Narcissistic Personality Disorder

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“When I look at narcissism through the vulnerability lens, I see the shame-based fear of being ordinary. I see the fear of never feeling extraordinary enough to be noticed, to be lovable, to belong, or to cultivate a sense of purpose.” – Brené Brown

There is no doubt that narcissists have an off-putting reputation. From Narcissus, the subject of a Greek myth, who fell in love with his own reflection to modern despotic leaders who commission gold statues of themselves[1], narcissists are generally viewed with disdain since being obsessed with oneself is viewed negatively in most modern societies. It is easy to see why people are critical of narcissists; the obsession with self implies that they will always put their own needs before the needs of others. For many narcissists, this is true.

However, it is essential to remember that many of the behaviors and attitudes that popular society deems to be undesirable character traits, including those exhibited by Narcissistic Personality Disorder (NPD) sufferers, are symptoms of mental health conditions.

NPD is defined as a “personality disorder characterized by exaggerated feelings of self-importance.[2]” People with this condition often crave admiration.[3] Typically, they obsess and daydream about power and control and feel frustrated when these dreams are not realized. On an interpersonal basis, they can seek to control others, which can lead to situations of abuse.

Socially, people with NPD tend to exhibit low levels of empathy and disdain for others. Because of this, people with NPD can appear arrogant and aloof. They tend to value themselves over others and expect to be treated as superior, regardless of their achievements. They usually have a very fragile ego and no tolerance for criticism and will frequently belittle others to boost their own self-esteem.

The DSM-V states that a person with NPD must have at least five of the following nine criteria to be classified:

  • Grandiose sense of self-importance
  • Preoccupation with power
  • Belief that they are “special”
  • Need to be admired
  • Sense of entitlement
  • Exploitation of others
  • Lack of empathy
  • Frequent envy of others and belief that others envy them
  • Arrogance[4]

Causes of Narcissistic Personality Disorder

It is important to remember that people with this condition do not enjoy it, although it may seem that they do. They live in a perpetual state of wanting something they feel entitled to that they will never get. As with most mental health conditions, NPD roots can be traced back to a combination of neurobiological and environmental causes, and it is not a personal fault of the person experiencing the disorder. In terms of life experiences, NPD is usually caused by one of two things: a narcissistic wound or narcissistic indulgence.

Narcissistic Wound

This is a life experience whereby a person feels  that they aren’t “good enough” as their real self. This could be due to familial, social, or societal pressures for the person to be a certain way. It could also be a response to abuse they have experienced.[5] They assume a superficial persona to cover up their fears of not measuring up to these standards or their beliefs that they are “less than.” This is a maladaptive coping strategy to feel more loved, respected, and valued. Overcompensation may also help them suppress the deep shame and self-hatred they feel.[6]

Narcissistic Indulgence

This often arises from early life conditions that influence the person with NPD to feel that they are superior. This will usually involve a childhood free from discipline, criticism, and control. Often, this is a result of being raised by someone with NPD. Sufferers grow up feeling that they are entitled to be treated differently and that rules for “normal” people do not apply to them.

Neurobiological

Neuroscientists have found physical evidence of narcissism in brain scans. In “Narcissists’ Lack of Empathy Tied to Less Gray Matter,” researchers Schulze et al. found that people with NPD had a lower volume of gray matter in the left anterior cortex.[7]  Other studies have found a lack of gray matter in both the prefrontal cortex and the insular cortex, which are the areas of the brain associated with empathy, compassion, and emotional regulation.[8][9]

Treatment of Narcissistic Personality Disorder

Narcissistic Personality Disorder is not usually the main reason people with the disorder seek mental health treatment. Typically, those with NPD often lack insight into how inappropriate their own actions and beliefs are, which can be a barrier to treatment. NPD frequently co-occurs with depression, bipolar disorder, and substance use disorder.[10]

There is no specific medication used to treat NPD on its own. However, common comorbid conditions such as anxiety, depression, or substance use disorder can be addressed with medications.

Treatment usually involves psychotherapy, which can help people learn to relate better to others and understand the root causes of the emotions associated with NPD. Cognitive Behavioral Therapy helps people control their thoughts and emotions more effectively, and clients can learn to replace their distorted thinking with more realistic ideas. Psychodynamic Therapy helps clients explore their past relationships and realize how their beliefs and behaviors have negatively affected their lives. Somatic Experiencing can also help people process the trauma that may have triggered their NPD.

Although NPD can be a challenging condition, human beings are capable of significant change. With the right help, it is possible to uncover and treat its root cause.

If you are concerned about any issues discussed in this blog, please contact Heather R. Hayes & Associates – call 800-335-0316 or email info@heatherhayes.com today.


[1] Walker, Shaun. “A Horse, A Horse … Turkmenistan President Honours Himself With Statue”. The Guardian, 2015, https://www.theguardian.com/world/2015/may/25/horse-turkmenistan-president-statute-berdymukhamedov.

[2] Caligor, Eve et al. “Narcissistic Personality Disorder: Diagnostic And Clinical Challenges”. American Journal Of Psychiatry, vol 172, no. 5, 2015, pp. 415-422. American Psychiatric Association Publishing, doi:10.1176/appi.ajp.2014.14060723. Accessed 9 Feb 2021.

[3] Burgmer, Pascal et al. “I Don’t Feel Ya: How Narcissism Shapes Empathy”. Self And Identity, 2019, pp. 1-17. Informa UK Limited, doi:10.1080/15298868.2019.1645730. Accessed 9 Feb 2021.

[4] Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: American Psychiatric Publishing. 2013. pp. 669–72. ISBN 978-0890425558.

[5] Irwin, H J. “Codependence, narcissism, and childhood trauma.” Journal of clinical psychology vol. 51,5 (1995): 658-65. doi:10.1002/1097-4679(199509)51:5

[6] Zamostny, K. P., Slyter, S. L., & Rios, P. (1993). Narcissistic injury and its relationship to early trauma, early resources, and adjustment to college. Journal of Counseling Psychology, 40(4), 501–510. https://doi.org/10.1037/0022-0167.40.4.501

[7] Schulze, Lars et al. “Gray matter abnormalities in patients with narcissistic personality disorder.” Journal of psychiatric research vol. 47,10 (2013): 1363-9. doi:10.1016/j.jpsychires.2013.05.017

[8] Ronningstam, Elsa. “Pathological Narcissism And Narcissistic Personality Disorder: Recent Research And Clinical Implications”. Current Behavioral Neuroscience Reports, vol 3, no. 1, 2016, pp. 34-42. Springer Science And Business Media LLC, doi:10.1007/s40473-016-0060-y. Accessed 9 Feb 2021.

[9] Nenadic, Igor et al. “Brain structure in narcissistic personality disorder: a VBM and DTI pilot study.” Psychiatry research vol. 231,2 (2015): 184-6. doi:10.1016/j.pscychresns.2014.11.001

[10] Stinson, Frederick S et al. “Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions.” The Journal of clinical psychiatry vol. 69,7 (2008): 1033-45. doi:10.4088/jcp.v69n0701

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