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Most people have heard the term “narcissist” but few are familiar with narcissistic personality disorder (NPD). While some might label a person as a narcissist because they’re self-serving or put a lot of emphasis on their looks, that isn’t the true criteria for NPD. In fact, many people who are diagnosed with narcissistic personality disorder don’t seem narcissistic on the surface. They may even come across as very giving when you first meet them. 

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Narcissistic personality disorder is a mental health condition that impacts self-worth and behavior. The condition causes an inflated sense of self importance and a lack of empathy for others while simultaneously contributing to fragile self-esteem that makes a person hypersensitive to criticism. The combination can cause significant inability to relate and interact with others in a positive, productive manner.

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Let’s delve a little further into how a person is diagnosed with narcissistic personality disorder, how prevalent the disorder is and what treatments exist.

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How Narcissistic Personality Disorder Develops

Narcissistic personality disorder affects a lot of people. Based on community samples, anywhere from 0.5% to 5% of the population has NPD. However, in clinical samples the rate of prevalence for NPD is 1% to 15% of the U.S. population. The lifetime rate of prevalence is 7.7% for men and 4.8% for women.

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The disorder often coexists with other mental health conditions, which is why diagnosis can be challenging and the condition is likely underreported. It’s common for someone with NPD to have a mood disorder like depression. 

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It’s not entirely known how NPD develops, but experts have zeroed in on contributing factors that could make someone more susceptible to the disorder. These potential contributing factors include:

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• Genetics
• Trauma in childhood
• Extreme praise in childhood
• Extreme judgment or neglect in childhood
• Exposure to a parent or caretaker with NPD

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Doctors have determined that narcissistic personality disorder tends to begin early in life when children are developing a sense of self based on feedback from their surroundings and how they perceive others. Studies have shown that characteristics of narcissism can begin showing up as young as two years old and the disorder develops around age seven. It’s believed that NPD develops mainly due to an unsuccessful relationship with a parent in childhood that involves emotional neglect or attachment dysfunction that negatively impacts self-worth.

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Research is also showing a connection between sense of self and self-worth that’s tied to expectations of perfection that begin early in life. People with NPD tend to be highly motivated to give off the perception of perfection at all times. This can lead to a number of issues such as lack of accountability for their actions, fragile ego, low self-esteem and extreme defensiveness.  

Characteristics of NPD

There are some key characteristics of NPD that clinicians use to diagnose the disorder. The DSM-5 diagnostic criteria for NPD includes:

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• Lack of empathy for others
• Grandiose sense of self-importance
• Fantasies of unlimited power, success or beauty
• Belief that they are special and can only be understood by other high-status or special people
• Sense of entitlement
• Need for excessive admiration or validation
• Interpersonally exploitative
• Envious of others and belief that others are envious of them
• Behaves in an arrogant manner

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Clinical diagnosis of NPD is made when a person meets at least five of the criteria listed above.. Grandiosity, lack of empathy for others and seeking excessive admiration are the key characteristics that are present in virtually all instances of NPD.

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It should be noted there are two primary types of narcissistic personality disorder, which influences the characteristics and behaviors that are exhibited.

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Grandiose/Overt Narcissistic Personality Disorder - A person with clinical grandiose NPD is fairly easy to spot. They tend to act bold, aggressive, exaggerate their capabilities and are more openly exploitative. This type of NPD is what people usually associate with narcissism. 

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Vulnerable/Covert Narcissistic Personality Disorder - This is the type of NPD that is identified less often because unlike grandiose narcissists, people with vulnerable NPD behave in more defensive ways due to hypersensitivity and lack of self-esteem. They also don’t exhibit grandiosity and need for admiration as overtly. Instead, vulnerable narcissists tend to take on the role of a victim to illicit praise, validation and empathy from others.  

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Other subtypes of NPD have been defined, however, most people who are diagnosed with the disorder are one of the two types above.

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Negative Effects of Narcissistic Personality Disorder

Often a person with NPD will know they have narcissistic traits, but that doesn’t mean they are seeking help or believe that their behavior is wrong. Unfortunately, many people with NPD are diagnosed due to having a co-occurring disorder or because NPD has caused major disruption in the person’s life, such as a divorce or job loss. 

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NPD can have profoundly negative effects for the person with the disorder and those around them. Negative consequences can include:

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• Difficulty with interpersonal relationships. 
• Feelings of isolation.
• Creating disruptive, toxic environments at the workplace. 
• Job loss or limited career success.
• Higher likelihood of self-harm.
• Higher risk of depression and anxiety.

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These are serious consequences that can have a large ripple effect. Of late, a lot of attention has been given to how NPD affects the workplace. Negative short-term and long-term effects have been identified that can cause societal and economic harm on a large scale. 

Available Treatment Options for NPD

Narcissistic personality disorder may not be a terminal illness, but it can feel equally hopeless when you learn about the diagnosis. Despite the prevalence of NPD, currently no standardized treatment options exist. The best that health professionals can offer at this time is talk therapy. 

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Talk therapy will make someone with NPD more aware of their actions and how they could affect others, but that’s a double-edged sword. Because of the nature of the disorder, someone with NPD is likely to quit therapy once these negative qualities are brought up and are perceived as criticism. The other issue is that talk therapy must be continued indefinitely. It’s a long-term treatment strategy with a very small response rate. 

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Transference-focused psychotherapy is a new strategy that is being tried for NPD after first being used for borderline personality disorder. With this type of therapy the patient meets with their therapist twice a week and essentially projects their feelings onto the therapist. It primarily involves the patient expressing their perceptions and the emotions they feel in the moment. 

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The goal is to focus on the patient’s perception, since the emotions of a person with NPD are largely driven by their perception of how they are being treated. In doing so the therapist can identify destructive thinking patterns, and the patient can develop a more positive self-image and form constructive behaviors.

Co-Occurring Disorder Treatment

If a co-occuring disorder is diagnosed, then the other disorder may be the primary focus of treatment initially. That could involve medications, different types of psychotherapy or even psychedelic therapy depending on the situation. 

Ketamine Shows Promise as a Possible Treatment for NPD

When you consider that there are no treatments beyond talk therapy and the response rate is low, it makes sense that psychiatrists want to explore the use of ketamine and other psychedelics to treat NPD. Ketamine is already used for treatment resistant depression, PTSD, OCD and anxiety. 

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Early clinical studies are showing promise for the therapy to be used as a treatment for NPD. It appears that ketamine could enhance the very things that a person with narcissistic personality disorder lacks that leads to the condition. A recent study published in Psychopharmacology showed strong evidence that psychedelic therapy can help people with NPD gain a greater sense of connection to others and improve empathic drive. The state of awe associated with psychedelic therapy is what led to a decrease in maladaptive narcissistic traits. 

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The research has been the catalyst for more ongoing studies in a clinical setting that are looking deeper into the use of psychedelic therapy for NPD. Ketamine is also being explored as a potential treatment for borderline personality disorder.

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Researchers hope that ketamine’s ability to enhance neuroplasticity and change perception will help people with NPD correct maladaptive narcissistic personality traits. Since psychedelic therapies are able to neurologically rewire hardwired thought patterns and build new synaptic connections to shift a person's viewpoint and thinking, they could be highly beneficial in curbing disruptive behaviors that are the result of NPD.

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There is still a lot more to learn, but the latest research is giving millions of people hope that in the near future there could be an effective pharmacological treatment for NPD and other personality disorders.  

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