When we think of individuals with Narcissistic personality disorder, many of us associate them with stigmatizing words like “evil”, “inhumane”, and “vile”. Indeed, this disorder is covered by misconceptions in daily life. Clearly, this does more harm than good, as those with the disorder may be much less likely to seek help given all the dehumanizing ideas about them. In order to erase these damaging stigmas, it helps to learn about it to represent people with NPD with a much more humane perspective.  

This article will cover the following points:

• Introduction to NPD
• Fragile self esteem
• Interpersonal relationships
• Psychotherapy and Parents
• What should I take away from this article?

Introduction to Narcissistic personality disorder

Narcissistic personality disorder (NPD) is a personality disorder that is part of the “dramatic/erratic” cluster[1]. Personality disorders are generally defined by persistent problems in maintaining a stable, positive identity and close and constructive relationships[3]. Under personality disorders in the DSM-5* are three clusters:

1. the “odd/eccentric”,
2. the “dramatic/erratic”,
3. and the “anxious/fearful”[1].

The “dramatic/erratic” cluster is generally defined by exaggerated emotional displays (including anger outbursts), unpredictable thinking or behavior, and symptoms ranging from highly inconsistent behavior to inflated self-esteem[3].

The criteria for NPD in the DSM-5 includes the presence of five or more of the following[1,3]:

• Grandiose view of one’s importance
• Preoccupation with one’s success, brilliance, or beauty
• Belief that one is special and can be understood only by high-status people
• Extreme need for admiration
• Strong sense of entitlement
• Tendency to exploit others
• Lack of empathy
• Envious of others
• Arrogant behavior or attitudes

People with Narcissistic personality disorder have an inflated view of their qualities, their success, and may seek relationships mainly to bolster their own self-esteem[5]. They require almost constant attention, and their relationships are disrupted by a lack of empathy, arrogance and often envy, and feelings of entitlement and expectations that others will do special favors for them[1]. They seem to feel superior and different to others.

A fragile self-esteem

Behind the superiority façade lies a very fragile self-esteem. It is theorized that people with NPD portray feelings of self-importance, self-absorption, and limitless success on the surface, but hide a very fragile self-esteem that is highly related to performance and/or evaluations from other people[3,8]. Furthermore, they often have pervasive feelings of insecurity, and thus do not take criticism well, often viewing constructive criticism as a personal attack[2,8]. Due to their fragile self-esteem, they attempt at boosting it through quests of respect and admiration from others[2].

Research suggests that they feel shame more frequently than those without NPD[10.. Furthermore, they tend to be more reactive than people without NPD after either a positive or a negative response, as it directly influences their self-esteem[3,11]. When their self-esteem is threatened, they may react aggressively, even denigrating the person in front of them, in order to protect their self-esteem[7,11]. It is understandable how this may become tiresome for friends and family.

Interpersonal relationships

People with Narcissistic personality disorder often have difficulties establishing and maintaining healthy, constructive relationships[9,11]. Likewise, their friends and families can find it draining to deal with some symptoms, such as the tendency to become aggressive for little things or comments, and the lack of empathy. Another reason is because people with Narcissistic personality disorder generally need a lot of admiration and approval, but often do not reciprocate it, due to their lack of empathy[8]. This can become dangerous too to their self-esteem as when people see them as “cold”, then criticize them.

Initially, people with NPD may present themselves as charming, polite, and confident, which are attractive for potential partners and friends. However, over time they can display signs of lack of emotional investment which may affect the bond and commitment of the partners in the long run[9,11]. People with NPD can of course enjoy relationships and care for others, but the unfortunate character traits may interfere in the long run[3,11].

People with NPD tend to utilize self-enhancement behaviors[1,11]. Self-enhancement is an emotional attributional bias in which people attribute success to their own doings, and failures to others’ doings or other external factors[11]. The underlying main idea is that the person with NPD feels good about their qualities, thus their self-esteem, and protects this by cutting ties between themselves and negative qualities[11]. This can further fuel their self-esteem’s over-reliance on situations. It is not that they absolutely do not care about others’ feelings, it is in fact because they lack a healthy way to deal with their low self-esteem[2,3].

Psychotherapy

A well-known possible treatment for people with Narcissistic personality disorder is psychotherapy, also known as “talk therapy”. The therapist helps the client improve their unstable self-esteem and have more realistic expectations of others[6]. Through this, the client can also develop empathy, as they learn to understand other people and to relate with others, establishing healthier ways to cope with their self-esteem[1].

During psychotherapy, the therapist helps the client identify and understand the behaviors, emotions, and ideas that contribute to their automatic thoughts and behaviors, such as a strong need for admiration[1,6]. The client then learns how to modify them for more adaptive behavioral and emotional outcomes. They also learn healthier coping techniques to replace the original maladaptive ones that have prolonged the undesirable symptoms[6].

Parents in therapy

Sometimes, it is the case that the client’s parents may have impacted the onset of their disorder, thus the therapist urges parents to be involved in their therapeutic process, for example by showing more love and affection [4,6]. Parents not providing adequate affection may instill the mindset of a child, making them believe that they are inadequate and not loved, and in response, they urge for that feeling of adequacy from others[3]. Thus, their self-esteem gradually becomes dependent on external people or factors. Similarly, parents who are overly-indulgent can also play a role in NPD. The reasoning is that these parents potentially foster in their children the idea that they are more special than others, and thus all their behaviors will be tolerated by other people too[1,3,4]. In general, when parents participate in their child’s psychotherapy process, it can be an amazing chance to restore the relationship, in the case of a broken one, or form new and healthier ways of communicating. Of course, parents may require and ask for private support as well, if needed, as the process can be as challenging as for the client themselves.

What should I take away from this article?

Throughout this article, it’s important to keep in mind that people with Narcissistic personality disorder do not choose to have this disorder. Because of the “negative” behaviors, people in contact with someone suffering from NPD may only strengthen stigmas and grow more intolerant of them. It is clear that people with NPD behave this way not because they want to and enjoy mistreating others, but because their low self-esteem may make it difficult for them to engage in healthier coping strategies

Also, always keep in mind that although there are “core” symptoms, not everyone suffering from NPD behaves the same way. This article functions merely as an educational and objective introduction to what it is like to live with NPD in general, and does not capture the entire scope of this disorder. Therefore, self- or other-diagnosis is NOT warranted from this article.

If we notice any behavior in someone we know that makes us suspicious, we could seek professional support, or let a family member be aware of certain behaviors. Although it is not our responsibility to stay and support the person, we can try to provide support, as this may be crucial.

*Diagnostic and Statistical Manual of Mental Disorders 5

Additional sources

1. The psychology of narcissism - YouTube
2. Living with NPD - YouTube

References  

1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5 (5th ed.). American Psychiatric Publishing.

2. Caskey, J. (2021, April 1). Fragile vs. Secure High Self-Esteem: Why Ego Isn't Real Self-Esteem. Life Intelligence. https://www.lifeintelligence.io/blog/fragile-vs-secure-high-self-esteem-why-ego-isnt-real-self-esteem

3. Kring, A. M., & Johnson, S. L. (2019). Abnormal Psychology: The Science and Treatment of Psychological Disorders(14th EMEA ed.). John Wiley & Sons.

4. Laulik, S., Chou, S., Browne, K. D., & Allam, J. (2013). The link between personality disorder and parenting behaviors: A systematic review. Aggression and Violent Behavior, 18(6), 644–655. https://doi.org/10.1016/j.avb.2013.07.017

5. Morf, C. C., & Rhodewalt, F. (2001). Unraveling the Paradoxes of Narcissism: A Dynamic Self-Regulatory Processing Model. Psychological Inquiry, 12(4), 177–196. https://doi.org/10.1207/s15327965pli1204_1

6. Pietrangelo, A. (2020, December 11). How to Treat Narcissistic Personality Disorder. Healthline. https://www.healthline.com/health/therapy-for-narcissism

7. Positive Thinking: What It Is, What It’s Not, and How to Do It. (2018, January 26). WebMD. https://www.webmd.com/mental-health/positive-thinking-overview

8. Raypole, B. C. (2019, November 7). The Insecurity Behind Narcissistic Personality (NPD) Explained. GoodTherapy.Org Therapy Blog. https://www.goodtherapy.org/blog/the-insecurity-behind-narcissistic-personality-npd-explained-1107194

9. Rhodewalt, F., Madrian, J. C., & Cheney, S. (1998). Narcissism, Self-Knowledge Organization, and Emotional Reactivity: The Effect of Daily Experiences on Self-Esteem and Affect. Personality and Social Psychology Bulletin, 24(1), 75–87. https://doi.org/10.1177/0146167298241006

10. Ritter, K., Vater, A., Rüsch, N., Schröder-Abé, M., Schütz, A., Fydrich, T., Lammers, C. H., & Roepke, S. (2014). Shame in patients with narcissistic personality disorder. Psychiatry Research, 215(2), 429–437. https://doi.org/10.1016/j.psychres.2013.11.019

11. Roark, S. R. (2012). Narcissistic personality disorder: impact on relationships. The Alabama Nurse, 39(4), 2–14.