Narcissistic personality disorder: symptoms, causes and treatment

Mind says it is human nature to be aware of our own needs, to express them and to want others to be aware of our abilities and achievements, and that these are not bad traits. A diagnosis of narcissistic personality disorder is considered if such thoughts, feelings and behaviours are very extreme and cause problems in relating to others.

Rethink Mental Illness describes living with NPD as feeling very important and special compared to other people, believing you are better than others and wanting a lot of attention or praise, feeling you deserve more rewards or special treatment, finding it harder to notice how other people feel, and feeling upset easily by criticism, especially when it affects how you see yourself.

• Believing there are special reasons that make you different, better or more deserving than others.

• Fragile self-esteem, so you rely on others to recognise your worth and needs.

• Wanting a lot of attention or praise.

• Finding it harder to notice how other people feel.

• Being seen as selfish and dismissive or unaware of other people's needs.

• Feeling upset easily by criticism.

The NHS says a person with a personality disorder thinks, feels, behaves or relates to others very differently from the average person, and there are several types. The Royal College of Psychiatrists says personality traits exist on a scale, and a personality disorder diagnosis can be given to people whose traits make it extremely difficult to manage emotions and feelings about themselves, others and the world, and who have significant problems coping day to day and in relationships.

It adds that until 2019, personality disorders were split into 10 categories, including narcissistic, and that these are still sometimes used by services and clinicians, although some terms are now considered stigmatising. Mind groups narcissistic personality disorder with antisocial, borderline and histrionic types as the emotional and impulsive group.

Many people would like personality disorder to be given a new name. The Royal College of Psychiatrists notes some people prefer to describe their difficulties as complex PTSD or as complex emotional needs.

The NHS says it is not clear exactly what causes personality disorders, but they are thought to result from a combination of the genes a person inherits and early environmental influences, for example a distressing childhood experience such as abuse or neglect. Rethink Mental Illness describes it as a mix of biological factors and the environment growing up, and notes that not everyone who experiences trauma will develop a personality disorder.

Mind lists factors that may contribute, including early life experiences such as neglect, loss of a parent, abuse, or often feeling afraid, unsupported or invalidated, and also bullying, poverty, discrimination and dislocation such as migration. It says not everyone who develops a personality disorder will have had a traumatic experience.

Mind says each personality disorder has its own diagnostic criteria and you must meet some of them to get a specific diagnosis. Anyone with possible personality disorder should have a structured assessment with a mental health specialist before being given a diagnosis, in line with NICE guidelines. To get NHS treatment, you should first visit your GP, who can refer you to your local community mental health team for assessment.

The NHS says the way personality disorders are diagnosed is changing: instead of a type such as borderline personality disorder, you may be diagnosed with mild, moderate or severe personality disorder, with particular personality traits. The Royal College of Psychiatrists says this new classification organises personality disorders by severity and how someone presents with one or more of five personality traits.

The NHS says treatment for a personality disorder usually involves a talking therapy and can also include other types of therapy and medicine. Talking therapy helps the person understand their thoughts, feelings and behaviours, and can last several months or years. Therapeutic communities, where someone visits or stays for intensive group therapy, may be offered to some people.

Rethink Mental Illness notes that NICE only has guidelines for borderline and antisocial personality disorder, so there is no NICE guideline specifically for NPD. Mind says more research is needed into which talking therapies help, and lists those NICE suggests for personality disorders: dialectical behaviour therapy (developed for borderline personality disorder), mentalisation-based therapy, cognitive behavioural therapy, cognitive analytic therapy, and others such as schema-focused therapy and psychodynamic therapy.

Mind and Rethink say there are no drugs specifically licensed or recommended for personality disorders, though many people also have depression, anxiety or psychosis and may be prescribed medicines for those. The NHS says such medicine may be prescribed to treat associated problems, for example an SSRI for moderate to severe depression.

The NHS says many people with a personality disorder recover over time. Mind says that sometimes people assume it is impossible to change, especially when it comes to personality, but research is showing that this is not the case, and that with time and the right treatment it is possible for things to change and improve.

The NHS adds that psychological or medical treatment is often helpful but support is sometimes all that is needed, and there is no single approach that suits everyone.

The NHS links to Mind, Rethink Mental Illness and the Royal College of Psychiatrists for support and information, and suggests asking a GP about support groups. Mind has coping strategies, for example breathing exercises, creative activities and journaling when feeling overwhelmed.

On the NHS, your GP can refer you to a community mental health team or a specialist personality disorder service if there is one locally, and Rethink Mental Illness says you can sometimes contact these services yourself. Mind notes that waiting times for talking treatments on the NHS can be long and that you may choose to see a counsellor or psychotherapist privately.

If you pay privately, ask whether the therapist has experience of personality disorders and which approach they use, and whether progress will be reviewed.