“Well, they’re obviously a narcissist.” 

This is a phrase we hear more and more in daily life: narcissism, narcissist, and narcissistic personality disorder have entered our common vocabulary, but not necessarily in a good way. Labeling someone a narcissist seems to be an easy way to attribute some of their negative behaviors to a pathology. While this can make it easier for us to navigate complex social situations and the hurtful or socially unacceptable actions of others, what we casually term narcissism can in fact refer to a very real personality disorder with a complex history that affects the lives of approximately 0.5% of the United States population, or 1 in 200 people.  

So what is narcissistic personality disorder (NPD)? In brief, it’s a complex condition that causes a problematic focus on the self to the detriment of social relations and life in general. Those diagnosed with NPD have an intense need for admiration, routinely behave in ways which make them seem more impressive than they are (referred to as a pattern of grandiosity), and often lack empathy for others, which can make it easier to exploit or behave arrogantly towards them. 

Of course, narcissism – selfishness – is a natural part of the human experience. It’s normal and healthy to protect our own interests and have high aims for ourselves. However, knowing the difference between NPD and casual self-interest is important if we want to have compassionate and informed conversations about ourselves and each other.

History of Narcissistic Personality Disorder

Narcissism is a term which derives from the Greek myth of Narcissus. According to the myth, the young man Narcissus caught his own reflection in a pond one day and fell in love with it. This love turned into obsession, and Narcissus ended up drowning in the pond, staring at himself so fixedly.[1] Obviously, like all myths, this is an exaggerated story, but it reflects something real about human nature by demonstrating that an unhealthy self-obsession has been present in humans for a very long time.

Many years later, in the early twentieth century, Sigmund Freud introduced the concept of narcissism into psychoanalytic theory. He described narcissism as a relatively normal stage of human infancy but suggested that humans needed to move beyond it to develop as well-rounded adults.[2] Other psychologists throughout the twentieth century recognized the type of self-obsession described by Freud in adults as pathological, articulating Narcissistic Personality Disorder as a condition for the first time.[3] In the 1970s, a diagnostic criterion was laid out for this personality disorder, which included the following three main criteria:

• Grandiosity
• Need for admiration
• Lack of empathy

In this capacity, NPD was included in the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-II) in 1980.[4]

Effects of Narcissistic Personality Disorder on Daily Life

Contemporary understandings of NPD posit it as a relatively controversial personality disorder because it is so hard to reliably diagnose. However, most psychological organizations agree that NPD is present when expressions of grandiosity, self-interest, need for admiration and praise, and a lack of general empathy become a functional impairment, not only to daily life but also to the stability of personality traits. This means that those who are diagnosed with NPD experience great difficulty maintaining a normal life – connecting with others, succeeding at work, etc. – as well as developing useful and healthy personality traits in adulthood.[5] 

Treatment for Narcissistic Personality Disorder

Treating NPD is complex, and there are various views on it from a therapeutic perspective. However, generally, therapeutic treatments for NPD primarily focus on psychotherapy, which aims to help individuals develop a more realistic self-image and improve interpersonal relationships. Cognitive Behavioral Therapy (CBT) is commonly used to address maladaptive thinking patterns and behaviors. CBT helps individuals recognize and challenge distorted thoughts, encouraging them to develop healthier cognitive patterns.

Another effective approach is psychodynamic therapy, which delves into unconscious motives and past experiences that contribute to narcissistic traits. This therapy aids in increasing self-awareness and understanding the underlying causes of narcissistic behaviors.[6] Additionally, schema therapy is useful for targeting deeply ingrained thought patterns and emotional responses. It helps people with NPD recognize their unmet needs and learn more adaptive ways to interact with others.[7] 

Group therapy can also be beneficial, as it provides opportunities for individuals to receive feedback and develop empathy in a social context.[8] Finally, Dialectical Behavior Therapy (DBT) has shown promise in teaching emotional regulation skills and enhancing interpersonal effectiveness.[9] These therapies are considered effective because they focus on modifying the individual’s self-concept, improving emotional regulation, and fostering empathic skills, all of which contribute to better relationships and more functional behavior. 

Consistent and targeted therapeutic interventions can lead to gradual personality changes, allowing people who have been diagnosed with NPD to lead more fulfilling and connected lives. Through understanding and intervention, therapy can offer a path to healing and growth for those struggling with narcissistic tendencies.

[1] Ellis, Havelock (1898). “Auto-erotism: A psychological study.” Alienist and Neurologist, 19, 260–299.

[2] Freud, Sigmund (1914). “On Narcissism: An Introduction.” SE, 14: 73-102.

[3] Kernberg, Otto F. (1975). “Borderline Conditions and Pathological Narcissism.” New York: J. Aronson.

[4] American Psychiatric Association. (1980). Diagnostic and Statistical Manual of Mental Disorders (3rd ed Washington, DC: Author.

[5] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: Author.

[6] Campbell, W. K., & Miller, J. D. (2011). The handbook of narcissism and narcissistic personality disorder: Theoretical approaches, empirical findings, and treatments. Wiley.

[7] Young, J. E., et al. (2003). Schema therapy: A practitioner’s guide. Guilford Press.

[8] Cain, N. M., et al. (2008). Beyond interpersonal skills: Group therapy with individuals diagnosed with NPD. Journal of Contemporary Psychotherapy, 38(3), 129-136.

[9] Lynch, T. R., et al. (2007). Dialectical behavioral therapy: A pilot for treating emotional dysregulation and aggression. Journal of Personality Disorders, 21(6), 445-451.