Narcissistic Personality Traits And Their Effects On Mental Health

In recent years, the terms “narcissist” and “narcissistic personality” have become commonly used in casual conversation. This widespread use has led to some misconceptions about what exactly these labels mean and when they may apply. Here, we’ll explore the answer to the question, “What is a 'narcissist' personality?” covering key signs and symptoms of narcissistic personality disorder and narcissistic traits, notes on terminology, effects on relationships and interpersonal functioning, and treatment options for pathological narcissism and narcissistic behaviors

What are personality disorders?

According to the American Psychological Association, a personality disorder is when “one's way of thinking, feeling, and behaving deviates from the expectations of the culture, causes distress or problems functioning, and lasts over time.” Personality disorders and specific personality disorders, such as narcissistic personality disorder, are considered to be a type of diagnosable mental illness. There are several different types of personality disorders, such as borderline personality disorder, paranoid personality disorder, schizotypal personality disorder, and narcissistic personality disorder, among others. Personality factors have also been associated with maladaptive defense mechanisms in personality disorders. 

Personality disorders are generally thought of as conditions that require long-term treatment and management rather than conditions that can be “cured,” though this may be possible in some cases. Treatment for personality disorders usually consists of some form of individual talk therapy, which often aims to help the individual learn to develop self-awareness of their behavioral patterns and coping tools for their symptoms. Talk therapy may also foster personal growth.  In some cases, medication, lifestyle changes, and family or couples therapy might also be recommended.

What is a narcissist? 

Although the term “narcissist” has become common in popular culture, many clinicians avoid using it. Instead, they may prefer language like a person having narcissistic tendencies, such as exaggerated self-preoccupation or inflated self-concept, or qualifying for a diagnosis of narcissistic personality disorder, or NPD (sometimes referred to as pathological narcissism). However, even pathological narcissistic traits exist on a spectrum.

Terminology: What is a narcissist vs. someone with narcissistic personality disorder?

Using the correct terminology for this type of condition can be important. NPD is a diagnosable mental health condition, just like depression or bipolar disorder. According to the American Psychiatric Association, NPD can also be a "complicated and nuanced" disorder.  While individuals can take steps to learn to better manage their symptoms, the development of what may constitute narcissistic personality disorder (or narcissistic pathology) is not a choice. Research has demonstrated differences in gray matter in the brains of those with NPD, further highlighting the fact that this NPD is an illness like any other. The harm that a person with this disorder can cause to those around them is real as well, but referring to this condition using nonjudgmental terminology may help reduce the stigma around it and encourage those experiencing symptoms to seek treatment. Moreover, many people with NPD may experience other mental health conditions, such as depression and substance use disorder.

About narcissistic personality disorder

In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), personality disorders are divided into categories, or “clusters.” Narcissistic personality disorder is classified as a cluster B personality disorder, along with antisocial personality disorder, borderline personality disorder, and histrionic personality disorder. The specific personality disorders in this cluster are typically characterized by behaviors that can be seen as “dramatic/erratic.”  While distinct, cluster B personality disorders share some common characteristics, including:

• Poor insight into their condition
• Unpredictable or erratic behaviors
• Impulsivity
• Challenges in regulating emotions
• Significant challenges with interpersonal relationships

Even when a person exhibits traits of narcissism, a diagnosis of narcissistic personality disorder also assesses whether it causes significant functional impairment and subjective distress, often in association with a co-occurring condition, such as depression and substance use disorder. Addressing personality functioning in interpersonal relationships may be one of the main focuses of therapy for NPD. 

It’s estimated that around 6% of US adults live with narcissistic personality disorder, though there’s some uncertainty with statistics on this illness. That’s because many people with NPD or other personality disorders don’t realize that their behaviors may indicate a diagnosable disorder and, therefore, may not seek help.

Symptoms of narcissistic personality disorder

The DSM-5 lists nine different criteria that mental health professionals can use to identify whether a person may have narcissistic personality disorder. These traits represent persistent characteristics and behavioral patterns that might be negatively affecting the person and those around them.  In order for this diagnosis to be considered, the individual must display at least five of the following nine symptoms.

1. An inflated/grandiose sense of self-importance

A grandiose sense of one’s own importance and own superiority is often a key symptom of NPD. The individual may believe that they are more important than others, which could lead them to behave selfishly or act in ways that put their needs or feelings above those of others.

2. A preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love

People with NPD may fixate on certain expectations for their own future, often relating to having high levels of power, beauty, intelligence, or other forms of success. They may firmly believe that they will achieve and/or deserve these things.

3. A belief that they are special and unique and can only be understood by, or should associate with, other special or high-status people or institutions

As discussed above, people with narcissistic personality disorder might believe that they’re more important than other people. As a result, they could reject spending time with people or in places that they don’t deem to be “high-status.”

4. A need for excessive admiration

A person with narcissistic personality disorder will often feel the need to receive frequent and glowing praise for who they are and what they’ve done. Since low self-esteem is often associated with this condition, the person may feel insecure or lost without frequent reassurance that they are worthy and impressive.

5. A sense of entitlement

A sense of entitlement is related to a sense of inflated self-importance and the belief that one is particularly special or unique. As a result of these beliefs, an individual with NPD might expect to receive privileges or praise, regardless of whether they’ve done anything to deserve or earn them. 

6. Interpersonally exploitative behavior

It’s not uncommon for a person living with NPD to exploit others for their own gain, since they tend to believe that their needs and desires are more important than anyone else’s. As a result, they may experience the impulse to intentionally lie, deceive, or manipulate in order to exploit others and get what they want.

7. A lack of empathy

It’s often harder for those with this type of personality disorder to feel a sense of empathy for others. The symptom of an exaggerated sense of self-importance may cause them to focus on themselves and their own needs without considering the effects of their actions on others.

8. Envy of others, or a belief that others are envious of them

Because they often believe they are uniquely talented and important, people with NPD symptoms may assume that others are envious of them. Or, upon seeing the successes or admiration of others, they may be more likely to feel strongly envious themselves.

9. Arrogant and haughty behaviors or attitudes

This final criterion is another that’s related to an inflated sense of self-importance and entitlement. Those symptoms may make a person with pathological narcissism behave in an arrogant way, because they often believe that they are more important or worthy than those around them.

Behavioral patterns that can show up 

There can be many behavioral patterns associated with NPD traits. Some behaviors that may show up in daily life might include:

• Reacting with anger (or rage) when criticized or questioned
• Experiencing severe depression from the fallout of unrealistic expectations related to achievements, accolades, or praise 
• Avoiding exposure to situations where one may be vulnerable or not receive the desired reception
• Demanding behaviors
• Perfectionism
• Pretending humility to garner compliments 

To maintain one's self-esteem and sense of identity, an individual with NPD may have an inflated self-concept. Often, grandiosity and self-preoccupation may conceal an unstable or negative sense of self and fear of emotional vulnerability. Findings also indicate that many behaviors associated with NPD stem from challenges with emotional regulation of fear, vulnerability, and shame. Self-loathing and a sense of inadequacy, for example, may prompt psychological defenses such as projection and self-idealization, such as fantasies of possessing great fame, success, and admiration. However, grandiosity as a coping strategy can also lead to hypersensitivity to criticism when a person encounters situations that challenge their self-concept. 

High functioning vs. socially isolated presentations

Research suggests there can be different manifestations (subtypes) of narcissistic personality disorder. 

High-functioning narcissism tends to refer to individuals who exhibit grandiose, competitive, and attention-seeking tendencies more pronouncedly. These individuals may be rewarded in society for qualities such as assertiveness, charm, and dominance, and may be seen as traditionally successful. Despite work success, they are likely to experience significant interpersonal difficulties. Depending on the presentation of NPD, such as grandiose or vulnerable (covert narcissism), a person's characteristics may also manifest differently. For example, a person with covert narcissism may exhibit passive-aggressive behaviors or experience social anxiety.

Other findings indicate that individuals with NPD may also be prone to social withdrawal and become socially isolated. Research published in the Journal of Personality and Social Psychology suggests that a person with NPD tends to experience perceived exclusion more readily. The researchers further noted that others may come to avoid individuals with higher levels of narcissism, affecting the quality of interpersonal relationships of those with NPD. In addition, conflict and loss of mutual relationships may lead to feelings of loneliness, heightening one's sense of exclusion.  

How pathological narcissism or narcissistic personality disorder can affect mental health

NPD is categorized as a mental health condition, so its symptoms are closely linked to mental health. First, some experts believe that it may be caused by past trauma, such as abuse in some cases. Trauma can affect mental health in many different ways, from contributing to the development of depression, post-traumatic stress disorder, or substance use disorders to causing chronic stress and problems in relationships. While there may be no single cause of NPD, there are some known risk factors that increase the likelihood of developing it, such as having certain inherited characteristics as a result of one’s genetic predispositions and social environment. Whether it’s linked to other mental health challenges like trauma or not, NPD itself can impact the overall mental health of an individual living with it. It’s important to note that NPD symptoms can significantly impact the mental health and well-being of those around the individual with this condition too, such as family members, partners, friends, and coworkers.

Emotional and physical well-being impacts

Those with NPD may experience significant stress that may affect their emotional and physical well-being. According to findings published in Behavioral Medicine, individuals with NPD tend to experience higher levels of interpersonal conflict and subjective distress. Additionally, challenges affecting emotional well-being may co-exist with other mental health conditions, such as depression and substance use disorder. 

Commonly co-occurring mental health conditions with pathological narcissism, or narcissistic personality disorder

Another way NPD can affect a person’s mental health is by increasing the likelihood of developing other co-occurring, or comorbid, mental health conditions. Research suggests that the following disorders are commonly comorbid with NPD: 

• Anorexia nervosa
• Mood disorders, such as depressive disorders, generalized anxiety disorder, and other mood disorders
• Other personality disorders, such as borderline personality disorder
• Substance use disorder (sometimes referred to as "substance abuse"

It’s also worth noting that many people with NPD actually live with shame, deep insecurity, and low self-esteem. Although their behaviors may seem to indicate the opposite, their symptoms may sometimes be attempts to control and enhance their own self-image and perception. As with other mental health conditions, substance use may be a form of coping with the distress and depressive symptoms that many people with NPD experience.

How NPD can affect relationships

NPD can also affect mental health by impacting a person’s relationships. Symptoms like exploitative behavior and a lack of empathy can strain and damage relationships with partners, friends, and family members. This can lead to stress, loneliness, and related health problems for both the individual living with NPD and their loved ones. 

Interpersonal difficulties in close relationships may be one of the areas most affected by some of the attitudes and behavioral patterns of those with NPD. For example, conflict cycles and empathy breakdowns can strain interpersonal relationships. In long-term relationships and collaborative relationships, such as familial relationships, partners and family members may report experiencing:

• Dependency
• Controlling behaviors
• Intrusive thoughts
• Gaslighting
• Distress
• Hostility
• Challenging financial behaviors
• Idealization as well as devaluation in mutual relationships
• Mood disorders 
• Somatic disorders 
• Abusive behaviors (verbal, emotional, physical)

Healthy boundaries that protect your own mental health

Experiencing self-centered, manipulative, and controlling behaviors can significantly affect a person's mental health and well-being. Establishing healthy boundaries to protect one's own mental health can be important, even if a person encounters pushback from the person with NPD. Some practical steps for personal safety and support might include:

• Identifying your own needs
• Using "I" statements to describe your needs, such as "I need more space" or "I don't feel comfortable with this."
• Seeking to avoid justifying your choices 
• Firmly stating your boundary, such as saying, "If you continue with name-calling, I will hang up."
• Following through with your boundary by disengaging from further discussion
• Steering the conversation to another topic when you feel you might become defensive
• Seeking out activities and other relationships that promote personal growth
• Speaking with a mental health professional for further guidance and practice in boundary setting

What can be mistaken for narcissism?

There can be other mental health conditions that overlap in presentation with symptoms of NPD, such as manic episodes of bipolar disorder. Typically, NPD may be misdiagnosed for:

• Bipolar disorder
• Antisocial personality disorder
• Borderline personality disorder
• Histrionic personality disorder
• Obsessive-compulsive disorder
• Substance use disorders
• Post-traumatic stress disorder

However, many people with NPD may also experience another personality disorder or condition.

Seeking support for an inflated sense of self-importance, low self-esteem, and other NPD symptoms

The symptoms of narcissistic personality disorder can cause significant challenges for a person’s daily functioning and overall well-being, and it can deeply affect the lives and health of those around them as well. That’s why seeking treatment for signs of NPD can be so important. With professional treatment over time, a person may be able to learn to better recognize and adjust their behaviors and how they affect others. Therapy can also help a person learn emotion regulation skills for managing challenges related to NPD.

Types of therapy for NPD and personality-related concerns

Talk therapy is one of the most common treatment methods for personality disorders of various types. Through any of a number of talk therapy methods, a therapist may help an individual with NPD learn to better manage their emotions, raise their self-esteem, and find healthier ways of interacting with other people. Some types of therapy that are often used for NPD symptoms may include:

• Cognitive behavioral therapy
• Dialectical behavioral therapy
• Schema therapy
• Transference-focused psychotherapy

If you’re experiencing signs of narcissistic personality disorder or another mental health condition, it’s usually recommended that you meet with a licensed mental health professional for evaluation and personalized treatment advice.

Those who aren’t displaying signs of this disorder but whose mental or emotional health has been affected by someone with this disorder may also benefit from seeking support from a healthcare professional like a therapist.

Online therapy for NPD 

In many cases, talk therapy can be equally effective when done online or in person, as research suggests. That means that individuals can often choose the format that works best for them without worrying about differences in quality of care. For example, those with busy schedules may choose online therapy because it usually offers a wider range of appointment times and doesn’t require time spent commuting to an office. Online therapy can also be preferable for those facing financial constraints, since virtual sessions tend to be more affordable than in-person sessions.