Inherited Narcissism: Is Narcissistic Personality Disorder Genetic?

Narcissistic personality disorder (NPD) is one of several mental health conditions involving deep-seated dysfunction in how a person understands and relates to the world, their identity, and the other people in their lives. Because it appears to be connected to a person’s core personality traits, many observers have wondered whether this disorder might be hard-wired into a person’s DNA. How much are narcissistic traits influenced by genetics?

While research indicates that genetic factors likely play a role in the emergence of NPD, the precise genes involved aren’t yet known. The best available estimates suggest that family history can explain between one-quarter and one-half of the variance in narcissistic personality disorder. Life experiences like childhood maltreatment and excessive criticism (or excessive praise) from parents may also have a significant impact. Some specific narcissistic tendencies, such as entitlement, might be more strongly inherited than others. Individuals whose mental health has been negatively affected by their relationships with people who have NPD may benefit from therapy.

Key features of narcissistic personality disorder

As described by the American Psychiatric Association, narcissistic personality disorder typically involves a pervasive and chronic pattern of thoughts and behaviors exhibiting the following qualities:

• Grandiosity: People with NPD typically believe they are superior to or more important than others. 
• Need for admiration: Someone with a narcissistic personality typically has a strong desire to be viewed as powerful, competent, important, or otherwise special by other people.
• Lack of empathy: Those with this condition may be unwilling or unable to take on the perspectives of others. They may not be distressed when those around them are upset and often display exploitative and manipulative behavior.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) states that this personality disorder can be identified by the presence of five or more of the following symptoms:

• An inflated sense of self-importance and a desire to be seen as important, often exaggerating accomplishments and competence
• A grandiose sense of “specialness” and a belief that one belongs among other “special” people
• Fantasies of being abnormally successful, powerful, talented, or beloved
• Arrogant and self-important behavior, often to mask feelings of low self-worth
• Craving and obsessively seeking positive regard; the need for constant admiration
• A diminished ability or desire to empathize with others
• Envy and preoccupation with the idea of envy from other people
• Taking advantage of or manipulating others frequently
• Strongly entitled attitude

NPD is one of 10 defined personality disorders, all of which tend to be present to a greater or lesser degree throughout an individual’s life. Symptoms of narcissistic personality disorder typically appear in adolescence or early adulthood, though some signs may be present in childhood. A person with NPD may be able to moderate certain personality traits with help from therapy, although an affected individual may have a hard time recognizing that their attitudes and actions are inappropriate.

Clinical vs. non-clinical narcissism

Not everyone who displays narcissistic tendencies meets the full criteria for NPD. Many clinicians and researchers regard narcissism as a personality trait that can vary considerably in severity between individuals. In general, only those whose severe narcissism significantly impairs their functioning in society and interpersonal relationships are considered to have pathological narcissism or NPD. 

Is pathological narcissism genetic?

Narcissistic personality disorder is not considered a strictly genetic disorder. No known single mutation or cluster of mutations reliably causes this mental illness. 

However, like many mental disorders, NPD does seem to have a genetic component, meaning it may be partly influenced by genes. Certain genetic variants may increase an individual’s vulnerability to certain kinds of psychological difficulties, such as impaired empathy or challenges with constructing an accurate self-image. This could lead someone who has a genetic predisposition to NPD to be more likely to develop narcissistic personality disorder when exposed to negative life experiences or poor behavioral modeling in childhood.

Some evidence suggests that certain specific narcissistic tendencies could be partly shaped by genetics. A 2014 study on identical twins in China found that the qualities of grandiosity and entitlement could be moderately heritable, with entitlement showing a stronger genetic basis.

Genetics of NPD and other personality disorders

Individuals may be diagnosed with more than one personality disorder, as well as other kinds of mental illness. Some researchers have suggested that the genetic variants predisposing a person to NPD might be common to many related conditions known as cluster B personality disorders (e.g., antisocial personality disorder, borderline personality disorder), reflecting a generalized vulnerability to atypical personality development.

For example, a foundational twin study from 2008 identified a genetic factor that was commonly found among people with six different personality disorders, including NPD. The authors noted that environmental influences appeared to be better predictors of which specific disorder an individual developed. 

This finding hasn’t yet been replicated by more up-to-date research. However, a 2023 paper reported evidence of apparent genetic overlap between personality disorders — including NPD — and experiences resembling psychosis in young people. This suggests that some of the genetic factors involved in NPD might represent a general susceptibility to mental illness rather than a predisposition to narcissism in particular.

Neurological differences in narcissistic personality disorder

Though the genetics of NPD aren’t yet fully understood, some studies have found possible differences in brain structure and function between healthy individuals and those high in narcissism. These might reflect developmental abnormalities resulting from genetic risk factors for this condition.

Functional neuroimaging studies have linked narcissism to higher-than-typical activity in areas of the brain associated with the perception of social exclusion. 

Others have found evidence of heightened responses in the dorsal anterior cingulate cortex, a region associated with negative emotions, following experiences of rejection.

These findings lend some support to the idea that many people with NPD may have an unstable sense of self-esteem and an exaggerated sensitivity to rejection from others. This could indicate that self-important behaviors in narcissism may be narcissistic defenses, or attempts to compensate for an extreme fear of being perceived negatively. This concept is sometimes referred to as “vulnerable narcissism,” as distinct from “grandiose narcissism.”

Researchers studying brain structure also found evidence of individual differences between those high and low in narcissism in various regions of the prefrontal cortex and insula. These areas are typically linked to many different mental functions, including:  

• Social processing
• Empathy
• Behavior control
• The ability to regulate emotions

Environmental influences on narcissism

While there’s no clear consensus on the precise heritability of narcissistic personality disorder, most researchers agree that there’s a substantial environmental component in addition to any genetic predisposition. 

One possible source of influence is negative parenting styles. A 2017 longitudinal study found that children whose parents displayed greater hostility and less behavior monitoring were usually more likely to develop exploitative, narcissistic behaviors. 

Other researchers have found that narcissistic personality disorder diagnosed later in life was often linked to an overly permissive and protective parenting approach. A failure to provide consequences for inappropriate behaviors in children might make them more susceptible to a sense of grandiosity and superiority. 

Traumatic events in childhood, such as neglect or abuse, may also trigger NPD. A 2022 study indicated that exploitative and entitled narcissistic behaviors were usually associated with more severe symptoms of trauma from early life experiences. Similarly, a 2023 meta-analysis reported that maltreatment in childhood generally increased the risk of both grandiose and vulnerable narcissism.

Does having a narcissistic parent cause NPD?

Although a family history of narcissistic personality disorder might be a risk factor for this condition, genetics may only tell part of the story. Even if one or both of your parents showed narcissistic attitudes or met the criteria for NPD, this doesn’t necessarily mean you’ll develop the disorder. 

That said, there may still be associated mental health risks. Having a close relationship with an individual high in narcissism can be emotionally draining and distressing, especially during your formative years. Those with NPD may engage in various forms of abuse, neglect, and behavioral instability. A 2022 study found that the children of parents with narcissistic traits were usually more likely to develop depression and anxiety.

If you grew up with a parent high in narcissism, seeking mental health care may help you process your experiences and improve your emotional well-being. Many different forms of psychotherapy may help with this task. However, you may want to pursue individual rather than family therapy. Unless your parent is willing to acknowledge their negative actions and work toward change, undergoing group treatment with them may be counterproductive.

Diagnosis and assessment

Only a mental health provider can diagnose narcissistic personality disorder. A formal diagnosis is typically made through a clinical assessment. In addition to evaluating symptoms, the clinician is often tasked with ruling out any other possible conditions before arriving at a diagnosis of NPD. 

Why a formal diagnosis matters

If you or a loved one has symptoms of narcissistic personality disorder, it could be important to seek out a mental health evaluation. A diagnosis can open doors to treatments, including evidence-based therapies and/or medications.

Treatment options for narcissistic personality disorder

Can narcissistic personality disorder be treated?

It’s a myth that personality disorders like narcissistic personality disorder are untreatable. In fact, it is possible to treat NPD, although treatment may be challenging. Typically, the primary obstacle to treatment is the individual’s inability or unwillingness to see their behavior as problematic. Many people who develop NPD never seek treatment. 

Evidence-based therapies for NPD

Evidence-based therapies for narcissistic personality disorder can include: 

• Cognitive behavioral therapy
• Schema therapy
• Mentalization-based therapy
• Transference-focused therapy

Coping strategies for individuals and loved ones

Having a family member with narcissistic traits can be challenging. It could be important to take proactive steps to safeguard your mental health. Here are some tips: 

• Encourage your family member to seek treatment.
• Set healthy boundaries for engagement. 
• Remind yourself that your loved one’s behavior is symptomatic of a mental illness, not personal to you. 
• Consider cutting off contact if the relationship becomes abusive.
• Seek support from a mental health professional who can teach you additional coping strategies.  

Getting support through BetterHelp

Readers who aren’t sure where to begin seeking help might want to consider online treatment involving an evidence-based approach, such as cognitive behavioral therapy. Talking with a therapist remotely often allows for more flexible scheduling and requires no commute, which can make it easier to fit into your weekly routine.

Research indicates that online treatments can be helpful for a variety of mental health needs. A 2020 meta-analysis found that internet-based cognitive behavioral therapy (CBT) was both satisfying to patients and effective in reducing symptoms of anxiety and depression.