Diagnosis spotlight: narcissistic personality disorder

Everyone knows someone who might be described as arrogant, self-absorbed or vain. When these traits are taken to an extreme, they can become pathological. In narcissistic personality disorder (NPD), self-centeredness overtakes a person and can hurt ones functioning, success and relationships with others. 

 

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In someone with NPD, there is a certain grandiosity and a need for admiration. This is further complicated by a lack of empathy. With NPD, it is expected that one is treated as special and valuable while other people might not even be on the radar. This can manifest in several ways.

According to the DSM-5 (the manual used to diagnose mental illness), people with NPD have an exaggerated sense of self-importance. This might manifest through overstating accomplishments or expecting recognition of superiority without the achievements to match. There can also be fantasies of unlimited success, power, brilliance, beauty, or ideal love. He might see himself as special or unique and therefore only able to be understood by or willing to associate with other people deemed special. There can also be an excessive need for admiration.

NPD might lead someone to take advantage of others. This can be done due to an unwillingness to recognize the feelings or needs of others. Someone with NPD might also be very envious or believe that others are envious of her. There is commonly displays of arrogant behaviors or attitudes.

No one knows exactly how NPD develops. It might be a combination of biology, temperament and early social interactions. It is believed that it can develop as a result of parenting that focuses too much on the child’s specialness. This might be done to increase the parents' own self-esteem. On the other hand, it is possible for it to develop as a response to a childhood of neglect and abuse.

When properly managed, people with NPD actually have some highly adaptive traits. They might have high self-confidence, allowing them to try new things. Their self-esteem can encourage positive risk-taking. NPD can make someone very charming, which can be socially advantageous when used responsibly. There is a lot of leadership potential that can be tapped into in a healthy way.

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Left unregulated, however, NPD can take over lives and lead to a lot of social problems. Friends and family might get worn down by the self-centeredness and lack of empathy, making it difficult to build and retain meaningful relationships. Professional relationships can also be disrupted due to shows of entitlement and an unwillingness to collaborate. At its most destructive end, people with NPD can become abusive. They are able to make their victims feel like they are at fault. 

People with NPD rarely seek treatment. They fail to see how they are being destructive to themselves and those around them. It is not uncommon for NPD to go untreated while those in his life end up seeking help for themselves. When treatment is sought, it is usually only at the insistence of loved ones.

NPD can be hard to treat. Treatment generally means psychotherapy, as there is no medication for NPD. The course of therapy might focus on changing beliefs and behaviors that are destructive. They might be taught to be more empathetic and learn how to use their talents and resources to help others. This might not change feelings such as entitlement, but in practical terms, it leads to a more functional life.

Specific symptoms, such as anger and impulsivity, can be worked on as well. In general, one might look for the areas in which NPD is causing the most problems and focus on those. For instance, if a business owner cannot retain employees because of the way he treats them, therapy might focus on respect and valuing the contributions of others. Group and couples therapy can also be beneficial, as it allows those with NPD to explore relationships and how they relate to others. 

Treatment can be difficult for those with NPD. It challenges their world views and asks for a lot in terms of change. It is usually a long-term process. This might be especially bothersome if the person with NPD does not believe she has a problem. Loved ones can be helpful by responding positively to the person with NPD seeking treatment and can offer praise and support as changes are gradually made. It can be a rough path, but the improvements in relationships are worth the effort.