Narcissistic Personality Disorder

Narcissus by Caravaggio

The prevalence of Narcissistic Personality Disorder (NPD) in the general population is estimated to be less than 1% although it is found in 2 -16% of psychiatric outpatients, usually in conjunction with other Personality Disorders. It is also diagnosed up to 75% more often in men, than women. People with NPD have a great need for admiration, a fragile self esteem and lack empathy. They believe that they are special or unique.

Diagnostic Criteria

At least 5 of the following are necessary for a diagnosis:

  1. Has a grandiose sense of self importance
  2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love
  3. Believes that they are ‘special’ and unique and can only be understood by other special people
  4. Requires excessive admiration
  5. Has a strong sense of entitlement (i.e. unreasonable expectations or automatic compliance with their expectations)
  6. Takes advantage of others to achieve their own ends
  7. Lacks empathy, unwilling to recognize or identify with the feelings or needs of others
  8. Is often envious or believes others are envious of them
  9. Shows arrogant, haughty behaviours or attitudes


Like most Personality Disorders, the cause of NPD is unsure. It has been suggested that a shaming event which occurs early in the person’s life, before which they had seen themselves as perfect, may cause them to build a narcissistic exterior to avoid any recurring shameful experience. Other factors identified as possibly contributing to this disorder include:

  1. Overindulgence and over evaluation by parents
  2. Valued by parents mainly as a means to regulate their own self esteem
  3. Excessive admiration never balanced by realistic feedback
  4. Unpredictable or unreliable care giving by parents
  5. Severe emotional childhood abuse
  6. Learnt manipulative behaviours from parents


Narcissism occurs in a spectrum of severity with NPD at the extreme end of the spectrum. People with NPD are controlling, blaming, self absorbed and intolerant of other’s views. They often feel humiliated or rejected when criticized and will protect themselves from this by reacting with anger or disdain to any real or imagined slight.

The lack of empathy and inability to tolerate criticism makes it very difficult for these individuals to work co-operatively with others or to maintain personal relationships. Sadly, it is unusual for people with NPD to seek therapy for this problem, either because they view themselves as nearly perfect and in no need of personal change, or because of their subconscious fears of exposure of their inadequacies. However, treatment for co-existing problems such as depression or anxiety may be sought and treated successfully.

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