Narcissistic personality disorder (NPD) is a diagnosis for a persistent pattern of grandiosity, a need for admiration and limited ability to recognise how other people feel. Popular use of "narcissist" has drifted far from the clinical meaning: only a professional assessing someone directly can identify the disorder.
Key points
- NPD is a diagnosis for a long-standing pattern of grandiosity, a need for admiration and limited empathy.
- Narcissistic traits sit on a continuum across the general population. The diagnosis is a different thing, and far rarer.
- No one can diagnose another person from the outside; popular use of "narcissist" has drifted far from the clinical meaning.
- Two presentations are described: grandiose, which is visible, and covert, marked by hypersensitivity to criticism, shame and withdrawal.
- No NICE guideline exists, and no NPD treatment has been tested in a randomised controlled trial.
Symptoms
- Grandiose: an inflated sense of importance, expecting admiration, using others to get it.
- Covert: hypersensitivity to criticism, shame, anxiety and withdrawal after rejection, alongside private beliefs about being special.
- People with NPD do seek help, usually for something else: depression, relationship difficulty, or a crisis. Dropout from therapy is high.
Causes and risk factors
- Traits in this group of personality disorders appear highly heritable, alongside early environmental influences.
- Childhood rejection, and separately being praised as having extraordinary abilities, have both been proposed, on limited evidence.
Treatment
- Talking therapies, sometimes in a therapeutic community; no medication is approved for NPD itself.
- Co-occurring problems such as depression, anxiety or alcohol use are treated in their own right and often respond first.
- Slow progress is the usual pattern in the evidence that exists, not a sign therapy is failing.
When to speak to a professional
- The same pattern has repeated across jobs and relationships for years and is causing real difficulty.
- A setback regularly leaves you unable to function for days, or you are drinking or using drugs to manage how you feel about yourself.
- If you are having thoughts of suicide or self-harm, treat it as urgent - NPD is associated with a raised risk.
If you need help now: Samaritans, call 116 123, free, 24/7. Shout, text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.