Narcissistic Personality Disorder: Symptoms, Cause and Treatment

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You may know or have described someone as narcissistic but did you know that narcissism is not just a character trait but an actual personality disorder?

Personality disorders are characterized as behavioural patterns or inner experiences that vary from the norm of the individual’s culture. These patterns are stable and have a long duration which can lead to distress or impairment in work, social environments and more. These patterns are seen in two or more of the following:

  1. Cognition

  2. Affect

  3. Interpersonal functioning

  4. Impulse control

According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), narcissistic personality disorder is defined as “a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts.” In short, people with this disorder believe that they are the centre of attention because they think they play an important role in everyone’s lives.


The DSM-5 states nine symptoms for narcissistic personality disorder (NPD) however, you must meet a minimum of five symptoms to be diagnosed with this disorder.

  1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)

  2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

  3. Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)

  4. Requires excessive admiration

  5. Has a very strong sense of entitlement, e.g., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations

  6. Is exploitative of others, e.g., takes advantage of others to achieve his or her own ends

  7. Lacks empathy, e.g., is unwilling to recognize or identify with the feelings and needs of others

  8. Is often envious of others or believes that others are envious of him or her

  9. Regularly shows arrogant, haughty behaviors or attitudes


There is no definite cause for NPD, however theories surrounding possible causes exist. One theory in specific is the biopsychosocial model of causation. This model suggests that causes are due to biological, social and psychological factors. Ultimately, there is not one factor in particular that is responsible for NPD.

Biological factors: genetic makeup

Social factors: interactions during early development

Psychological factors: individual’s temperament shaped by the environment

Diagnosis and Treatment

Personality disorders like NPD must be diagnosed by a mental health professional (i.e. psychologist or psychiatrist). General practitioners are typically not trained to make this type of diagnosis. So while you may discuss your issues with your family doctor, they would need to refer you to a mental health professional. Further, it is important to note that the diagnosis does not require any invasive tests such as blood, urine, or genetic tests. The mental health professional will come to a conclusion after comparing your life history and symptoms with the symptoms listed above.

Personality disorders such as NPD are usually diagnosed in adulthood rather than during adolescence or childhood. This is because children/teens are still developing and maturing which means their personality may change as well. Though uncommon, some children or teens are diagnosed with NPD but their symptoms must have been stable for a minimum of 1 year.

Once diagnosed, treatment should be sought. Treatment usually involves long-term psychotherapy with an experienced therapist. In addition, medications may also be prescribed to help manage troubling symptoms.


Dr. M. Arnold Muller

Dr. M. Arnold Muller

Dr. M. Arnold Muller is a licensed School and Clinical Psychologist currently based in Toronto, Ontario, with 31 years of practice experience in two countries. Prior to his time in Canada, he spent the first half of his career in South Africa. Dr. Muller has a Ph.D. with specialization in Psychotherapy from the University of Pretoria, and a Masters Degree in Clinical Psychology. He also has a second Masters Degree in Practical Theology from the University of Stellenbosch.

Dr. Muller has worked in many settings including school boards, addiction centres, correctional institutions, the military, churches, and private practices. Spending time in these organizations has allowed him to gain an astounding amount of experience in psychological assessment, diagnosis, and treatment plan preparation and application.

Dr. Muller also has training and exposure to Neurofeedback Training, Somatic Experiencing, crisis intervention, conflict resolution and managing cultural differences. In his spare time, you can find him hiking, travelling, working on his photography, poetry, and spending time with his family and friends.

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