Causes of Narcissistic Personality Disorder: NPD Risk Factors

Eilaf Meenai
September 28, 2025
Authored by: Eilaf Meenai, MD
Edited by: Emma Loker, B.S
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Over the past few decades, researchers have observed a gradual rise in narcissistic traits among young adults in the US – a trend some call the “narcissism epidemic.”1 This is because more and more people report feeling entitled, needing recognition, or seeking status compared to earlier generations. 

While it’s difficult to say whether there’s a true rise in narcissistic personality disorder (NPD) or just greater awareness of narcissistic tendencies, it raises the question: what’s behind this trend?

In truth, there’s no single agreed-upon cause of narcissistic traits. Instead, researchers point to a combination of genetic, biological, environmental, cultural, and social factors that all seem to play a contributing role. 

If you’re concerned about the signs of NPD in yourself or someone you care about, a mental health professional can help you get to the root of the problem. They can also discuss potential treatment options and avenues for recovery. 

This page can also work as a useful guide for understanding the causes of narcissistic personality disorder, as it discusses:

  • What narcissistic personality disorder is
  • Potential causes of NPD
  • NPD risk factors
  • Whether it’s possible to prevent narcissistic personality disorder
  • Where to find professional support for NPD
Woman with one eyebrow raised wondering what the causes of narcissistic personality disorder are

What Is Narcissistic Personality Disorder?

Narcissistic personality disorder (NPD) is a mental health condition in which a person has an inflated sense of self-importance and struggles with empathy for others. 

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), NPD is diagnosed when someone shows at least five of the following nine features:2

  1. A grandiose sense of self-importance (for example, exaggerating achievements or expecting recognition without real accomplishments)
  2. Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
  3. Belief that they are “special” and can only be understood by, or should associate with, other high-status people or institutions
  4. A need for excessive admiration
  5. A sense of entitlement (expecting special treatment)
  6. Exploitation of others to achieve personal goals
  7. A lack of empathy and an unwillingness to recognize or identify with the needs of others
  8. Envy of others or the belief that others are envious of them
  9. Arrogant, haughty behaviors or attitudes

Further, there are two main subtypes of narcissism that can appear in NPD. These are:

  1. Grandiose narcissism: The “classic” form of narcissism with openly arrogant and attention-seeking behaviors. People with this type tend to dominate conversations, brag about achievements, and demand admiration.
  2. Vulnerable narcissism: Instead of being loud and boastful, this form of narcissism shows up as hypersensitivity and withdrawal. People with this type of NPD may appear shy, but still hold strong beliefs of being special and deserving more than others.

Causes of Narcissistic Personality Disorder

NPD isn’t the result of a single gene or too much time spent on social media. It’s a far more complicated disorder than this. In fact, the roots of NPD lie in a mix of biology and environment. So, DNA, brain chemistry, subtle molecular changes, childhood experiences, parenting, and cultural pressures may all have a role to play. We discuss these potential contributory factors in the upcoming sections.

Genetic and Biological Factors

Narcissistic traits are likely partly heritable, with estimates ranging anywhere from 25% to nearly 80%. For instance, one large study found that identical twins were far more likely than fraternal twins to both meet the diagnostic threshold for narcissistic traits.3

Recent research has also discovered that people with NPD have higher levels of oxidative stress. This is when your body has too many harmful molecules that damage cells – including brain cells. In fact, one study found higher levels of a specific marker of DNA damage, called “8-OH-DG,” in people with NPD.4 

The levels of this marker were linked to being overly sensitive in relationships – an issue many people with NPD struggle with. Therefore, the emotional ups and downs associated with NPD may not be “all in the mind,” but linked to real changes happening in the body. 

Additionally, research also shows that people with NPD often have less gray matter – the part of the brain that processes information about empathy, decision-making, and emotional control.5 In other words, the brain regions that help us understand and care about others may not work as strongly in people with NPD. 

Environmental Influences

The environment a person grows up in may also have a role to play in the development of NPD. Both too much praise and too much criticism can push a child toward narcissistic traits. For example, children who are constantly told they’re “special” might start to believe it as fact. 

As evidence of this, a well-known study that followed over 500 children for 18 months found that children who were overpraised by parents showed higher narcissism scores over time.8

In contrast, those who grow up in environments of neglect and harsh criticism may end up developing narcissism as a defense mechanism. 

Attachment research also backs this contrasting finding. Children who don’t experience consistent warmth from caregivers are more likely to form insecure attachments, so they may have difficulty trusting others and regulating their emotions. Therefore, to compensate, some may develop a façade of superiority.6

Finally, studies also link early physical, emotional, or sexual abuse to higher rates of personality disorders, including NPD.7

Social Factors

The society we live in may also have a big impact on how narcissism shows up. Some cultures celebrate success, independence, and personal achievement. This focus may not be a bad thing in isolation. However, research does show that cultures with strong emphases on individual goals tend to have higher levels of narcissism compared to collectivist cultures with community and family ties.9

Then there’s the role of social media. Platforms like Instagram and TikTok reward carefully curated photos, constant updates, and, let’s be honest, a pretty considerable amount of “showing off.” Therefore, it makes sense that heavy social media use, especially when tied to appearance and attention-seeking, is linked to higher narcissistic traits.10

Social media also gives rise to increased materialism and consumer culture. When “what you own” is seen as “who you are,” it’s easy to measure your self-worth by possessions. Unsurprisingly, such materialistic values are closely tied to higher narcissism, especially when status symbols like luxury brands are used to boost self-image.10

Risk Factors for Developing NPD

Regardless of factors like culture and social media, not everyone has the same chance of developing NPD. Some people are simply more at risk because of where they come from, who they are, or the circumstances they were born into. The following sections take a closer look at potential NPD risk factors. 

Family History

As previously briefly mentioned, having a family member with NPD could raise someone’s chances of developing it. In fact, as much as 70% of the risk for NPD can be explained by inherited factors.11 This means that if your parent or sibling has NPD, you might carry a higher genetic vulnerability.

Growing up with a narcissistic parent or sibling could also shape your environment. This is because children learn behaviors by watching the people around them. So, if a parent often shows entitlement, lacks empathy, or uses manipulation, these patterns may be picked up and repeated. 

While researchers note that the shared family environment plays a smaller role than genetics, it can still reinforce narcissistic tendencies. Therefore, over time, such behaviors could become part of how a child learns to relate to others. 

However, it’s important to note that not every child of a narcissistic parent will go on to develop NPD. Having a direct relative with the disorder may increase the risk of NPD development, but it still doesn’t make it certain.

Sex Assigned at Birth

Statistically speaking, being male is a strong risk factor for NPD. A meta-analysis of over 350 studies with nearly half a million people found that men consistently scored higher than women on narcissism.12

In addition, data from large-scale population studies in the US indicate that the lifetime prevalence of NPD is about 7.7% among men, compared to 4.8% among women. This means men are approximately 1.5 times more likely to meet criteria for NPD.13

This trend was also seen in a Chinese clinical outpatient study. About 7.0% of males were diagnosed with NPD, compared to 1.4% of females, which is more than a fivefold difference.14

Narcissistic traits emphasize outward, “grandiose” features like entitlement, assertiveness, dominance, and self-promotion – characteristics that tend to align more closely with cultural stereotypes of masculinity. 

Personality Traits 

Some personality traits may act like fertile soil for narcissistic traits to develop. One of the major frameworks researchers use to categorize traits is the Big Five personality model, which includes:15

  1. Neuroticism: How prone someone is to anxiety and insecurity
  2. Extraversion: Energy, sociability, assertiveness, and attention-seeking
  3. Openness to experience: Curiosity, creativity, and willingness to try new things
  4. Agreeableness: Empathy and concern for others
  5. Conscientiousness: Self-discipline, organization, and impulse control

Studies show that certain configurations of these traits are more common in people with pathological narcissism. For instance, low agreeableness is a consistent pattern in both grandiose and vulnerable types of NPD. Plus, generally speaking:

  • Grandiose narcissism tends to combine high extraversion with low agreeableness, and sometimes lower neuroticism
  • Vulnerable narcissism is more linked with high neuroticism. It also shows signs of low self-esteem, introversion, and sensitivity16

Cultural and Social Risk Factors

The rates of NPD and narcissistic traits vary widely across the world. So, coming from certain geographical regions or cultural backgrounds may increase your risk of developing NPD.

In a US survey of over 34,600 adults, 6.2% of people had NPD at some point in their lives. Certain demographic groups were also at more risk than others, potentially due to socioeconomic factors. Younger adults and divorced, separated, widowed, or never married people also had higher rates.13

In contrast, when researchers looked at 13 different countries, the overall prevalence of personality disorders (which includes NPD) ranged from 2.4% to 7.9%.17 These countries included China, Mexico, Nigeria, South Africa, and several European nations.

Can You Prevent Narcissistic Personality Disorder?

The short answer is no. The majority of the known risk factors for NPD, such as biology, family history, or where someone grew up, are things you simply can’t change. They’re part of a person’s physical makeup and background. And while these experiences may raise the risk of NPD, avoiding them does not guarantee protection. 

While this information may sound pessimistic, it doesn’t mean the traits associated with NPD are a life-long sentence. With long-term therapy, people with NPD can work on their symptoms, difficulties with empathy, fragile self-esteem, or troubled relationships, and see meaningful improvement.

Seek Help for Narcissistic Personality Disorder at Mission Connection

If you recognize narcissistic traits in yourself that are interfering with your personal and professional life, you don’t have to face them alone. 

At Mission Connection, our licensed therapists are here to help. We provide thorough evaluations to determine if your symptoms fit with narcissistic personality disorder. From there, we guide you through the available evidence-based therapy options so you can make an informed choice about what treatment could work best for you.

Although there’s no quick “cure” for NPD, the right treatment can help you build healthier living patterns and improve your relationships. Call us today for more information or get started online. 

Causes of Narcissistic Personality Disorder: NPD Risk Factors

References

  1. Twenge, J. (2009). The narcissism epidemic: Living in the age of entitlement. APA PsycNet. https://psycnet.apa.org/record/2009-05058-000
  2. Mitra, P., Fluyau, D., & Torrico, T. J. (2024, March 1). Narcissistic Personality Disorder. PubMed. https://www.ncbi.nlm.nih.gov/books/NBK556001/
  3. Torgersen, S., Lygren, S., Øien, P. A., et al. (2000). A twin study of personality disorders. Comprehensive Psychiatry, 41(6), 416–425. https://doi.org/10.1053/comp.2000.16560
  4. Jauk, E., & Kanske, P. (2021). Can neuroscience help to understand narcissism? A systematic review of an emerging field. Personality Neuroscience, 4(3). https://doi.org/10.1017/pen.2021.1
  5. Schulze, L., Dziobek, I., Vater, A., et al. (2013). Gray matter abnormalities in patients with narcissistic personality disorder. Journal of Psychiatric Research, 47(10), 1363–1369. https://doi.org/10.1016/j.jpsychires.2013.05.017
  6. Set, Z. (2020). The mediating role of narcissism, vulnerable narcissism and self-compassion in the relationship between attachment dimensions and psychopathology. Anatolian Journal of Psychiatry, 21(0), 1. https://doi.org/10.5455/apd.99551
  7. Ross, A. G., Giri, S., Anyasodor, A. E., et al. (2024). Adverse childhood experiences leading to narcissistic personality disorder: A case report. BMC Psychiatry, 24(1). https://doi.org/10.1186/s12888-024-06307-9
  8. Brummelman, E., Thomaes, S., Nelemans, S. A., Orobio de Castro, B., Overbeek, G., & Bushman, B. J. (2015). Origins of narcissism in children. Proceedings of the National Academy of Sciences, 112(12). https://doi.org/10.1073/pnas.1420870112
  9. Jauk, E., Breyer, D., Kanske, P., & Wakabayashi, A. (2021). Narcissism in independent and interdependent cultures. Personality and Individual Differences, 177, 110716. https://doi.org/10.1016/j.paid.2021.110716
  10. Casale, S., & Banchi, V. (2020). Narcissism and problematic social media use: A systematic literature review. Addictive Behaviors Reports, 11(100252), 100252. https://doi.org/10.1016/j.abrep.2020.100252
  11. Kendler, K. S., Aggen, S. H., Czajkowski, N., et al. (2008). The structure of genetic and environmental risk factors for DSM-IV personality disorders. Archives of General Psychiatry, 65(12), 1438. https://doi.org/10.1001/archpsyc.65.12.1438
  12. Grijalva, E., Newman, D. A., Tay, L., et al. (2015). Gender differences in narcissism: A meta-analytic review. Psychological Bulletin, 141(2), 261–310. https://doi.org/10.1037/a0038231
  13. Stinson, F. S., Dawson, D. A., Golstein, R. B., et al. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder. The Journal of Clinical Psychiatry, 69(7), 1033–1045. https://doi.org/10.4088/jcp.v69n0701
  14. He, H., Xu, M., Fei, Z., et al. (2022). Sex differences in personality disorders in a Chinese clinical population. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.1006740
  15. Widiger, T., & Crego, C. (2019). The five factor model of personality structure: An update. World Psychiatry, 18(3), 271–272. https://doi.org/10.1002/wps.20658
  16. Allroggen, M., Rehmann, P., Schürch, E., Morf, C. C., & Kölch, M. (2018). The relationship between narcissism and personality traits of the five-factor model in adolescents and young adults. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 46(6), 516–522. https://doi.org/10.1024/1422-4917/a000588
  17. Huang, Y., Kotov, R., de Girolamo, G., et al. (2009). DSM–IV personality disorders in the WHO World Mental Health Surveys. British Journal of Psychiatry, 195(1), 46–53. https://doi.org/10.1192/bjp.bp.108.058552

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