narcissistic personality disorder

Narcissistic Personality Disorder: Signs, Causes, Treatment And Prognosis

Narcissistic personality disorder: signs, causes

A narcissistic personality disorder is a serious condition (2) and also very common (5) in many countries (6) (7). Symptoms usually start during the childhood of the patient (1). It is more than just striving for recognition and attention (8), however, those are typical symptoms too (4). Behind the often self-absorbed or arrogant appearance are usually pain and suffering (9) – and essentially weak self-esteem (10). There are currently several treatments available (3).

Read all the important information about narcissistic personality disorder here!

ICD code for this condition is F60.

narcissistic personality disorder

Narcissistic personality disorder: Description

When people present themselves as very self-absorbed, always looking for faults in others rather than themselves, the term “narcissism” quickly comes up. But what is a narcissist? People with a narcissistic personality have an extreme need for attention, recognition, and admiration. They often stand out for their arrogance and self-idealization. They cannot bear criticism and failure can plunge them into serious crises. However, narcissistic people have difficulty empathizing with other people. They often condescend to others. Dealing with narcissists is therefore very challenging.

There are always discussions about whether our society is becoming increasingly narcissistic. Are people only focused on their success and a perfect self-presentation? There is no clear answer to this question. However, narcissism is a phenomenon that has long preoccupied people. Even in Greek mythology, we find Narcissus – a young man who falls in love with his own reflection and rejects the love of all others.

It is important to distinguish between narcissism and a genuine narcissistic personality disorder. Narcissists are often very ambitious. You can therefore be found in management positions and can lead a very successful life. However, if narcissism is very pronounced and causes suffering for the person concerned and his environment, narcissism becomes pathological (pathological narcissism). The transition from a personality trait to a disorder is fluid. Although narcissism is much discussed in society, little research has been done on narcissistic personality disorder.

Narcissistic personality disorder: How many people are affected?

About one percent of the population suffers from narcissistic personality disorder. Men receive a diagnosis more often than women. Most of those affected seek treatment for other mental illnesses. They often suffer from depression, other personality disorders, somatoform disorders (physical complaints without organic cause), fears, eating disorders, or addiction problems.

Types of narcissistic personality disorder

According to a study by Russ and his colleagues (2008) narcissistic personality disorder can be divided into three types:

  • grand narcissism
  • vulnerable-fragile narcissism
  • exhibitionistic narcissism with a high level of function

Narcissistic personality disorder: grandiose malignant type

People of the grandiose or malignant type can become a danger to society. Malignant narcissism is a combination of narcissism, aggression, paranoia and antisocial behavior. A devilish mixture, which can move people to extremely cruel deeds. Stalin and Hitler, for example, are described as malignant narcissists. They are convinced of their greatness. If they do not feel adequately valued by others, they take revenge without remorse. The rejection does not have to be real. Because of their paranoid tendency, they quickly see enemies in their fellow men.

Narcissistic personality disorder: vulnerable-fragile type

Vulnerable-fragile narcissism initially seems atypical, as it is characterized by a depressive mood, anxiety, and shame. This form is therefore also known as “covert narcissism”. People of this type are very sensitive to criticism and failure. You have great difficulty in empathizing with others. Those affected seek therapeutic help more often than the other types because of depression and other psychological symptoms.

Narcissistic personality disorder: exhibitionist type

The exhibitionist type publicly displays its magnificence. In this way, he attracts the attention he needs. This type can adapt well and be very successful in our competitive world. His appearance appears very self-confident. Towards others, these people behave arrogantly and coolly. This form is also known as “open narcissism”.

However, people with a narcissistic personality disorder can also appear very confident and grandiose at one moment and shortly afterwards show signs of depression and anxiety. It is therefore conceivable that the different types are facets of one and the same disorder. Research in this area is still in its infancy.

Symptoms Of Narcissistic Personality Disorder

One speaks of a personality disorder when people show a certain pattern in behavior, thinking, and feelings that deviate greatly from the expectations of the socio-cultural environment. These inflexible personality traits lead to suffering and impairment in social, professional, or other areas.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), at least five of the following symptoms must be present for the diagnosis of narcissistic personality disorder:

The patients concerned

  • have an exaggerated sense of their own importance
  • have fantasies of boundless success, power, beauty or ideal love
  • believe to be special and unique and only understood by special or respected people
  • expect excessive admiration from others
  • expect others to treat them with special preference and automatically respond to their expectations
  • exploit others to achieve their own goals
  • have little empathy; do not want to empathize with others
  • often feel envy for others or believe others are envious of them
  • behave arrogantly and presumptuously

However, the symptoms of narcissism are not always so clear. Some do not openly show their arrogance. The signs are then only recognizable if you look very closely.

For a long time, experts have assumed that narcissistic personality disorder is associated with high self-esteem. However, since our June 2020 update of this article (our articles are updated three times per year), we can describe that recent studies show that the self-esteem of those affected is low. They disguise their self-esteem doubts through their self-important self-representation. So there can be no question of self-love. People with narcissistic personality disorder suffer from inner emptiness and are very dependent on the recognition of others. Upgrading oneself or devaluing others is an attempt to cope with negative feelings. An offense such as a separation of the partner can lead to revenge, but can also cause depression and even suicide.

Causes And Risk Factor For The Narcissistic Personality Disorder

Narcissistic personality disorder arises from an interaction of various factors. According to recent twin studies, genes have a greater influence on narcissistic personality disorder than in other personality disorders. But environmental influences also play an important role.

Relevant Environmental Factors

Many experts see the roots of narcissism in childhood. However, the theories about its origin vary widely and there is currently no reliable evidence. The only consensus is that narcissistic disorder is due to unfavorable interactions with caregivers.

The leading researcher in the field of narcissistic personality disorder, Otto Kernberg, assumes that emotionally cold or latently aggressive parents promote an exaggerated self-image. Children who receive little recognition cope with this violation of self-esteem by focusing on achievements for which they are praised (for example, school achievements). Other researchers suspect that children who are not given boundaries by their parents may develop an unrealistic and perfectionist self-image. Both parenting styles ultimately represent the neglect of the child’s needs. Children need security and love, but also boundaries. For healthy development, they also need to learn how to deal with disappointments, the ability to take themselves back and put themselves in the shoes of others.

Diagnosis Of Narcissistic Personality Disorder

A psychiatrist or psychotherapist should be consulted to diagnose a narcissistic personality disorder. The therapist can make a diagnosis on the basis of specific questions based on the diagnostic criteria. The diagnosis also serves to distinguish it from other personality disorders, for example, histrionic personality disorder, which is characterized by egocentric and theatrical behavior, or borderline personality disorder. If possible, the therapist will also ask close relatives how they experience the affected person. The therapist might ask the following questions to diagnose narcissistic personality disorder:

  1. Do you feel you are doing great things in your life?
  2. Do you often have the impression that others do not recognize your greatness?
  3. Do you find it exhausting to deal with other people’s feelings and interests?

The diagnosis of narcissistic personality disorder is often perceived by those affected as an attack on their person. A good explanation of the background of the diagnosis is therefore of great importance. The diagnosis is not intended to condemn the person concerned, but to help him or her to better understand themselves and their environment. This understanding is often very relieving for both the affected persons and their relatives.

Treatment Of Narcissistic Personality Disorder

Narcissistic people have no insight into the fact that their own behavior creates problems. They are – at least superficially – convinced of the magnificence of their self and look for the fault in other people. When narcissists seek treatment, it is usually because of an additional mental disorder, such as depression, alcohol, or drug addiction. Psychotherapeutic methods are used to treat narcissistic personality disorder.

Relationship building

An essential component of a successful narcissism therapy is a trusting relationship between the person affected and the therapist. Narcissistic persons often find it very difficult to get involved with the therapist. Admitting that they need help is perceived by narcissists as a defeat and a threat to their self-image. Often they first devalue the therapist in order to maintain their superiority. It may therefore take some time before the patient is ready to trust and work with the therapist.


The therapist helps the affected person to better understand their behavior and feelings. Narcissistic behavior is often an attempt to compensate for negative feelings. However, arrogance and arrogance are not well received by fellow human beings. In order to improve the relationship with other people, the person concerned must work on his or her empathy, i.e. to be able to empathize better with others. The therapist works with the client to develop new behavioral strategies that contribute to better interact with other people.

Realistic claims

The mental health of people with narcissistic personality disorder is particularly at risk if their excessive demands are not met. Every insult is a threat to his own self. An important measure in therapy is therefore to question the demands and set goals that can actually be achieved.

Parents of the patient hope that the therapist can cure narcissism. It is true that nowadays, unlike in the past, it is no longer assumed that narcissistic personality disorder cannot be changed. But unlike an illness, a personality disorder is inherent in the personality itself. In a true sense, therefore, one cannot expect narcissism to be curable. However, in about half of the people, the symptoms are reduced within two years – thanks to therapy.

The goal of therapy is not to turn the narcissist into a different person. Rather, the therapy is an offer to the affected person to change extreme behavior and ways of thinking with the help of the therapist and thus also to improve his or her own life. The therapist develops the therapy goals together with the patient. Ultimately, therapy is about reducing suffering.

Personal Relationships 

Managing a partnership with someone who has a narcissistic personality disorder is a great challenge. For narcissists, the world practically revolves around them. Putting oneself in the place of one’s partner (or other people) is not one of their strengths.

For a functioning partnership, it is not only important that the narcissist is treated by a therapist. The partner should also seek professional help to learn more about how to deal with a narcissist.

You can read more about this topic in the article Narcissistic Personality Disorder: Partnership.

Prognosis For Narcissistic personality disorder

People who have a sense of achievement and good relationship experiences have a favorable prognosis. The better the self-perception becomes, the easier it is to recognize and work on the narcissistic traits themselves. The prognosis is worse for those affected who cannot get involved with the therapist because of their arrogance, have many failures in life and abuse drugs or alcohol.

Narcissistic personality disorder also entails an increased risk of suicide. When one’s own magnificence is shaken, a deep insult sets in. As a result, some of those affected take their own lives.

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