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  • Writer's pictureMelissa Paulsen, MA, LMFT, RPT-S

Narcissistic Personality Disorder (NPD)

“Hate is the complement of fear and narcissists like being feared. It imbues them with an intoxicating sensation of omnipotence.” ― Sam Vaknin, Malignant Self Love: Narcissism Revisited

Narcissistic Personality Disorder (NPD) is something that has always been around but lately it seems to be becoming more of a “mainstream” topic much like bullying was a few years ago. The word narcissism comes from Greek mythology and a story you’ve probably heard before. In a nutshell, Narcissus was an attractive young man who went to get a drink of water from a pond, stream, or some other water source. While doing so he saw his reflection for the first time and became so mesmerized by his own looks that he tried to kiss and embrace the reflection, failing miserably (obviously). He refused to leave the image he had found and lost his will to live. So he died.

You’ve probably heard someone use the phrase He/She/You “are so narcissistic”. When someone says this, what they typically mean is the person is arrogant or thinks very highly of themselves. In reality, an actual diagnosis of Narcissistic Personality Disorder is much more than that.

The DSM-5 Criteria includes the following:

1. An exaggerated sense of self-importance.

2. Wanting to be recognized as superior even when achievements do not warrant superiority.

3. Exaggeration of achievements and talents.

4. Preoccupied with fantasies about success, power, achievement, brilliance, beauty, or the perfect mate.

5. Believing you are superior and feeling you can only associate with those who are as equally special and superior as you.

6. Requiring others to admire you constantly.

7. A sense of entitlement.

8. Expecting special favors and thinking others should comply with your demands without hesitation.

9. Taking advantage of others to get what you want.

10. Inability or unwillingness to recognize others’ feelings and needs.

11. Being envious of others and believing others are envious of you.

12. Behaving arrogantly.

NPD effects roughly 6% of the general population and is more common in men than in women. The best treatment for NPD is psychotherapy, group therapy, and family therapy as there is no medication to treat NPD. Medication will, however, help with co-occurring symptoms such as depression or anxiety.

NPD symptoms are typically noticeable around age 8 because this is when kids will start to compare themselves to others. If NPD symptoms exist in a child, the best treatment will involve the parents, as a recent study found a direct correlation between parents who overvalue their children and children who are narcissistic. While a lot of research has found how parents treat their children can cause narcissism, NPD can also be caused by genetics and brain chemistry. In addition, emotional and physical abuse can cause a child to overcompensate leading them to create a persona of perfection and superiority. So basically, if it’s not genetics, it comes down to parenting to the extreme either thinking the child is so much greater than all other children or devaluing and possibly abusing the child.

Again, NPD is much more than healthy confidence and self-esteem. It is putting yourself (or you kid!) above all others and feeling that no one is as important or as worthy as you are (or your kid is!). It is believing you are perfect, powerful, and something others should aspire to be. Not surprisingly, it is nearly impossible to sustain a relationship with someone who has NPD. The good news is that NPD can be managed successfully through psychotherapy. If you suspect that you or someone you know has NPD, try taking this online quiz to get a better idea: If you find that you or that person does have NPD, contact a mental health professional in your area to begin treatment.


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