Narcissistic personality disorder
| Narcissistic personality disorder | |
|---|---|
| Narcissus (1597–99) by Caravaggio; the man in love with his own reflection | |
| Specialty | Psychiatry, clinical psychology |
| Symptoms | Exaggerated feelings of self-importance, excessive craving for admiration, reduced levels of empathy |
| Usual onset | Early adulthood |
| Duration | Long term |
| Causes | A combination of genetic and environmental factors. Social theories of NPD are weak and causality is unclear. |
| Diagnostic method | Based on symptoms |
| Differential diagnosis | Bipolar disorder, mania and hypomania, antisocial personality disorder, substance abuse, borderline personality disorder, histrionic personality disorder, grandiose delusions. |
| Treatment | Psychotherapy, pharmaceuticals for comorbid disorders |
| Prevalence | 0.5% to 6.2% |
| Personality disorders |
|---|
| DSM-5 classification |
| ICD-11 classification |
| Others |
Narcissistic personality disorder (NPD) is a complex and heterogeneous personality disorder characterized by patterns of grandiosity, entitlement, low empathy, and interpersonal difficulties, which can manifest as either grandiose ("thick-skinned") or vulnerable ("thin-skinned") forms. Grandiose individuals display arrogance, social dominance, and exploitative behaviors, while vulnerable individuals show shame, inferiority, hypersensitivity, and extreme reactions to criticism. NPD often involves impaired emotional empathy, superficial relationships, and difficulty tolerating disagreement. It is often comorbid with other mental disorders and associated with significant functional impairment and psychosocial disability.
Criteria for diagnosing narcissistic personality disorder are listed in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), while the International Classification of Diseases (ICD) contains criteria only for a general personality disorder since the introduction of the latest edition.
There is no standard treatment for NPD. Its high comorbidity with other mental disorders influences treatment and outcomes. Psychotherapeutic treatments generally fall into two categories: psychoanalytic/psychodynamic and cognitive behavioral therapy, with growing support for integration of both in therapy. However, there are few studies on the effectiveness of treatments. Treatment is frequently not sought; one's subjective experience of the mental disorder, as well as one's agreement to and level of engagement with treatment, are highly dependent on one's motivation to change.
NPD’s etiology is thought to be largely genetic and neurobiological, with structural and functional brain differences in areas related to self-processing and empathy. Assessment tools such as the Narcissistic Personality Inventory or Pathological Narcissism Inventory can help differentiate subtypes. NPD has historical roots in psychoanalytic theory and remains a subject of controversy in psychiatric classification, while its manifestations continue to appear in literature and media as exemplars of extreme self-focus and entitlement.