Narcissistic Personality Disorder: Signs, Traits, and Tests

Medically Reviewed by Zilpah Sheikh, MD on February 13, 2024
Written by Julie Marks
8 min read

Narcissistic personality disorder (NPD) is one of several personality disorders. People with this condition have an inflated idea of themselves, and they need a lot of attention from other people. They often struggle to understand other people’s feelings.

People with NPD may not have high self-esteem. Their NPD may be more related to feelings of entitlement. A therapist can help get to the bottom of it.

Narcissism vs. narcissistic personality disorder

There’s a difference between being self-absorbed (someone who's often called a narcissist) and having narcissistic personality disorder.

Experts consider narcissism a trait. On the other hand, NPD is a mental illness. With NPD, a pattern of behavior affects all areas of a person’s life. You can have narcissistic traits but not meet the official criteria for NPD.

How common is narcissistic personality disorder?

Researchers aren’t sure exactly how many people have NPD. Part of the reason is many hide their narcissistic thoughts or behaviors. Some data suggests that about 0.5%-5% of people in the U.S. might have NPD. Up to 75% of these cases occur in people assigned male at birth (AMAB).

People with narcissistic personality disorder might:

  • Upset other people often
  • Struggle to keep relationships
  • Put themselves first
  • Have an overblown sense of worth
  • Think they know the “right” way
  • Think about themselves most of the time and talk about themselves a lot
  • Crave attention and admiration
  • Think that they should interact only with those whom they consider worthy
  • Exaggerate their talents and achievements
  • Brag about their success
  • Hold themself to irrationally high standards
  • Set unrealistic goals
  • Have wide, fast mood swings
  • Have a hard time taking others’ feelings seriously
  • Strive to win, whatever it takes
  • Fantasize about unlimited success, money, intelligence, beauty, love, and power
  • Have a delicate self-esteem
  • Crave compliments
  • Be self-critical
  • Get angry when other people don’t cater to them
  • Feel jealous of others’ success
  • Take advantage of other people
  • Have a fear of being vulnerable
  • Be sensitive to criticism or rejection
  • Have depression
  • Be a perfectionist
  • Avoid situations where they could fail

NPD is a spectrum disorder, which means the signs may vary quite a bit in type and severity. For instance, a person’s symptoms can range from mild to pathological.

NPD causes problems in many areas of life, including close relationships. These interpersonal issues, which are often driven by symptoms of NPD, include:

  • Being easily hurt
  • Overreacting
  • Struggling to take criticism
  • Making excuses for own flaws or failings
  • Refusing to take responsibility
  • Attempting to sway or manipulate others
  • Being hypercompetitive
  • Only associating with people deemed to be on “their level”
  • Reacting with rage
  • Shaming others
  • Being emotionally neglectful
  • Not listening
  • Interrupting often

Someone like this may appear to have high self-esteem, but sometimes the opposite is true. There may be a deep sense of insecurity underneath the grand exterior. Someone can be narcissistic and not have the disorder. They may be self-absorbed and hypercompetitive, but not to the extent that it disrupts their daily life.

It’s proven that people are often drawn to narcissists and find them attractive, charismatic, and exciting. Confidence can be charming. Successful leaders often have narcissistic qualities.

Personality disorders are longstanding, ingrained, dysfunctional patterns of thinking, behaving, and relating to other people. These signs can show up as early as age 8, when children start to become aware of how people react to them. People with narcissistic personality disorder tend not to perceive that they may have a mental health problem, which may make them less likely to seek evaluation or treatment.

A recent study at Ohio State University says many people readily admit to being a narcissist. But while narcissism may be common, narcissistic personality disorder is rare.

Narcissistic personality disorder test

There are no lab tests to confirm a mental disorder. Many professionals use the Narcissistic Personality Inventory, a list of 40 questions that measures things such as how much attention and power someone craves.

Doctors also use the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to make a diagnosis. This guide lists nine criteria for NPD. To get a diagnosis, you must have at least five of them.

The exact cause is not known. Like most mental and personality disorders, it’s likely due to a complex combination of factors including:

  • Genes. People with NPD are more likely to have family members with it.
  • Environment including parent-child relationships. Kids often imitate the behaviors they observe in their parents. Overprotective parenting styles may also foster habits that can lead to NPD.
  • Neurobiology (the connection between your behavior and your nervous system).Research suggests people with NPD may have small differences in their brain structure.
  • Culture. NPD seems to be more common in people who grow up in cultures that value personal independence. The disorder is less likely to affect those who live in cultures that stress the importance of community.

People whose parents put them on a pedestal and shower them with endless praise may be at higher risk for NPD, a recent study found. Then again, the opposite is true, too. Children who are ignored or abused may develop NPD almost as a survival instinct. They may feel that they need to look out for themselves because no one else will.

NPD happens more in males than females. It usually shows up in teens or young adults. Keep in mind that children -- and really anyone -- can act in ways that seem narcissistic at times. This doesn’t usually mean they have NPD or will develop it later.

There is no cure, but therapy can help. The goal is to build up the person’s poor self-esteem and foster more realistic expectations of others. Treatment usually centers on talk therapy. Sometimes people call this psychotherapy.

Talk therapy can help a person with NPD relate to other people better and understand their feelings and behaviors. Talk therapy can help a person with NPD to:

  • Accept and maintain relationships with other people, including coworkers
  • Recognize their own strengths and weaknesses
  • Learn to accept criticism or failures
  • Develop more realistic goals
  • Let go of unrealistic goals and desires

Some types of talk therapy are:

  • Cognitive behavioral therapy (CBT). CBT helps you identify and change your negative thoughts and behaviors.
  • Metacognitive therapy. It’s a type of CBT that specifically helps you stop unhealthy beliefs and thinking.
  • Dialectical behavioral therapy (DBT). DBT is a type of CBT that’s especially beneficial if you struggle to manage your emotions.
  • Group therapy. With group therapy, multiple people meet at the same time for a session.
  • Couples or family therapy. A therapy session that focuses on couples or a family unit is sometimes helpful.

There are no medicines specifically for NPD. But doctors may prescribe drugs that are usually used to treat related mental health disorders, such as depression or anxiety. Some of these are:

  • Antidepressants
  • Anti-anxiety meds
  • Antipsychotics
  • Anticonvulsants

Relaxation exercises, such as yoga or mindfulness meditation, might also be helpful if you have NPD.

There aren’t drugs to treat this mental disorder, but depression and anxiety sometimes go hand in hand with narcissism, and there are helpful drugs for those conditions.

If the narcissist abuses alcohol or drugs (which is common), it’s important to get treatment for the addictions, too.

With children, experts suggest that parents who give too much praise cut back, while those who don’t give enough attention should step up.

Narcissists can learn how to relate to others in more positive ways, but it depends on how open they are to critical feedback and how willing they are to change.

People with NPD often have other mental health conditions, such as anxiety, depression, bipolar disorder, eating disorders, or other personality disorders. They’re also more likely to abuse drugs or alcohol.

Some possible complications of NPD and the conditions that overlap are:

  • Trouble at work or school
  • Relationship issues
  • Physical health problems
  • Thoughts about suicide
  • Suicidal behaviors

If you have NPD, it may be tempting not to stick with treatment. Here are tips for seeing it through:

  • Keep an open mind.
  • Focus on your goals and the rewards of treatment.
  • Keep your appointments and follow your doctor’s advice.
  • Get help for any addictions or other mental health problems.

If you are living with or in a close relationship with a person with NPD, here are tips for taking care of yourself:

  • Set boundaries. Tell them what is and isn’t acceptable to you.
  • Don’t get caught up in their way of viewing you.
  • Be prepared for the relationship to change.
  • Don’t take it personally. People with NPD may try to get a reaction out of you, but it’s best if you don’t respond.
  • Let go of any need for approval from the person with NPD.
  • Look for other people who will support you.
  • Look for other sources of meaning and fulfillment in your life.
  • Realize that you can’t change someone with NPD.
  • Protect yourself. Don’t let the person with NPD convince you that their behavior is your fault.
  • Take care of your own mental health. You may want to see a therapist who can help you work through your emotions.
  • Don’t overlook warning signs of suicide or self-harm. Call 911 if you think the person with NPD is in danger.

NPD is a mental health disorder that can negatively affect your relationship with yourself and others. If you struggle with NPD symptoms, therapy, medications, and relaxation strategies can help. Talk to a doctor or therapist if you think you have NPD.

What qualifies as narcissistic abuse?

Narcissistic abuse is a type of emotional abuse that’s caused by narcissistic behaviors. The person with narcissism may threaten, insult, criticize, mistreat, or manipulate you.

What is the best treatment for a narcissist?

Therapy can be an effective treatment option for someone who struggles with narcissistic thoughts or behaviors. Sometimes, doctors might also prescribe medicines or suggest relaxation methods.

Can narcissists live a happy life?

Not all narcissists are unhappy or stressed. Some people just have mild narcissistic traits. But if their thoughts or behaviors are severe, they may disrupt a person’s life. Treatment can help a person with NPD manage their symptoms and improve relationships with others.

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