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Narcissistic Personality Disorder

Narcissistic Personality Disorder, or NPD, is part of the Cluster B, or Dramatic group of disorders and is a mental illness that manifests as an excessive preoccupation with personal adequacy, power, vanity and prestige. It is more commonly diagnosed in males and is believed to affect approximately 6.2% of the population.

People with NPD appear to be arrogant, or appear to believe they have an unjustified sense of entitlement and demonstrate grandiosity in their beliefs and behavior.  They have a strong desire for admiration and praise but seem to lack any sense of empathy or ability to appreciate perspectives of others. Although symptoms are frequently judged as being excessively arrogant and perceptions are that the person with NPD believes that they are superior to peers, the person with NPD did previously in fact feel inferior, inadequate and perhaps a deep shame; the unconscious defends this threatening belief, by developing Narcissism.

NPD is often the product of childhood abuse; when a child is abused or when they experience trauma the mind attempts to discover a method to help forget about the wounds and to prevent this abuse from happening again; as a defense mechanism, narcissism develops. NPD is in fact similar to an almost bullet-proof emotional shield that has been erected as an attempt to entirely protect their feelings and belief that they are inferior in some way. NPD can also develop as a result of Preoccupied or Unresolved Attachments with Primary Caregivers; at times perhaps with overindulgence alternating with neglectful parenting.

People with NPD have an overwhelming fear of powerlessness, as perhaps their power to be safe was taken away by somebody more powerful than them, through abuse or neglect. Erecting a defense that manifests as superiority serves to protect the mind, ensuring they don’t become a victim again. People with NPD remain hypersensitive to insults (real or imagined), criticism, or defeat, possibly reacting with rage, shame, and humiliation.

Families, friends or partners of people with NPD may have difficulty persuading them into therapy as the person with NPD may believe that if they were take away their protective layer, their ‘super-power’, a vulnerable and excessively emotional child will be revealed. Suggestion that there is something wrong with a person with NPD will devastate although they may not show it as they do find showing their own pain difficult.

Narcissistic Traits: description of NPD symptoms (from Also additional information about NPD for family members.)

Can Narcissistic Personality Disorder be cured?

Many of the symptoms of NPD can be treated though psychotherapy provided the person is willing to be treated. The main goal of these psychotherapies is to help the person to develop healthier self-esteem and more realistic expectations of others.

Most narcissistic people will only reluctantly agree to go to therapy if a significant person in their life is threatening to leave them, or if someone is threatening their comfort, their reputation, or their status if they don’t.

PDAN’s basis of work is that people with any personality disorders who actually want to change, can be helped. Now some people with PD, especially with NPD, rarely want to change. PDAN’s role here is to walk a delicate balance informing people with NPD that there are good therapy treatments for them, and informing family members that sometimes people with NPD refuse any help.

Presentation by Dr. Elsa Ronningstam on Narcissistic Personality Disorder, from December 2014.
Discussion of various treatments of NPD starts at minute 52.

Results of NPD treatment depend strongly on individual motivation and external circumstances.

Tips for therapists on navigating narcissism and maintaining momentum in treatment:
“The amount of leverage, or “meaningful” consequences the narcissist faces helps determine the possibility of maintaining the motivation and compliance necessary for achieving an effective treatment outcome. Additionally, the therapist needs to cultivate a robust connection with this client, as narcissists are more prone to disappearing into a state of hyper-autonomy, entitlement, and self-aggrandizement. Therapists must be sturdy enough to show up as a “real” person, not just an expert, to bypass the cynical, approval-seeking, charming, defiantly avoidant, and tough-guy modes. The therapist engages in a (limited) re-parenting advocate for the vulnerable part of this larger-than-life client, hidden behind the “masks.”
Understanding Narcissism, online page by therapist and author Wendy Behary.



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