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Narcissistic Personality Disorder

Narcissistic Personality Disorder (NPD) is a personality disorder marked most by an inflated sense of importance, ultra-confidence and an extreme need for admiration and attention. Individuals with NPD believe that they are superior to others and disregard other people’s feelings. Behind this mask of superiority lies a fragile self-esteem, vulnerable to the slightest criticism. Narcissistic personality disorder is characterized by dramatic, emotional and socially inappropriate behavior.

Symptoms of Narcissistic Personality Disorder

Individuals with NPD may seem like they have confidence or strong self-esteem but this is rarely the case. People who have healthy confidence and self-esteem don’t value themselves more than they value others. NPD is like having self esteem made of a hot air balloon, it may appear large but it’s empty and easily deflated. When an individual with NPD feels as though they have been deflated they will typically spiral into shame which is so profoundly painful and intolerable that the blow may cause them to come back with an even more inflated ego to overcompensate.

People involved in close relationships with individuals with NPD describe them as conceited, boastful and pretentious. They may have been drawn to what they perceived as strength in the beginning but they are later turned off by the NPD’s tendency to monopolize conversations, belittle or look down on people, and portray sense of entitlement. And when they don’t receive the special treatment to which they feel entitled, they may react with rage, impatience or anger.

NPD Symptoms Include:

  • Feeling superior to others
  • Obsessed with power, success and appearance
  • Lying about achievements or talents
  • Craving constant praise and admiration
  • Believing that they are special
  • Failing to care about other people’s feelings and needs
  • High expectations of others to collude
  • Easily takes advantage of others
  • Expressing disdain for those they feel are inferior or less than
  • Strong tendency to compare and be jealous of others
  • Believe that everyone is jealous of them
  • Relationship difficulties
  • Unrealistic lofty goals
  • Easily hurt and rejected
  • Profound shame
  • Fragile self-esteem
  • Grandiose behavior
  • Appearing unemotional

Treatment

Individuals will rarely seek treatment on their own for NPD. It would be hard for them to imagine they might need help or that there could be anything wrong with them. They may seek treatment due to external pressure, such as a court order to “fix” someone with whom they are in a relationship with. As with all personality disorders, psychotherapy is the recommended course of treatment. There are no medications specifically used to treat narcissistic personality disorder, however medication may be used to treat co-occurring depression or anxiety.

Types of Treatment Include:

Cognitive behavioral therapy – CBT assists individual to identify unhealthy, negative beliefs and behaviors and cognitive distortions and then to replace them with healthy, positive ones.

Group therapy – Group therapy, in which the individual may meet with a group of people with similar conditions is helpful in reducing defenses and learning to trust and better relate to others.

Personality traits are deeply ingrained making them difficult to change. Therapy may take several years. The short-term goal of psychotherapy for narcissistic personality disorder is to address such issues as substance abuse for which they are at very high risk, as well as depression, and shame. The long-term goal is to challenge cognitive distortions and create a realistic authentic self-image.