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Narcissism and narcissistic personality disorder (NPD)

Reviewed by Robert Bogenberger, PhD

Illustration of a man looking into a mirror with his reflection wearing a crown and confetti being tossed

What is narcissistic personality disorder?

Narcissistic personality disorder (NPD) is a mental health disorder featuring overblown levels of self-importance, arrogance, and selfishness, as well as a lack of empathy for others.

Narcissism vs. NPD

It’s possible to be a narcissist or have narcissistic qualities without having NPD. Narcissism exists on a spectrum. At one end are the “healthier” expressions of narcissism, in which someone has larger-than-average feelings of self-esteem or self-confidence.  

NPD sits on the other extreme of the spectrum. It affects a person’s ability to live a normal life and have healthy relationships. They may mask insecurities with self-aggrandizing, manipulative, or attention-seeking behavior.

NPD vs. antisocial personality disorder

NPD shares many symptoms with antisocial personality disorder (ASPD), but there are some distinct differences between the two.1 People with NPD behave the way they do because they have an inflated sense of self-importance. People with ASPD, on the other hand, tend to exploit others largely because they have no regard for their feelings. It’s possible for someone to have both NPD and ASPD.

What causes NPD?

There’s no one cause of narcissistic personality disorder, but potential risk factors include:

  • Genetics: You may have a higher risk of developing NPD if you have a relative who suffers from it. Genetics aren’t the only cause, though—you can develop NPD even without a family history of the disorder.
  • Biochemistry: Some evidence suggests that a person’s unique brain structure, as well as the balance of chemicals in their brain, may lead to NPD.
  • Family relationships: Research shows that narcissism may be the result of unhealthy parent-child relationships, usually involving excessive praise.2 However, being somewhat narcissistic doesn’t guarantee a person will eventually develop NPD.

Do narcissists know they’re narcissists?

They may not use the word “narcissist,” but some narcissistic people will admit they think they’re better than others.3

Narcissists also seem to be aware that they come across as arrogant, and that other people don’t see them as generously as they see themselves.

Types of narcissism

Narcissism tends to appear in two different forms: grandiose (or “overt”) and vulnerable (or “covert”).4

Grandiose narcissism

People with grandiose (overt) narcissism have an inflated sense of self and little empathy for others. They tend to have many familiar narcissistic traits: aggression, extroversion, attention-seeking behaviors, entitlement, and feelings of superiority.

Grandiose narcissists are driven by a need for recognition and admiration. They seek praise and are drawn to the limelight but are very sensitive to criticism. They find it hard to self-regulate when they experience any kind of failure.

Vulnerable narcissism

Vulnerable (covert) narcissists are as self-obsessed as grandiose narcissists, but they tend to shy away from the spotlight because of their sensitivity to criticism. Covert narcissists may appear insecure and defensive, even as they have an inflated sense of self-importance. They fear that others will think they’re inadequate, and they tend to belittle other people to make themselves seem more impressive in comparison.

Because people struggle with self-esteem for many reasons, it can be hard to identify covert narcissism. What distinguishes a covert narcissist is their need to feel superior, their belief that they deserve special treatment, and the manipulative or passive-aggressive behaviors they use to reach their goals.

Traits of narcissism

  • Entitlement: Narcissists believe they deserve praise, special treatment, power, and authority. They also crave the time, energy, loyalty, and admiration of others.
  • Overconfidence: Narcissists have an inflated sense of self, often overestimating their own abilities and importance.
  • Attention-seeking: Grandiose narcissists seek praise, admiration, and glory. Vulnerable narcissists may seek special attention to compensate for their insecurities.
  • Power fantasies: Narcissists have grand visions for their future, often including grand successes or positions of power.
  • Superiority: Both types of narcissists are convinced they’re better than most people.
  • Manipulation: Narcissists will manipulate others to achieve their goals or receive praise.
  • Lack of empathy: It’s difficult for narcissists to consider others’ feelings.
  • Emotional immaturity: Narcissists often have a hard time regulating their emotions, which can lead to outbursts when their egos are threatened.

Signs you may be in a relationship with a narcissist

They seem charming—at first

Initially, you might find a narcissist attractive or impressive. They often make a good first impression and can come off as self-assured and charming.5 Because narcissists seek attention and praise, they often develop the skills to inspire these responses. But over time, narcissists tend to show their true colors.

They’re critical of others, including you

A narcissist may be extremely critical of everyone around them. Deep down, many narcissists are insecure and hypersensitive. They use their sense of superiority as a shield and react strongly when it’s threatened.

When you first enter into a relationship with a narcissist, they make you feel special. But strong relationships require vulnerability that narcissists aren’t equipped to handle. Eventually, a narcissist will turn their critical eye on their partner and cast themselves as the victim in any conflicts.6

They neglect your emotional needs

Narcissists lack empathy, making it hard for them to care for a partner.7 Your emotional needs often go unnoticed or unanswered. A narcissist might do this on purpose, or they may just be so self-involved that they don’t prioritize you. Either way, you’ll end up feeling neglected.

They’re manipulative

Narcissists are willing to manipulate and devalue others, including romantic partners, to get what they want and protect their own sense of self-worth.8 They may employ emotionally abusive tactics like gaslighting to keep partners dependent on them.

How to treat narcissism

The primary treatment for narcissism, including NPD, is psychotherapy (also called “talk therapy”). With therapy, a narcissist can learn to identify the thoughts that may be shaping their harmful behaviors. A mental health professional can also help a narcissist learn to consider others’ feelings and tolerate criticism without lashing out.

It can be difficult to treat people with NPD because they may not look for treatment. People often seek therapy because they know they have a problem, even if they aren’t exactly sure what it is. People with NPD, however, have built their personality around being better than others. Even if they realize they a problem, their ego might stop them from seeking help.

“Am I a narcissist?”

It’s normal to crave some amount of attention from other people. But if your need for admiration starts to cause problems in your relationships, it may be time to talk to a therapist. A mental health professional can give you a formal diagnosis and establish a treatment plan. Search our directory to find a licensed counselor near you.

How to leave a narcissistic relationship

If you’re worried you may be in a relationship with a narcissist, help is available. It’s important to set healthy boundaries and cultivate a deep sense of self that doesn’t depend on your partner. It may also help to go to counseling either on your own or as a couple.

Please note: Couples counseling is not recommended if your partner’s treatment has crossed the line into abuse. If you’re experiencing abuse, you can get free, confidential help 24/7 by calling the National Domestic Abuse Hotline at 1-800-799-SAFE (7233).

About the author

The editorial team at works with the world’s leading clinical experts to bring you accessible, insightful information about mental health topics and trends.

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