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Narcissistic Personality Disorder: A Guide to Understanding NPD

Do you know someone who seems to think they are better than everyone else? Someone who needs constant praise and attention yet shows little genuine empathy for others? These could be signs of narcissistic personality disorder (NPD).

While we all have some narcissistic tendencies, people with NPD take them to the extreme. Their exaggerated self-importance and grandiosity often make relationships challenging, leaving loved ones hurt or exploited.

But behind their confident façade, narcissists struggle with fragile self-esteem and try to mask feelings of inadequacy. They crave validation from others to prop up their shaky sense of identity.

Don’t lose hope if you think you may have NPD or a loved one shows symptoms. With treatment and lifestyle changes, people with NPD can better manage their disorder, develop healthier relationships, and lead more fulfilling lives.

Example – When Jason first met Alicia, he was swept away by her beauty, wit, and infectious laugh. She radiated confidence and always commanded the attention of those around her.

But as time passed, Alicia’s flawless façade began to show cracks. She constantly demanded Jason’s praise and affection yet casually disregarded his needs. When confronted about her selfish behaviour, she flew into a rage. It soon became clear Alicia wasn’t just confident – she exhibited all the classic signs of narcissistic personality disorder (NPD).

Young Woman With Narcissistic Personality Disorder

Types of Narcissism

Overt/GrandioseTend to be extroverted, aggressive, and demanding. Have an inflated but fragile sense of self-importance and need for constant admiration.
Covert/VulnerableTend to be introverted and hypersensitive. Have feelings of inadequacy and are afraid of criticism or disapproval. May appear shy but have underlying grandiosity.
MalignantForm of severe narcissism with antisocial behaviours. Often seek to gain power and get revenge for what they perceive as unfair treatment—lack of empathy and willingness to exploit others.
CommunalAppear helpful, altruistic, and invested in others on the surface. However, actions are motivated by the need for social advancement rather than genuine care for the community.
AntagonisticHighly competitive with tendencies toward aggression, hostility, and putting others down. Prone to anger when perceiving interactions as a win/lose scenario.

While not officially designated diagnoses, these subtypes can help characterize how narcissism manifests. Overt and covert narcissism comprise the two main categories, while malignant, communal, and antagonistic describe additional possible traits.

Discussing these distinctions with a mental health professional can provide deeper insight into narcissistic behaviour and tendencies.

Symptoms and Diagnosis

People with NPD tend to exhibit some common behavioural and emotional patterns. Not all symptoms may be present, but someone with NPD will usually show several of the following:

  • Grandiose sense of self-importance – They have an exaggerated sense of talent or importance and expect others to recognize them as superior.
  • Fantasies of success, power, and beauty – They often create elaborate fantasies surrounding their abilities and desirability.
  • Need for constant admiration – They expect others to cater to them, praising and validating their abilities. Criticism is poorly tolerated.
  • Sense of entitlement – They believe they deserve and are entitled to more privileges and better treatment than others.
  • Interpersonally exploitative – They will try to take advantage of others to serve their interests and needs. Empathy for others’ feelings is lacking.
  • Arrogant attitudes and behaviour – They often act arrogant, superior, and patronizingly.
  • Envy of others – They believe others are envious of them and may react negatively if they feel threatened by others’ success.

Some other common behaviours are seen in NPD:

  • Exaggerating achievements or talents
  • Focusing conversations on themselves
  • Seeking association only with high-status people
  • Becoming impatient or angry when not catered to
  • Reacting strongly to criticism, rejection, or failure

NPD often co-occurs with other mental health issues:

  • Depression or bipolar disorder
  • Substance abuse
  • Other personality disorders

A person must exhibit at least 5 symptoms above to be diagnosed with NPD. Many narcissists do not recognize their behaviour as problematic, so they may not seek evaluation. Often, a loved one prompts assessment and treatment.

Diagnosis typically involves:

  • Clinical interview with a psychiatrist, psychologist or therapist
  • Discussion of symptoms, thoughts, behaviours, and history
  • Input from loved ones
  • Evaluation for co-occurring disorders
  • Review of DSM-5 diagnostic criteria

There are no medical tests that can diagnose NPD. However, assessment is important for appropriate treatment. People with NPD can improve relationships and lead happier lives with proper management.

Do you recognize any narcissistic traits in yourself or a loved one? Review this checklist of common NPD symptoms:

  • ✅ Grandiose sense of self-importance
  • ✅ Fantasies of success, power, beauty
  • ✅ Needs constant admiration
  • ✅ Sense of entitlement
  • ✅ Takes advantage of others
  • ✅ Arrogant behaviour
  • ✅ Lacks empathy
  • ✅ Envies others
  • ✅ Reacts to criticism with rage

Causes and Risk Factors

The exact causes of NPD are unknown, but research suggests certain factors may contribute:

  • Genetics – NPD seems to run in families, indicating a possible genetic predisposition. Certain personality traits and brain differences may be inherited.
  • Childhood experiences – Neglect, excessive adoration, abuse, unstable caregivers, or other invalidating experiences in childhood may impact personality development.
  • Cultural values emphasizing individualism, competition, status, and wealth enable narcissistic traits. Cultures focused on community have lower NPD rates.
  • Parenting style – Overindulgence and overvaluation (“you’re so special”) or excessive criticism may contribute to children developing narcissistic tendencies.

Other risk factors for NPD:

  • Childhood mental health problems
  • Beautiful physical appearance
  • Above-average intellect or athletic ability
  • Positions of authority, power, or high status

The exact interplay of these factors is complex and varies between individuals. There are likely multiple pathways leading to the development of narcissistic personality disorder.

While the causes of NPD are not entirely determined, some theories suggest:

  • Problems with emotion regulation in the brain
  • Imbalances in neurotransmitters like dopamine and serotonin
  • Early life experiences sculpting neural pathways

Ongoing research is exploring the biological underpinnings and environmental triggers for NPD. Genetics load the gun, but the environment pulls the trigger, as the saying goes.

Uncovering the roots of NPD will enable the development of more targeted, practical treatment approaches.

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Impacts on Relationships and Daily Life

The exaggerated self-focus and lack of empathy seen in NPD can profoundly impact relationships with friends, family, and romantic partners. People with NPD prioritize their needs and desires above all else. This creates significant interpersonal problems:

Romantic Relationships

  • Partners feel unloved, used, or exploited
  • Narcissists lose interest when partners can’t meet their “perfect” expectations
  • Relationships follow a pattern of idealization, devaluation, and abandonment


  • Narcissists only befriend people they deem worthy of their time
  • They lack reciprocity, empathy, and genuine interest in others’ lives
  • Friendships tend to be shallow and easily dissolved when needs aren’t met

Family Members

  • Family often bears the brunt of narcissistic rage, criticism, and entitlement.
  • Parents sometimes enable narcissistic behaviours in their children
  • Siblings and extended family feel mistreated and develop resentment

Workplace and Education

  • Narcissists frequently clash with authority figures
  • They are threatened by coworkers outperforming them
  • Teamwork and compromise are challenging for them
  • Many underperform relative to natural talents and intellect

Financial and Legal Concerns

  • Impulsive spending to impress others and maintain their desired lifestyle
  • Taking financial or legal risks due to feelings of invincibility
  • Anger issues can lead to physical fights or domestic disputes

Mental Health Impacts

  • Depression, anxiety, and substance abuse problems are more common
  • Extreme disappointment when reality doesn’t match their grandiose fantasies
  • May experience suicidal thoughts when faced with failure or rejection

Getting appropriate treatment, setting boundaries, and adjusting expectations can help minimize the relationship devastation caused by NPD. With work, healthy and rewarding relationships are possible.

Real Examples

Example 1: When Camila eats with friends, she often orders the most expensive dishes and expects others to foot the bill. She frequently looks at herself in the mirror and takes multiple selfies during the meal. Camila will suddenly remember an impressive accomplishment to redirect attention if the conversation shifts away from her. These behaviours reflect Camila’s sense of entitlement and need for constant admiration.

Example 2: John insistently claims he can bench press more than anyone else at the gym, yet never does strength training. He constantly glares at other muscular men and tries to diminish their abilities. John’s fragile ego leads him to make exaggerated claims about his own prowess while envying the achievements of others.

Example 3: The famous singer Beyla is known for lavish, indulgent productions at her concerts and award shows. She requires a large entourage catering to her every need. In interviews, Beyla boasts about her incredible talent and intelligence yet cannot take constructive feedback from directors or collaborate effectively. Her grandiose displays, entitlement, and arrogance suggest narcissism. 

Treatment Options

While living with NPD presents challenges, various treatment approaches can help manage symptoms. The key is customizing treatment based on each individual’s situation.


Talk therapy is the mainstay of treatment for narcissistic personality disorder. Some common modalities include:

  • Cognitive behavioural therapy (CBT) – Identifying and adapting negative thought patterns
  • Dialectical behaviour therapy (DBT) – Regulating emotions and managing stress
  • Schema therapy – Addressing core emotional themes from childhood
  • Psychodynamic psychotherapy – Increasing self-awareness of motivations and defence mechanisms

Finding a therapist experienced with NPD is crucial. The therapist should offer compassion while holding the narcissist accountable.


While no medications directly treat NPD, doctors may prescribe drugs to address related mental health issues like:

  • Antidepressants – For co-occurring depression and anxiety
  • Mood stabilizers – To help regulate emotions
  • Antipsychotics – In severe cases with delusions or paranoia

Medication can be combined with psychotherapy for a comprehensive approach.

Other Therapies

Additional strategies that may help manage NPD include:

  • Group therapy – Connecting with others also diagnosed with NPD
  • Family therapy – Improving communication and relationships with loved ones
  • Social skills training – Learning empathy, emotion regulation, and conflict resolution skills

Ongoing treatment participation offers narcissists the best chance at leading happier, healthier lives. There are plenty of reasons to be hopeful.

Coping Strategies and Self-Care

Living with narcissistic personality disorder presents daily challenges. Implementing positive coping strategies and self-care can help manage the condition.

Set small, achievable goals.

  • Break down big tasks into smaller steps
  • Set realistic goals you can reach
  • Build self-confidence through accomplishing goals

Identify triggers

  • Keep a journal tracking your emotional states
  • Note situations that spark negative reactions
  • Plan to avoid triggers when possible

Practice self-validation

  • Counteract negative self-talk with honest self-appraisal
  • Identify positive qualities without exaggeration
  • Seek balanced feedback from trusted friends

Learn to tolerate criticism

  • Start with non-personal feedback from work or hobbies
  • Remind yourself that you have worth beyond external validation
  • Talk through criticisms productively rather than lashing out

Prioritize self-care

  • Make time for relaxing activities like reading or nature walks
  • Don’t neglect sleep, healthy eating, and exercise
  • Try yoga, meditation, or mindfulness to reduce stress

Consider support groups

  • Connect with others, managing narcissistic tendencies
  • Share challenges and solutions in a judgment-free space
  • Find a sense of community and understanding

With commitment and compassion towards yourself, you can develop healthier patterns of thinking and behaving.

Here is a Top 10 list of tips for people with NPD to better manage their disorder:

  1. Seek feedback from trusted friends
  2. Admit faults and imperfections
  3. Listen attentively to others’ feelings
  4. Apologize when you make a mistake
  5. Thank those who have helped you
  6. Congratulate others on their achievements
  7. Volunteer time to help those in need
  8. Replace anger with calm acceptance
  9. Balance pride with humility
  10. Focus on being a good person over being “great”

Managing Narcissism in Loved Ones

Coping with a narcissistic partner, family member, or friend presents unique challenges. While you can’t force someone with NPD to change, you can modify your behaviours to improve the relationship.

Set boundaries

  • Be clear about what behaviors you will accept vs. won’t tolerate
  • Follow through on specified consequences when boundaries are crossed
  • Limit contact if the narcissist refuses to respect your needs

Avoid escalation

  • Stay calm, and don’t take their comments personally
  • Don’t try to argue facts with someone detached from reality
  • Walk away and revisit issues later when emotions have cooled

Have realistic expectations

  • Recognize you didn’t cause their NPD and can’t cure it
  • Don’t expect genuine empathy, reciprocity, or deep emotional intimacy
  • Incremental change may be possible, but narcissists rarely change fundamentally

Get support

  • Seek counselling to process your feelings and needs
  • Connect with others who understand your challenges
  • Develop relationships that provide the care and reciprocity you deserve

Practice self-care

  • Make time for activities that reduce your stress
  • Be compassionate to yourself when you mess up
  • Don’t neglect your own needs in hopes of pleasing the narcissist

With appropriate boundaries and expectations, relationships with narcissists can improve. But progress requires acknowledging your limits. You must care for your well-being first.

Narcissism vs. Confidence

What’s the difference between healthy confidence and narcissism? While it may seem subtle, there are distinct contrasts:

  • Confidence reflects reasonable self-assurance and recognition of limitations. Narcissism reflects an inflated, unrealistic self-image divorced from actual abilities.
  • Confident people want others to succeed. Narcissists feel threatened by others’ success.
  • Confidence fosters good relationships through empathy and reciprocity. Narcissism strains relationships via exploitation and entitlement.

In short, confidence coexists with humility- narcissism masks underlying insecurity. Confidence attracts people; narcissism ultimately repels them.

Overcoming Narcissistic Tendencies

For those exhibiting narcissistic patterns, change is possible with concerted effort:

  • Seek feedback – Ask trusted friends for honest appraisals of your less desirable traits. Avoid sycophants who only reinforce your egotism.
  • Admit faults – We all have flaws. Owning your shortcomings without excuses opens the door to growth.
  • Develop empathy – Put yourself in others’ shoes. How do your behaviours impact them emotionally? Exercise compassion.
  • Cultivate gratitude – Notice all you have rather than obsessing over perceived slights or wanting more. Keep a gratitude journal.
  • Find purpose – Use your talents to contribute meaningfully to the world, detached from the need for glory or renown.

With consistent mindfulness, narcissistic patterns can transform into emotional maturity. We all deserve the chance to change for the better.

Overcoming NPD Example

Julia was a narcissist who manipulated people her whole life to get ahead. But after her lies finally ruined her career and marriage, she hit rock bottom. Joining intensive therapy and a support group, she learned to empathize with others and find purpose through volunteering. Though it was a long road, Julia overcame her narcissism by committing to change. She says, “I had to be willing to take a hard look at myself first.”

In Summary

Despite its reputation, narcissistic personality disorder does not have to define you or doom your relationships. With compassionate self-awareness and proper treatment, people with NPD can lead rich, meaningful lives filled with mutually fulfilling connections.

Similarly, if you have a loved one with NPD, appropriate boundaries and empathy for yourself and them can improve your interactions. There is hope.

No matter your role, an increased understanding of NPD provides a path to overcome narcissism’s grasp. By leaning on community support and professional help, we all can move forward to healthier and happier futures.

Frequently Asked Questions (FAQs)

Red flags include needing constant praise, reacting strongly to perceived slights, exploiting people, lacking empathy, exaggerating achievements, and expressing feelings of entitlement.

Many are unaware. They justify their behaviour and blame relationship struggles on others. However, some recognize their problematic patterns and want to change.

The narcissist's initial charm hooks the codependent, who then compromises their well-being to please the narcissist. They hope desperately to regain the idealization phase.

People with NPD can achieve healthy relationships through commitment to treatment and self-improvement. But it takes work to develop self-awareness, empathy, and emotional maturity.

Take care before getting romantically involved with a narcissist. Work on developing emotional intimacy first and notice if they can reciprocate affection. Going slowly protects your heart.

There is an increased risk but not inevitability. Good parenting focused on emotional support versus excessive praise or criticism can lower their risk. Therapy helps too.

Picture of Pareen Sehat MC, RCC

Pareen Sehat MC, RCC

Pareen’s career began in Behaviour Therapy, this is where she developed a passion for Cognitive Behavioural Therapy approaches. Following a Bachelor of Arts with a major in Psychology she pursued a Master of Counselling. Pareen is a Registered Clinical Counsellor (RCC) with the BC Association of Clinical Counsellors. She specializes in CBT and Lifespan Integrations approaches to anxiety and trauma. She has been published on major online publications such as - Yahoo, MSN, AskMen, PsychCentral, Best Life Online, and more.

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