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What is Narcissism?
Narcissism is a personality trait characterized by a grandiose sense of self-importance, a preoccupation with one’s own needs and desires, and a lack of empathy for others. In addition, narcissistic individuals may have an inflated sense of their abilities, accomplishments, or attractiveness. As a result, they may believe they are entitled to special treatment or admiration.
They may also have difficulty recognizing or caring about the feelings of others and may even engage in manipulative or exploitative behaviors to fulfill their own needs. Narcissism is typically considered a maladaptive trait that can cause interpersonal challenges and other negative outcomes.
Narcissistic Personality Disorder (NPD) is a mental health disorder defined by a pervasive pattern of grandiosity (in fantasy or behavior), a persistent need for admiration, and a lack of concern for others. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the criteria for NPD include:1
- Grandiose sense of self-importance or uniqueness, including exaggerating achievements and talents and expecting to be recognized as superior
- Preoccupation with dreams of unlimited wealth, fame, dominance, genius, or perfect love
- Thinking that they are “special” and unique and that only other special or high-status individuals can or should associate with and understand them
- Requiring excessive admiration and affirmation from others
- Having a sense of entitlement, such as expecting to receive preferential treatment or that their wishes will always be granted
- Being interpersonally manipulative, using another person to further one’s own goals
- Lacking empathy and being unwilling to acknowledge or relate to the feelings and needs of others
- Frequently envious of others or believes others are envious of them
- Displaying arrogant, haughty, or patronizing attitudes or behaviors
For a diagnosis of narcissistic personality disorder, these traits must be persistent and damaging, leading to significant distress or functional impairment in multiple areas of life. It is important to note that a trained mental health professional should only diagnose NPD, as it requires a thorough assessment of the individual’s history and symptoms.
Here are some examples of the types of narcissism:2
- Grandiose Narcissism: Exaggerated sense of self-importance, a belief in one’s exceptional abilities and talents, and a need for admiration and attention from others
- Vulnerable Narcissism: Fragile self-esteem, a fear of rejection, and a tendency to feel threatened by criticism or failure. People with vulnerable narcissism may also experience chronic feelings of emptiness or loneliness
- Malignant Narcissism: Combination of grandiosity, antisocial personality, and a lack of empathy or concern for others. To achieve their goals, people with malignant narcissism may engage in manipulative, exploitative, or abusive behaviors
- Covert Narcissism: More subtle, hidden form of self-importance and entitlement. People with covert narcissism may appear modest or self-effacing on the surface. However, they may still have a strong need for admiration and validation
- Collective Narcissism: Exaggerated belief in the greatness or superiority of one’s social or cultural group. Collective narcissists may view their group as unique, special, or superior to others and may be intolerant of criticism or dissent
These types of narcissism are not mutually exclusive. Many people may exhibit traits of more than one type. Additionally, not all people with narcissistic traits will meet the criteria for narcissistic personality disorder.3
Statistics about Narcissism and Narcissistic Personality Disorder
- According to the DSM-5, the prevalence of NPD in the general US population is between 0.5 and 5%.4
- Studies have found that men are more likely to be diagnosed with NPD than women. However, some researchers suggest that this gender difference may be due to how narcissism is measured and that women may exhibit narcissistic behaviors differently than men.5
- NPD is often comorbid with other mental health conditions, such as anxiety disorders, mood disorders, substance use disorders, and other personality disorders, such as borderline personality disorder and histrionic personality disorder.6
- Narcissistic traits may be more prevalent in younger adults and may decline with age.7
- According to a significant epidemiological study conducted by National Institutes of Health researchers, 9.4% of Americans in their 20s have narcissistic personality disorder at some point, compared to only 3.2% of those over 65.8
- A small 2017 assessment of case studies found that persons with NPD had several physical ailments and serious social issues.9
- Studies have found a positive correlation between social media use and narcissistic traits. For example, one study found that individuals who frequently use social media platforms, such as Facebook and Twitter, have higher levels of narcissism.10
- Some research suggests that individuals with narcissistic traits may be more likely to engage in substance use and other risky behaviors.11
- NPD is associated with an increased risk of suicidal behavior, particularly in individuals who also have depression.12
Causes of Narcissism
Below are some potential causes or contributing factors of narcissism:
- Genetics and Biology: Genetic and biological factors may contribute to the development of narcissism, such as differences in brain structure or neurotransmitter functioning.
- Childhood Environment: Early experiences in childhood, such as neglect, emotional abuse, or overindulgence, may contribute to the development of narcissistic traits. For example, a child who receives excessive praise and attention for their achievements may develop an inflated sense of self-importance.
- Parenting Styles: Some research suggests that parenting styles characterized by overprotection, overindulgence, or lack of emotional warmth may contribute to developing narcissistic behaviors. Parents who model narcissistic behaviors may also be more likely to raise children who exhibit these traits.
- Cultural and Social Factors: Cultural values and social norms may promote or reward self-promotion and self-enhancement, which may contribute to the development of narcissistic traits. For example, individualistic cultures may place more emphasis on self-expression and self-assertion than collectivistic cultures.
- Psychological Factors: Some researchers suggest that narcissistic traits may be a defense mechanism against underlying feelings of insecurity, shame, or inadequacy. For example, an individual who feels deeply insecure may develop an exaggerated sense of self-importance to cope with these feelings.
It’s crucial to understand that the development of narcissism is a complicated and multidimensional process and that these elements may interact extensively. Moreover, not everyone who encounters these factors will go on to exhibit narcissistic characteristics, and not everyone who exhibits these characteristics will have encountered these factors.
Additionally, while no direct evidence suggests that OCD, anxiety, or ADHD directly cause narcissism, individuals with these conditions may exhibit narcissistic characteristics to cope with their symptoms or underlying emotions.
For example, according to studies, having OCD increases the risk of eventually developing NPD.13,14 As a coping mechanism for their worry and obsessive thoughts, people with OCD may become too self-important or perfectionists. An anxious person seeking control and attention might exhibit narcissistic behaviors as a coping mechanism for their anxieties and inadequacies.15 And to make up for their impulsivity and distractibility, someone with ADHD may want continual stimulation and attention.16
However, it’s important to note that not all individuals with these conditions will develop narcissistic traits, and not all individuals with narcissistic traits will have an underlying mental health condition. Instead, they may be influenced by other factors such as parenting styles, cultural and social factors, and genetics.
Furthermore, research has shown some differences in brain structure and function in individuals with narcissistic personality disorder compared to those without NPD. However, the exact cause of these differences is still not fully understood. Further research is needed to determine the underlying workings.
Also, it’s important to recognize that while these brain changes have been seen in people with NPD, they are not exclusive to this disorder. They can also be present in people with other mental health conditions or even those who are not mentally ill.
Some of the brain differences observed in individuals with NPD include:
- Reduced gray matter volume in the prefrontal cortex: The prefrontal cortex is responsible for executive functions such as decision-making, planning, and self-control. Studies have shown that individuals with NPD have reduced gray matter volume in this brain area.
- Increased activity in the brain’s reward center: Studies have shown that individuals with NPD have increased activity in the ventral striatum, a region of the brain associated with reward processing and motivation. This may contribute to the intense need for admiration and attention that is characteristic of NPD.
- Reduced activity in areas associated with empathy: Research has suggested that individuals with NPD may have reduced activity in regions of the brain associated with empathy and emotional regulation. This may contribute to the lack of empathy and disregard for others’ feelings.
Symptoms of Narcissism
Here are some common symptoms of narcissism:
- Grandiose sense of self-importance and superiority
- Preoccupation with fantasies of power, success, and attractiveness
- Need for excessive admiration and attention from others
- Expectations of favoritism and a sense of entitlement
- Exploitative behavior in relationships and lack of empathy for others
- Belief in one’s own superiority and lack of respect for other’s opinions and feelings
- Feeling of envy toward others and the belief that others envy them
- Arrogant and cavalier behavior toward others
- Need for control and a lack of flexibility in thinking and behavior
- Hypersensitivity to criticism or perceived slights
How to Deal With a Narcissist & When to Seek Help
Dealing with a narcissist can be challenging and may require a multifaceted approach. However, below are some strategies that may help manage relationships with a narcissistic individual:
- Set clear boundaries: Establish clear boundaries and stick to them. This may involve saying “no” to unreasonable requests or behaviors or limiting the time and energy you are willing to give to the relationship.
- Don’t engage in power struggles: Narcissists often thrive on power struggles and conflict, so avoid getting drawn into arguments or debates with them. Instead, try to remain calm and detached and don’t take their behavior personally.
- Avoid feeding their ego: Narcissists constantly need validation and attention, so avoid giving them excessive compliments or admiration. Instead, focus on acknowledging their positive behaviors without inflating their self-importance.
- Maintain a support network: Dealing with a narcissist can be emotionally draining, so it’s important to have a support network of family, friends, or a therapist to turn to for help and perspective.
- Practice self-care: Make sure to take care of your own needs and well-being. This may involve setting aside time for relaxation and self-care activities or seeking professional help.
- Consider professional help: If the narcissistic individual is causing significant distress or harm, it may be helpful to seek the assistance of a mental health professional. A therapist can help you develop coping strategies and set boundaries, and may also work with the narcissistic individual to address their behavior.
Additionally, individuals who struggle with NPD frequently avoid seeking treatment or medical advice for narcissism because they don’t want to believe that anything may be wrong. If they get help, it’s more likely to be for depressive symptoms, drug or alcohol abuse, or another mental health issue. Unfortunately, they may find it difficult to accept and adhere to treatment if they perceive it as an insult to their self-worth.
Consider seeking an assessment from a medical or mental health expert if you’re worried that you display narcissistic characteristics or if you’re experiencing overwhelming grief. The correct medical care can improve your quality of life and make it more enjoyable and meaningful.
Treatments & Therapy for Narcissism
The most effective form of treatment for narcissism is ongoing counseling. It enables you to see your issues more clearly and discover potential solutions. Therapy for narcissistic personality disorder can be beneficial in many ways. Below are some of the possible benefits:17
- Improved self-awareness: Therapy can help individuals with narcissism better understand their behavior and its impact on others. This increased self-awareness can lead to greater insight and a willingness to change problematic behaviors.
- Enhanced empathy: Narcissistic individuals may struggle with empathy and have difficulty understanding and responding to the emotions of others. Narcissist counseling can assist people in growing in empathy and compassion, improving their interpersonal interactions.
- Improved coping skills: Individuals with narcissism may struggle with emotional regulation and have difficulty coping with stress and setbacks. Therapy can teach individuals healthier ways to cope with difficult emotions and situations.
- Increased flexibility: People with narcissistic personality disorder may struggle with rigid thinking and have difficulty adapting to new situations or perspectives. Therapy can help individuals develop flexibility and openness to new ideas and experiences.
- Improved relationships: Narcissistic behavior can strain relationships with others. Therapy can help individuals learn to communicate more effectively, set healthy boundaries, and develop healthier relationship patterns.
There is no drug used explicitly for narcissistic personality disorder treatment. However, to manage symptoms like anxiety and depression that frequently coexist with NPD, your psychotherapist could suggest using medications. Medications may consist of:
- Antidepressants: Depression is often treated with selective serotonin reuptake inhibitors (SSRIs). Compared to other antidepressants, this class of medication has fewer adverse effects.
- Mood stabilizers: Your doctor may recommend a mood stabilizer like lithium to lessen mood fluctuations.
- Antipsychotic drugs: These medicines can assist with anxiety and depressive symptoms.
The following types of licensed mental health specialists are qualified in the treatment for narcissism:
- Psychiatrist: A medical doctor specializing in diagnosing and treating mental health disorders, including NPD. Psychiatrists may prescribe medication to help manage symptoms and may also provide psychotherapy.
- Psychologist: A mental health professional specializing in assessing and treating mental health conditions, including NPD. Psychologists may provide different types of therapy.
- Clinical social worker: A licensed mental health professional who counsels and supports individuals with mental health conditions. Clinical social workers may provide different types of therapy, including individual, group, or family therapy.
- Licensed Professional Counselor (LPC): A licensed mental health professional who provides counseling and support to individuals with mental health conditions. LPCs may provide different types of therapy, including individual, group, or family therapy.
The process of psychotherapy for narcissistic personality disorder typically involves several stages, including assessment, goal setting, and treatment. Here’s a general overview of what you might expect:
- Assessment: The first step in psychotherapy for NPD is typically an assessment, which may involve an evaluation of your symptoms, a review of your medical history, and a discussion of your current life circumstances. Your therapist may use various assessment tools to help guide the process and develop an individualized treatment plan.
- Goal setting: Once your therapist has a better understanding of your symptoms and needs, they will work with you to set goals for therapy. These goals may include improving your self-awareness, developing healthier coping skills, building stronger relationships with others, or managing specific symptoms of NPD.
- Treatment: The actual narcissistic personality disorder treatment will depend on your needs and goals. Various therapy approaches may be used, including cognitive behavioral therapy, psychodynamic therapy, schema therapy, interpersonal therapy, and group therapy. Your therapist may also use a combination of approaches to address your specific needs.18,19
- Progress monitoring: Your therapist will monitor your progress and adjust the treatment plan as needed throughout therapy. This may involve regular check-ins, assessments, or adjustments to your goals or treatment approach.
- Maintenance: After the active phase of therapy is complete, your therapist may work with you to develop a maintenance plan. This will help you maintain your progress and continue to build on the skills and insights you gained in therapy.
Keep in mind that treatment for narcissism can be challenging and may require a long-term commitment. It may also involve working through difficult emotions and addressing problematic behaviors, which can sometimes be uncomfortable or even painful. However, with the proper support and a commitment to the process, psychotherapy can be an effective tool for improving your quality of life and building stronger, healthier relationships with others.
Narcissism Therapy Costs & Insurance Coverage
The cost of narcissistic personality disorder treatment can vary depending on several factors, including the type of therapy, the length of treatment, and the therapist’s qualifications and experience. Below are some general guidelines for the cost of therapy for narcissistic personality disorder in Tennessee:
- Out-of-pocket costs: According to a 2019 analysis, the average cost of psychotherapy in the United States ranges from $100 to $200 per session, depending on several factors, including the state in which you reside and the therapist’s experience and qualifications.20
- Insurance coverage: Many health insurance plans cover therapy for mental health conditions, including NPD. However, coverage can vary widely depending, again, on many variables. Athena Care is in-network with most major insurance plans with multiple mental health treatment clinics in Tennessee. Therefore, filling out our free, no-obligation online insurance verification form is the most efficient method for finding out more about your insurance coverage for narcissistic personality disorder treatment. After completing the form, one of our expert care coordinators will review your policy and thoroughly explain your options for treatment for narcissism. Rest assured, all submitted or discussed information is confidential.
- Sliding scale fees: Some therapists may offer sliding scale fees based on your income and ability to pay. This can make therapy for narcissists more affordable.
- Online therapy: Online therapy or teletherapy may be more affordable for individuals who live in remote areas or have difficulty accessing in-person treatment. Online therapy can cost anywhere from $50 to $150 per session.21
It’s important to note that while therapy can be expensive, it’s also an investment in your mental health and well-being. Many therapists provide an initial consultation or session without charge, allowing you to discuss your needs and determine whether therapy for narcissistic personality disorder is right for you. Additionally, some therapists may offer packages or discounts for multiple sessions, making treatment more affordable over the long term.
Treatment Success & Outlook for Narcissism
Overall, the outlook for narcissistic personality disorder treatment is generally positive. However, treatment success can depend on many factors, including the severity of the condition, the individual’s motivation to change, and the quality of the therapeutic relationship.
While psychotherapy is the most common treatment for narcissism, and studies have shown that it can effectively reduce symptoms and improve overall functioning, it can be challenging for individuals with NPD. It requires them to confront their behaviors and thought patterns, which can be difficult for some people with narcissism to do.
Therapy for narcissistic personality disorder is typically a long-term process that requires commitment and effort from the individual seeking treatment. As a result, progress may be slow and incremental, and setbacks may occur along the way.
The length of therapy for narcissistic personality disorder can vary significantly from person to person. Some people may need continuous care to manage their symptoms and sustain their improvement. In the end, the length of therapy for NPD is highly individualized based on each person’s particular requirements and objectives. However, with a dedicated therapist and a willingness to change, many individuals with NPD can significantly improve their lives.
There is little data on the effectiveness of various narcissistic personality disorder treatment methods, and the studies conducted thus far have had conflicting outcomes. This may be partly explained by the fact that NPD sufferers self-terminate treatment at greater rates, according to some research.
However, the psychodynamic and cognitive behavioral approach to therapy is generally considered the most effective narcissistic personality disorder treatment. Studies have shown that this approach to therapy can effectively reduce narcissistic traits and improve overall functioning. Still, the success rates vary widely depending on the individual and the specific approach used.
For example, a review of 27 studies on the effectiveness of psychotherapy for narcissistic personality disorder found that therapy reduced narcissistic traits in about 40% of cases.22 In contrast, other studies have reported success rates ranging from 25% to 60%.
Several signs may indicate that narcissistic personality disorder treatment is working, including the following:
- Increased self-awareness: A key component of narcissist counseling is helping individuals develop greater self-awareness and insight into their behavior and thought patterns. As therapy progresses, you may find that you can recognize when you are engaging in narcissistic behavior. As a result, you may be better able to regulate your emotions and responses.
- Improved relationships: One of the goals of treatment for narcissism is to help individuals build more positive and healthy relationships with others. As treatment progresses, you may notice that your relationships with friends, family members, and romantic partners improve and that you can better communicate and empathize with others.
- Reduced symptoms: People with narcissistic personality disorder may experience a range of symptoms, including anxiety, depression, and difficulty regulating emotions. As therapy progresses, you may find that these symptoms improve, and you can better cope with stress and anxiety.
- Greater sense of well-being: Ultimately, the goal of therapy for narcissism is to help individuals improve their overall sense of well-being and quality of life. As treatment progresses, you may feel more fulfilled and satisfied and have a greater sense of purpose and meaning.
- Mayo Clinic Staff. “Narcissistic Personality Disorder – Diagnosis and Treatment.” Mayo Clinic, 15 Nov. 2022, www.mayoclinic.org/diseases-conditions/narcissistic-personality-disorder/diagnosis-treatment/drc-20366690.
- Telloian, Courtney. “5 Types of Narcissism and How to Spot Each.” Psych Central, 15 Sept. 2021, psychcentral.com/health/types-of-narcissism#recap.
- Mancao, Alyssa “Lia,” LCSW. “Not Every Narcissist Has Narcissistic Personality Disorder: A Therapist Explains.” Mindbodygreen, 16 Mar. 2020, www.mindbodygreen.com/articles/not-every-narcissist-has-narcissistic-personality-disorder.
- Stinson, Frederick S., et al. “Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Narcissistic Personality Disorder.” The Journal of Clinical Psychiatry, vol. 69, no. 7, Physicians Postgraduate Press, Inc., July 2008, pp. 1033–45. https://doi.org/10.4088/jcp.v69n0701.
- Hoertel, Nicolas, et al. “Examining Sex Differences in DSM-IV-TR Narcissistic Personality Disorder Symptom Expression Using Item Response Theory (IRT).” Psychiatry Research-neuroimaging, vol. 260, Elsevier BV, Feb. 2018, pp. 500–07. https://doi.org/10.1016/j.psychres.2017.12.031.
- Mitra, Paroma. “Narcissistic Personality Disorder.” StatPearls – NCBI Bookshelf, 13 Mar. 2023, www.ncbi.nlm.nih.gov/books/NBK556001.
- “Do Narcissistic Traits Wane as People Age?” Neuroscience News, 21 Sept. 2019, neurosciencenews.com/narcissism-aging-14956.
- Dingfelder, Sadie F. “Reflecting on Narcissism: Are Young People More Self-obsessed Than Ever Before?” American Psychological Association, Feb. 2011, www.apa.org/monitor/2011/02/narcissism.
- Kacel, Elizabeth L., et al. “Narcissistic Personality Disorder in Clinical Health Psychology Practice: Case Studies of Comorbid Psychological Distress and Life-Limiting Illness.” Behavioral Medicine, vol. 43, no. 3, Heldref Publications, Aug. 2017, pp. 156–64. https://doi.org/10.1080/08964289.2017.1301875.
- Casale, Silvia, and Vanessa Banchi. “Narcissism and Problematic Social Media Use: A Systematic Literature Review.” Addictive Behaviors Reports, vol. 11, Elsevier BV, Jan. 2020, p. 100252. https://doi.org/10.1016/j.abrep.2020.100252.
- Welker, Logan E., et al. “Grandiose and Vulnerable Narcissism: Associations With Alcohol Use, Alcohol Problems and Problem Recognition.” Journal of American College Health, vol. 67, no. 3, Taylor and Francis, Apr. 2019, pp. 226–34. https://doi.org/10.1080/07448481.2018.1470092.
- Coleman, Daniel, et al. “Narcissistic Personality Disorder and Suicidal Behavior in Mood Disorders.” Journal of Psychiatric Research, vol. 85, Elsevier BV, Feb. 2017, pp. 24–28. https://doi.org/10.1016/j.jpsychires.2016.10.020.
- Rehman, Maria Rafique Rabia Hanif, Misbah. “Narcissism as a Predictor of Obsessive Compulsive Disorder, Perfectionism and Achievement Motivation Among Adults.” Zenodo (CERN European Organization for Nuclear Research), CERN European Organization for Nuclear Research, Nov. 2021, https://doi.org/10.5281/zenodo.5719758.
- Pena-Garijo, Josep, et al. “Personality Disorders in Obsessive-Compulsive Disorder: A Comparative Study Versus Other Anxiety Disorders.” The Scientific World Journal, vol. 2013, Hindawi Publishing Corporation, Dec. 2013, pp. 1–7. https://doi.org/10.1155/2013/856846.
- Paulhus, Delroy L., and Kevin L. Williams. “The Dark Triad of Personality: Narcissism, Machiavellianism, and Psychopathy.” Journal of Research in Personality, vol. 36, no. 6, Elsevier BV, Dec. 2002, pp. 556–63. https://doi.org/10.1016/s0092-6566(02)00505-6.
- Miller, Carlin J., et al. “Childhood Attention-Deficit/Hyperactivity Disorder and the Emergence of Personality Disorders in Adolescence.” The Journal of Clinical Psychiatry, vol. 69, no. 9, Physicians Postgraduate Press, Inc., Sept. 2008, pp. 1477–84. https://doi.org/10.4088/jcp.v69n0916.
- “Narcissistic Personality Disorder.” Cleveland Clinic, 2020, my.clevelandclinic.org/health/diseases/9742-narcissistic-personality-disorder#management-and-treatment.
- Dieckmann, E., and Wendy T. Behary. “Schematherapie: Ein Ansatz Zur Behandlung Narzisstischer Persönlichkeitsstörungen.” Fortschritte Der Neurologie Psychiatrie, vol. 83, no. 08, Thieme Medical Publishers (Germany), Aug. 2015, pp. 463–78. https://doi.org/10.1055/s-0035-1553484.
- Brazier, Yvette. All About Narcissistic Personality Disorder. 29 July 2022, www.medicalnewstoday.com/articles/9741#treatment.
- Baron, Jess. “Top 10 Mental Health CPT Codes 2022.” Simple Practice, 22 Jan. 2023, www.simplepractice.com/blog/top-billed-cpt-codes.
- Grupa, Tom. “How Much Does Therapy Cost?” Thervo, 28 Oct. 2022, thervo.com/costs/how-much-does-therapy-cost.
- Nook, Erik C., et al. “A Cognitive-Behavioral Formulation of Narcissistic Self-Esteem Dysregulation.” Focus, vol. 20, no. 4, American Psychiatric Association Publishing, Oct. 2022, pp. 378–88. https://doi.org/10.1176/appi.focus.20220055.
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