The word “narcissist” might make you think of people who spend a few seconds too long admiring themselves in the bathroom mirror or posting hourly selfies on Instagram. In fact, “narcissist” derives from the Greek hunter Narcissus, who died while staring into his reflection in the river (#spoileralert).
But narcissistic personality disorder (NPD) isn’t the same as your everyday idea of someone who’s a tad too vain. “It’s actually a personality disorder,” says Jennifer Hartstein, PsyD, psychologist in New York City. “They can’t read the social cues. They can’t recognize how their behavior impacts someone else or what they need to be doing to build relationships.”
You can sum up NPD as an “inability to put yourself in someone else’s shoes,” says Khadijah Watkins, MD, psychiatrist at New York-Presbyterian Hospital, Weill Cornell Medicine. “You are the only person that matters.”
NPD is more common among men than women. It affects around 6.2 percent of Americans, according to the Personality Disorders Awareness Network.
Common signs of narcissistic personality disorder include:
Having an unjustified sense of superiority and entitlement
Exploiting or manipulating others to achieve goals
Fantasizing over ideal romance, power, and prestige
Disregarding the feelings of others
Expecting others to treat them favorably or give excessive attention
Pursuing selfish goals
In some ways, these personality traits can bring success to someone with NPD; these are traits that can help them get ahead, to an extent. “Someone with narcissistic personality disorder may be at the top of their company or own their own company,” says Susan Samuels, MD, psychiatrist at New York-Presbyterian Hospital, Weill Cornell Medicine. “But people [who] work for them may not like them very much, and they may not be able to hold on to employees very much.”
In relationships, friends or partners may eventually start to feel unheard, uncared about, or even controlled. In fact, a 2014 study found that people with NPD or borderline personality disorder were more likely to be domestic abusers compared to the general population, due to the lack of empathy and inflated sense of importance.
But it’s important to know the difference between narcissism and NPD. “People can have confidence and narcissistic tendencies,” says Dr. Watkins. However, to be considered NPD, “there is a significant degree of impairment and there’s a pervasive pattern of behaving in this way to the detriment of your personal relationships.”
Treating Narcissistic Personality Disorder
Like many personality disorders, NPD is tough to treat because, by definition, the symptoms are ingrained in the person’s personality. The inflated ego that comes with NPD makes this even tougher. “You have to get through someone’s belief that there’s nothing wrong with them,” says Dr. Hartstein. “They’re often not willing to see that.”
Usually, someone with NPD won’t recognize how destructive their narcissism is until something goes wrong. They may be used to succeeding at work or earning top grades in school. It may take a traumatic event (like a divorce or losing a job) to serve as a reality check—”something that they would have never thought would have happened to them because of this elated sense of self,” says Dr. Watkins.
For someone who seeks help, there are a couple unique goals of psychotherapy for NPD, according to Dr. Watkins.
Learning effective interpersonal skills, including recognizing the needs of others
Developing realistic expectations for relationships, disrupting idealizations of how things “should” be and what they think they are entitled to
Effective treatment for narcissistic personality disorder should help someone get “insight into what they do and how it impacts and affects others in their relationships,” says Dr. Watkins. In the end, this should be a positive, helping the patient achieve happier, long-term relationships.