Narcissistic Personality Disorder (NPD) Signs, Treatments, Therapy

31 - Jan - 2022

It is through our relationships that the term Narcissistic Personality Disorder (NPD) can be meaningful.

You may be feeling disappointed or angry with others for not recognising, appreciating or understanding you. You may find yourself feeling hurt, thinking you are out of place, or have the wrong people around you.

‘’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. These are not bad traits. However, if these thoughts, feelings and behaviours are very extreme and cause problems in relating to others, you may get a diagnosis of narcissistic personality disorder.” (Source:

The purpose of this blog post is to try and help you understand whether your struggles or that of someone you know might be usefully considered through the lens of the term Narcissistic Personality Disorder. Understanding and increased awareness of what is wrong for us gives us the opportunity to make different choices. Whilst the terminology has the potential to bring with it all sorts of negative connotations and judgments, paying close attention to your reactions in reading this article will, we hope, provide you with helpful information.

This article is constructed firstly to talk about where the term Narcissistic Personality Disorder (NPD) comes from, secondly, to talk about what the lived experience might be if you are someone for whom NPD might have relevance. (By lived experience we mean how you might feel, think and take action). Thirdly, the article considers how psychology has ‘observed and formulated’ NPD and the characteristics they associate with it. (This can be helpful because in your interactions with others - partners, friends, family, colleagues, bosses, teachers etc you may have received such feedback). Finally, it offers some thoughts about sources of help and therapy.

Understanding of NPD

The origin of the term NPD comes from the grouping of behaviours and characteristics observed in people by psychologists through research studies. Disorders are not identified through blood tests, or MRI scans and are therefore subjectively applied with the intention of helping to provide support through psychopharmacological and psychological means. 

The cause of narcissistic personality disorder is likely to be complex. Some factors that could be linked are: 

  • Environment - mismatch in parent-child relationship, parenting styles that are overprotective or neglectful with excessive adoration or excessive criticism.
  • Genetics - inherited characteristics.
  • Neurobiology -  the connection between the brain, nervous system, thinking and behaviour. 

Research shows it is more common in males than females, and it often begins in the teens or early adulthood. Some children may show traits of narcissism, however these traits may be related to age and not necessarily show serious signs of the disorder.

The lived experience of NPD

According to 

You may:

  • believe that there are special reasons that make you different, better or more deserving than others
  • have fragile self-esteem, so that you rely on others to recognise your worth and your needs
  • feel upset if others ignore you and don't give you what you feel you deserve
  • resent other people's successes
  • put your own needs above other people's, and demand they do too
  • be told you are selfish and dismissive or unaware of other people's needs.’’

Observed characteristics of NPD narcissistic personality disorder.

Narcissistic personality disorder is considered a condition in which people may be viewed as having an inflated sense of their own importance, a need for excessive attention and admiration and a lack of understanding and empathy for others. It has been observed that fulfilling relationships with other people around them – this includes relationships with friends, work colleagues, family members, and especially romantic partners.

  • Require constant, excessive admiration.
  • Have a sense of entitlement. 
  • Have an exaggerated sense of self-importance. 
  • Exaggerate their achievements or talents.
  • Fantasise about their success, beauty, power or their partner. 
  • Associate themselves only with the people who seem ‘’special’’ in their eyes. 
  • Believe they are superior and better than most people.
  • Are arrogant, look down or reject the people who they see as inferior.
  • Expect other people to follow their demands and expectations. 
  • Take advantage of others to achieve their goals. 
  • Lack empathy and ability to recognise other people’s needs and feelings.
  • Aim to have the best possessions e.g. best car, electronics and house.  
  • Believe others envy them.

In relationships with other people narcissists might be seen as: 

  • Becoming angry when they don’t receive admiration or attention.
  • Belittling others to make themselves seem superior.
  • Having problems controlling their emotions, behaviour and anger. 
  • Reacting badly to change and stress. 
  • Feeling unhappy with the little or simple things.
  • Reacting extremely if the other person doesn’t follow their demands and expectations.
  • Feeling unsatisfied in their relationships.

It is very common for people with narcissistic personality disorder to have problems with relationships, work or school, suffer with depression and anxiety, abuse drugs or alcohol and even struggle with suicidal thoughts.

Considering the gap between how people with NPD think of themselves as opposed to how they are perceived they may find it easier or harder to get a job that they want, or fit in within any circle of people that they wish to be associated with. As in all relationships it takes time for trust, understanding and attachment to form so a consequence of NPD is the impact on this gap of perception on how relationships form, develop and are sustained.  

Getting help and NPD therapy

If you recognise aspects of your personality, characteristics or behaviours that are common to narcissistic personality disorder or you are overwhelmed by the feelings of sadness or depression, consider psychotherapy. 

In order to find a therapist to help you we suggest that you focus on the following:

  1. Find a therapist who says they work with NPD - all therapists have an ethical obligation to only work with concerns where they have relevant competence.
  2. Remember that the therapy relationship is unique - being one where you can and need to speak freely - of course this may be hard because you will have had bad experiences in other types of relationship.
  3. Be prepared to commit to therapy although it may well feel uncomfortable at times - remembering it might be crucial to tell your therapist about any discomfort.