Narcissistic Personality Disorder

What Causes Narcissistic Personality Disorder?

The exact cause of NPD has not been discovered. Several factors, however, seem to put an individual at increased risk of NPD.

• Family history and genetics. People with NPD often have a family history of the same disorder. Therefore, scientists suspect a genetic component to NPD, but no definite association with any gene or group of genes has been discovered.
• Childhood experiences. People who experience neglect, abuse, or abandonment during childhood may be at a higher risk for NPD. In addition, extreme parental attention styles, either neglect or overprotectiveness, may be a risk factor.

Is Narcissistic Personality Disorder Hereditary?

Scientists have not yet been able to identify a specific genetic component that increases the risk of NPD. Inherited genes may increase an individual’s susceptibility to NPD, but the disorder’s actual development may result from external triggering circumstances.

How Is Narcissistic Personality Disorder Detected?

Like all personality disorders, NPD involves a pattern of symptomatic behavior that remains consistent for a long time. By definition, NPD symptoms must begin in childhood or early adulthood.

Possible warning signs of NPD include:

• Difficulty controlling emotions
• Impulsive behavior
• Feeling stress over changes in routines
• Expecting special treatment and getting angry when it’s not received
• Reacting with anger to criticism
• Belittling others to establish superiority
• Obsession with perfection, and moodiness when it’s not achieved

How Is Narcissistic Personality Disorder Diagnosed?

Diagnosis of NPD begins with determining that the patient has a cluster of symptoms that meet the diagnostic criteria for the disorder. A doctor will start with a physical exam to rule out biological problems that may be causing symptoms. After these exams, if the doctor suspects that NPD or another personality disorder is the cause of the symptoms, they may recommend a psychological or psychiatric assessment to solidify the diagnosis further.

Diagnostic steps may include:

• A physical exam. This exam will rule out physical conditions that could be causing the symptoms.
• Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history. Family members or caregivers may also be asked to participate in these assessments.

The results of the psychological assessments will be compared to the diagnostic criteria for NPD in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM criteria for NPD include:

• Persistent inflated sense of importance, need for admiration, lack of empathy, and attention-seeking.
• At least five symptoms are present.
• The symptoms cause impairment (such as interfering with relationships).
• The symptoms are not typical of the person’s developmental stage or culture.
• The symptoms are not the result of substance abuse or a medical condition.
• The symptoms begin by early adulthood and are consistent over time.

PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

How Is Narcissistic Personality Disorder Treated?

There is no cure for NPD, and no medications are commonly used to treat the core disorder. Instead, the most common treatment course involves psychotherapy, with drugs sometimes used to treat other co-existing mental illnesses.

Therapies

Psychotherapy may effectively manage the effects of NPD, and the general course of treatment is the same as that for other personality disorders. Therapy aims to help the patient to identify their problematic patterns of behavior and understand their root causes. A therapist will also try to help the patient learn ways to develop better relationships.

However, people with NPD typically do not believe that they have a problem and are often resistant to the idea of pursuing treatment. When they do participate in therapy, they may interpret suggestions by the therapist as criticism. As a result, they may react negatively or even end the treatment.

Medications

Medicines may be used to treat symptoms such as depression or anxiety, which often co-exist with NPD. The drugs used to treat these symptoms include selective serotonin reuptake inhibitors (SSRIs), mood stabilizers such as lithium, or antipsychotics such as aripiprazole or risperidone.

How Does Narcissistic Personality Disorder Progress?

People with NPD may be socially adept and successful in areas where their personality traits are valued, such as business, politics, entertainment, or sports. However, these same personality traits are often not valued in interpersonal relationships, resulting in difficulty maintaining healthy connections with others. This, along with an underlying fragile sense of self-worth, can lead to social and health complications.

NPD can have long-term adverse effects, including:

• Conflicts at work or school
• Failure of personal relationships
• Domestic violence
• Depression
• Anxiety
• Substance abuse

How Is Narcissistic Personality Disorder Prevented?

There is no way to prevent NPD from developing, but early intervention can sometimes help teach the person how to build and maintain better relationships.

Narcissistic Personality Disorder Caregiver Tips

Many people with narcissistic personality disorder also suffer from other brain and mental health-related issues, a situation called co-morbidity. Here are a few of the disorders commonly associated with NPD:

• Up to a third of people with NPD also suffer from depression or another mood disorder such as bipolar disorder.
• An estimated 40% of people with NPD have an anxiety disorder.
• About 40% of people with NPD also struggle with alcoholism or substance abuse.
• People with NPD are at an increased risk of dying by suicide.

Other personality disorders are often co-morbid with NPD, most commonly antisocial, borderline, histrionic, and schizotypal personality disorders.

Narcissistic Personality Disorder Brain Science

Some researchers have been looking for clues to the underlying neurological causes of NPD by examining brain function and structure in people with NPD. One study has discovered that the brains of participants with NPD were smaller in an area called the anterior insular cortex. This part of the brain is responsible for a wide range of functions, but research has suggested that it plays a role in emotional regulation and the sense of self. It also seems to be crucial in the development of empathy.

In the study, people with NPD had less brain tissue (called gray matter) in the left anterior insula and other parts of the brain than people without the disorder. The researchers also found that the size of the left anterior insula in all participants was directly related to self-reported measures of empathy.

Narcissistic Personality Disorder Research

Title: Emotional Dysregulation in Para-suicidal Behavior

Stage: Recruiting

Principal investigator: Berge Osnes, PhD

Haukeland University Hospital

Bergen, Norway 

This is a naturalistic cohort pre-post study investigating aspects of emotional processing and how possible changes in emotional processing are related to the successful treatment of non-suicidal self-injury and suicidal ideation in a program of Dialectical Behavior Therapy. In addition, we wish to identify to what extent the intensity and frequency of non-suicidal self-injury and suicidal ideation are related to difficulty in emotion regulation, as indicated by self-report measures and psychophysiological measures.

Title: Circuit-Based Approach to Suicide: Biomarkers, Predictors, and Novel Therapeutics

Stage: Recruiting

Principal investigator: Joan Camprodon, MD, PhD

Massachusetts General Hospital

Boston, MA 

This neuroimaging study aims to determine the effectiveness of iTBS-TMS to the IPL in reducing suicide risk in patients with MDD and BPD. This study also seeks to identify the structural and functional circuit properties that characterize the suicidal brain and the signatures that explain the clinical severity of the suicidal risk. Moreover, this study aims to determine biological and dimensional predictors of anti-suicidal response to iTBS-TMS and its mechanism of action.

Title: Dialectical Behavior Therapy Rutgers University Research Program (DBT-RU)

Stage: Recruiting

Contact: Shireen L Rizvi, PhD

Rutgers University

Piscataway, NJ 

This protocol establishes a research-oriented psychological treatment clinic within the Graduate School of Applied and Professional Psychology (GSAPP), called the Dialectical Behavior Therapy Rutgers University Research Program (DBT-RU). The overall aim of the proposed research is to find ways to improve therapist training in existing treatments for complex and difficult-to-treat problems (e.g., DBT, prolonged exposure), develop new and more effective treatments, and improve the understanding of severe psychopathology. Consequently, this proposed research will have four branches: (1) training of research clinicians and evaluation of training methods; (2) training of clinical evaluators for the research studies and evaluation of assessment training methods; (3) assessment of treatment outcome, including assessment of mediators and moderators of change (both clinician and client data); (4) assessment and analyses of the psychopathology of subject populations who participate in the DBT-RU.