Narcissistic Personality Disorder: NPD Symptoms, Diagnosis, & Treatment Options

Narcissistic personality disorder (NPD) is a mental health condition that affects between 1%-2% of American adults.¹ Results from a large-scale study showed that there’s a lifetime NPD prevalence of 6.2%, with 7.7% in men and 4.8% in women.²

At its core, NPD is a personality disorder marked by patterns of grandiosity, an intense need for admiration, and difficulty recognizing the feelings of others. These patterns are long-term ways of thinking and behaving that often start in early adulthood. The disorder is also linked to fragile self-esteem and a higher risk of other mental health struggles.

If you suspect that you or someone you care about has signs of NPD, a mental health professional can help you better understand the condition and discuss treatment options. This page can also work as a guide for recognizing NPD symptoms, as it explores:

What narcissistic personality disorder is
The different types of narcissism
Symptoms of NPD
Causes and risk factors for NPD
The narcissistic personality disorder diagnostic process
Potential impacts of NPD on life and relationships
Treatment options for NPD
Where to find professional support

What Is Narcissistic Personality Disorder?

Narcissistic personality disorder is a long-standing pattern of behavior where a person shows grandiosity, has a constant need for admiration, and struggles to empathize with others. It is classified as a Cluster B personality disorder in the DSM-5.³

Cluster B includes conditions with dramatic or unpredictable behaviors. Alongside NPD, this group also includes borderline, antisocial, and histrionic personality disorders.

For a DSM-5 diagnosis of NPD, a person must meet five or more of the following nine criteria:³

Grandiose sense of self-importance (for example, exaggerating achievements)
Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
Belief that they are “special” and unique
Need for excessive admiration
Sense of entitlement (expects special treatment or automatic compliance)
Interpersonally exploitative behavior (uses others to get what they want)
Lack of empathy (unwilling to recognize others’ feelings and needs)
Envy of others or the belief that others are envious of them
Arrogant, haughty behaviors or attitudes

Narcissism exists on a spectrum. Many people have narcissistic traits, like ambition or vanity, that aren’t harmful. NPD, however, is when these traits become damaging, both to the person and those around them.

Types of Narcissism

The DSM-5 does not officially list different types of narcissistic personality disorder. Instead, it recognizes NPD as a single diagnosis.

However, researchers and clinicians have observed that people with NPD can come across quite differently in how they act and relate to others. Over time, this has led to the idea that there may be different subtypes of narcissism.

The following are the main types of narcissism based on these observations:⁴

Grandiose narcissism: This is the most recognizable form of NPD. It’s where a person actively seeks admiration and attention, believes they are more important than others, and acts arrogantly or entitled. People with this type typically appear confident, but underneath, they show little empathy and exploit others to get what they want.
Vulnerable narcissism: Instead of being outgoing, a person with this type can seem insecure and very sensitive to criticism. They are described as “thin-skinned” and struggle with feelings of rejection or envy. Yet, even though they might not show it openly, they still carry a hidden belief that they are special or superior.
High-functioning narcissism: In this type, a person can appear successful and socially skilled. Because they perform well in their careers and relationships, their narcissistic traits are often mistaken for normal confidence. Yet, in reality, the classic patterns of needing admiration and struggling with empathy are present.

Symptoms of Narcissistic Personality Disorder

Unlike many medical conditions, NPD does not show up through physical signs you can see on the surface. So you won’t find a blood test or scan that confirms it.

Instead, like many mental health conditions, the symptoms appear in the way a person thinks and behaves. These are mostly psychological, emotional, and behavioral patterns that determine how a person views themselves and interacts with others. We break these signs down into their categories in the following sections.

Core Psychological and Emotional Symptoms of NPD

Emotional and psychological symptoms in NPD reflect the internal experiences that shape a person’s self-perception.⁵These include:

A strong belief that they are more important, talented, or special than others
Persistent daydreams about success, beauty, power, or brilliance
A built-in expectation that they should receive special treatment, recognition, or privileges without necessarily earning them. When they don’t receive it, frustration or anger can quickly follow
Hypersensitivity to feedback, which can feel like an insult to them. As a result, they might immediately react with defensiveness or visible anger
Superficial confidence but a fragile self-image
Difficulty understanding or caring about other people’s feelings

Behavioral Symptoms of NPD

Behavioral symptoms are the outward expressions of the inner psychological and emotional experiences. They are observable in interactions with others and may include the following:

Speaking in a condescending tone, belittling others, or assuming the rules apply to everyone else but not to them
Frequently feeling jealous of others’ success or assuming others are envious of them
Exploiting other people to achieve personal goals or boost self-image
Constant need for admiration during conversations

Causes and Risk Factors of Narcissistic Personality Disorder

Early theories of the origin of NPD connected childhood adversities to its development. These theories postulated that if parents overvalued their child, were too lenient, or failed to show warmth, the child could grow into an adult with narcissistic traits.

As research continued to grow, we learnt that NPD can actually emerge from multiple, interacting developmental factors. We also now know that grandiose and vulnerable forms of narcissism have different origins.

Grandiose narcissism has been linked to parental overvaluation and lenient discipline. On the other hand, vulnerable narcissism has stronger ties to childhood adversity such as abuse, neglect, rejection, or invalidation.

Certain traits in childhood can also increase the risk of developing narcissistic traits later on. These include being highly impulsive, constantly needing attention, acting bossy with peers, or having trouble handling criticism.⁶

On the flip side, there are protective factors too. For example, when parents stay consistently involved and set healthy limits, this seems to reduce the chance that narcissistic patterns will take hold.⁷

How Narcissistic Personality Disorder Is Diagnosed

Diagnosing NPD is not a quick or straightforward process. Mental health professionals rely on a structured evaluation that combines detailed history-taking and standardized criteria from the DSM-5.

For a diagnosis to be made, a person must display at least five out of nine specific features discussed earlier. These traits must also:

Be stable over time
Pervasive across situations
Cause significant distress or impairment in social, occupational, or other areas of functioning

The diagnostic process also involves ruling out other explanations for NPD symptoms. This is because traits of narcissism can overlap with other personality disorders and mental health conditions. For instance, people with schizoid personality disorder may also appear socially detached, while those with bipolar disorder during manic episodes may present with inflated self-esteem.

Distinguishing NPD from these conditions requires careful assessment of the person’s long-term behavioral patterns.

NPD must also be differentiated from other cluster B personality disorders, which share some similarities. For example:³

In antisocial personality disorder, both a lack of empathy and disregard for others are common. But people with antisocial traits are more likely to display impulsivity, aggression, and unlawful behavior.
Borderline personality disorder has instability and an intense fear of abandonment, whereas narcissism centers on admiration and validation.
Histrionic personality disorder shares the element of attention-seeking with NPD. However, narcissistic people tend to exaggerate their achievements to gain respect, while those with histrionic traits rely more on emotional drama or seductiveness.

Impact of NPD on Life and Relationships

Narcissistic personality disorder typically has significant and lasting effects on various areas of life.

In romantic and family relationships, NPD is associated with high burden, distress, and impaired relationship satisfaction.

In a large study of 683 people (partners or family members of people with narcissism), 69% met criteria for a depressive disorder and 82% for an anxiety disorder.⁸ Psychological abuse, emotional dependency, and reduced mutual emotional support were strongly linked with the presence of narcissistic traits in a partner.

NPD also tends to create dysfunction in the workplace. For example, people with NPD can initially project confidence and ambition, and these traits are often mistaken for leadership potential. Over time, however, their intolerance of criticism, inflated sense of entitlement, and tendency to exploit others can undermine teamwork.

In fact, a study in organizational psychology revealed that NPD is linked to “cognitive organizational cynicism,” – a culture of distrust that weakens ethical decision-making.⁹

Further, the presence of NPD is linked with increased risk for mental health issues. For instance, a study found that people with NPD had higher baseline and follow-up measures of depression and anxiety. Over six months, those with more severe impairment (in social, romantic, and work domains) experienced more psychological distress.¹⁰

Treatment Options for Narcissistic Personality Disorder

There is no quick fix or “one and done” treatment for narcissistic personality disorder. Changing deep-rooted thought patterns and behaviors takes consistent effort over a long period.

Treatment focuses on helping people understand the impact of their actions, improving emotional regulation, and building healthier relationships.

The following are the treatment options used to treat NPD:

Psychotherapy

At present, there is no FDA-approved treatment studied specifically for NPD. However, psychotherapy, or “talk therapy,” is considered to be the main treatment for NPD as it has shown benefits for people in managing symptoms and improving functioning.¹¹

The following types of therapy are used for personality disorders such as NPD:

Cognitive behavioral therapy (CBT): CBT challenges distorted beliefs, such as unrealistic ideas of superiority or excessive fear of failure
Schema therapy: This works on deep-seated patterns formed in childhood, such as unmet emotional needs or learned ways of relating to others
Psychodynamic therapy: Focuses on unconscious conflicts and the impact of early life experiences on current relationships and self-esteem

The goal of therapy is not to “cure” narcissism but to help people build healthier self-esteem, develop empathy, manage criticism better, and form more balanced relationships.

Medication

There are no medications approved by the FDA for narcissistic personality disorder. However, medication may still play a role in treatment when symptoms overlap with other mental health conditions.

For example, antidepressants are used if a person with NPD is also struggling with depression. Mood stabilizers or antipsychotics may also help with irritability, impulsivity, or mood swings.

Medication alone does not address the underlying personality patterns of NPD. Instead, it can only manage specific symptoms that interfere with daily life.

Lifestyle and Supportive Approaches

Changes to lifestyle and support systems can help people with NPD manage symptoms and improve relationships with others. Lifestyle and supportive approaches for NPD may include:

Establishing healthy routines through regular exercise, balanced nutrition, and consistent sleep to stabilize mood and reduce irritability
Practicing mindfulness or relaxation techniques like meditation, yoga, or deep breathing to manage stress
Journaling or reflecting to see how behavior affects others and identify patterns you may want to change
Surrounding yourself with people who provide honest but respectful feedback, and avoiding environments that encourage unhealthy dynamics
Family therapy or psychoeducation sessions to improve communication and reduce conflict at home
Structured groups for people dealing with personality disorders or related challenges to gain a sense of connection and reduce isolation

Learn More About NPD Treatment at Mission Connection

At Mission Connection, our team of professionals can walk you through different NPD treatment options and guide you in choosing the most effective route for your needs.

What sets Mission Connection apart is our focus on long-term support and practical strategies you can actually apply in daily life. We can also adapt treatment to your life, offering flexible outpatient and online options.

Our clinicians can work with you to identify unhelpful patterns, strengthen healthier ways of relating to others, and build skills that make lasting change possible. Call us or reach out online to learn more about treatment for NPD.

References

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van Schie, C. C., Jarman, H. L., Huxley, E., & Grenyer, B. F. S. (2020). Narcissistic traits in young people: Understanding the role of parenting and maltreatment. Borderline Personality Disorder and Emotion Dysregulation, 7(1). https://doi.org/10.1186/s40479-020-00125-7
Thalib, H. I., Zobairi, A., Khan, S., et al. (2024, October 29). Tracing the link between narcissistic personality disorder and childhood overgratification. Cureus. https://doi.org/10.7759/cureus.72638
Day, N. J. S., Bourke, M. E., Townsend, M. L., & Grenyer, B. F. S. (2019). Pathological narcissism: A study of burden on partners and family. Journal of Personality Disorders, 34(6), 1–15. https://doi.org/10.1521/pedi_2019_33_413
Sabir, I., Hussain, S., Majid, M. B., Rehman, A., Sarwar, A., & Nawaz, F. (2020). Impact of narcissistic personality disorder on cognitive organizational cynicism with mediating role of psychological capital in selected hospitals of Punjab Pakistan. Future Business Journal, 6(1). https://doi.org/10.1186/s43093-020-00035-8
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