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Narcissistic Personality Disorder (NPD): Symptoms, Causes & Treatment

Narcissistic Personality Disorder (NPD): Symptoms, Causes & Treatment

Narcissistic Personalty Disorder

What is Narcissistic Personality Disorder?

People often think of narcissism as a social media trend, an absorption in yourself and your selfies. A small amount of narcissism is actually normal and necessary for a healthy survival instinct in its most basic and Darwinian form. But excessive arrogance and intense, self-centered attitudes can become destructive and then it is considered narcissistic personality disorder (NPD) (x).

Symptoms of NPD

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), NPD requires at least five of the following characteristics (x):

  • Self-importance
  • Entitlement
  • Superiority
  • Arrogance
  • Grandiose fantasies about great success, power, beauty or love
  • Need for admiration and craving attention
  • Using other people to reach goals
  • Lack of empathy
  • Envying others or believing that people envy them

Recently, the DSM has evolved into an alternative model to further diagnose NPD, based on (x):

  • Identity – defined based on others’ opinions, with wavering self-esteem and emotions
  • Self-direction – focused on gaining approval and creates high personal standards
  • Empathy – awareness of other people’s needs and reactions only when the narcissist thinks they are relevant
  • Intimacy – shallow relationships that only serve to boost the narcissist’s self-esteem and little interest in other people’s experiences

Other Signs

  • Manipulating others and distorting facts to boost their status and image (x)
  • A struggle to form fulfilling, lasting relationships, leading to depression and anxiety (x)
  • Inability to deal with stress and change (x)
  • Depression, substance abuse and even attempted suicide after a significant failure, such as a job loss (x)
Narcissistic Personality Disorder Symptoms

Dimensions of Narcissism

Narcissists are not always easy to spot. Some may appear self-important, vain, energetic and talkative. Some seem withdrawn and sensitive and crave attention in gentler, subtler ways (x, x, x).

Grandiose (Overt) Narcissism

Grandiose narcissism comes across as assertive, dominant and confident. People with these characteristics are also more likely to hold leadership positions. Signs include (x, x):

  • Exaggerating skills and accomplishments
  • Monopolizing conversations
  • Belittling other people by overvaluing their own success
  • Wounded ego after criticism
  • Usually stable ego, although inflated
  • Expressing contempt after they hurt someone

Vulnerable (Covert) Narcissism

Narcissism is not always forward and invasive, but sometimes introverted. Researchers have also identified vulnerable narcissistic qualities, which may be harder to spot (x):

  • Quiet smugness and superiority, usually judging quietly and listening, rather than speaking
  • Withdrawn self absorption
  • Lack of empathy
  • Passive-aggression
  • High sensitivity
  • Feeling special and misunderstood
  • Impersonal relationships, using smugness as a defense mechanism

Malignant Narcissism

Malignant narcissism is considered the most severe type of this particular personality disorder, combining narcissism and antisocial personality disorder (x). In these cases, the person shows potentially dangerous aggression and antisocial behavior (x):

  • Deliberate distress to other people
  • Impulsive and aggressive
  • Lashing out at others to protect their own fragile egos
  • Lying and psychologically manipulating people into thinking their lies are true
  • Binary views — smart/dumb, black/white, winner/loser
  • Difficulties processing emotional information

Causes & Triggers for NPD

Narcissistic behaviors conceal deep feelings of shame, vulnerability and insecurity relieved only by frequent praise and admiration (x, x). The narcissistic mindset is likely caused by several factors:

Genetics

There is no specific gene for narcissism, but studies show that personality disorders are mostly or moderately genetic. Narcissistic personalities show imbalances in certain chemicals, such as serotonin and dopamine (x, x, x).

Environment

Similarly, environment and social interaction also play a role. Research suggests that narcissism is a response to social exclusion and hypersensitivity in a part of the brain that reacts to distress (x).

Narcissism roots in childhood. A narcissist may have had an unhealthy relationship with a parent as a child. If children are constantly criticized and neglected or excessively adored and overprotected, they could develop narcissistic behaviors to compensate. They may establish an inflated self-image and crave constant admiration to maintain it (x, x).

Young children are naturally self-centered and have difficulties understanding other people’s needs. However, sometimes a child’s development gets stuck at this level of narcissism instead of passing through it (x).

Neurobiology

In studies, NPD patients had a significantly thinner cerebral cortex, a section of the brain strongly linked to the ability for compassion (x).

Research suggests that narcissism is a response to social exclusion and hypersensitivity in a part of the brain that reacts to distress. Excess self-esteem and tendency to avoid close relationships protects narcissists from social exclusion. According to the study, they had less activity in parts of the brain linked to physical pain, depression, mood disorders and feelings of distress in social exclusion, which may protect them against social failures (x).

Other Possible Causes

  • Trauma or abuse
  • Insensitive parenting
  • Over sensitivity
  • Poverty and social discrimination in childhood (x)
  • Drug or alcohol abuse (x, x)

Treatment for NPD

There is no specific medication for NPD, but standard treatment includes (x):

  • Psychodynamic psychotherapy, focusing on underlying conditions
  • Mentalization-based treatment to reflect on their own state of mind, as well as others’
  • Cognitive-behavioral therapy, designed to change the patient’s thinking and teach them more adaptive behaviors (x)
  • Transference-focused therapy, focusing on the patient’s relationship to the therapist

In addition, some people with NPD may also have other accompanying conditions to treat (x, x):

Supplements

Natural remedies are helpful in these cases, improving brain chemical levels linked to depression, aggression, anxiety and sleeplessness. They can also improve impulse control and obsessive-compulsive behavior (x).

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Supplements are meant to promote general well-being and it is important to note that the remedies listed here are not a substitute for legitimate medical advice. Talk to a doctor if you are experiencing problems with your health before taking any supplements.

St. John’s Wort

Medical experts believe that St. John’s wort — the herb Hypericum perforatum — raises levels of the brain chemicals serotonin, dopamine and norepinephrine (x).

Several studies have found it as effective as standard antidepressants, with fewer side effects (x, x). It also helped people with OCD and anxiety from sleep deprivation (x, x). People who cannot tolerate standard antidepressants may find it helpful (x) in 600 mg dosages.

Melatonin

Melatonin is a natural hormone that increases when darkness sets in, causing sleepiness and boosting heart health (x). In studies, melatonin supplements helped people fall asleep quicker and longer. This significantly improved sleep quality and morning alertness. The supplements also increased brain serotonin levels, improving the subjects’ response to stress (x, x, x). For full effects, take melatonin in 1 to 3 mg dosages before bed.

Ashwagandha

Ashwagandha extract powder is from the root of the Withania somnifera plant. It is a safe, proven adaptogen that reduces cortisol levels. Cortisol is linked to stress and anxiety, which can cause depression, anxiety, sleeplessness and obesity (x, x). In studies, ashwagandha effectively reduced obsessive-compulsive behaviors linked to serotonin levels, significantly improved mental well-being and sleep and reduced stress and food cravings (x, x, x). The recommended dosage is 450 mg up to three times a day.

Other Supplements for NPD

Stress

  • Ginseng – 1,000 to 2,000 mg either once or twice a day
  • Rhodiola – 400 mg one to two times a day (x)

Insomnia

Depression

  • Tryptophan – 500 mg up to three times a day
  • Tyrosine – 400 mg up to three times a day
  • GABA – 750 mg one to two times a day (x)

Anxiety

  • Ginkgo biloba – 175 mg two or three times a day
  • Valerian – 300 to 600 mg daily
  • GABA – 750 mg either once or twice a day
  • Theanine – 100 to 200 mg up to three times a day (x)

Bipolar Disorder

Improving General Health

A healthy lifestyle supports good mental health, and essential nutrient deficiencies are common in mental disorders (x). Substance abuse and eating disorders affect depression and other mood disorders (x), and research links personality disorders to heart disease — specifically NPD to gastrointestinal disorders (x). Daily supplementation with specific nutrients may be helpful (x):

The Bottom Line

NPD is a personality disorder characterized by patterns of superiority, craving admiration and inability to understand other people’s feelings. It can cause significant distress to patients and people in their lives.

Although there is no specific medication for NPD, a healthy lifestyle and natural remedies can relieve related burdens — stress, depression, anxiety, sleep problems and other mental health issues.

 
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