Pathological Narcissism: How To Identify The Signs

Medically reviewed by Nikki Ciletti, M.Ed, LPC
Updated April 16, 2024by BetterHelp Editorial Team
Content warning: Please be advised, the below article might mention trauma-related topics that include abuse which could be triggering to the reader. If you or someone you love is experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7. Please also see our Get Help Now page for more immediate resources.

The word narcissism comes from the story of a mythical Greek youth, Narcissus, who was cursed by the gods and fell in love with his own reflection. He fell in love with his own reflection in the waters of a spring and died staring at that reflection. A person who is narcissistic does not necessarily have to be beautiful to believe that they are. A person with narcissistic tendencies may be confident that they are superior to others regardless of who they are.

What is narcissistic personality disorder?

The American Psychological Association defines personality as “the enduring configuration of characteristics and behavior that comprises an individual’s unique adjustment to life, including major traits, interests, drives, values, self-concept, abilities, and emotional patterns.” It can be influenced by life experiences and situations, environment, and inherited characteristics.

Personality disorders are a group of mental health conditions characterized by unhealthy patterns of feeling, thinking, and behaving. These behaviors and experiences are often different from the expectations of the culture in which the affected individual lives. People who have a personality disorder sometimes have a difficult time coping with everyday problems and getting along with other people. They may believe that their way of thinking and acting is normal behavior. Because they may have a different view of people and the world, they may find it difficult to participate in some educational, family, and/or social activities.

Does someone you know have narcissistic personality disorder?
Narcissistic personality disorder (NPD), also sometimes referred to as pathological narcissism, is one of several personality disorders in the Diagnostic and Statistical Manual of Mental Disorders. It is a mental health condition that is typically characterized by an inflated sense of self-importance, a need for excessive admiration and attention, a lack of empathy for others, and troubled relationships.

People with narcissistic personality disorder may find their relationships unfulfilling, and others may avoid being around them. They may become disappointed or frustrated if they are not given admiration or favors that they feel they deserve.

Characteristics of someone with narcissistic personality disorder may include:

  • Having a grandiose feeling of self-importance, such as exaggerating talents or achievements or overestimating abilities
  • Demanding excessive admiration focused on fantasies of power, success, and beauty
  • Paying close attention to self-image (how they are viewed by others)
  • Belittling other people’s concerns or problems and/or acting as if others’ problems were unimportant
  • Showing patronizing attitudes and/or overconfident behaviors
  • Having a sense of entitlement
  • Monopolizing conversations and looking down upon or belittling people whom they perceive as inferior
  • Insisting on having the best of everything, such as the nicest home, car, or office

Additionally, people with pathological narcissism may find it difficult to handle anything they perceive as criticism. They may become angry or impatient, feel slighted easily, have difficulty controlling behavior and emotions, and experience major problems handling stress and adapting to change. They may feel depressed if they do not achieve what they perceive as perfection. Many people with pathological narcissism secretly experience feelings of shame, vulnerability, and fear of humiliation.

What is pathological narcissism?

A certain amount of self-love may be healthy and normal. However, when an over-inflated sense of self-worth is present and a person begins to believe that they are better than others, this can have a negative impact on several areas of the person’s life.

Characteristics of pathological narcissism may lead a person to have a chronic need for personal gratification and attention. Additionally, they may be socially dominant and ambitious. A tendency to brag, a lack of empathy toward others, and a dependence on others to fulfill responsibilities can also be common.


What causes this type of narcissism?

Researchers have not identified an exact cause of pathological narcissism. Some believe that the disorder forms when infants and young children fail to experience normal bonding with caregivers, especially maternal figures. According to the Cleveland Clinic, it may be a combination of genetics, upbringing, childhood experience, and culture

A person with pathological narcissism may not recognize their own behavior and be unable to admit that they might have a problem. They may experience difficulty developing meaningful relationships that last. This may be because their personality is sometimes abusive and belittling toward others.

Effects of pathological narcissism

People who live or work with someone who experiences pathological narcissism may feel overwhelmed. The physical and emotional impacts of living with or working with a person who has pathological narcissism can be quite severe.

A person with NPD may be prone to blame others for their mistakes and attempt to make them feel guilty for their problems. This can cause tension at work and, if left unresolved, can lead to violence in the workplace.

When a person with narcissistic personality disorder does not get their way, they may become angry or aggressive. Some people with narcissistic personality disorder physically or sexually abuse others as a means of controlling them.

At the beginning of a romantic relationship, people with narcissistic traits may be charming. However, over time, they can become cold and manipulative. This can result in anxiety and/or depression for their partner.

Complications associated with pathological narcissism may include an increased risk of alcohol and/or substance use, relationship difficulties, work or school difficulties, depression, and suicidal* thoughts or behaviors.

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

* If you or a loved one is experiencing suicidal thoughts, reach out for help immediately. The 988 Suicide and Crisis Lifeline can be reached at 988 and is available 24/7. The Lifeline also offers assistance via live chat on its website.

Diagnosing pathological narcissism

Narcissistic personality disorder is diagnosed through clinical evaluation. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it is defined in terms of personality traits of attention-seeking and grandiosity and in impairments in relationships.

The DSM-5 states that at least five of the following criteria must be present for a diagnosis of narcissistic personality disorder to be made:

Does someone you know have narcissistic personality disorder?
  • Fantasies about beauty, success, and power dominate the individual’s thoughts.
  • The individual needs to be admired all the time.
  • The individual lacks empathy (the ability to recognize the feelings and needs of others).
  • Their behavior appears arrogant or haughty.
  • The individual is envious of other’s successes or believes others envy them.
  • The individual has an exaggerated sense of self-importance.
  • The individual feels that they are “special” and can only relate to other “special” people.
  • The individual shows exploitative behavior and takes advantage of others.
  • The person feels an entitlement to most things.

Treating pathological narcissism

While there is no known cure for pathological narcissism, with psychotherapy, some people may begin to understand what causes their disorder and learn how to relate with others more effectively. Learning to effectively communicate with others may result in improved behavior and a change in overall attitude. Further, it may help the individual set and achieve realistic goals and expectations.

Many people with NPD don’t attend therapy to treat narcissism, but rather to address an uncomfortable symptom and avoid future discomfort. According to the Cleveland Clinic, a therapist may use cognitive behavioral therapy, dialectical behavior therapy, group therapy, metacognitive therapy, or couples or family therapy to treat people with narcissistic personality disorder. They may at least stay long enough to identify some of their triggers and learn coping mechanisms. 

During therapy, they may also learn to relate better with others and to identify the causes of their emotions. In some cases, therapy for narcissistic personality disorder may help people learn to work harder to maintain relationships, manage their feelings, and accept criticism.

For some, medications may be ordered to help manage some symptoms, such as aggression, depression, and anxiety.

When it’s time to see a doctor

People with pathological narcissism may not believe that anything is wrong. Therefore, they may be unlikely to seek treatment. Initially, some people with narcissistic personality disorder who seek treatment do so for symptoms such as depression, anxiety, or alcohol or drug use.

If you or someone you love is experiencing symptoms of pathological narcissism, it may help to seek support to begin to understand the dynamics of the disorder. A counselor may be able to help you develop the tools you need to achieve mental wellness and relate to others more effectively. If you recognize the symptoms of narcissistic personality in yourself or if you are feeling overwhelmed by sadness or depression, consider reaching out to a mental healthcare provider.

If you don’t feel comfortable with traditional in-person therapy, you might consider online therapy, which research has demonstrated to be just as effective as in-person therapy. An online counselor can provide a safe outlet to discuss your concerns and help you create a plan of action to address whatever challenges you’re facing. 

With online therapy, you can sign up for therapy from the comfort and safety of your own home. You can communicate with a therapist via phone, live chat, videoconferencing, or a combination of these modalities. 


Pathological narcissism can manifest in a variety of ways, such as grandiosity, a lack of empathy, and a sense of entitlement. If you or someone you know exhibits symptoms of narcissistic personality disorder (NPD), know that there are treatments available through therapy, whether in person or online. Even small amounts of therapy may make a difference for both a person with NPD and those around them. Take the first step toward getting support and reach out to BetterHelp today.
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