All About Personality Disorders: Narcissistic Personality Disorder #4

Narcissistic Personality Disorder

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Narcissistic Personality Disorder (NPD) is a personality disorder characterised by an extreme preoccupation with oneself. It is a cluster B disorder, and the prevalence in the general population seems to be around 1% (Millon, 1996), although this is higher in men and the clinical population. It is essentially an extreme version of egocentricism, and is one of the more well-known personality disorders. That being said, due to the types of symptoms those with NPD have, it can be difficult to treat, and generally little is known about the causes as well. There is still research in this field however, and this will be examined in this article.

In the DSM-V the criteria for diagnosis of NPD is as followings :- A) impairment in the self (identity and/or self-direction) and interpersonal functioning (empathy and/or intimacy). B) Pathological personality traits (grandiosity and/or attention-seeking) C) these impairments must be stable across time and situation D) these impairments must not be due to social norms, or a development stage E) and finally the impairments must not be due to drugs, or another medical condition. Clearly, having NPD would effect someone’s live negatively, as they would struggle both internally, and with their external relationships.

There is no conclusively known cause of NPD. However, lots of research has looked at what factors make this disorder more likely to develop. For example, Groopman & Cooper (2006) identifies 8 possible factors during childhood which could lead to NPD forming in adulthood. These are 1) an oversensitive temperament at birth, 2) being given excessive admiration but not realistic feedback, 3) the child receives either excessive praise or criticism, 4) the child is overindulged and overvalued by the parents, 5) the child is perceived by the parent as having perceived exceptionally good looks or abilities, 6) emotional abuse, 7) unreliable caregiving from the parents, 8) learning maladaptive behaviours from peers/parents. These are all factors that could lead to a child growing into an adult with NPD, but it is not an extensive list, and not all children that experience these factors will develop NPD. Some of the symptoms of NPD are actually normal to see in children, especially during certain development stages, however the problem comes when these behaviours continue into adulthood (Cooper, 1984).


As well as factors during childhood, it could be that brain structure and functioning factor into the development of NPD. Indeed, it has been found that those with NPD have grey matter abnormalities in their left anterior insula (Schuzle et al, 2013). It is unknown whether this abnormality is due to the disorder, or causes the disorder however. To investigate this, research would need to follow high-risk individuals as they develop NPD.

Another theory suggests NPD occurs because, on a subconscious level, an individual feels deeply flawed. They feel due to these flaws they would never be accepted among their peers, and therefore their NPD develops as a kind of defence mechanism to this. This theory was put forward by Golomb in 1992. Clearly, as with all complex disorders, it is most likely a combination of differing factors that will lead to NPD.

Treatment of those with NPD can often be difficult, as they often will not seek therapy. They will reject that their behaviour is harmful, and this means they will not seek help, and will not be compliant (Freeman, Breitmeyer & Flint, 2000). However, when therapy is given, it is often psychotherapy that is used, most likely to explore the conditions within the patients childhood that caused NPD to occur (Mayo Clinic). Alternatively, Johns (1987) suggests that the severity of NPD can vary along a continuum, and because of this the type of treatment needed will vary from case to case. Schema therapy, which aims to integrate differing approaches to therapy, such as cognitive and psychodynamic, has also shown to be useful (Young, Klosko & Weishaar, 2003). Alternatively, group therapy has been suggested to be useful, as it helps the patient explore boundaries, develop trust, increase self-awareness and accept feedback from others, all these skills help those with NPD greatly.

NPD is characterised by intense preoccupation which effects many areas of life. While no cause is known, a lot of developmental, subconscious and biological factors are thought to increase the likelihood of NPD occurring. Treatment can be difficult due to the nature of NPD, however a lot of different types of talking therapies have been shown to be useful, though research in this field is lacking.


Cooper AM: Narcissism in normal development, in Character Pathology. Edited by Zales M. New York, Brunner/Mazel, 1984, pp. 39–56.

Freeman, Arthur; Angela Breitmeyer; Melissa Flint (2000). “The Challenges in Diagnosing Narcissistic Personality Disorder: Difficult to Define, but “We Know It When We See It””. Clinical Forum.

Golomb, Elan PhD (1992). Trapped in the Mirror. New York: Morrow, p. 23.

Groopman, Leonard C. M.D.; Cooper, Arnold M. M.D. (2006). “Narcissistic Personality Disorder”Personality Disorders – Narcissistic Personality Disorder. Armenian Medical Network.

Millon, Theodore (1996). Disorders of Personality: DSM-IV-TM and Beyond. New York: John Wiley and Sons. p. 393

Narcissistic personality disorder: Symptoms –” Mayo Clinic. N.p., n.d. Web. 2 Dec. 2011.

Stephen M. Johnson (1 May 1987). Humanizing the narcissistic style. W.W. Norton. p. 39. ISBN 978-0-393-70037-4

Young, Klosko, Weishaar: Schema Therapy – A Practitioner’s Guide, 2003, p. 375.




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