NPD is not exactly the same as being a narcissist.
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.
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-: We use it as a throw-away term.
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"I know, they're so narcissistic," when in fact
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it's actually a personality disorder where
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they can't read the social cues, they can't
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recognize how their behavior impacts someone else,
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or what they need to be doing to build relationships.
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-: So narcissistic personality disorder can best
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be described by an inability to put yourself
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in someone else's shoes.
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You are the only person that matters.
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And it's basically all about you and what you want
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and what makes you happy, and it doesn't account
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for anyone else around you, anyone else's needs
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or wants or desires.
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-: This is that kind of full-of-themselves, arrogant,
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aloof person who can't admit when they're wrong,
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can't acknowledge that there's any sort of thing
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that they're doing that's unacceptable or inappropriate.
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-: Somebody with narcissistic personality disorder
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may be at the top of their company or own their own
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company or run their own company, but people that
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work for them may not like them very much.
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And they may not be able to hold onto employees very much.
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They may get into a relationship that seems great
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at the beginning, but they can't hold onto that relationship
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because the other person in the relationship doesn't
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feel heard or understood.
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Being in a relationship with somebody who's a narcissist
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can be really tough because that person is very, very,
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very self-focused, and may not even notice the other
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person in the room or what their needs are.
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-: People can have confidence and have some narcissistic
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tendencies maybe, but narcissistic personality disorder
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is a disorder, so there's a significant degree
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of impairment and there's a pervasive pattern
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of behaving in this way to the detriment of your
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And that is the difference between someone who maybe
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is a little bit more confident than they should be
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or having a moment where they feel entitled.
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Someone with a personality disorder will have that
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as a pervasive pattern of interacting
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and engaging with the world.
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-: Narcissistic personality disorder is really hard
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to treat because you have to get through someone's
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belief that there is nothing wrong with them,
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and they're often not willing to see that.
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-: Typically you'll see people enter into treatment
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in the midst of a divorce or a major breakup.
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There might be a loss of employment,
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something that they would have never thought would
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have happened to them because of this elated
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sense of self and this almost near-grandiose way
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of thinking about them and what they're entitled
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to and what they deserve.
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So the goals of treatment would be largely to help
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them develop insight, develop effective interpersonal
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skills, develop realistic expectations of what they want
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for a mate, what they want for themselves in terms
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of success at work, what they want from their friends.
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That would be the ultimate goal, to help them develop
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some realistic expectations and insight into what they do
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and how it impacts and affects others
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and their relationships.
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(slow jazz music)
Narcissistic personality disorder. Atlanta, GA: Personality Disorders Awareness Network. (Accessed on March 30, 2018 at http://www.pdan.org/what-are-personality-disorders/narcissistic-personality-disorder/.)
Narcissistic personality disorder. Washington, DC: U.S. National Library of Medicine. (Accessed on March 30, 2018 at https://medlineplus.gov/ency/article/000934.htm.)
Rakovec-Felser Z. Domestic violence and abuse in intimate relationship from public health perspective. Health Psychol Res. 2014 Nov 6;2(3):1821.