Diagnosis of Narcissistic Personality Disorder:

A physical exam should be done first to rule out any medical conditions that might be causing some of the symptoms, along with a study of the person’s mental health history and the results of a self-assessed questionnaire.

According to the 5th edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), an individual must satisfy at least five out of the following nine criteria to receive a diagnosis of NPD:

1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
3. Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
4. Requires excessive admiration.
5. Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).
6. Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).
7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
8. Is often envious of others or believes that others are envious of him or her.
9. Shows arrogant, haughty behaviors or attitudes.

A person can be diagnosed with more than one personality disorder.

Causes of Narcissistic Personality Disorder:

The exact causes of NPD remain unknown; however, genetic and environmental factors have been implicated.

• Family history – An individual is at increased risk of developing NPD if he or she has a family history of this condition.
• Environmental factors – include adverse childhood experiences, unpredictable or unreliable caregiving by parents when younger — including pampering or being overly critical — and learning the behaviors of psychological manipulation from authority figures and/or peers.

One theory is that some children learn that performance is the pathway to being better than anyone else, thus getting constant desired attention, which then develops into NPD. This explains why criticism is so devastating.

Narcissistic Personality Disorder complications:

Complications of NPD can include relationship difficulties, conflicts at the workplace resulting in redundancy, coexistent major depressive disorder or generalized anxiety disorder, addiction problems such as alcohol dependency syndrome, and increased risk of suicidal behavior.

Treatment for Narcissistic Personality Disorder:

Psychotherapy or talk therapy is the treatment of choice for people with NPD, although most people with NPD don’t think they need it. It is not true that narcissists will never recover. Many do if they commit to the treatment process.

• Talk therapy – can help those with NPD relate better with other people and to recognize and accept their actual competence and potential so they can tolerate criticisms and/or failures in a healthier and more adaptive way. Self-loathing is also addressed.

  Talk therapy will also examine thought processes and emotions with the goal of understanding them, seeing how negative emotional responses are triggered, and responding more appropriately to them.

• Family therapy – can be useful in giving family a voice to the pain caused by the person’s narcissistic behavior in a way that’s safe for the person, with the goal of repairing the relationships and developing better ways of communication and treatment of each other.
• Individual therapy – can help the person with NPD address self-esteem issues and think logistically through healthy ways to deal with stress or emotionally draining events.

If the person with NPD does not get long-term therapy, they can end up completely isolated because of the self-centeredness, self-loathing, and critical or condescending treatment of those who tried to care. Recovery is possible, and relationships can often be repaired.

Substance related disorders – Treatment for substance or alcohol addiction or dependence is vital if any talk therapy is to be successful, as drugs or alcohol abuse will only continue the cycle of denial or avoidance of dealing with the narcissistic behavior.

Coping With Narcissistic Personality Disorder:

Living with someone with NPD can be very difficult.

• Individual and family therapy –  can be very helpful in learning how to set boundaries, communicate clearly, deflect manipulation and gaslighting attempts, handle stress, and avoid enablement.
• Self-care – can help one feel less restricted and more independent. Exercise, healthy eating habits, getting enough sleep, and time with friends and family provide a much-needed mental break and more energy.