NPD have a highly vulnerable self-image, which is at-risk of being injured by criticisms, losses, and slights. It can have a significant impact on their marriages, relationships and careers. Often they will refuse to take risks if they don’t feel assured of success.

To have a clinical NPD diagnosis, an individual must have at least five of the nine DSM-5 symptoms. These symptoms are: 1) A grandiose sense of self-importance. 2) Preoccupation with fantasies of unlimited success, power, intelligence, beauty, or love.

3) A belief that they are unique and should only associate with other high-status people 4) Require excessive admiration. 5) A sense of entitlement. 6) Exploits others. 7) Lacks empathy. 8) Is envious of others or believes others are envious of them. 9) Is arrogant.

NPD can occur alongside other mental health conditions. These include depression, anxiety, bipolar disorder, eating disorders, substance use disorder, and other personality disorders such as borderline, histrionic, antisocial, obsessive-compulsive, and paranoid personality types.

Although NPD occurs in only .5% of the US population, it is more common among certain groups. The prevalence spikes significantly in certain careers—17% of first year medical students and 20% of people in the military have NPD. 75% of individuals with NPD are male. 

There is no standard protocol of treatment for NPD, although therapy is typically recommended. The challenge is that most narcissistic individuals do not believe they need treatment, and rarely seek out help. As a result, research into treatment options is limited.