What is narcissistic personality disorder (NPD)?

Narcissistic personality disorder, also known as pathological narcissism, is a mental health condition in which a person believes they are better than everyone else. While many people occasionally behave in a narcissistic way, people with NPD have problems that affect their relationships and everyday life.

People with NPD may look too much to others to boost their self-esteem. They have less empathy and have trouble forming deep relationships. Traits are ongoing and can cause significant distress.

NPD is one of a group of personality disorders. In these conditions, the way you behave causes problems for yourself or others. NPD affects around 1 to 6 people in the community out of 100.

What is the difference between narcissism, narcissistic personality type and narcissistic personality disorder?

The main difference is that narcissism and narcissistic personality type are within the range of normal human behaviour, whereas narcissistic personality disorder is a mental health condition that affects a person's everyday life.

Everyone can show narcissism from time to time. Traits can include:

• feeling self-important
• not showing empathy
• wanting attention
• wanting to be admired by other people
• being selfish
• being aggressive
• being insensitive

Someone who shows a lot of narcissistic traits might have a narcissistic personality type. Their behaviour is still normal. Personality traits can include:

• feeling very entitled
• having little or no empathy for the feelings of others
• feeling more important than other people

What are the symptoms of NPD?

People with NPD have a very exaggerated sense of their own importance. Symptoms can include:

• feeling special, or feeling like they are better than everyone else
• fantasising about power, beauty, success or intelligence
• exaggerating achievements and abilities
• seeking attention and admiration from others
• believing that they are entitled to special treatment
• believing that others are envious of them
• lacking empathy and taking advantage of other people

There is another type of NPD known as vulnerable narcissism, or covert narcissism. It is a disorder that includes traits that are the opposite of someone believing they are better than everyone else. People with vulnerable narcissism can:

• be overly sensitive to others' opinions
• be introverted or have low self-esteem
• feel insecure
• feel a deep need for attention

People with NPD may have trouble handling criticism, feel hurt easily or have low self-esteem. They may also have problems with relationships and work.

It can be hard for others to deal with the symptoms of NPD. This means people with NPD can become isolated.

What causes NPD?

As with many personality disorders, the exact cause of NPD is not known. Researchers believe it may be caused a mixture of genes, early childhood experiences and psychological factors.

Early childhood risk factors include:

• excessive praise or judgement by parents
• trauma or abuse

When should I see my doctor?

You should see your doctor if you or someone you know has symptoms of NPD and is struggling to manage their relationships or their lives. Your doctor may refer you to a psychiatrist or psychologist who has experience treating people with personality disorders.

It can be difficult for someone with NPD to seek treatment as they often do not recognise that they have a problem. The first step is for the person to become aware that their behaviour is affecting their life and relationships.

How is NPD diagnosed?

Diagnosis can be hard as the symptoms of NPD can overlap with other disorders. A mental health professional can diagnose NPD based on your symptoms and how you interact with others.

How is NPD treated?

Psychotherapy, or talking to a therapist, is the most useful treatment approach for people with NPD. The aim of treatment is to develop a more realistic self-image and enable you to relate to others more positively. Therapy is a long-term process and its success depends on your ability to see your struggles and commit to changing your behaviours.

Type of therapy you can try include the following:

• Psychodynamic therapy — this helps a person understand their behaviours, moods and disruptive thoughts.
• Cognitive behaviour therapy (CBT) — this helps people identify negative, unhelpful behaviour patterns and replace them with more productive and positive ones.
• Relationship or couples therapy — this can help you and your partner gain a better understanding of negative patterns within the relationship, and help you address them.

There's no specific medicine used to treat narcissistic personality disorder. Sometimes medicines may be used for related issues such as depression or anxiety.

Resources and support

If you need help, talking to your doctor is a good place to start. If you'd like to find out more or talk to someone else, here are some organisations that can help:

• SANE Australia (for people living with a mental illness) — call 1800 187 263.
• Beyond Blue (for anyone feeling depressed or anxious) — call 1300 22 4636 or chat online.
• Black Dog Institute (for people affected by mood disorders) — online help.
• Lifeline (for anyone having a personal crisis) — call 13 11 14 or chat online.
• Suicide Call Back Service (for anyone thinking about suicide) — call 1300 659 467.
• Medicare Mental Health — for advice and to get connected to local mental health services, call 1800 595 212. Check the operating times.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available 24 hours a day, 7 days a week.

Do you prefer to read in languages other than English?

• Transcultural Mental Health Centre has many resources about wellbeing and mental health in different languages.

Looking for information for Aboriginal and/or Torres Strait Islander people?

• Yarn Safe has mental health and wellbeing information for Aboriginal and/or Torres Strait Islander people.
• Wellmob has more mental health information and resources Aboriginal and/or Torres Strait Islander people.