Narcissistic Personality Disorder (NPD): Symptoms, Causes & Treatment

What is Narcissistic Personality Disorder?

People often think of narcissism as a social media trend, an absorption in yourself and your selfies. A small amount of narcissism is actually normal and necessary for a healthy survival instinct in its most basic and Darwinian form. But excessive arrogance and intense, self-centered attitudes can become destructive and then it is considered narcissistic personality disorder (NPD).

Symptoms of NPD

Diagnostic and Statistical Manual of Mental Disorders (DSM-5)





Grandiose fantasies about great success, power, beauty or love

Need for admiration and craving attention

Using other people to reach goals

Lack of empathy

Envying others or believing that people envy them

Recently, the DSM has evolved into an alternative model to further diagnose NPD, based on:

Identity – defined based on others’ opinions, with wavering self-esteem and emotions

Self-direction – focused on gaining approval and creates high personal standards

Empathy – awareness of other people’s needs and reactions only when the narcissist thinks they are relevant

Intimacy – shallow relationships that only serve to boost the narcissist’s self-esteem and little interest in other people’s experiences

Other Signs

Manipulating others and distorting facts to boost their status and image


Inability to deal with stress and change



Dimensions of Narcissism

Narcissists are not always easy to spot. Some may appear self-important, vain, energetic and talkative. Some seem withdrawn and sensitive and crave attention in gentler, subtler ways.

Grandiose (Overt) Narcissism

Grandiose narcissism comes across as assertive, dominant and confident. People with these characteristics are also more likely to hold leadership positions. Signs include:

Exaggerating skills and accomplishments

Monopolizing conversations

Belittling other people by overvaluing their own success

Wounded ego after criticism

Usually stable ego, although inflated

Expressing contempt after they hurt someone

Vulnerable (Covert) Narcissism

Narcissism is not always forward and invasive, but sometimes introverted. Researchers have also identified vulnerable narcissistic qualities, which may be harder to spot:

Quiet smugness and superiority, usually judging quietly and listening, rather than speaking

Withdrawn self absorption

Lack of empathy


High sensitivity

Feeling special and misunderstood

Impersonal relationships, using smugness as a defense mechanism

Malignant Narcissism

Malignant narcissism is considered the most severe type of this particular personality disorder, combining narcissism and antisocial personality disorder. In these cases, the person shows potentially dangerous aggression and antisocial behavior:

Deliberate distress to other people

Impulsive and aggressive

Lashing out at others to protect their own fragile egos

Lying and psychologically manipulating people into thinking their lies are true

Binary views — smart/dumb, black/white, winner/loser

Difficulties processing emotional information

Causes & Triggers for NPD

Narcissistic behaviors conceal deep feelings of shame, vulnerability and insecurity relieved only by frequent praise and admiration. The narcissistic mindset is likely caused by several factors:


There is no specific gene for narcissism, but studies show that personality disorders are mostly or moderately genetic. Narcissistic personalities show imbalances in certain chemicals, such as serotonin and dopamine.


Similarly, environment and social interaction also play a role. Research suggests that narcissism is a response to social exclusion and hypersensitivity in a part of the brain that reacts to distress.

Narcissism roots in childhood. A narcissist may have had an unhealthy relationship with a parent as a child. If children are constantly criticized and neglected or excessively adored and overprotected, they could develop narcissistic behaviors to compensate. They may establish an inflated self-image and crave constant admiration to maintain it.

Young children are naturally self-centered and have difficulties understanding other people’s needs. However, sometimes a child’s development gets stuck at this level of narcissism instead of passing through it.


In studies, NPD patients had a significantly thinner cerebral cortex, a section of the brain strongly linked to the ability for compassion.

Research suggests that narcissism is a response to social exclusion and hypersensitivity in a part of the brain that reacts to distress. Excess self-esteem and tendency to avoid close relationships protects narcissists from social exclusion. According to the study, they had less activity in parts of the brain linked to physical pain, depression, mood disorders and feelings of distress in social exclusion, which may protect them against social failures.

Other Possible Causes

Trauma or abuse

Insensitive parenting

Over sensitivity

Poverty and social discrimination in childhood

Drug or alcohol abuse

Treatment for NPD

There is no specific medication for NPD, but standard treatment includes:

Psychodynamic psychotherapy, focusing on underlying conditions

Mentalization-based treatment to reflect on their own state of mind, as well as others’

Cognitive-behavioral therapy, designed to change the patient’s thinking and teach them more adaptive behaviors

Transference-focused therapy, focusing on the patient’s relationship to the therapist

In addition, some people with NPD may also have other accompanying conditions to treat:


Stress and anxiety

Bipolar disorder


Substance abuse

Eating disorders



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Supplements are meant to promote general well-being and it is important to note that the remedies listed here are not a substitute for legitimate medical advice. Talk to a doctor if you are experiencing problems with your health before taking any supplements.

St. John’s Wort

St. John’s wortHypericum perforatum

sleep deprivation




AshwagandhaWithania somniferaobesity

Other Supplements for NPD












Ginkgo biloba




Bipolar Disorder


Improving General Health

A healthy lifestyle supports good mental health, and essential nutrient deficiencies are common in mental disorders. Substance abuse and eating disorders affect depression and other mood disorders, and research links personality disorders to heart disease — specifically NPD to gastrointestinal disorders. Daily supplementation with specific nutrients may be helpful:

Amino acids

Vitamin B6

Vitamin B12

Folic acid

Vitamin C

Vitamin D3





Fish oil

The Bottom Line

NPD is a personality disorder characterized by patterns of superiority, craving admiration and inability to understand other people’s feelings. It can cause significant distress to patients and people in their lives.

Although there is no specific medication for NPD, a healthy lifestyle and natural remedies can relieve related burdens — stress, depression, anxiety, sleep problems and other mental health issues.

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