Narcissistic personality disorder: Difference between revisions

Narcissistic personality disorder
Narcissistic personality disorder
	Narcissus (1597–99) by Caravaggio; the man in love with his own reflection
Specialty	Psychiatry, clinical psychology
Symptoms	Exaggerated feelings of self-importance, excessive craving for admiration, reduced levels of empathy
Usual onset	Early adulthood
Duration	Long term
Causes	A combination of genetic and environmental factors. Social theories of NPD are weak and causality is unclear.
Diagnostic method	Based on symptoms
Differential diagnosis	Bipolar disorder, mania and hypomania, antisocial personality disorder, substance abuse, borderline personality disorder, histrionic personality disorder, grandiose delusions.
Treatment	Psychotherapy, pharmaceuticals for comorbid disorders
Frequency	6.2%citations

Browse history interactively

← Previous edit Next edit →

Content deleted Content added

VisualWikitext

Inline

Revision as of 22:16, 10 September 2024

Narcissistic personality disorder (NPD) is a personality disorder characterized by a life-long pattern of exaggerated feelings of self-importance, an excessive need for admiration, and a diminished ability to empathize with other people's feelings. Narcissistic personality disorder is one of the sub-types of the broader category known as personality disorders.^[1]^[2] It is often comorbid with other mental disorders and associated with significant functional impairment and psychosocial disability.^[1]

Personality disorders are a class of mental disorders characterized by enduring and inflexible maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by any culture. These patterns develop by early adulthood, and are associated with significant distress or impairment.^[3]^[4]^[5] Criteria for diagnosing personality disorders are listed in the sixth chapter of the International Classification of Diseases (ICD) and in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM).

There is no standard treatment for NPD.^[6]^[7] Its high comorbidity with other mental disorders influences treatment choice and outcomes.^[6] Psychotherapeutic treatments generally fall into two categories: psychoanalytic/psychodynamic and cognitive behavioral therapy, with growing support for integration of both in therapy.^[8]^[9] However, there is an almost complete lack of studies determining the effectiveness of treatments.^[7] One's subjective experience of the mental disorder, as well as their agreement to and level of engagement with treatment, are highly dependent on their motivation to change.^[10]

Signs and symptoms

Despite outward signs of grandiosity, many people with NPD struggle with symptoms of intense shame, worthlessness, low self-compassion, and self-loathing.^[11]^[12] Their view of themselves is extremely malleable and dependent on others' opinions of them. They are also hypersensitive to criticism and possess an intense need for admiration.^[13]^[14]^[15] People with NPD gain self-worth and meaning through this admiration.^[16]^[17] Individuals with NPD are often motivated to achieve their goals, status, improvement, and perfectionism, and to ignore relationships or avoid situations due to fears of incompetence, failure, worthlessness, inferiority, shame, humiliation, and losing control.^[12]^[6]

People with NPD will try to gain social status and approval in an attempt to avoid and combat these feelings,^[18] often by exaggerating their skills, accomplishments, and their degree of intimacy with people they consider high-status.^[19]^[20]^[21] Alongside this, they may have difficulty accepting help,^[22] vengeful fantasies, a sense of entitlement,^[20]^[23] and they may feign humility. They are more likely to try forms of plastic surgery due to a desire to gain attention and to be seen as beautiful.^[2]^[24]^[25] A sense of personal superiority may lead them to monopolize conversations, look down on others or to become impatient and disdainful when other persons talk about themselves.^[2]^[11] Drastic shifts in levels of self-esteem can result in a significantly decreased ability to regulate emotions.^[26]

Patients with NPD have an impaired ability to recognize facial expressions or mimic emotions, as well as a lower capacity for emotional empathy and emotional intelligence.^[27]^[28] However they do not display a compromised capacity for cognitive empathy or an impaired theory of mind, which are the abilities to understand others' feelings and attribute mental states to oneself or others respectively.^[29] They may also have difficulty relating to others’ experiences and being emotionally vulnerable.^[30] People with NPD are less likely to engage in prosocial behavior.^[30] They can still act in selfless ways to improve others' perceptions of them, advance their social status, or if explicitly told to.^[31] Despite these characteristics, they are more likely to overestimate their capacity for empathy.^[32]

It is common for people with NPD to have difficult relationships.^[33]^[34]^[35]^[36] Narcissists may disrespect others' boundaries or idealize and devalue them. They commonly keep people emotionally distant, and project, deny,^[37] or split. Narcissists respond with anger and hostility towards rejection,^[38]^[33]^[39] and can degrade, insult, or blame others who disagree with them.^[40]^[41]

They generally lack self-awareness, and will have a difficult time understanding their own traits and narcissistic tendencies, either due to a belief that NPD characteristics do not apply to them, or due to a refusal to accept or endorse negative characteristics in an attempt to maintain a positive self image.^[42]^[43] Narcissists can have difficulty seeing multiple perspectives on issues and might engage in black and white thinking.^[44] Despite this, people with NPD will often feel as they are skilled at accurately assessing others' feelings.^[45]

Problematic social media use

In April 2018, a meta-analysis published in the Journal of Personality found that the positive correlation between grandiose narcissism and social networking sites (SNS) usage was replicated across platforms (including Facebook and Twitter).^[46] In July 2018, a meta-analysis published in Psychology of Popular Media found that grandiose narcissism positively correlated with time spent on social media, frequency of status updates, number of friends or followers, and frequency of posting self-portrait digital photographs.^[47] In March 2020, the Review of General Psychology published a meta-analysis that found a small-to-moderate association between SNS use and narcissism.^[48] In June 2020, Addictive Behaviors published a systematic review finding a consistent, positive, and significant correlation between grandiose narcissism and problematic social media use.^[49]

Diagnosis

The DSM-5 indicates that: "Many highly successful individuals display personality traits that might be considered narcissistic. Only when these traits are inflexible, maladaptive, and persisting, and cause significant functional impairment or subjective distress, do they constitute narcissistic personality disorder."^[2] Given the high-function sociability associated with narcissism, some people with NPD might not view such a diagnosis as a functional impairment to their lives.^[50] Although overconfidence tends to make people with NPD very ambitious, such a mindset does not necessarily lead to professional high achievement and success, because they refuse to take risks, in order to avoid failure or the appearance of failure.^[2]^[25] Moreover, the psychological inability to tolerate disagreement, contradiction, and criticism, makes it difficult for persons with NPD to work cooperatively or to maintain long-term relationships.^[51]

DSM-5

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) describes NPD as possessing at least five of the following nine criteria.^[2]

A grandiose sense of self-importance (exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
Believing that they are "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
Requiring excessive admiration
A sense of entitlement (unreasonable expectations of especially favorable treatment or automatic compliance with their expectations)
Being interpersonally exploitative (taking advantage of others to achieve their own ends)
Lacking empathy (unwilling to recognize or identify with the feelings and needs of others)
Often being envious of others or believing that others are envious of them
Showing arrogant, haughty behaviors or attitudes

Within the DSM-5, NPD is a cluster B personality disorder.^[2] Individuals with cluster B personality disorders often appear dramatic, emotional, or erratic.^[2] Narcissistic personality disorder is a mental disorder characterized by a life-long pattern of exaggerated feelings of self-importance, an excessive craving for admiration, and a diminished ability to empathize with others' feelings.^[1]^[2]

A diagnosis of NPD, like other personality disorders, is made by a qualified healthcare professional in a clinical interview. In the narcissistic personality disorder, there is a fragile sense of self that becomes a view of oneself as exceptional.^[1]

Narcissistic personality disorder usually develops either in youth or in early adulthood.^[2] True symptoms of NPD are pervasive, are apparent in varied social situations, and are rigidly consistent over time. Severe symptoms of NPD can significantly impair the person's mental capabilities to develop meaningful human relationships, such as friendship, kinship, and marriage. Generally, the symptoms of NPD also impair the person's psychological abilities to function socially, either at work or at school, or within important societal settings. The DSM-5 indicates that, in order to qualify as symptomatic of NPD, the person's manifested personality traits must substantially differ from social norms.^[2]

ICD-11 and ICD-10

In the International Statistical Classification of Diseases and Related Health Problems, 11th Edition ICD-11 of the World Health Organization (WHO), all personality disorders are diagnosed under a single title called "personality disorder". The criteria for diagnosis are mainly concerned with assessing dysfunction, distress and maladaptive behavior. Once a diagnosis has been made, the clinician then can draw upon five trait domains to describe the particular causes of dysfunction, as these have major implications for potential treatments.^[52] NPD, as it currently conceptualised, would correspond more or less entirely to the ICD-11 trait of Dissociality, which includes self-centredness (grandiosity, attention-seeking, entitlement and egocentricity) and lack of empathy (callousness, ruthlessness, manipulativeness, interpersonal exploitativeness, and hostility).^[52]^[53]

In the previous edition, the ICD-10, narcissistic personality disorder (NPD) is listed under the category of "other specific personality disorders", meaning the ICD-10 required that cases otherwise described as NPD in the DSM-5 would only need to meet a general set of diagnostic criteria.^[54]

Differential diagnosis

The occurrence of narcissistic personality disorder presents a high rate of comorbidity with other mental disorders.^[55] People with a fragile variant of NPD (see Subtypes) are prone to bouts of psychological depression, often to the degree that meets the clinical criteria for a co-occurring depressive disorder.^[56] NPD is associated with the occurrence of bipolar disorder and substance use disorders,^[1]^[25] especially cocaine use disorder.^[2] NPD may also be comorbid or differentiated with the occurrence of other mental disorders, including histrionic personality disorder, borderline personality disorder, antisocial personality disorder, or paranoid personality disorder.^[2] NPD should also be differentiated from mania and hypomania as these cases can also present with grandiosity, but present with different levels of functional impairment.^[2] It is common for children and adolescents to display personality traits that resemble NPD, but such occurrences are usually transient, and register below the clinical criteria for a formal diagnosis of NPD.^[11]

Subtypes

Although the DSM-5 diagnostic criteria for NPD has been viewed as homogeneous, there are a variety of subtypes used for classification of NPD.^[1]^[57]^[58] There is poor consensus on how many subtypes exist, but there is broad acceptance that there are at least two: grandiose or overt narcissism, and vulnerable or covert narcissism.^[8]^[57] However, none of the subtypes of NPD are recognized in the DSM-5 or in the ICD-11.

Empirically verified subtypes

Some research has indicated the existence of three subtypes of NPD,^[59] which can be distinguished by symptom criteria, comorbidity and other clinical criteria. These are as follows:

Grandiose/Overt: the group exhibits grandiosity, entitlement, interpersonal exploitativeness and manipulation, pursuit of power and control, lack of empathy and remorse, and marked irritability and hostility.^[60] This group was noted for high levels of comorbid antisocial and paranoid personality disorders, substance abuse, externalizing, unemployment and greater likelihood of violence.^[59]^[61] Of note, Russ et al. observed that this group "do not appear to suffer from underlying feelings of inadequacy or to be prone to negative affect states other than anger", an observation corroborated by recent research which found this variant to show strong inverse associations with depressive, anxious-avoidant, and dependant/victimised features.^[61]

Vulnerable/Covert: this variant is defined by feelings of shame, envy, resentment, and inferiority (which is occasionally "masked" by arrogance), entitlement, a belief that one is misunderstood or unappreciated, and excessive reactivity to slights or criticism. This variant is associated with elevated levels of neuroticism, psychological distress, depression, and anxiety. In fact, recent research suggests that vulnerable narcissism is mostly the product of dysfunctional levels of neuroticism.^[62] Vulnerable narcissism is sometimes comorbid with diagnoses of avoidant, borderline and dependent personality disorders.^[59]^[61]

High-functioning/Exhibitionistic: A third subtype for classifying people with NPD, initially theorized by psychiatrist Glen Gabbard, is termed high functioning or exhibitionistic.^[63]^[59] This variant has been described as "high functioning narcissists [who] were grandiose, competitive, attention-seeking, and sexually provocative; they tended to show adaptive functioning and utilize their narcissistic traits to succeed."^[57] This group has been found to have relatively few psychological issues and high rates of obsessive-compulsive personality disorder, with excessive perfectionism posited as a potential cause for their impairment.^[59]

Others

Oblivious/Hypervigilant: Glen Gabbard described two subtypes of NPD in 1989, later referred to as equivalent to, the grandiose and vulnerable subtypes.^[64]^[65]^[63] The first was the "oblivious" subtype of narcissist, equivalent to the grandiose subtype. It was described as being grandiose, arrogant and thick-skinned, while also exhibiting personality traits of helplessness and emotional emptiness, low self-esteem and shame. These were observed in people with NPD to be expressed as socially avoidant behavior in situations where self-presentation is difficult or impossible, leading to withdrawal from situations where social approval is not given.

The second subtype Gabbard described was termed "hypervigilant", equivalent to the vulnerable subtype. People with this subtype of NPD were described as having easily hurt feelings, an oversensitive temperament, and persistent feelings of shame.

Communal narcissism: A fourth type is the communal narcissist. Communal narcissism is a form of narcissism that occurs in group settings. It is characterized by an inflated sense of importance and a need for admiration from others. In relation to the grandiose narcissist, a communal narcissist is arrogant and self-motivating, and shares the sense of entitlement and grandiosity. However, the communal narcissist seeks power and admiration in the communal realm. They see themselves as altruistic, saintly, caring, helpful, and warm.^[66]^[67] Individuals who display communal narcissism often seek out positions of power and influence within their groups.

Millon's subtypes

In the study Disorders of Personality: DSM-IV-TM and Beyond (1996), Theodore Millon suggested five subtypes of NPD, although they did not identify specific treatments per subtype.^[5]


Subtype	Features
Unprincipled Narcissist	Deficient conscience; unscrupulous, amoral, disloyal, fraudulent, deceptive, arrogant, exploitive; a con artist and charlatan; dominating, contemptuous, vindictive.
Amorous narcissist	Sexually seductive, enticing, beguiling, tantalizing; glib and clever; disinclined to real intimacy; indulges hedonistic desires; bewitches and inveigles others; pathological lying and swindling. Tends to have many affairs, often with exotic partners.
Compensatory narcissist	Seeks to counteract or cancel out deep feelings of inferiority and lack of self-esteem; offsets deficits by creating illusions of being superior, exceptional, admirable, noteworthy; self-worth results from self-enhancement.
Elitist narcissist	Feels privileged and empowered by virtue of special childhood status and pseudo-achievements; entitled façade bears little relation to reality; seeks favored and good life; is upwardly mobile; cultivates special status and advantages by association.
Normal narcissist	Least severe and most interpersonally concerned and empathetic, still entitled and deficient in reciprocity; bold in environments, self-confident, competitive, seeks high targets, feels unique; talent in leadership positions; expecting recognition from others.

Masterson's subtypes (exhibitionist and closet)

In 1993, James F. Masterson proposed two subtypes for pathological narcissism, exhibitionist and closet.^[68] Both fail to adequately develop an age- and phase- appropriate self because of defects in the quality of psychological nurturing provided, usually by the mother. A person with exhibitionist narcissism is similar to NPD described in the DSM-IV and differs from closet narcissism in several ways. A person with closet narcissism is more likely to be described as having a deflated, inadequate self-perception and greater awareness of emptiness within. A person with exhibitionist narcissism would be described as having an inflated, grandiose self-perception with little or no conscious awareness of feelings of emptiness. Such a person would assume that their condition was normal and that others were just like them. A person with closet narcissism is described to seek constant approval from others and appears similar to those with borderline personality disorder in the need to please others. A person with exhibitionist narcissism seeks perfect admiration all the time from others.^[69]

Malignant narcissism

Malignant narcissism, a term first coined in Erich Fromm's 1964 book The Heart of Man: Its Genius for Good and Evil,^[70] is a syndrome consisting of a combination of NPD, antisocial personality disorder, and paranoid traits. A person with malignant narcissism was described as deriving higher levels of psychological gratification from accomplishments over time, suspected to worsen the disorder. Because a person with malignant narcissism becomes more involved in psychological gratification, it was suspected to be a risk factor for developing antisocial, paranoid, and schizoid personality disorders. The term malignant is added to the term narcissist to indicate that individuals with this disorder have a severe form of narcissistic disorder that is characterized also by features of paranoia, psychopathy (anti-social behaviors), aggression, and sadism.^[71]

Historical demarcation of grandiose and vulnerable types

Over the years, many clinicians and theorists have described two variants of NPD akin to the grandiose and vulnerable expressions of trait narcissism. Some examples include:^[72]


	Grandiose Phenotype	Vulnerable Types
Kohut & Wolf (1978)	Mirror-hungry	Ideal-hungry
Broucek (1982)	Egotistical	Dissociative
Rosenfeld (1987)	Thick-skinned	Thin-skinned
Gabbard (1989, 1998, 2009)	Oblivious	Hypervigilant
Gersten (1991)	Overly grandiose	Overly vulnerable
Wink (1992)	Willful	Hypersensitive
Masterson (1993)	Exhibitionist	Closet
Fiscalini (1993)	Special child	Shamed child
Cooper and Maxwell (1995)	Empowered	Disempowered

Assessment and screening

Narcissistic Personality Inventory

Risk factors for NPD and grandiose/overt and vulnerable/covert subtypes are measured using the narcissistic personality inventory, an assessment tool originally developed in 1979, which has undergone multiple iterations with new versions in 1984, 2006 and 2014. It captures principally grandiose narcissism, but also seems to capture elements of vulnerability. A popular three-factor model has it that grandiose narcissism is assessed via the Leadership/Authority and Grandiose/Exhibitionism facets, while a combination of grandiose and vulnerable traits are indexed by the Entitlement/Exploitativeness facet.^[73]

Pathological Narcissism Inventory

The Pathological Narcissism Inventory (PNI) was designed to measure fluctuations in grandiose and vulnerable narcissistic states, similar to what is ostensibly observed by some clinicians (though empirical demonstration of this phenomenon is lacking). While having both "grandiosity" and vulnerability scales, empirically both seem to primarily capture vulnerable narcissism.^[73]^[74]

The PNI scales show significant associations with parasuicidal behavior, suicide attempts, homicidal ideation, and several aspects of psychotherapy utilization.^[75]

Five-Factor Narcissism Inventory

In 2013, the Five-Factor Narcissism Inventory (FFNI) was defined as a comprehensive assay of grandiose and vulnerable expressions of trait narcissism. The scale measures 11 traits of grandiose narcissism and 4 traits of vulnerable narcissism, both of which correlate with clinical ratings of NPD (with grandiose features of arrogance, grandiose fantasies, manipulativeness, entitlement and exploitativeness showing stronger relations).^[76] Later analysis revealed that the FFNI actually measures three factors:^[77]

Agentic Extraversion: an exaggerated sense of self-importance, grandiose fantasies, striving for greatness and acclaim, social dominance and authoritativeness, and exhibitionistic, charming interpersonal conduct.
Self-Centred Antagonism: disdain for others, psychological entitlement, interpersonally exploitative and manipulative behaviour, lack of empathy, anger in response to criticism or rebuke, suspiciousness, and thrill-seeking.
Narcissistic Neuroticism: shame-proneness, oversensitivity and negative emotionality to criticism and rebuke, and excessive need for admiration to maintain self-esteem.

Grandiose narcissism is a combination of agency and antagonism, and vulnerability is a combination of antagonism and neuroticism. The three factors show differential associations with clinically important variables. Agentic traits are associated with high self-esteem, positive view others and the future, autonomous and authentic living, commitment to personal growth, sense of purpose in life and life satisfaction. Neurotic traits show precisely the opposite correlation with all of these variables, while antagonistic traits show more complex associations; they are associated with negative view of others (but necessarily of the self), a sense of alienation from their 'true self', disinterest in personal growth, negative relationships with others, and all forms of aggression.^[77]^[78]

Millon Clinical Multiaxial Inventory

The Millon Clinical Multiaxial Inventory (MCMI) is another diagnostic test developed by Theodore Millon. The MCMI includes a scale for narcissism. The NPI and MCMI have been found to be well correlated.^[79] Whereas the MCMI measures narcissistic personality disorder (NPD), the NPI measures narcissism as it occurs in the general population; the MCMI is a screening tool. In other words, the NPI measures "normal" narcissism; i.e., most people who score very high on the NPI do not have NPD. Indeed, the NPI does not capture any sort of narcissism taxon as would be expected if it measured NPD.^[80]

A 2020 study found that females scored significantly higher on vulnerable narcissism than males, but no gender differences were found for grandiose narcissism.^[81]

Causes

The cause of narcissistic personality disorder (NPD) is unclear, although there is evidence for a strong biological or genetic underpinning.^[82] Research has found NPD has a strong heritable component.^[82]^[83]^[84]^[85] It is unclear if or how much a person's upbringing contributes to the development of NPD, although many speculative theories have been proposed.^[82]^[86]^[87]^[88]

Evidence to support social factors in the development of NPD is limited.^[82]^[88] Some studies have found NPD correlates with permissive and overindulgent parenting in childhood, while others have found correlations with harsh discipline, neglect or abuse.^[82] Findings have been inconsistent, and scientists do not know if these correlations are causal, as these studies do not control for genetic confounding.^[82]^[88]

This problem of genetic confounding is explained by psychologist Svenn Torgersen in a 2009 review:^[88]

If parents treat their children badly, and the children develop personality disorders, it does not necessarily mean that the treatment of the children is the cause of the development. An alternative explanation may be that the parents themselves have some personality disorder traits, partly due to genes. These genetically influenced traits correlate with poor parenting, explaining the genetic influence on parenting. The children inherit the genes and subsequently develop personality disorders. The personality disorders might thus have developed in any case, independent of the childhood conditions.^[88]

Twin studies allow scientists to assess the influence of genes and environment, in particular, how much of the variation in a trait is attributed to the "shared environment" (influences shared by twins, such as parents and upbringing) or the "unshared environment" (measurement error, noise, differing illnesses between twins, randomness in brain growth, and social or non-social experiences that only one twin experienced).^[89]^[90]^[88] According to a 2018 review, twin studies of NPD have found little or no influence from the shared environment, and a major contribution of genes and the non-shared environment:^[83]

Taken together, these studies have consistently demonstrated that genetic influence constitutes a major source of NPD. Non-shared environments also exert substantial influence on NPD. Notably, shared environments had no significant influence on NPD in any of these studies.
— Lu & Cai, 2018^[83]

According to neurogeneticist Kevin Mitchell, a lack of influence from the shared environment indicates that the non-shared environmental influence may be largely non-social, perhaps reflecting innate processes such as randomness in brain growth.^[90]

Neuroscientists have also studied the brains of people with NPD using structural imaging technology.^[91] A 2021 review concluded the most consistent finding among NPD patients is lowered gray matter volume in the medial prefrontal cortex.^[91] Studies of the occurrence of narcissistic personality disorder identified structural abnormalities in the brains of people with NPD, specifically, a lesser volume of gray matter in the left, anterior insular cortex.^[92] The results of a 2015 study associated the condition of NPD with a reduced volume of gray matter in the prefrontal cortex.^[93] The regions of the brain identified and studied – the insular cortex and the prefrontal cortex – are associated with the human emotions of empathy and compassion, and with the mental functions of cognition and emotional regulation. The neurological findings of the studies suggest that NPD may be related to a compromised capacity for emotional empathy and emotional regulation.^[94]

Evolutionary models of NPD have also been proposed.^[82] According to psychologist Marco Del Giudice, cluster B traits including NPD, predict increased mating success and fertility. NPD could potentially be an adaptive evolutionary phenomena, though a risky one that can sometimes result in social rejection and failure to reproduce.^[82] Another proposal is that NPD may result from an excess of traits which are only adaptive in moderate amounts (leadership success increases with moderate degrees of narcissism, but declines at the high end of narcissism).^[82]

Research on NPD is limited, because patients are hard to recruit for study.^[91] The cause of narcissistic personality disorder requires further research.^[88]^[82]

Management

Treatment for NPD is primarily psychotherapeutic; there is no clear evidence that psychopharmacological treatment is effective for NPD, although it can prove useful for treating comorbid disorders.^[8]^[95] Psychotherapeutic treatment falls into two general categories: psychoanalytic/psychodynamic and cognitive behavioral. Psychoanalytic therapies include schema therapy, transference focused psychotherapy, mentalization-based treatment and metacognitive psychotherapy. Cognitive behavioral therapies include cognitive behavioral therapy and dialectal behavior therapy. Formats also include group therapy and couples therapy.^[9] The specific choice of treatment varies based on individual presentations.^[96]

Management of narcissistic personality disorder has not been well studied, however many treatments tailored to NPD exist.^[7]^[1] Therapy is complicated by the lack of treatment-seeking behavior in people with NPD, despite mental distress. Additionally, people with narcissistic personality disorders have decreased life satisfaction and lower qualities of life, irrespective of diagnosis.^[97]^[98]^[99]^[100]^[101] People with NPD often present with comorbid mental disorders, complicating diagnosis and treatment.^[1] NPD is rarely the primary reason for which people seek mental health treatment. When people with NPD enter treatment (psychologic or psychiatric), they often express seeking relief from a comorbid mental disorder, including major depressive disorder, a substance use disorder (drug addiction), or bipolar disorder.^[25]

Prognosis

As of 2020^[update], no treatment guidelines exist for NPD and no empirical studies have been conducted on specific NPD groups to determine efficacy for psychotherapies and pharmacology.^[7]^[8] Though there is no known single cure for NPD, there are some things one can do to lessen its symptoms. Medications such as antidepressants, which treat depression, are commonly prescribed by healthcare providers; mood stabilizers to reduce mood swings and antipsychotic drugs to reduce the prevalence of psychotic episodes.

The presence of NPD in patients undergoing psychotherapy for the treatment of other mental disorders is associated with slower treatment progress and higher dropout rates.^[1] In this therapy, the goals often are examining traits and behaviors that negatively affect life, identifying ways these behaviors cause distress to the person and others, exploring early experiences that contributed to narcissistic defenses, developing new coping mechanisms to replace those defenses, helping the person see themselves and others in more realistic and nuanced ways, rather than wholly good or wholly bad, identifying and practicing more helpful patterns of behavior, developing interpersonal skills, and learning to consider the needs and feelings of others.^[102]

Epidemiology

As of 2018^[update], overall prevalence is estimated to range from 0.8% to 6.2%.^[103]^[104] In 2008 under the DSM-IV, lifetime prevalence of NPD was estimated to be 6.2%, with 7.7% for men and 4.8% for women,^[105] with a 2015 study confirming the gender difference.^[106] In clinical settings, prevalence estimates range from 1% to 15%.^[6]^[107] The occurrence of narcissistic personality disorder presents a high rate of comorbidity with other mental disorders.^[84]

History

The term "narcissism" comes from a first century (written in the year 8 AD) book by the Roman poet Ovid. Metamorphoses Book III is a myth about two main characters, Narcissus and Echo. Narcissus is a handsome young man who spurns the advances of many potential lovers. When Narcissus rejects the nymph Echo, named this way because she was cursed to only echo the sounds that others made, the gods punish him by making him fall in love with his own reflection in a pool of water. When Narcissus discovers that the object of his love cannot love him back, he slowly pines away and dies.^[108]

The concept of excessive selfishness has been recognized throughout history. In ancient Greece, the concept was understood as hubris. It is only since the late 1800s that narcissism has been defined in psychological terms:^[109]

Havelock Ellis (1898) was the first psychologist to use the term when he linked the myth to the condition in one of his patients.^[109]
Sigmund Freud (1905–1953) used the terms "narcissistic libido" in his Three Essays on the Theory of Sexuality.^[110]^[109]
Ernest Jones (1913/1951) was the first to construe extreme narcissism as a character flaw.
Robert Waelder (1925) published the first case study of narcissism. His patient was a successful scientist with an attitude of superiority, an obsession with fostering self-respect, and a lack of normal feelings of guilt. The patient was aloof and independent from others and had an inability to empathize with others' situations, and was selfish sexually. Waelder's patient was also overly logical and analytical and valued abstract intellectual thought (thinking for thinking's sake) over the practical application of scientific knowledge.

Narcissistic personality was first described by the psychoanalyst Robert Waelder in 1925.^[111] The term narcissistic personality disorder (NPD) was coined by Heinz Kohut in 1968.^[112]^[113] Waelder's initial study has been influential in the way narcissism and the clinical disorder Narcissistic personality disorder are defined today^[114]

Freudianism and psychoanalysis

Much early history of narcissism and NPD originates from psychoanalysis. Regarding the adult neurotic's sense of omnipotence, Sigmund Freud said that "this belief is a frank acknowledgement of a relic of the old megalomania of infancy";^[115] and concluded that: "we can detect an element of megalomania in most other forms of paranoic disorder. We are justified in assuming that this megalomania is essentially of an infantile nature, and that, as development proceeds, it is sacrificed to social considerations."^[116]

Narcissistic injury and narcissistic scar are terms used by Freud in the 1920s. Narcissistic wound and narcissistic blow are other, almost interchangeable, terms.^[117] When wounded in the ego, either by a real or a perceived criticism, a narcissistic person's displays of anger can be disproportionate to the nature of the criticism suffered;^[11] but typically, the actions and responses of the NPD person are deliberate and calculated.^[2] Despite occasional flare-ups of personal insecurity, the inflated self-concept of the NPD person is primarily stable.^[2]

In The Psychology of Gambling (1957), Edmund Bergler considered megalomania to be a normal occurrence in the psychology of a child,^[118] a condition later reactivated in adult life, if the individual takes up gambling.^[119] In The Psychoanalytic Theory of Neurosis (1946), Otto Fenichel said that people who, in their later lives, respond with denial to their own narcissistic injury usually undergo a similar regression to the megalomania of childhood.^[120]

Narcissistic supply

Narcissistic supply was a concept introduced by Otto Fenichel in 1938, to describe a type of admiration, interpersonal support, or sustenance drawn by an individual from his or her environment and essential to their self-esteem.^[121] The term is typically used in a negative sense, describing a pathological or excessive need for attention or admiration that does not take into account the feelings, opinions, or preferences of other people.^[122]

Narcissistic rage

The term narcissistic rage was a concept introduced by Heinz Kohut in 1972. Narcissistic rage was theorised as a reaction to a perceived threat to a narcissist's self-esteem or self-worth. Narcissistic rage occurs on a continuum from aloofness, to expressions of mild irritation or annoyance, to serious outbursts, including violent attacks.^[123]

Narcissistic rage reactions are not necessarily limited to narcissistic personality disorder. They may also be seen in catatonic, paranoid delusion, and depressive episodes.^[123] It was later suggested that narcissistic people have two layers of rage; the first layer of rage being directed constant anger towards someone else, with the second layer being self-deprecating.^[124]

Object relations

In the second half of the 20th century, in contrast to Freud's perspective of megalomania as an obstacle to psychoanalysis, in the US and UK Kleinian psychologists used the object relations theory to re-evaluate megalomania as a defence mechanism.^[125] This Kleinian therapeutic approach built upon Heinz Kohut's view of narcissistic megalomania as an aspect of normal mental development, by contrast with Otto Kernberg's consideration of such grandiosity as a pathological distortion of normal psychological development.^[126]

To the extent that people are pathologically narcissistic, the person with NPD can be a self-absorbed individual who passes blame by psychological projection and is intolerant of contradictory views and opinions; is apathetic towards the emotional, mental, and psychological needs of other people; and is indifferent to the negative effects of their behaviors, whilst insisting that people should see them as an ideal person.^[127] The merging of the terms "inflated self-concept" and "actual self" is evident in later research on the grandiosity component of narcissistic personality disorder, along with incorporating the defence mechanisms of idealization and devaluation and of denial.^[128]

Comparison to other personality disorders

NPD shares properties with borderline personality disorder, including social stigma, unclear causes and prevalence rates. In a 2020 study, it was argued that NPD is following a similar historical trend to borderline personality disorder: "In the past three decades, enormous progress has been made to elucidate the psychopathology, longitudinal course, and effective treatment for BPD. NPD, which remains as similarly stigmatized and poorly understood as BPD once was, now carries the potential for a new wave of investigation and treatment development."^[129]

However, NPD also shares some commonality with the now discredited "multiple personality disorder" (MPD) personality constellation in popular culture and clinical lore. MPD received a high level of mainstream media attention the 1980s, followed by a nearly complete removal from public discourse within the following two decades; this was in part due to thorough debunking many of its propositions and the evident societal harm created by its entry into the legal defence realm. Similar to MPD, NPD has been the subject of high levels of preoccupation in social and popular media forums, without a firm empirical basis despite over a century of description in clinical lore. The NPD label may be misused colloquially and clinically to disparage a target for the purpose of buttressing one's own self-esteem, or other motives that are detrimental for the person receiving the label. Finally, the rise in popular interest in NPD is not accompanied by hypothesized increases in narcissism among recent generations, despite widespread assumptions to the contrary.^[130]

Controversy

The extent of controversy about narcissism was on display when the committee on personality disorders for the 5th Edition (2013) of the Diagnostic and Statistical Manual of Mental Disorders recommended the removal of Narcissistic Personality from the manual. A contentious three-year debate unfolded in the clinical community with one of the sharpest critics being John Gunderson, who led the DSM personality disorders committee for the 4th edition of the manual.^[131]

The American Psychiatric Association's (APA) formulation, description, and definition of narcissistic personality disorder, as published in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Ed., Text Revision (DSM-IV-TR, 2000), was criticised by clinicians as inadequately describing the range and complexity of the personality disorder that is NPD. That it is excessively focused upon "the narcissistic individual's external, symptomatic, or social interpersonal patterns – at the expense of ... internal complexity and individual suffering", which reduced the clinical utility of the NPD definition in the DSM-IV-TR.^[50]

In revising the diagnostic criteria for personality disorders, the work group for the list of "Personality and Personality Disorders" proposed the elimination of narcissistic personality disorder (NPD) as a distinct entry in the DSM-5, and thus replaced a categorical approach to NPD with a dimensional approach, which is based upon the severity of the dysfunctional-personality-trait domains.^[132]^[133] Clinicians critical of the DSM-5 revision characterized the new diagnostic system as an "unwieldy conglomeration of disparate models that cannot happily coexist", which is of limited usefulness in clinical practice.^[134] Despite the reintroduction of the NPD entry, the APA's re-formulation, re-description, and re-definition of NPD, towards a dimensional view based upon personality traits, remains in the list of personality disorders of the DSM-5.

A 2011 study concluded that narcissism should be conceived as personality dimensions pertinent to the full range of personality disorders, rather than as a distinct diagnostic category.^[135] In a 2012 literature review about NPD, the researchers concluded that narcissistic personality disorder "shows nosological inconsistency, and that its consideration as a trait domain needed further research would be strongly beneficial to the field."^[136] In a 2018 latent structure analysis, results suggested that the DSM-5 NPD criteria fail to distinguish some aspects of narcissism relevant to diagnosis of NPD and subclinical narcissism.^[137]

In popular culture

Suzanne Stone-Maretto, Nicole Kidman's character in the film To Die For (1995), wants to appear on television at all costs, even if this involves murdering her husband. A psychiatric assessment of her character noted that she "was seen as a prototypical narcissistic person by the raters: on average, she satisfied 8 of 9 criteria for narcissistic personality disorder... had she been evaluated for personality disorders, she would receive a diagnosis of narcissistic personality disorder".^[138]
Jay Gatsby, the eponymous character of F. Scott Fitzgerald's novel The Great Gatsby (1925), "an archetype of self-made American men seeking to join high society", has been described as a "pathological narcissist" for whom the "ego-ideal" has become "inflated and destructive" and whose "grandiose lies, poor sense of reality, sense of entitlement, and exploitive treatment of others" conspire toward his own demise.^[139]

References

^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l Caligor E, Levy KN, Yeomans FE (May 2015). "Narcissistic personality disorder: diagnostic and clinical challenges". The American Journal of Psychiatry. 172 (5): 415–422. doi:10.1176/appi.ajp.2014.14060723. PMID 25930131.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q ^r ^s Diagnostic and statistical manual of mental disorders : DSM-5 (5th ed.). Arlington, VA: American Psychiatric Association. 2013. pp. 72–669. ISBN 978-0-89042-554-1. OCLC 830807378.
^ Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, Virginia: American Psychiatric Association. 2013. pp. 646–49. ISBN 978-0-89042-555-8.
^ Berrios GE (1993). "European views on personality disorders: a conceptual history". Comprehensive Psychiatry. 34 (1). W.B. Saunders Ltd: 14–30. doi:10.1016/0010-440X(93)90031-X. PMID 8425387.
^ ^a ^b Millon T, Davis RD (1996). Disorders of Personality: DSM-IV and Beyond. New York City: John Wiley & Sons, Inc. p. 226. ISBN 978-0-471-01186-6.
^ ^a ^b ^c ^d Mitra P, Fluyau D (2022). "Narcissistic Personality Disorder". StatPearls. Treasure Island, Florida: StatPearls Publishing. PMID 32310461. Retrieved 1 May 2022.
^ ^a ^b ^c ^d King RM, Grenyer BF, Gurtman CG, Younan R (1 March 2020). "A clinician's quick guide to evidence-based approaches: Narcissistic personality disorder". Clinical Psychologist. 24 (1). Melbourne, Australia: Australian Psychological Society: 91–95. doi:10.1111/cp.12214. hdl:10536/DRO/DU:30136767. ISSN 1328-4207. S2CID 216198008.
^ ^a ^b ^c ^d Yakeley J (5 July 2018). "Current understanding of narcissism and narcissistic personality disorder". BJPsych Advances. 24 (5): 305–315. doi:10.1192/bja.2018.20. ISSN 2056-4678. S2CID 148566892.
^ ^a ^b Weinberg I, Ronningstam E (March 2020). "Dos and Don'ts in Treatments of Patients With Narcissistic Personality Disorder". Journal of Personality Disorders. 34 (Suppl). Guilford Press: 122–142. doi:10.1521/pedi.2020.34.supp.122. PMID 32186986. S2CID 214583609.
^ Personality Disorders and Pathology: Integrating Clinical Assessment and Practice in the DSM-5 and ICD-11 Era. American Psychological Association. 2022. ISBN 978-1-4338-3576-6. JSTOR j.ctv2h43b0f.
^ ^a ^b ^c ^d "Narcissistic personality disorder – Symptoms & causes". Mayo Clinic. Phoenix, Arizona: Mayo Foundation for Medical Education and Research. 18 November 2017. Retrieved 28 June 2018.
^ ^a ^b Kramer U, Pascual-Leone A, Rohde KB, Sachse R (March 2018). "The role of shame and self-compassion in psychotherapy for narcissistic personality disorder: An exploratory study" (PDF). Clinical Psychology & Psychotherapy. 25 (2): 272–282. doi:10.1002/cpp.2160. PMID 29265698.
^ Ronningstam E, Baskin-Sommers AR (June 2013). "Fear and decision-making in narcissistic personality disorder-a link between psychoanalysis and neuroscience". Dialogues in Clinical Neuroscience. 15 (2): 191–201. doi:10.31887/DCNS.2013.15.2/eronningstam. PMC 3811090. PMID 24174893.
^ Krusemark EA, Lee C, Newman JP (January 2015). "Narcissism dimensions differentially moderate selective attention to evaluative stimuli in incarcerated offenders". Personality Disorders. 6 (1): 12–21. doi:10.1037/per0000087. PMC 4293238. PMID 25330183.
^ Vater A, Ritter K, Schröder-Abé M, Schütz A, Lammers CH, Bosson JK, Roepke S (March 2013). "When grandiosity and vulnerability collide: Implicit and explicit self-esteem in patients with narcissistic personality disorder". Journal of Behavior Therapy and Experimental Psychiatry. 44 (1): 37–47. doi:10.1016/j.jbtep.2012.07.001. PMID 22902785.
^ Yang PS, Huang TL (April 2004). "Pessimistic mood in decompensated narcissistic patient". Chang Gung Medical Journal. 27 (4): 318–321. PMID 15239200.
^ Perfectionism, Shame, and Aggression in Depressive Patients With Narcissistic Personality Disorder. Jane Fjermestad-Noll, Elsa Ronningstam, Bo S. Bach, Bent Rosenbaum, and Erik Simonsen, Journal of Personality Disorders 2020 34:Supplement, 25-41
^ Ritter K, Vater A, Rüsch N, Schröder-Abé M, Schütz A, Fydrich T, et al. (February 2014). "Shame in patients with narcissistic personality disorder". Psychiatry Research. 215 (2): 429–437. doi:10.1016/j.psychres.2013.11.019. PMID 24321228. S2CID 15919085.
^ Gabbard GO (January 2022). "Narcissism and suicide risk". Annals of General Psychiatry. 21 (1): 3. doi:10.1186/s12991-022-00380-8. PMC 8783517. PMID 35065658.
^ ^a ^b Coleman D, Lawrence R, Parekh A, Galfalvy H, Blasco-Fontecilla H, Brent DA, et al. (February 2017). "Narcissistic Personality Disorder and suicidal behavior in mood disorders". Journal of Psychiatric Research. 85: 24–28. doi:10.1016/j.jpsychires.2016.10.020. PMC 5191918. PMID 27816770.
^ Ponzoni S, Beomonte Zobel S, Rogier G, Velotti P (August 2021). "Emotion dysregulation acts in the relationship between vulnerable narcissism and suicidal ideation". Scandinavian Journal of Psychology. 62 (4): 468–475. doi:10.1111/sjop.12730. PMC 8360132. PMID 33956346.
^ Kacel EL, Ennis N, Pereira DB (2017). "Narcissistic Personality Disorder in Clinical Health Psychology Practice: Case Studies of Comorbid Psychological Distress and Life-Limiting Illness". Behavioral Medicine. 43 (3): 156–164. doi:10.1080/08964289.2017.1301875. PMC 5819598. PMID 28767013.
^ Lowenstein J, Purvis C, Rose K (2016). "A systematic review on the relationship between antisocial, borderline and narcissistic personality disorder diagnostic traits and risk of violence to others in a clinical and forensic sample". Borderline Personality Disorder and Emotion Dysregulation. 3: 14. doi:10.1186/s40479-016-0046-0. PMC 5062934. PMID 27777779.
^ Loron AM, Ghaffari A, Poursafargholi N (October 2018). "Personality Disorders among Individuals Seeking Cosmetic Botulinum Toxin Type A (BoNTA) Injection, a Cross-Sectional Study". The Eurasian Journal of Medicine. 50 (3): 164–167. doi:10.5152/eurasianjmed.2018.17373. PMC 6263231. PMID 30515036.
^ ^a ^b ^c ^d Ronningstam E (2016). "New Insights into Narcissistic Personality Disorder". Psychiatric Times. 33 (2). New York City: MJH Associates: 11. Archived from the original on 17 August 2018. Retrieved 17 August 2018.
^ Ronningstam E (7 February 2017). "Intersect between self-esteem and emotion regulation in narcissistic personality disorder - implications for alliance building and treatment". Borderline Personality Disorder and Emotion Dysregulation. 4 (1): 3. doi:10.1186/s40479-017-0054-8. PMC 5296946. PMID 28191317.
^ Ronningstam E (March 2020). "Internal Processing in Patients With Pathological Narcissism or Narcissistic Personality Disorder: Implications for Alliance Building and Therapeutic Strategies". Journal of Personality Disorders. 34 (Suppl): 80–103. doi:10.1521/pedi.2020.34.supp.80. PMID 32186980. S2CID 213181317.
^ Zajenkowski M, Maciantowicz O, Szymaniak K, Urban P (2018). "Vulnerable and Grandiose Narcissism Are Differentially Associated With Ability and Trait Emotional Intelligence". Frontiers in Psychology. 9: 1606. doi:10.3389/fpsyg.2018.01606. PMC 6120976. PMID 30210418.
^ Eddy CM (1 May 2021). "Self-serving social strategies: A systematic review of social cognition in narcissism". Current Psychology. 42 (6): 4362–4380. doi:10.1007/s12144-021-01661-3. ISSN 1936-4733. S2CID 235587088.
^ ^a ^b Baskin-Sommers A, Krusemark E, Ronningstam E (July 2014). "Empathy in narcissistic personality disorder: from clinical and empirical perspectives". Personality Disorders. 5 (3): 323–333. doi:10.1037/per0000061. PMC 4415495. PMID 24512457.
^ Stolz DS, Vater A, Schott BH, Roepke S, Paulus FM, Krach S (2021). "Reduced frontal cortical tracking of conflict between self-beneficial versus prosocial motives in Narcissistic Personality Disorder". NeuroImage. Clinical. 32: 102800. doi:10.1016/j.nicl.2021.102800. PMC 8405953. PMID 34461435.
^ Ritter K, Dziobek I, Preissler S, Rüter A, Vater A, Fydrich T, et al. (May 2011). "Lack of empathy in patients with narcissistic personality disorder". Psychiatry Research. 187 (1–2): 241–247. doi:10.1016/j.psychres.2010.09.013. PMID 21055831. S2CID 7718348.
^ ^a ^b Gewirtz-Meydan A, Finzi-Dottan R (April 2018). "Narcissism and Relationship Satisfaction from a Dyadic Perspective: The Mediating Role of Psychological Aggression". Marriage & Family Review. 54 (3): 296–312. doi:10.1080/01494929.2017.1359814. ISSN 0149-4929. S2CID 148631814.
^ Cramer P (October 2010). "Narcissism through the ages: What happens when narcissists grow older?". Journal of Research in Personality. 45 (5): 479–92. doi:10.1016/j.jrp.2011.06.003.
^ Mathieu C (October 2013). "Personality and job satisfaction: The role of narcissism". Personality and Individual Differences. 55 (6): 650–54. doi:10.1016/j.paid.2013.05.012.
^ Ellison WD, Acuff MC, Kealy D, Joyce AS, Ogrodniczuk JS (August 2020). "Narcissism and Quality of Life: The Mediating Role of Relationship Patterns". The Journal of Nervous and Mental Disease. 208 (8). Lippincott Williams & Wilkins: 613–618. doi:10.1097/NMD.0000000000001170. PMID 32229790. S2CID 213949270.
^ Di Pierro R, Costantini G, Benzi IM, Madeddu F, Preti E (April 2019). "Grandiose and entitled, but still fragile: A network analysis of pathological narcissistic traits". Personality and Individual Differences. 140: 15–20. doi:10.1016/j.paid.2018.04.003. S2CID 149618835.
^ Ellison WD, Acuff MC, Kealy D, Joyce AS, Ogrodniczuk JS (August 2020). "Narcissism and Quality of Life: The Mediating Role of Relationship Patterns". The Journal of Nervous and Mental Disease. 208 (8). Lippincott Williams & Wilkins: 613–618. doi:10.1097/nmd.0000000000001170. PMID 32229790. S2CID 213949270.
^ Barry CT, Kauten RL (2014). "Nonpathological and pathological narcissism: which self-reported characteristics are most problematic in adolescents?". Journal of Personality Assessment. 96 (2): 212–9. doi:10.1080/00223891.2013.830264. PMID 24007215. S2CID 23508050.
^ Ronningstam E (2005). Identifying and understanding the narcissistic personality. New York City: Oxford University Press. pp. 22–27. ISBN 978-0-19-803396-7. OCLC 61329826.
^ "Understanding Relational Dysfunction in Borderline, Narcissistic, and Antisocial Personality Disorders: Clinical Considerations, Presentation of Three Case Studies, and Implications for Therapeutic Intervention". www.davidpublisher.com. Retrieved 20 July 2022.
^ Cooper LD, Balsis S, Oltmanns TF (April 2012). "Self- and informant-reported perspectives on symptoms of narcissistic personality disorder". Personality Disorders. 3 (2): 140–154. doi:10.1037/a0026576. PMC 3396740. PMID 22452774.
^ Kramer U, Pascual-Leone A, Rohde KB, Sachse R (March 2018). "The role of shame and self-compassion in psychotherapy for narcissistic personality disorder: An exploratory study" (PDF). Clinical Psychology & Psychotherapy. 25 (2): 272–282. doi:10.1002/cpp.2160. PMID 29265698.
^ Jauk E, Kanske P. Jauk E, Kanske P (2021). "Can neuroscience help to understand narcissism? A systematic review of an emerging field". Personality Neuroscience. 4: e3. doi:10.1017/pen.2021.1. PMC 8170532. PMID 34124536.[
^ Bilotta E, Carcione A, Fera T, Moroni F, Nicolò G, Pedone R, et al. (15 August 2018). "Symptom severity and mindreading in narcissistic personality disorder". PLOS ONE. 13 (8): e0201216. Bibcode:2018PLoSO..1301216B. doi:10.1371/journal.pone.0201216. PMC 6093639. PMID 30110368.
^ Gnambs T, Appel M (2018). "Narcissism and Social Networking Behavior: A Meta-Analysis". Journal of Personality. 86 (2). Wiley-Blackwell: 200–212. doi:10.1111/jopy.12305. PMID 28170106.
^ McCain JL, Campbell WK (2018). "Narcissism and Social Media Use: A Meta-Analytic Review". Psychology of Popular Media Culture. 7 (3). American Psychological Association: 308–327. doi:10.1037/ppm0000137. S2CID 152057114. Archived from the original on 20 October 2021. Retrieved 9 June 2020.
^ Appel M, Marker C, Gnambs T (2020). "Are Social Media Ruining Our Lives? A Review of Meta-Analytic Evidence". Review of General Psychology. 24 (1). American Psychological Association: 60–74. doi:10.1177/1089268019880891.
^ Casale S, Banchi V (2020). "Narcissism and problematic social media use: A systematic literature review". Addictive Behaviors Reports. 11. Elsevier: 100252. doi:10.1016/j.abrep.2020.100252. PMC 7244927. PMID 32467841.
^ ^a ^b Ronningstam E (February 2010). "Narcissistic personality disorder: a current review". Current Psychiatry Reports. 12 (1): 68–75. doi:10.1007/s11920-009-0084-z. PMID 20425313. S2CID 19473736.
^ Golomb E (1992). Trapped in the Mirror: Adult Children of Narcissists in Their Struggle For Self (1st ed.). New York: W. W. Morrow. ISBN 0-688-09471-6. OCLC 23143624.^{[page needed]}
^ ^a ^b Bach B, First MB (October 2018). "Application of the ICD-11 classification of personality disorders". BMC Psychiatry. 18 (1): 351. doi:10.1186/s12888-018-1908-3. PMC 6206910. PMID 30373564.
^ Bach B, Kramer U, Doering S, di Giacomo E, Hutsebaut J, Kaera A, et al. (April 2022). "The ICD-11 classification of personality disorders: a European perspective on challenges and opportunities". Borderline Personality Disorder and Emotion Dysregulation. 9 (1): 12. doi:10.1186/s40479-022-00182-0. PMC 8973542. PMID 35361271.
^ WHO (2010) ICD-10: Specific Personality Disorders
^ Paris J (April 2014). "Modernity and narcissistic personality disorder". Personality Disorders. 5 (2): 220–226. doi:10.1037/a0028580. PMID 22800179.
^ "Narcissistic personality disorder", MedlinePlus, U.S. National Library of Medicine, 8 July 2018
^ ^a ^b ^c Levy KN (August 2012). "Subtypes, dimensions, levels, and mental states in narcissism and narcissistic personality disorder". Journal of Clinical Psychology. 68 (8): 886–897. doi:10.1002/jclp.21893. PMID 22740389.
^ Sedikides C (January 2021). "In Search of Narcissus". Trends in Cognitive Sciences. 25 (1): 67–80. doi:10.1016/j.tics.2020.10.010. PMID 33229145. S2CID 227063824.
^ ^a ^b ^c ^d ^e Russ E, Shedler J, Bradley R, Westen D (November 2008). "Refining the construct of narcissistic personality disorder: diagnostic criteria and subtypes". The American Journal of Psychiatry. 165 (11): 1473–1481. doi:10.1176/appi.ajp.2008.07030376. PMID 18708489.
^ Miller JD, Hoffman BJ, Gaughan ET, Gentile B, Maples J, Keith Campbell W (October 2011). "Grandiose and vulnerable narcissism: a nomological network analysis". Journal of Personality. 79 (5). Wiley: 1013–1042. doi:10.1111/j.1467-6494.2010.00711.x. PMID 21204843.
^ ^a ^b ^c Tanzilli A, Gualco I (March 2020). "Clinician Emotional Responses and Therapeutic Alliance When Treating Adolescent Patients With Narcissistic Personality Disorder Subtypes: A Clinically Meaningful Empirical Investigation". Journal of Personality Disorders. 34 (Suppl): 42–62. doi:10.1521/pedi.2020.34.supp.42. PMID 32186983. S2CID 213186868.
^ Miller JD, Lynam DR, Vize C, Crowe M, Sleep C, Maples-Keller JL, Few LR, Campbell WK (April 2018). "Vulnerable Narcissism Is (Mostly) a Disorder of Neuroticism". Journal of Personality. 86 (2): 186–199. doi:10.1111/jopy.12303. ISSN 0022-3506. PMID 28170100.
^ ^a ^b Gabbard GO (January 2022). "Narcissism and suicide risk". Annals of General Psychiatry. 21 (1). BioMed Central Ltd.: 3. doi:10.1186/s12991-022-00380-8. PMC 8783517. PMID 35065658. S2CID 246083162.
^ Gabbard GO (1989). "Two subtypes of narcissistic personality disorder". Bulletin of the Menninger Clinic. 53 (6): 527–532. PMID 2819295.
^ Gabbard GO (March 2009). "Transference and Countertransference: Developments in the Treatment of Narcissistic Personality Disorder". Psychiatric Annals. 39 (3). Thorofare, New Jersey: SLACK Incorporated: 129–136. doi:10.3928/00485713-20090301-03. ISSN 0048-5713.
^ Gebauer JE, Sedikides C, Verplanken B, Maio GR (November 2012). "Communal narcissism". Journal of Personality and Social Psychology. 103 (5): 854–878. doi:10.1037/a0029629. PMID 22889074.
^ Lancer D (6 March 2021). "Know the Kind of Narcissist You're Dealing With and Symptoms". PsychologyToday.com.
^ Masterson JF (1993). The Emerging Self: A Developmental Self & Object Relations Approach to the Treatment of the Closet Narcissistic Disorder of the Self. Hove, Sussex, England: Psychology Press. p. 4. ISBN 978-1-315-82578-6.
^ Lowenstein J, Purvis C, Rose K (13 October 2016). "A systematic review on the relationship between antisocial, borderline and narcissistic personality disorder diagnostic traits and risk of violence to others in a clinical and forensic sample". Borderline Personality Disorder and Emotion Dysregulation. 3 (14). BioMed Central: 14. doi:10.1186/s40479-016-0046-0. PMC 5062934. PMID 27777779.
^ Fromm E (1964). The Heart of Man: Its Genius for Good and Evil. San Francisco, California: Harper & Row. p. 92. ISBN 978-9933-432-30-0.
^ Lenzenweger MF, Clarkin JF, Caligor E, Cain NM, Kernberg OF (2018). "Malignant Narcissism in Relation to Clinical Change in Borderline Personality Disorder: An Exploratory Study". Psychopathology. 51 (5): 318–325. doi:10.1159/000492228. PMID 30184541. S2CID 52160230.
^ Pincus AL, Roche MJ (2011). "Narcissistic Grandiosity and Narcissistic Vulnerability". In Campbell WK, Miller JD (eds.). The Handbook of Narcissism and Narcissistic Personality Disorder: Theoretical Approaches, Empirical Findings, and Treatments. John Wiley & Sons, Inc. pp. 31–40. doi:10.1002/9781118093108.ch4. ISBN 978-1-118-09310-8.
^ ^a ^b Miller JD, Lynam DR, Campbell WK (February 2016). "Measures of Narcissism and Their Relations to DSM-5 Pathological Traits: A Critical Reappraisal". Assessment. 23 (1): 3–9. doi:10.1177/1073191114522909. PMID 24550548. S2CID 24303584.
^ Miller JD, Lynam DR, Campbell WK (February 2016). "Rejoinder: A Construct Validity Approach to the Assessment of Narcissism". Assessment. 23 (1): 18–22. doi:10.1177/1073191115608943. PMID 26463683. S2CID 220416652.
^ Pincus AL, Ansell EB, Pimentel CA, Cain NM, Wright AG, Levy KN (September 2009). "Initial construction and validation of the Pathological Narcissism Inventory". Psychological Assessment. 21 (3). American Psychological Association: 365–379. doi:10.1037/a0016530. PMID 19719348.
^ Miller JD, Few LR, Wilson L, Gentile B, Widiger TA, Mackillop J, Keith Campbell W (September 2013). "The Five-Factor Narcissism Inventory (FFNI): a test of the convergent, discriminant, and incremental validity of FFNI scores in clinical and community samples". Psychological Assessment. 25 (3): 748–758. doi:10.1037/a0032536. PMID 23647044.
^ ^a ^b Kaufman SB, Weiss B, Miller JD, Campbell WK (February 2020). "Clinical Correlates of Vulnerable and Grandiose Narcissism: A Personality Perspective". Journal of Personality Disorders. 34 (1): 107–130. doi:10.1521/pedi_2018_32_384. PMID 30179576. S2CID 52154467.
^ Du TV, Miller JD, Lynam DR (August 2022). "The relation between narcissism and aggression: A meta-analysis". Journal of Personality. 90 (4): 574–594. doi:10.1111/jopy.12684. PMID 34689345. S2CID 239767063.
^ Auerbach JS (December 1984). "Validation of two scales for narcissistic personality disorder". Journal of Personality Assessment. 48 (6). Taylor & Francis: 649–653. doi:10.1207/s15327752jpa4806_13. PMID 6520692.
^ Foster JD, Campbell WK (October 2007). "Are there such things as 'Narcissists'? A taxometric analysis of the Narcissistic Personality Inventory". Personality and Individual Differences. 43 (6). Amsterdam, Netherlands: Elsevier. doi:10.1016/j.paid.2007.04.003.
^ Green A, MacLean R, Charles K (1 December 2020). "Recollections of parenting styles in the development of narcissism: The role of gender". Personality and Individual Differences. 167. Amsterdam, Netherlands: Elsevier: 110246. doi:10.1016/j.paid.2020.110246. ISSN 0191-8869. S2CID 224958195.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j Del Giudice M (2018), Del Giudice M (ed.), "Personality Disorders", Evolutionary Psychopathology, Oxford University Press, pp. 272–284, doi:10.1093/med-psych/9780190246846.003.0012, ISBN 978-0-19-024684-6
^ ^a ^b ^c Luo YL, Cai H (2018), Hermann AD, Brunell AB, Foster JD (eds.), "The Etiology of Narcissism: A Review of Behavioral Genetic Studies", Handbook of Trait Narcissism, Cham: Springer International Publishing, p. 150, doi:10.1007/978-3-319-92171-6_16, ISBN 978-3-319-92170-9, retrieved 8 June 2024
^ ^a ^b Torgersen S, Myers J, Reichborn-Kjennerud T, Røysamb E, Kubarych TS, Kendler KS (December 2012). "The heritability of Cluster B personality disorders assessed both by personal interview and questionnaire". Journal of Personality Disorders. 26 (6). Guilford Press: 848–866. doi:10.1521/pedi_2012_26_060. PMC 3606922. PMID 23281671.
^ Reichborn-Kjennerud T (1 March 2010). "The genetic epidemiology of personality disorders". Dialogues in Clinical Neuroscience. 12 (1). Taylor & Francis: 103–114. doi:10.31887/DCNS.2010.12.1/trkjennerud. PMC 3181941. PMID 20373672.
^ Gabbard GO (2014). Gabbard's treatments of psychiatric disorders (Fifth/DSM-5 ed.). Washington, D.C.: American Psychiatric Association. doi:10.1176/appi.books.9781585625048.gg72. ISBN 978-1-58562-442-3. OCLC 872383308.
^ Paris J (2014). "Modernity and narcissistic personality disorder". Personality Disorders: Theory, Research, and Treatment. 5 (2): 220–226. doi:10.1037/a0028580. ISSN 1949-2723.
^ ^a ^b ^c ^d ^e ^f ^g Torgersen S (2009). "The nature (and nurture) of personality disorders". Scandinavian Journal of Psychology. 50 (6): 624–632. doi:10.1111/j.1467-9450.2009.00788.x. ISSN 0036-5564. PMID 19930262.
^ Del Giudice M (2018), Del Giudice M (ed.), "Individual and Sex Differences", Evolutionary Psychopathology, Oxford University Press, pp. 68–94, doi:10.1093/med-psych/9780190246846.003.0003, ISBN 978-0-19-024684-6, retrieved 8 June 2024
^ ^a ^b Mitchell KJ (2018). Innate: how the wiring of our brains shapes who we are. Princeton: Princeton University Press. pp. 84–86, 54. ISBN 978-0-691-17388-7.
^ ^a ^b ^c Jauk E, Kanske P (2021). "Can neuroscience help to understand narcissism? A systematic review of an emerging field". Personality Neuroscience. 4: e3. doi:10.1017/pen.2021.1. ISSN 2513-9886. PMC 8170532. PMID 34124536.
^ Schulze L, Dziobek I, Vater A, Heekeren HR, Bajbouj M, Renneberg B, et al. (October 2013). "Gray matter abnormalities in patients with narcissistic personality disorder". Journal of Psychiatric Research. 47 (10). Elsevier: 1363–1369. doi:10.1016/j.jpsychires.2013.05.017. PMID 23777939.
^ Nenadic I, Güllmar D, Dietzek M, Langbein K, Steinke J, Gaser C (February 2015). "Brain structure in narcissistic personality disorder: a VBM and DTI pilot study". Psychiatry Research. 231 (2). Elsevier Ireland: 184–186. doi:10.1016/j.pscychresns.2014.11.001. PMID 25492857. S2CID 17073607.
^ Ronningstam E (19 January 2016). "Pathological Narcissism and Narcissistic Personality Disorder: Recent Research and Clinical Implications" (PDF). Current Behavioral Neuroscience Reports. 3 (1): 34–42. doi:10.1007/s40473-016-0060-y. S2CID 49575408. Archived (PDF) from the original on 17 August 2018.
^ "Narcissistic personality disorder – Diagnosis and treatment". mayoclinic.org. 18 November 2017. Retrieved 28 June 2018.
^ Kramer U, Berthoud L, Keller S, Caspar F (June 2014). "Motive-Oriented Psychotherapeutic Relationship Facing a Patient Presenting with Narcissistic Personality Disorder: A Case Study". Journal of Contemporary Psychotherapy. 44 (2): 71–82. doi:10.1007/s10879-013-9249-5. S2CID 9514109.
^ Soyer RB, Rovenpor JL, Kopelman RE, Mullins LS, Watson PJ (May 2001). "Further assessment of the construct validity of four measures of narcissism: replication and extension". The Journal of Psychology. 135 (3): 245–258. doi:10.1080/00223980109603695. PMID 11577967. S2CID 31486515.
^ Morf CC, Schürch E, Küfner A, Siegrist P, Vater A, Back M, Mestel R, Schröder-Abé M (June 2017). "Expanding the Nomological Net of the Pathological Narcissism Inventory: German Validation and Extension in a Clinical Inpatient Sample". Assessment. 24 (4): 419–443. doi:10.1177/1073191115627010. PMID 26874362. S2CID 13765609.
^ Egan V, Chan S, Shorter GW (September 2014). "The Dark Triad, happiness and subjective well-being" (PDF). Personality and Individual Differences. 67: 17–22. doi:10.1016/j.paid.2014.01.004. S2CID 17277308.
^ Soeteman DI, Verheul R, Busschbach JJ (June 2008). "The burden of disease in personality disorders: diagnosis-specific quality of life". Journal of Personality Disorders. 22 (3): 259–268. doi:10.1521/pedi.2008.22.3.259. PMID 18540798.
^ Ellison WD, Acuff MC, Kealy D, Joyce AS, Ogrodniczuk JS (August 2020). "Narcissism and Quality of Life: The Mediating Role of Relationship Patterns". The Journal of Nervous and Mental Disease. 208 (8): 613–618. doi:10.1097/NMD.0000000000001170. PMID 32229790. S2CID 213949270.
^ "Can Narcissists Change?". Psych Central. 17 December 2017.
^ Cailhol L, Pelletier É, Rochette L, Laporte L, David P, Villeneuve É, et al. (May 2017). "Prevalence, Mortality, and Health Care Use among Patients with Cluster B Personality Disorders Clinically Diagnosed in Quebec: A Provincial Cohort Study, 2001-2012". Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie. 62 (5): 336–342. doi:10.1177/0706743717700818. PMC 5459230. PMID 28403655.
^ Dhawan N, Kunik ME, Oldham J, Coverdale J (July–August 2010). "Prevalence and treatment of narcissistic personality disorder in the community: a systematic review". Comprehensive Psychiatry. 51 (4): 333–339. doi:10.1016/j.comppsych.2009.09.003. PMID 20579503.
^ Stinson FS, Dawson DA, Goldstein RB, Chou SP, Huang B, Smith SM, et al. (July 2008). "Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions". The Journal of Clinical Psychiatry. 69 (7): 1033–1045. doi:10.4088/jcp.v69n0701. PMC 2669224. PMID 18557663.
^ Grijalva E, Newman DA, Tay L, Donnellan MB, Harms PD, Robins RW, Yan T (March 2015). "Gender differences in narcissism: a meta-analytic review". Psychological Bulletin. 141 (2): 261–310. doi:10.1037/a0038231. PMID 25546498. Archived from the original on 17 February 2017.
^ Sederer LI (2009). "Chapter 4: Personality Disorders". Blueprints Psychiatry (Fifth ed.). Philadelphia, Pennsylvania: Wolters Kluwer/Lippincott Williams & Wilkins. p. 29. ISBN 978-0-7817-8253-1. Archived from the original on 11 January 2017 – via Google Books.
^ "Narcissus Greek mythology". britannica.com. Britanica. Retrieved 14 September 2021.
^ ^a ^b ^c Millon T, Grossman S, Millon C, Meagher S, Ramnath R (2004). Personality Disorders in Modern Life (PDF). Wiley. p. 343. ISBN 978-0-471-23734-1.
^ Zuern JD (1998), "Freud: On Narcissism", CriticaLink, University of Hawaii.
^ Waelder R (1925). "The psychoses: Their mechanisms and accessibility to influence". International Journal of Psycho-Analysis. 6: 259–281.
^ O'Donohue WT, Fowler KA, Lilienfeld SO (2007). Personality disorders : toward the DSM-V. Los Angeles: Sage Publications. p. 235. ISBN 978-1-4129-0422-3. OCLC 77716529.
^ Kohut H (1968). "The psychoanalytic treatment of narcissisticppersonality disorders. Outline of a systematic approach". The Psychoanalytic Study of the Child. 23. Taylor & Francis: 86–113. doi:10.1080/00797308.1968.11822951. PMID 5759031.
^ Bergmann MS (1987). Anatomy of Loving; Man's Quest to Know what Love I. Ballantine Books. ISBN 978-0-449-90553-1.
^ Freud S, Richards A, Strachey J (1990). Case Histories II. London, England: Penguin Books. p. 113. ISBN 978-0-14-013799-6. OCLC 490712192.
^ Freud, p. 203.
^ Akhtar S (2018) [2009]. Comprehensive Dictionary of Psychoanalysis. Abingdon, England: Routledge. p. 182. ISBN 978-1-85575-471-3.
^ Bergler E (1974). Halliday J, Fuller P (eds.). The Psychology of Gambling. London, England: International Universities Press. pp. 176, 182. ISBN 978-1-111-91633-6.
^ Lindner RM (May 1950). "The Psychodynamics of Gambling". The Annals of the American Academy of Political and Social Science. 269 (1): 93–107. doi:10.1177/000271625026900114. S2CID 144827078.
^ Fenichel O (2016). Psychoanalytic Theory of Neurosis. Abingdon, England: Taylor & Francis. p. 420. ISBN 978-1-138-14782-9. OCLC 960836519.
^ Fenichel O (1938). "The Drive to Amass Wealth" (PDF). The Psychoanalytic Quarterly. 7 (1): 69–95. doi:10.1080/21674086.1938.11925342. Archived from the original (PDF) on 2 November 2019. Retrieved 16 September 2021.
^ "StackPath". www.healthyplace.com. Retrieved 10 October 2019.[unreliable source?]
^ ^a ^b Malmquist CP (2006). Homicide: A Psychiatric Perspective. Washington, D.C.: American Psychiatric Association. pp. 181–82. ISBN 978-1-58562-204-7.
^ Vaknin S (2003) [1999]. Malignant Self Love: Narcissism Revisited. Narcissus. p. 191. ISBN 80-238-3384-7.
^ Hughes JM (2004). From obstacle to ally: the evolution of psychoanalytic practice. New York: Brunner-Routledge. p. 175. ISBN 978-1-58391-890-6. OCLC 57488252.
^ Hughes JM (2004). From obstacle to ally: the evolution of psychoanalytic practice. New York: Brunner-Routledge. p. 149. ISBN 978-1-58391-890-6. OCLC 57488252.
^ Wright AG, Stepp SD, Scott LN, Hallquist MN, Beeney JE, Lazarus SA, Pilkonis PA (October 2017). "The effect of pathological narcissism on interpersonal and affective processes in social interactions". Journal of Abnormal Psychology. 126 (7): 898–910. doi:10.1037/abn0000286. PMC 5679127. PMID 29106275. S2CID 46847228.
^ Siegel JP (September 2006). "Dyadic splitting in partner relational disorders". Journal of Family Psychology. 20 (3): 418–422. doi:10.1037/0893-3200.20.3.418. PMID 16937998.
^ Choi-Kain L (March 2020). "Commentary on the Special Issue: Narcissistic Personality Disorder: A Coming of Age". Journal of Personality Disorders. 34 (Suppl): 210–213. doi:10.1521/pedi.2020.34.supp.210. PMID 32186984. S2CID 214583509.
^ Wetzel E, Brown A, Hill PL, Chung JM, Robins RW, Roberts BW (December 2017). "The Narcissism Epidemic Is Dead; Long Live the Narcissism Epidemic" (PDF). Psychological Science. 28 (12): 1833–1847. doi:10.1177/0956797617724208. PMID 29065280. S2CID 10073811.
^ Zanor C. "A Fate That Narcissists Will Hate: Being Ignored". The New York Times. Retrieved 9 November 2010.
^ "DSM-5: Proposed Revisions: Personality and Personality Disorders". American Psychiatric Association. 13 February 2010. Archived from the original on 3 December 2010.
^ Holden C (March 2010). "Psychiatry. APA seeks to overhaul personality disorder diagnoses". Science. 327 (5971): 1314. doi:10.1126/science.327.5971.1314. PMID 20223959.
^ Shedler J, Beck A, Fonagy P, Gabbard GO, Gunderson J, Kernberg O, et al. (September 2010). "Personality disorders in DSM-5". The American Journal of Psychiatry. 167 (9): 1026–1028. doi:10.1176/appi.ajp.2010.10050746. PMID 20826853.
^ Karterud S, Øien M, Pedersen G (September 2011). "Validity aspects of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, narcissistic personality disorder construct". Comprehensive Psychiatry. 52 (5): 517–526. doi:10.1016/j.comppsych.2010.11.001. PMID 21193181.
^ Alarcón RD, Sarabia S (January 2012). "Debates on the narcissism conundrum: trait, domain, dimension, type, or disorder?". The Journal of Nervous and Mental Disease. 200 (1): 16–25. doi:10.1097/NMD.0b013e31823e6795. PMID 22210358. S2CID 24405066.
^ Aslinger EN, Manuck SB, Pilkonis PA, Simms LJ, Wright AG (July 2018). "Narcissist or narcissistic? Evaluation of the latent structure of narcissistic personality disorder". Journal of Abnormal Psychology. 127 (5): 496–502. doi:10.31234/osf.io/tv7r9. PMC 6051431. PMID 30010367.
^ Hesse M, Schliewe S, Thomsen RR (December 2005). "Rating of personality disorder features in popular movie characters". BMC Psychiatry. 5 (1): 45. doi:10.1186/1471-244X-5-45. PMC 1325244. PMID 16336663.
^ Mitchell G. "The Great Narcissist: A Study of Fitzgerald's Gatsby, by Giles Mitchell". fitzgerald.narod.ru. Retrieved 22 October 2017.

@@ Line 16: / Line 16: @@
 | onset = Early adulthood<ref name=DSM5/>
 | duration = Long term<ref name=DSM5/>
+| causes = A combination of genetic and environmental factors. Social theories of NPD are weak and causality is unclear.
-| causes = A combination of genetic and environmental factors, including trauma, neglect, and rejection in childhood.<ref>{{Citation |last1=Mitra |first1=Paroma |title=Narcissistic Personality Disorder |date=2023 |url=http://www.ncbi.nlm.nih.gov/books/NBK556001/ |work=StatPearls |access-date=2023-12-27 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=32310461 |last2=Fluyau |first2=Dimy}}</ref>
 | risks =
 | diagnosis = Based on symptoms
@@ Line 31: / Line 31: @@
 '''Narcissistic personality disorder''' ('''NPD''') is a [[personality disorder]] characterized by a life-long pattern of [[grandiosity|exaggerated feelings of self-importance]], an excessive need for [[admiration]], and a diminished ability to [[empathy|empathize]] with other people's feelings. Narcissistic personality disorder is one of the sub-types of the broader category known as [[personality disorder]]s.<ref name=Caligor_2015/><ref name=DSM5/> It is often comorbid with other mental disorders and associated with significant functional impairment and [[psychosocial]] disability.<ref name="Caligor_2015" />
-Personality disorders are a class of [[mental disorder]]s characterized by enduring and inflexible [[maladaptive]] patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by any culture. These patterns develop by early adulthood, and are associated with significant distress or impairment.<ref name="DSM-5-general personality disorder">{{Cite book|url=https://books.google.com/books?id=-JivBAAAQBAJ|title=Diagnostic and Statistical Manual of Mental Disorders|publisher=[[American Psychiatric Association]]|year=2013|isbn=978-0-89042-555-8|edition=Fifth|location=Arlington, Virginia|pages=646–49}}</ref><ref>{{cite journal | vauthors = Berrios GE | title = European views on personality disorders: a conceptual history | journal = Comprehensive Psychiatry | volume = 34 | issue = 1 | pages = 14–30 | year = 1993 | pmid = 8425387 | doi = 10.1016/0010-440X(93)90031-X | publisher = W.B. Saunders Ltd | authorlink = Germán Elías Berríos }}</ref><ref name="Millon1">{{cite book|title=Disorders of Personality: DSM-IV and Beyond| vauthors = Millon T, Davis RD |publisher=[[Wiley (publisher)|John Wiley & Sons, Inc.]]|year=1996|isbn=978-0-471-01186-6|location=New York City|page=226|author-link=Theodore Millon}}</ref> Criteria for diagnosing personality disorders are listed in the sixth chapter of the ''[[International Statistical Classification of Diseases and Related Health Problems|International Classification of Diseases]]'' (ICD) and in the [[American Psychiatric Association]]'s ''[[Diagnostic and Statistical Manual of Mental Disorders]]'' (DSM).
+Personality disorders are a class of [[mental disorder]]s characterized by enduring and inflexible [[maladaptive]] patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by any culture. These patterns develop by early adulthood, and are associated with significant distress or impairment.<ref name="DSM-5-general personality disorder">{{Cite book|url=https://books.google.com/books?id=-JivBAAAQBAJ|title=Diagnostic and Statistical Manual of Mental Disorders|publisher=[[American Psychiatric Association]]|year=2013|isbn=978-0-89042-555-8|edition=Fifth|location=Arlington, Virginia|pages=646–49}}</ref><ref>{{cite journal |vauthors=Berrios GE |year=1993 |title=European views on personality disorders: a conceptual history |journal=Comprehensive Psychiatry |publisher=W.B. Saunders Ltd |volume=34 |issue=1 |pages=14–30 |doi=10.1016/0010-440X(93)90031-X |pmid=8425387 |authorlink=}}</ref><ref name="Millon1">{{cite book|title=Disorders of Personality: DSM-IV and Beyond| vauthors = Millon T, Davis RD |publisher=[[Wiley (publisher)|John Wiley & Sons, Inc.]]|year=1996|isbn=978-0-471-01186-6|location=New York City|page=226|author-link=Theodore Millon}}</ref> Criteria for diagnosing personality disorders are listed in the sixth chapter of the ''[[International Statistical Classification of Diseases and Related Health Problems|International Classification of Diseases]]'' (ICD) and in the [[American Psychiatric Association]]'s ''[[Diagnostic and Statistical Manual of Mental Disorders]]'' (DSM).
 There is no standard treatment for NPD.<ref name="Mitra_2022">{{cite book | vauthors = Mitra P, Fluyau D | chapter = Narcissistic Personality Disorder |date=2022 | chapter-url = http://www.ncbi.nlm.nih.gov/books/NBK556001/ | title = StatPearls |location=Treasure Island, Florida|publisher=StatPearls Publishing |pmid=32310461 |access-date=2022-05-01 }}</ref><ref name="King_2020">{{Cite journal | vauthors = King RM, Grenyer BF, Gurtman CG, Younan R |date=March 1, 2020 |title=A clinician's quick guide to evidence-based approaches: Narcissistic personality disorder |journal=[[Clinical Psychologist]]|publisher=[[Australian Psychological Society]]|location=Melbourne, Australia|volume=24 |issue=1 |pages=91–95 |doi=10.1111/cp.12214 |hdl=10536/DRO/DU:30136767 |s2cid=216198008 |issn=1328-4207|hdl-access=free }}</ref> Its high comorbidity with other mental disorders influences treatment choice and outcomes.<ref name="Mitra_2022" /> [[Psychotherapy|Psychotherapeutic]] treatments generally fall into two categories: [[Psychoanalysis|psychoanalytic]]/[[Psychodynamic psychotherapy|psychodynamic]] and [[cognitive behavioral therapy]], with growing support for integration of both in therapy.<ref name="Yakeley_2018">{{Cite journal | vauthors = Yakeley J |date=July 5, 2018 |title=Current understanding of narcissism and narcissistic personality disorder |journal=BJPsych Advances |volume=24 |issue=5 |pages=305–315 |doi=10.1192/bja.2018.20 |s2cid=148566892 |issn=2056-4678|doi-access=free }}</ref><ref name=":Ronningstam_2016">{{cite journal | vauthors = Weinberg I, Ronningstam E | title = Dos and Don'ts in Treatments of Patients With Narcissistic Personality Disorder | journal = Journal of Personality Disorders | volume = 34 | issue = Suppl | pages = 122–142 | date = March 2020 | pmid = 32186986 | doi = 10.1521/pedi.2020.34.supp.122 | publisher = [[Guilford Press]] | s2cid = 214583609 }}</ref> However, there is an almost complete lack of studies determining the effectiveness of treatments.<ref name="King_2020" /> One's subjective experience of the mental disorder, as well as their agreement to and level of engagement with treatment, are highly dependent on their motivation to change.<ref>{{Cite book |url=https://www.jstor.org/stable/j.ctv2h43b0f |title=Personality Disorders and Pathology: Integrating Clinical Assessment and Practice in the DSM-5 and ICD-11 Era |date=2022 |publisher=American Psychological Association |jstor=j.ctv2h43b0f |isbn=978-1-4338-3576-6}}</ref>
 == Signs and symptoms ==
-Despite outward signs of grandiosity, many people with NPD struggle with symptoms of intense [[shame]], worthlessness, low [[self-compassion]], and [[Self-hatred|self-loathing]].<ref name="mayo1">{{cite web |date=18 November 2017 |title=Narcissistic personality disorder – Symptoms & causes |url=https://www.mayoclinic.org/diseases-conditions/narcissistic-personality-disorder/symptoms-causes/syc-20366662 |access-date=28 June 2018 |website=[[Mayo Clinic]] |publisher=Mayo Foundation for Medical Education and Research |location=Phoenix, Arizona}}</ref><ref name="Kramer_2018">{{cite journal | vauthors = Kramer U, Pascual-Leone A, Rohde KB, Sachse R | title = The role of shame and self-compassion in psychotherapy for narcissistic personality disorder: An exploratory study | journal = Clinical Psychology & Psychotherapy | volume = 25 | issue = 2 | pages = 272–282 | date = March 2018 | pmid = 29265698 | doi = 10.1002/cpp.2160 | url = https://serval.unil.ch/resource/serval:BIB_EFC9C7A83CF6.P001/REF.pdf }}</ref> Their view of themselves is extremely malleable and dependent on others' opinions of them. They also are hypersensitive to criticism and possess an intense need for admiration.<ref>{{cite journal | vauthors = Ronningstam E, Baskin-Sommers AR | title = Fear and decision-making in narcissistic personality disorder-a link between psychoanalysis and neuroscience | journal = Dialogues in Clinical Neuroscience | volume = 15 | issue = 2 | pages = 191–201 | date = June 2013 | doi = 10.31887/DCNS.2013.15.2/eronningstam | pmid = 24174893 | pmc = 3811090 }}</ref><ref>{{cite journal | vauthors = Krusemark EA, Lee C, Newman JP | title = Narcissism dimensions differentially moderate selective attention to evaluative stimuli in incarcerated offenders | journal = Personality Disorders | volume = 6 | issue = 1 | pages = 12–21 | date = January 2015 | doi = 10.1037/per0000087 | pmid = 25330183 | pmc = 4293238 }}</ref><ref>{{cite journal | vauthors = Vater A, Ritter K, Schröder-Abé M, Schütz A, Lammers CH, Bosson JK, Roepke S | title = When grandiosity and vulnerability collide: Implicit and explicit self-esteem in patients with narcissistic personality disorder | journal = Journal of Behavior Therapy and Experimental Psychiatry | volume = 44 | issue = 1 | pages = 37–47 | date = March 2013 | pmid = 22902785 | doi = 10.1016/j.jbtep.2012.07.001 }}</ref> People with NPD gain self-worth and meaning through this admiration.<ref>{{cite journal | vauthors = Yang PS, Huang TL | title = Pessimistic mood in decompensated narcissistic patient | journal = Chang Gung Medical Journal | volume = 27 | issue = 4 | pages = 318–321 | date = April 2004 | pmid = 15239200 }}</ref><ref>[https://guilfordjournals.com/doi/abs/10.1521/pedi.2020.34.supp.25 Perfectionism, Shame, and Aggression in Depressive Patients With Narcissistic Personality Disorder]. Jane Fjermestad-Noll, Elsa Ronningstam, Bo S. Bach, Bent Rosenbaum, and Erik Simonsen, Journal of Personality Disorders 2020 34:Supplement, 25-41</ref> Individuals with NPD are often motivated to achieve their goals, status, improvement, and [[Perfectionism (psychology)|perfectionism]], and to ignore relationships or avoid situations due to fears of incompetence, failure, worthlessness, inferiority, shame, humiliation, and losing control.<ref name="Kramer_2018" /><ref name="Mitra_2022" />
+Despite outward signs of grandiosity, many people with NPD struggle with symptoms of intense [[shame]], worthlessness, low [[self-compassion]], and [[Self-hatred|self-loathing]].<ref name="mayo1">{{cite web |date=18 November 2017 |title=Narcissistic personality disorder – Symptoms & causes |url=https://www.mayoclinic.org/diseases-conditions/narcissistic-personality-disorder/symptoms-causes/syc-20366662 |access-date=28 June 2018 |website=[[Mayo Clinic]] |publisher=Mayo Foundation for Medical Education and Research |location=Phoenix, Arizona}}</ref><ref name="Kramer_2018">{{cite journal | vauthors = Kramer U, Pascual-Leone A, Rohde KB, Sachse R | title = The role of shame and self-compassion in psychotherapy for narcissistic personality disorder: An exploratory study | journal = Clinical Psychology & Psychotherapy | volume = 25 | issue = 2 | pages = 272–282 | date = March 2018 | pmid = 29265698 | doi = 10.1002/cpp.2160 | url = https://serval.unil.ch/resource/serval:BIB_EFC9C7A83CF6.P001/REF.pdf }}</ref> Their view of themselves is extremely malleable and dependent on others' opinions of them. They are also hypersensitive to criticism and possess an intense need for admiration.<ref>{{cite journal | vauthors = Ronningstam E, Baskin-Sommers AR | title = Fear and decision-making in narcissistic personality disorder-a link between psychoanalysis and neuroscience | journal = Dialogues in Clinical Neuroscience | volume = 15 | issue = 2 | pages = 191–201 | date = June 2013 | doi = 10.31887/DCNS.2013.15.2/eronningstam | pmid = 24174893 | pmc = 3811090 }}</ref><ref>{{cite journal | vauthors = Krusemark EA, Lee C, Newman JP | title = Narcissism dimensions differentially moderate selective attention to evaluative stimuli in incarcerated offenders | journal = Personality Disorders | volume = 6 | issue = 1 | pages = 12–21 | date = January 2015 | doi = 10.1037/per0000087 | pmid = 25330183 | pmc = 4293238 }}</ref><ref>{{cite journal | vauthors = Vater A, Ritter K, Schröder-Abé M, Schütz A, Lammers CH, Bosson JK, Roepke S | title = When grandiosity and vulnerability collide: Implicit and explicit self-esteem in patients with narcissistic personality disorder | journal = Journal of Behavior Therapy and Experimental Psychiatry | volume = 44 | issue = 1 | pages = 37–47 | date = March 2013 | pmid = 22902785 | doi = 10.1016/j.jbtep.2012.07.001 }}</ref> People with NPD gain self-worth and meaning through this admiration.<ref>{{cite journal | vauthors = Yang PS, Huang TL | title = Pessimistic mood in decompensated narcissistic patient | journal = Chang Gung Medical Journal | volume = 27 | issue = 4 | pages = 318–321 | date = April 2004 | pmid = 15239200 }}</ref><ref>[https://guilfordjournals.com/doi/abs/10.1521/pedi.2020.34.supp.25 Perfectionism, Shame, and Aggression in Depressive Patients With Narcissistic Personality Disorder]. Jane Fjermestad-Noll, Elsa Ronningstam, Bo S. Bach, Bent Rosenbaum, and Erik Simonsen, Journal of Personality Disorders 2020 34:Supplement, 25-41</ref> Individuals with NPD are often motivated to achieve their goals, status, improvement, and [[Perfectionism (psychology)|perfectionism]], and to ignore relationships or avoid situations due to fears of incompetence, failure, worthlessness, inferiority, shame, humiliation, and losing control.<ref name="Kramer_2018" /><ref name="Mitra_2022" />
 People with NPD will try to gain social status and approval in an attempt to avoid and combat these feelings,<ref name="pmid24321228">{{cite journal | vauthors = Ritter K, Vater A, Rüsch N, Schröder-Abé M, Schütz A, Fydrich T, Lammers CH, Roepke S | display-authors = 6 | title = Shame in patients with narcissistic personality disorder | journal = Psychiatry Research | volume = 215 | issue = 2 | pages = 429–437 | date = February 2014 | pmid = 24321228 | doi = 10.1016/j.psychres.2013.11.019 | s2cid = 15919085 }}</ref> often by exaggerating their skills, accomplishments, and their degree of intimacy with people they consider high-status.<ref>{{cite journal | vauthors = Gabbard GO | title = Narcissism and suicide risk | journal = Annals of General Psychiatry | volume = 21 | issue = 1 | pages = 3 | date = January 2022 | doi = 10.1186/s12991-022-00380-8 | pmid = 35065658 | pmc = 8783517 | doi-access = free }}</ref><ref name="Narcissistic Personality Disorder a">{{cite journal | vauthors = Coleman D, Lawrence R, Parekh A, Galfalvy H, Blasco-Fontecilla H, Brent DA, Mann JJ, Baca-Garcia E, Oquendo MA | display-authors = 6 | title = Narcissistic Personality Disorder and suicidal behavior in mood disorders | journal = Journal of Psychiatric Research | volume = 85 | pages = 24–28 | date = February 2017 | doi = 10.1016/j.jpsychires.2016.10.020 | pmid = 27816770 | pmc = 5191918 }}</ref><ref>{{cite journal | vauthors = Ponzoni S, Beomonte Zobel S, Rogier G, Velotti P | title = Emotion dysregulation acts in the relationship between vulnerable narcissism and suicidal ideation | journal = Scandinavian Journal of Psychology | volume = 62 | issue = 4 | pages = 468–475 | date = August 2021 | doi = 10.1111/sjop.12730 | pmid = 33956346 | pmc = 8360132 }}</ref> Alongside this, they may have difficulty accepting help,<ref>{{cite journal | vauthors = Kacel EL, Ennis N, Pereira DB | title = Narcissistic Personality Disorder in Clinical Health Psychology Practice: Case Studies of Comorbid Psychological Distress and Life-Limiting Illness | journal = Behavioral Medicine | date = 2017 | volume = 43 | issue = 3 | pages = 156–164 | doi = 10.1080/08964289.2017.1301875 | pmid = 28767013 | pmc = 5819598 }}</ref> [[Revenge|vengeful fantasies]], a sense of entitlement,<ref name="Narcissistic Personality Disorder a"/><ref>{{cite journal | vauthors = Lowenstein J, Purvis C, Rose K | title = A systematic review on the relationship between antisocial, borderline and narcissistic personality disorder diagnostic traits and risk of violence to others in a clinical and forensic sample | journal = Borderline Personality Disorder and Emotion Dysregulation | date = 2016 | volume = 3 | pages = 14 | doi = 10.1186/s40479-016-0046-0 | pmid = 27777779 | pmc = 5062934 | doi-access = free }}</ref> and they may feign [[humility]]. They are more likely to try forms of [[plastic surgery]] due to a desire to gain attention and to be seen as beautiful.<ref name="DSM5" /><ref>{{cite journal | vauthors = Loron AM, Ghaffari A, Poursafargholi N | title = Personality Disorders among Individuals Seeking Cosmetic Botulinum Toxin Type A (BoNTA) Injection, a Cross-Sectional Study | journal = The Eurasian Journal of Medicine | volume = 50 | issue = 3 | pages = 164–167 | date = October 2018 | doi = 10.5152/eurasianjmed.2018.17373 | pmid = 30515036 | pmc = 6263231 }}</ref><ref name="ronningstam2016">{{cite journal |vauthors=Ronningstam E |year=2016 |title=New Insights into Narcissistic Personality Disorder |url=http://www.psychiatrictimes.com/special-reports/new-insights-narcissistic-personality-disorder |journal=[[Psychiatric Times]] |location=New York City |publisher=MJH Associates |volume=33 |issue=2 |page=11 |access-date=17 August 2018 |archive-date=17 August 2018 |archive-url=https://web.archive.org/web/20180817061541/http://www.psychiatrictimes.com/special-reports/new-insights-narcissistic-personality-disorder |url-status=dead }}</ref> A sense of personal superiority may lead them to monopolize conversations, look down on others or to become impatient and disdainful when other persons talk about themselves.<ref name="DSM5" /><ref name="mayo1" /> Drastic shifts in levels of self-esteem can result in a significantly decreased ability to [[Emotional dysregulation|regulate emotions]].<ref>{{cite journal | vauthors = Ronningstam E | title = Intersect between self-esteem and emotion regulation in narcissistic personality disorder - implications for alliance building and treatment | journal = Borderline Personality Disorder and Emotion Dysregulation | volume = 4 | issue = 1 | pages = 3 | date = 2017-02-07 | pmid = 28191317 | pmc = 5296946 | doi = 10.1186/s40479-017-0054-8 | doi-access = free }}</ref>
-Patients with NPD have an impaired ability to recognize facial expressions or mimic emotions, as well as a lower capacity for [[Empathy|emotional empathy]] and [[emotional intelligence]].<ref>{{cite journal | vauthors = Ronningstam E | title = Internal Processing in Patients With Pathological Narcissism or Narcissistic Personality Disorder: Implications for Alliance Building and Therapeutic Strategies | journal = Journal of Personality Disorders | volume = 34 | issue = Suppl | pages = 80–103 | date = March 2020 | doi = 10.1521/pedi.2020.34.supp.80 | pmid = 32186980 | s2cid = 213181317 }}</ref><ref name="pmid30210418">{{cite journal | vauthors = Zajenkowski M, Maciantowicz O, Szymaniak K, Urban P | title = Vulnerable and Grandiose Narcissism Are Differentially Associated With Ability and Trait Emotional Intelligence | journal = Frontiers in Psychology | volume = 9 | issue =  | pages = 1606 | date = 2018 | pmid = 30210418 | pmc = 6120976 | doi = 10.3389/fpsyg.2018.01606 | doi-access = free }}</ref> However they do not display a compromised capacity for cognitive empathy or an impaired [[theory of mind]], which are the abilities to understand others' feelings and attribute mental states to oneself or others respectively.<ref>{{Cite journal | vauthors = Eddy CM |date=2021-05-01 |title=Self-serving social strategies: A systematic review of social cognition in narcissism |journal=Current Psychology |volume=42 |issue=6 |pages=4362–4380 |language=en |doi=10.1007/s12144-021-01661-3 |s2cid=235587088 |issn=1936-4733|doi-access=free }}</ref> They may also have difficulty relating to other's experiences and being emotionally vulnerable.<ref name="pmid24512457">{{cite journal | vauthors = Baskin-Sommers A, Krusemark E, Ronningstam E | title = Empathy in narcissistic personality disorder: from clinical and empirical perspectives | journal = Personality Disorders | volume = 5 | issue = 3 | pages = 323–333 | date = July 2014 | pmid = 24512457 | pmc = 4415495 | doi = 10.1037/per0000061 }}</ref> People with NPD are less likely to engage in prosocial behavior.<ref name="pmid24512457"/> They can still act in selfless ways to improve other's image of them, advance their [[social status]], or if explicitly told to.<ref name="pmid34461435">{{cite journal | vauthors = Stolz DS, Vater A, Schott BH, Roepke S, Paulus FM, Krach S | title = Reduced frontal cortical tracking of conflict between self-beneficial versus prosocial motives in Narcissistic Personality Disorder | journal = NeuroImage. Clinical | volume = 32 | issue =  | pages = 102800 | date = 2021 | pmid = 34461435 | pmc = 8405953 | doi = 10.1016/j.nicl.2021.102800 }}</ref> Despite these characteristics, they are more likely to overestimate their capacity for empathy.<ref name="pmid21055831">{{cite journal | vauthors = Ritter K, Dziobek I, Preissler S, Rüter A, Vater A, Fydrich T, Lammers CH, Heekeren HR, Roepke S | display-authors = 6 | title = Lack of empathy in patients with narcissistic personality disorder | journal = Psychiatry Research | volume = 187 | issue = 1–2 | pages = 241–247 | date = May 2011 | pmid = 21055831 | doi = 10.1016/j.psychres.2010.09.013 | s2cid = 7718348 }}</ref>
+Patients with NPD have an impaired ability to recognize facial expressions or mimic emotions, as well as a lower capacity for [[Empathy|emotional empathy]] and [[emotional intelligence]].<ref>{{cite journal | vauthors = Ronningstam E | title = Internal Processing in Patients With Pathological Narcissism or Narcissistic Personality Disorder: Implications for Alliance Building and Therapeutic Strategies | journal = Journal of Personality Disorders | volume = 34 | issue = Suppl | pages = 80–103 | date = March 2020 | doi = 10.1521/pedi.2020.34.supp.80 | pmid = 32186980 | s2cid = 213181317 }}</ref><ref name="pmid30210418">{{cite journal | vauthors = Zajenkowski M, Maciantowicz O, Szymaniak K, Urban P | title = Vulnerable and Grandiose Narcissism Are Differentially Associated With Ability and Trait Emotional Intelligence | journal = Frontiers in Psychology | volume = 9 | issue =  | pages = 1606 | date = 2018 | pmid = 30210418 | pmc = 6120976 | doi = 10.3389/fpsyg.2018.01606 | doi-access = free }}</ref> However they do not display a compromised capacity for cognitive empathy or an impaired [[theory of mind]], which are the abilities to understand others' feelings and attribute mental states to oneself or others respectively.<ref>{{Cite journal | vauthors = Eddy CM |date=2021-05-01 |title=Self-serving social strategies: A systematic review of social cognition in narcissism |journal=Current Psychology |volume=42 |issue=6 |pages=4362–4380 |language=en |doi=10.1007/s12144-021-01661-3 |s2cid=235587088 |issn=1936-4733|doi-access=free }}</ref> They may also have difficulty relating to others’ experiences and being emotionally vulnerable.<ref name="pmid24512457">{{cite journal | vauthors = Baskin-Sommers A, Krusemark E, Ronningstam E | title = Empathy in narcissistic personality disorder: from clinical and empirical perspectives | journal = Personality Disorders | volume = 5 | issue = 3 | pages = 323–333 | date = July 2014 | pmid = 24512457 | pmc = 4415495 | doi = 10.1037/per0000061 }}</ref> People with NPD are less likely to engage in prosocial behavior.<ref name="pmid24512457"/> They can still act in selfless ways to improve others' perceptions of them, advance their [[social status]], or if explicitly told to.<ref name="pmid34461435">{{cite journal | vauthors = Stolz DS, Vater A, Schott BH, Roepke S, Paulus FM, Krach S | title = Reduced frontal cortical tracking of conflict between self-beneficial versus prosocial motives in Narcissistic Personality Disorder | journal = NeuroImage. Clinical | volume = 32 | issue =  | pages = 102800 | date = 2021 | pmid = 34461435 | pmc = 8405953 | doi = 10.1016/j.nicl.2021.102800 }}</ref> Despite these characteristics, they are more likely to overestimate their capacity for empathy.<ref name="pmid21055831">{{cite journal | vauthors = Ritter K, Dziobek I, Preissler S, Rüter A, Vater A, Fydrich T, Lammers CH, Heekeren HR, Roepke S | display-authors = 6 | title = Lack of empathy in patients with narcissistic personality disorder | journal = Psychiatry Research | volume = 187 | issue = 1–2 | pages = 241–247 | date = May 2011 | pmid = 21055831 | doi = 10.1016/j.psychres.2010.09.013 | s2cid = 7718348 }}</ref>
-It is common for people with NPD to have difficult relationships.<ref name = "Gewirtz-Meydan_2018">{{Cite journal | vauthors = Gewirtz-Meydan A, Finzi-Dottan R |date = April 2018 |title=Narcissism and Relationship Satisfaction from a Dyadic Perspective: The Mediating Role of Psychological Aggression |journal=Marriage & Family Review |language=en |volume=54 |issue=3 |pages=296–312 |doi=10.1080/01494929.2017.1359814 |issn=0149-4929 |s2cid=148631814}}</ref><ref>{{Cite journal | vauthors = Cramer P |date=October 2010 |title=Narcissism through the ages: What happens when narcissists grow older? |journal=Journal of Research in Personality |language=en |volume=45 |issue=5 |pages=479–92 |doi=10.1016/j.jrp.2011.06.003}}</ref><ref>{{Cite journal | vauthors = Mathieu C |date=October 2013 |title=Personality and job satisfaction: The role of narcissism |url=https://linkinghub.elsevier.com/retrieve/pii/S0191886913002298 |journal=Personality and Individual Differences |language=en |volume=55 |issue=6 |pages=650–54 |doi=10.1016/j.paid.2013.05.012}}</ref><ref>{{cite journal | vauthors = Ellison WD, Acuff MC, Kealy D, Joyce AS, Ogrodniczuk JS | title = Narcissism and Quality of Life: The Mediating Role of Relationship Patterns | journal = The Journal of Nervous and Mental Disease | volume = 208 | issue = 8 | pages = 613–618 | date = August 2020 | pmid = 32229790 | doi = 10.1097/NMD.0000000000001170 | publisher = [[Lippincott Williams & Wilkins]] | s2cid = 213949270 }}</ref> Narcissists may disrespect other's boundaries or [[Idealization and devaluation|idealize and devalue]] them. They commonly keep people emotionally distant, and [[Psychological projection|project]], deny,<ref>{{cite journal | vauthors = Di Pierro R, Costantini G, Benzi IM, Madeddu F, Preti E | title = Grandiose and entitled, but still fragile: A network analysis of pathological narcissistic traits. | journal = Personality and Individual Differences | date = April 2019 | volume = 140 | pages = 15–20 | doi = 10.1016/j.paid.2018.04.003 | s2cid = 149618835 }}</ref> or [[Splitting (psychology)|split]]. Narcissists respond with anger and hostility towards rejection,<ref>{{cite journal | vauthors = Ellison WD, Acuff MC, Kealy D, Joyce AS, Ogrodniczuk JS | title = Narcissism and Quality of Life: The Mediating Role of Relationship Patterns | journal = The Journal of Nervous and Mental Disease | volume = 208 | issue = 8 | pages = 613–618 | date = August 2020 | pmid = 32229790 | doi = 10.1097/nmd.0000000000001170 | publisher = [[Lippincott Williams & Wilkins]] | s2cid = 213949270 }}</ref><ref name = "Gewirtz-Meydan_2018" /><ref name="pmid24007215">{{cite journal | vauthors = Barry CT, Kauten RL | title = Nonpathological and pathological narcissism: which self-reported characteristics are most problematic in adolescents? | journal = Journal of Personality Assessment | volume = 96 | issue = 2 | pages = 212–9 | date = 2014 | pmid = 24007215 | doi = 10.1080/00223891.2013.830264 | s2cid = 23508050 }}</ref> and can degrade, insult, or blame others who disagree with them.<ref>{{Cite book | vauthors = Ronningstam E |url= https://www.worldcat.org/oclc/61329826 |title=Identifying and understanding the narcissistic personality |date=2005 |publisher=[[Oxford University Press]] |isbn=978-0-19-803396-7 |location=New York City |pages=22–27 |oclc=61329826}}</ref><ref>{{Cite web |title=Understanding Relational Dysfunction in Borderline, Narcissistic, and Antisocial Personality Disorders: Clinical Considerations, Presentation of Three Case Studies, and Implications for Therapeutic Intervention |url=http://www.davidpublisher.com/index.php/Home/Article/index?id=41668.html |access-date=2022-07-20 |website=www.davidpublisher.com}}</ref>
+It is common for people with NPD to have difficult relationships.<ref name = "Gewirtz-Meydan_2018">{{Cite journal | vauthors = Gewirtz-Meydan A, Finzi-Dottan R |date = April 2018 |title=Narcissism and Relationship Satisfaction from a Dyadic Perspective: The Mediating Role of Psychological Aggression |journal=Marriage & Family Review |language=en |volume=54 |issue=3 |pages=296–312 |doi=10.1080/01494929.2017.1359814 |issn=0149-4929 |s2cid=148631814}}</ref><ref>{{Cite journal | vauthors = Cramer P |date=October 2010 |title=Narcissism through the ages: What happens when narcissists grow older? |journal=Journal of Research in Personality |language=en |volume=45 |issue=5 |pages=479–92 |doi=10.1016/j.jrp.2011.06.003}}</ref><ref>{{Cite journal | vauthors = Mathieu C |date=October 2013 |title=Personality and job satisfaction: The role of narcissism |url=https://linkinghub.elsevier.com/retrieve/pii/S0191886913002298 |journal=Personality and Individual Differences |language=en |volume=55 |issue=6 |pages=650–54 |doi=10.1016/j.paid.2013.05.012}}</ref><ref>{{cite journal | vauthors = Ellison WD, Acuff MC, Kealy D, Joyce AS, Ogrodniczuk JS | title = Narcissism and Quality of Life: The Mediating Role of Relationship Patterns | journal = The Journal of Nervous and Mental Disease | volume = 208 | issue = 8 | pages = 613–618 | date = August 2020 | pmid = 32229790 | doi = 10.1097/NMD.0000000000001170 | publisher = [[Lippincott Williams & Wilkins]] | s2cid = 213949270 }}</ref> Narcissists may disrespect others' boundaries or [[Idealization and devaluation|idealize and devalue]] them. They commonly keep people emotionally distant, and [[Psychological projection|project]], deny,<ref>{{cite journal | vauthors = Di Pierro R, Costantini G, Benzi IM, Madeddu F, Preti E | title = Grandiose and entitled, but still fragile: A network analysis of pathological narcissistic traits. | journal = Personality and Individual Differences | date = April 2019 | volume = 140 | pages = 15–20 | doi = 10.1016/j.paid.2018.04.003 | s2cid = 149618835 }}</ref> or [[Splitting (psychology)|split]]. Narcissists respond with anger and hostility towards rejection,<ref>{{cite journal | vauthors = Ellison WD, Acuff MC, Kealy D, Joyce AS, Ogrodniczuk JS | title = Narcissism and Quality of Life: The Mediating Role of Relationship Patterns | journal = The Journal of Nervous and Mental Disease | volume = 208 | issue = 8 | pages = 613–618 | date = August 2020 | pmid = 32229790 | doi = 10.1097/nmd.0000000000001170 | publisher = [[Lippincott Williams & Wilkins]] | s2cid = 213949270 }}</ref><ref name = "Gewirtz-Meydan_2018" /><ref name="pmid24007215">{{cite journal | vauthors = Barry CT, Kauten RL | title = Nonpathological and pathological narcissism: which self-reported characteristics are most problematic in adolescents? | journal = Journal of Personality Assessment | volume = 96 | issue = 2 | pages = 212–9 | date = 2014 | pmid = 24007215 | doi = 10.1080/00223891.2013.830264 | s2cid = 23508050 }}</ref> and can degrade, insult, or blame others who disagree with them.<ref>{{Cite book | vauthors = Ronningstam E |url= https://www.worldcat.org/oclc/61329826 |title=Identifying and understanding the narcissistic personality |date=2005 |publisher=[[Oxford University Press]] |isbn=978-0-19-803396-7 |location=New York City |pages=22–27 |oclc=61329826}}</ref><ref>{{Cite web |title=Understanding Relational Dysfunction in Borderline, Narcissistic, and Antisocial Personality Disorders: Clinical Considerations, Presentation of Three Case Studies, and Implications for Therapeutic Intervention |url=http://www.davidpublisher.com/index.php/Home/Article/index?id=41668.html |access-date=2022-07-20 |website=www.davidpublisher.com}}</ref>
-They generally lack [[self-awareness]], and will have a difficult time understanding their own traits and narcissistic tendencies, either due to a belief that NPD characteristics do not apply to them, or due to a refusal to accept or endorse negative characteristics in an attempt to maintain a positive self image.<ref>{{cite journal | vauthors = Cooper LD, Balsis S, Oltmanns TF | title = Self- and informant-reported perspectives on symptoms of narcissistic personality disorder | journal = Personality Disorders | volume = 3 | issue = 2 | pages = 140–154 | date = April 2012 | doi = 10.1037/a0026576 | pmid = 22452774 | pmc = 3396740 }}</ref><ref>{{cite journal | vauthors = Kramer U, Pascual-Leone A, Rohde KB, Sachse R | title = The role of shame and self-compassion in psychotherapy for narcissistic personality disorder: An exploratory study | journal = Clinical Psychology & Psychotherapy | volume = 25 | issue = 2 | pages = 272–282 | date = March 2018 | doi = 10.1002/cpp.2160 | pmid = 29265698 | url = https://serval.unil.ch/resource/serval:BIB_EFC9C7A83CF6.P001/REF.pdf }}</ref> Narcissists can have difficulty seeing multiple perspectives on issues and [[Splitting (psychology)|black and white thinking]].<ref>Jauk E, Kanske P. {{cite journal | vauthors = Jauk E, Kanske P | title = Can neuroscience help to understand narcissism? A systematic review of an emerging field | journal = Personality Neuroscience | date = 2021 | volume = 4 | pages = e3 | doi = 10.1017/pen.2021.1 | pmid = 34124536 | pmc = 8170532 }}[</ref> Despite this, people with NPD will often feel as they are skilled at accurately assessing others' feelings.<ref>{{cite journal | vauthors = Bilotta E, Carcione A, Fera T, Moroni F, Nicolò G, Pedone R, Pellecchia G, Semerari A, Colle L | display-authors = 6 | title = Symptom severity and mindreading in narcissistic personality disorder | journal = PLOS ONE | volume = 13 | issue = 8 | pages = e0201216 | date = 2018-08-15 | pmid = 30110368 | pmc = 6093639 | doi = 10.1371/journal.pone.0201216 | bibcode = 2018PLoSO..1301216B | doi-access = free }}</ref>
+They generally lack [[self-awareness]], and will have a difficult time understanding their own traits and narcissistic tendencies, either due to a belief that NPD characteristics do not apply to them, or due to a refusal to accept or endorse negative characteristics in an attempt to maintain a positive self image.<ref>{{cite journal | vauthors = Cooper LD, Balsis S, Oltmanns TF | title = Self- and informant-reported perspectives on symptoms of narcissistic personality disorder | journal = Personality Disorders | volume = 3 | issue = 2 | pages = 140–154 | date = April 2012 | doi = 10.1037/a0026576 | pmid = 22452774 | pmc = 3396740 }}</ref><ref>{{cite journal | vauthors = Kramer U, Pascual-Leone A, Rohde KB, Sachse R | title = The role of shame and self-compassion in psychotherapy for narcissistic personality disorder: An exploratory study | journal = Clinical Psychology & Psychotherapy | volume = 25 | issue = 2 | pages = 272–282 | date = March 2018 | doi = 10.1002/cpp.2160 | pmid = 29265698 | url = https://serval.unil.ch/resource/serval:BIB_EFC9C7A83CF6.P001/REF.pdf }}</ref> Narcissists can have difficulty seeing multiple perspectives on issues and might engage in [[Splitting (psychology)|black and white thinking]].<ref>Jauk E, Kanske P. {{cite journal | vauthors = Jauk E, Kanske P | title = Can neuroscience help to understand narcissism? A systematic review of an emerging field | journal = Personality Neuroscience | date = 2021 | volume = 4 | pages = e3 | doi = 10.1017/pen.2021.1 | pmid = 34124536 | pmc = 8170532 }}[</ref> Despite this, people with NPD will often feel as they are skilled at accurately assessing others' feelings.<ref>{{cite journal | vauthors = Bilotta E, Carcione A, Fera T, Moroni F, Nicolò G, Pedone R, Pellecchia G, Semerari A, Colle L | display-authors = 6 | title = Symptom severity and mindreading in narcissistic personality disorder | journal = PLOS ONE | volume = 13 | issue = 8 | pages = e0201216 | date = 2018-08-15 | pmid = 30110368 | pmc = 6093639 | doi = 10.1371/journal.pone.0201216 | bibcode = 2018PLoSO..1301216B | doi-access = free }}</ref>
 === Problematic social media use ===
@@ Line 95: / Line 95: @@
 === Others ===
-'''[[Codependency|Oblivious]]/[[Grandiosity|Hypervigilant]]:'''  Glen Gabbard described two subtypes of NPD in 1989, later referred to as equivalent to, the grandiose and vulnerable subtypes.<ref>{{Cite journal | vauthors = Gabbard GO |date=1989 |title=Two subtypes of narcissistic personality disorder |journal=Bulletin of the Menninger Clinic |volume=53 |issue=6 |pages=527–532|pmid=2819295 }}</ref><ref>{{Cite journal | vauthors = Gabbard GO |date=March 2009 |title=Transference and Countertransference: Developments in the Treatment of Narcissistic Personality Disorder |journal=[[Psychiatric Annals]] |publisher=SLACK Incorporated|location=Thorofare, New Jersey|volume=39 |issue=3 |doi=10.3928/00485713-20090301-03 |issn=0048-5713}}</ref><ref name="Gabbard_2022">{{cite journal | vauthors = Gabbard GO | title = Narcissism and suicide risk | journal = Annals of General Psychiatry | volume = 21 | issue = 1 | pages = 3 | date = January 2022 | pmid = 35065658 | doi = 10.1186/s12991-022-00380-8 | publisher = BioMed Central Ltd. | pmc = 8783517 | s2cid = 246083162 | doi-access = free }}</ref> The first was the "oblivious" subtype of narcissist, equivalent to the grandiose subtype. It was described as being grandiose, arrogant and thick-skinned, while also exhibiting personality traits of helplessness and emotional emptiness, low self-esteem and shame. These were observed in people with NPD to be expressed as socially avoidant behavior in situations where self-presentation is difficult or impossible, leading to withdrawal from situations where social approval is not given.
+'''[[Codependency|Oblivious]]/[[Grandiosity|Hypervigilant]]:'''  Glen Gabbard described two subtypes of NPD in 1989, later referred to as equivalent to, the grandiose and vulnerable subtypes.<ref>{{Cite journal | vauthors = Gabbard GO |date=1989 |title=Two subtypes of narcissistic personality disorder |journal=Bulletin of the Menninger Clinic |volume=53 |issue=6 |pages=527–532|pmid=2819295 }}</ref><ref>{{Cite journal | vauthors = Gabbard GO |date=March 2009 |title=Transference and Countertransference: Developments in the Treatment of Narcissistic Personality Disorder |journal=[[Psychiatric Annals]] |publisher=SLACK Incorporated|location=Thorofare, New Jersey|volume=39 |issue=3 |pages=129–136 |doi=10.3928/00485713-20090301-03 |issn=0048-5713}}</ref><ref name="Gabbard_2022">{{cite journal | vauthors = Gabbard GO | title = Narcissism and suicide risk | journal = Annals of General Psychiatry | volume = 21 | issue = 1 | pages = 3 | date = January 2022 | pmid = 35065658 | doi = 10.1186/s12991-022-00380-8 | publisher = BioMed Central Ltd. | pmc = 8783517 | s2cid = 246083162 | doi-access = free }}</ref> The first was the "oblivious" subtype of narcissist, equivalent to the grandiose subtype. It was described as being grandiose, arrogant and thick-skinned, while also exhibiting personality traits of helplessness and emotional emptiness, low self-esteem and shame. These were observed in people with NPD to be expressed as socially avoidant behavior in situations where self-presentation is difficult or impossible, leading to withdrawal from situations where social approval is not given.
 The second subtype Gabbard described was termed "hypervigilant", equivalent to the vulnerable subtype. People with this subtype of NPD were described as having easily hurt feelings, an oversensitive [[temperament]], and persistent feelings of shame.
-'''Communal narcissism:''' A fourth type is the communal narcissist. Communal narcissism is a form of narcissism that occurs in group settings. It is characterized by an inflated sense of importance and a need for admiration from others. In relation to the grandiose narcissist, a communal narcissist is arrogant and self-motivating, and shares the sense of entitlement and grandiosity. However, the communal narcissist seeks power and admiration in the communal realm. They see themselves as altruistic, saintly, caring, helpful, and warm.<ref name="pmid22889074">{{cite journal | vauthors = Gebauer JE, Sedikides C, Verplanken B, Maio GR | title = Communal narcissism | journal = Journal of Personality and Social Psychology | volume = 103 | issue = 5 | pages = 854–878 | date = November 2012 | pmid = 22889074 | doi = 10.1037/a0029629 }}</ref><ref>{{cite web |date=6 March 2021 |title=Know the Kind of Narcissist You're Dealing With and Symptoms |url=https://www.psychologytoday.com/us/blog/toxic-relationships/202103/know-the-kind-narcissist-youre-dealing-and-symptoms |publisher=PsychologyToday.com |vauthors=Lancer D}}</ref> Individuals who display communal narcissism often seek out positions of power and influence within their groups.
+'''[[#Communal_narcissism|Communal narcissism]]:''' A fourth type is the communal narcissist. Communal narcissism is a form of narcissism that occurs in group settings. It is characterized by an inflated sense of importance and a need for admiration from others. In relation to the grandiose narcissist, a communal narcissist is arrogant and self-motivating, and shares the sense of entitlement and grandiosity. However, the communal narcissist seeks power and admiration in the communal realm. They see themselves as altruistic, saintly, caring, helpful, and warm.<ref name="pmid22889074">{{cite journal | vauthors = Gebauer JE, Sedikides C, Verplanken B, Maio GR | title = Communal narcissism | journal = Journal of Personality and Social Psychology | volume = 103 | issue = 5 | pages = 854–878 | date = November 2012 | pmid = 22889074 | doi = 10.1037/a0029629 }}</ref><ref>{{cite web |date=6 March 2021 |title=Know the Kind of Narcissist You're Dealing With and Symptoms |url=https://www.psychologytoday.com/us/blog/toxic-relationships/202103/know-the-kind-narcissist-youre-dealing-and-symptoms |publisher=PsychologyToday.com |vauthors=Lancer D}}</ref> Individuals who display communal narcissism often seek out positions of power and influence within their groups.
 ==== Millon's subtypes ====
@@ Line 181: / Line 181: @@
 === Narcissistic Personality Inventory ===
 {{Main|Narcissistic Personality Inventory}}
-Risk factors for NPD and grandiose/overt and vulnerable/covert subtypes are measured using the [[Narcissistic Personality Inventory|narcissistic personality inventory]], an assessment tool originally developed in 1979, has undergone multiple iterations with new versions in 1984, 2006 and 2014. It captures principally grandiose narcissism, but also seems to capture elements of vulnerability. A popular three-factor model has it that grandiose narcissism is assessed via the Leadership/Authority and Grandiose/Exhibitionism facets, while a combination of grandiose and vulnerable traits are indexed by the Entitlement/Exploitativeness facet.<ref name="Miller_20162">{{cite journal | vauthors = Miller JD, Lynam DR, Campbell WK | title = Measures of Narcissism and Their Relations to DSM-5 Pathological Traits: A Critical Reappraisal | journal = Assessment | volume = 23 | issue = 1 | pages = 3–9 | date = February 2016 | pmid = 24550548 | doi = 10.1177/1073191114522909 | s2cid = 24303584 }}</ref>
+Risk factors for NPD and grandiose/overt and vulnerable/covert subtypes are measured using the [[Narcissistic Personality Inventory|narcissistic personality inventory]], an assessment tool originally developed in 1979, which has undergone multiple iterations with new versions in 1984, 2006 and 2014. It captures principally grandiose narcissism, but also seems to capture elements of vulnerability. A popular three-factor model has it that grandiose narcissism is assessed via the Leadership/Authority and Grandiose/Exhibitionism facets, while a combination of grandiose and vulnerable traits are indexed by the Entitlement/Exploitativeness facet.<ref name="Miller_20162">{{cite journal | vauthors = Miller JD, Lynam DR, Campbell WK | title = Measures of Narcissism and Their Relations to DSM-5 Pathological Traits: A Critical Reappraisal | journal = Assessment | volume = 23 | issue = 1 | pages = 3–9 | date = February 2016 | pmid = 24550548 | doi = 10.1177/1073191114522909 | s2cid = 24303584 }}</ref>
 === Pathological Narcissism Inventory ===
@@ Line 204: / Line 204: @@
 ==  Causes ==
+The cause of narcissistic personality disorder (NPD) is unclear, although there is evidence for a strong biological or genetic underpinning.<ref name=":0">{{Citation |last=Del Giudice |first=Marco |title=Personality Disorders |date=2018 |work=Evolutionary Psychopathology |pages=272–284 |editor-last=Del Giudice |editor-first=Marco |url=https://academic.oup.com/book/1052/chapter/138276725 |access-date= |publisher=Oxford University Press |language=en |doi=10.1093/med-psych/9780190246846.003.0012 |isbn=978-0-19-024684-6 |url-access=subscription}}</ref> Research has found NPD has a strong [[heritability|heritable]] component.<ref name=":0" /><ref name=":2" /><ref name="Paris_2012">{{cite journal |vauthors=Torgersen S, Myers J, Reichborn-Kjennerud T, Røysamb E, Kubarych TS, Kendler KS |date=December 2012 |title=The heritability of Cluster B personality disorders assessed both by personal interview and questionnaire |journal=Journal of Personality Disorders |publisher=[[Guilford Press]] |volume=26 |issue=6 |pages=848–866 |doi=10.1521/pedi_2012_26_060 |pmc=3606922 |pmid=23281671}}</ref><ref>{{cite journal |vauthors=Reichborn-Kjennerud T |date=1 March 2010 |title=The genetic epidemiology of personality disorders |journal=Dialogues in Clinical Neuroscience |publisher=[[Taylor & Francis]] |volume=12 |issue=1 |pages=103–114 |doi=10.31887/DCNS.2010.12.1/trkjennerud |pmc=3181941 |pmid=20373672}}</ref> It is unclear if or how much a person's upbringing contributes to the development of NPD, although many speculative theories have been proposed.<ref name=":0" /><ref name=":1">{{Cite book |url= |title=Gabbard's treatments of psychiatric disorders |vauthors=Gabbard GO |date=2014 |publisher=[[American Psychiatric Association]] |isbn=978-1-58562-442-3 |edition=Fifth/DSM-5 |location=Washington, D.C. |doi=10.1176/appi.books.9781585625048.gg72 |oclc=872383308 |authorlink=}}</ref><ref>{{Cite journal |last=Paris |first=Joel |date=2014 |title=Modernity and narcissistic personality disorder. |url=https://doi.apa.org/doi/10.1037/a0028580 |journal=Personality Disorders: Theory, Research, and Treatment |language=en |volume=5 |issue=2 |pages=220–226 |doi=10.1037/a0028580 |issn=1949-2723 |url-access=subscription}}</ref><ref name=":4">{{Cite journal |last=Torgersen |first=Svenn |date=2009 |title=The nature (and nurture) of personality disorders |journal=Scandinavian Journal of Psychology |language=en |volume=50 |issue=6 |pages=624–632 |doi=10.1111/j.1467-9450.2009.00788.x |issn=0036-5564 |doi-access=free|pmid=19930262 }}</ref>
+Evidence to support social factors in the development of NPD is limited.<ref name=":0" /><ref name=":4" /> Some studies have found NPD correlates with permissive and overindulgent parenting in childhood, while others have found correlations with harsh discipline, neglect or abuse.<ref name=":0" /> Findings have been inconsistent, and scientists do not know if these correlations are [[Causality|causal]], as these studies do not control for genetic [[confounding]].<ref name=":0" /><ref name=":4" />
-Although there are no specific causes for NPD, it is described using the [[biopsychosocial model]] which describes a combination of [[risk factor]]s from biological, psychological and socio-environmental factors.<ref name="Mitra_2022" /><ref name="Luo_2018">{{cite book | vauthors = Luo YL, Cai H |chapter=The Etiology of Narcissism: A Review of Behavioral Genetic Studies |date=2018 |title=Handbook of Trait Narcissism |pages=149–156 |publisher=[[Springer International Publishing]] |location=New York City|isbn=978-3-319-92170-9 |doi=10.1007/978-3-319-92171-6_16 }}</ref> This includes but is not limited to genetics, [[neurobiology]], trauma, abuse and parenting. Recent evidence drawn from the longitudinal study of personality disorders suggests that narcissistic personality disorder represents the emergent product of both underlying temperament systems (notably anger), which are genetically influenced and expressed in neurobehavioral systems, as well as environmental inputs; both domains are important to [[pathogenesis]].<ref>{{cite journal |last1=Lenzenweger |first1=Mark |title=Proximal Processes, Temperament, and Pathological Narcissism: An Empirical Exploration from the Longitudinal Study of Personality Disorders |journal=Psychopathology |date=2023 |volume=56 |issue=1–2 |pages=41–51 |doi=10.1159/000524796 |pmid=35609557 |s2cid=249043760 |url=https://karger.com/psp/article-pdf/56/1-2/41/3961347/000524796.pdf}}</ref>
+This problem of genetic confounding is explained by psychologist [[Svenn Torgersen]] in a 2009 review:<ref name=":4" />
-=== Genetic ===
-Evidence suggests there is a high [[heritability]] of NPD, with a number of genetic influences indicating varying rates of heritability based on subtype.<ref name="Luo_2018" /><ref name="Paris_2012">{{cite journal | vauthors = Torgersen S, Myers J, Reichborn-Kjennerud T, Røysamb E, Kubarych TS, Kendler KS | title = The heritability of Cluster B personality disorders assessed both by personal interview and questionnaire | journal = Journal of Personality Disorders | volume = 26 | issue = 6 | pages = 848–866 | date = December 2012 | pmc = 3606922 | doi = 10.1521/pedi_2012_26_060 | publisher = [[Guilford Press]] | pmid = 23281671 }}</ref><ref>{{cite journal | vauthors = Reichborn-Kjennerud T | title = The genetic epidemiology of personality disorders | journal = Dialogues in Clinical Neuroscience | volume = 12 | issue = 1 | pages = 103–114 | date = 1 March 2010 | pmid = 20373672 | pmc = 3181941 | doi = 10.31887/DCNS.2010.12.1/trkjennerud | publisher = [[Taylor & Francis]] }}</ref> A number of twin studies historically suggested for the heritability of NPD, including personality disorders in general.<ref>{{cite journal | vauthors = Livesley WJ, Jang KL, Jackson DN, Vernon PA | title = Genetic and environmental contributions to dimensions of personality disorder | journal = The American Journal of Psychiatry | volume = 150 | issue = 12 | pages = 1826–1831 | date = December 1993 | pmid = 8238637 | doi = 10.1176/ajp.150.12.1826 }}</ref><ref name="Torgersen">{{cite journal | vauthors = Torgersen S, Lygren S, Oien PA, Skre I, Onstad S, Edvardsen J, Tambs K, Kringlen E | display-authors = 6 | title = A twin study of personality disorders | journal = Comprehensive Psychiatry | volume = 41 | issue = 6 | pages = 416–425 | date = November 2000 | pmid = 11086146 | doi = 10.1053/comp.2000.16560 }}</ref>
+{{Quote|text=If parents treat their children badly, and the children develop personality disorders, it does not necessarily mean that the treatment of the children is the cause of the development. An alternative explanation may be that the parents themselves have some personality disorder traits, partly due to genes. These genetically influenced traits correlate with poor parenting, explaining the genetic influence on parenting. The children inherit the genes and subsequently develop personality disorders. The personality disorders might thus have developed in any case, independent of the childhood conditions.<ref name=":4" />}}
-=== Environment ===
-Environmental and social influences on the development of NPD have been proposed.<ref name="Paris_2012" /> One theory suggests that pathological narcissism may develop from an impaired [[Attachment theory|emotional attachment]] to primary caregivers.<ref name="Magid">{{cite book| vauthors = Magid K |title=High Risk Children without a Conscience|url=https://books.google.com/books?id=88C74pQcIm4C|access-date=17 November 2012|year=1987|publisher=[[Bantam Books]]|location=New York City|isbn=978-0-553-05290-9|page=67}}</ref> That lack of psychological and emotional attachment to a parental figure can result in the child's perception of themselves as unimportant and unconnected to other people, usually, family, community and society. Typically, the child comes to believe that they have a personality defect that makes them unvalued and unwanted;<ref name="Johns">{{cite book| vauthors = Johnson SM |title=Humanizing the Narcissistic Style|url=https://books.google.com/books?id=WxV2QgAACAAJ|access-date=29 October 2013|year=1987|publisher=[[W.W. Norton]]|location=New York City|isbn=978-0-393-70037-4|page=39|url-status=live|archive-url=https://web.archive.org/web/20140704131400/http://books.google.com/books?id=WxV2QgAACAAJ|archive-date=4 July 2014|df=dmy-all}}</ref> overindulgent, permissive parenting or insensitive and over-controlling parenting are risk factors towards the development of NPD in a child.<ref name="mayo1" /><ref name="medline" />
+Twin studies allow scientists to assess the influence of genes and environment, in particular, how much of the variation in a trait is attributed to the "shared environment" (influences shared by twins, such as parents and upbringing) or the "unshared environment" (measurement error, noise, differing illnesses between twins, randomness in brain growth, and social or non-social experiences that only one twin experienced).<ref>{{Citation |last=Del Giudice |first=Marco |title=Individual and Sex Differences |date=2018 |work=Evolutionary Psychopathology |pages=68–94 |editor-last=Del Giudice |editor-first=Marco |url=https://academic.oup.com/book/1052/chapter/138261824 |access-date=2024-06-08 |publisher=Oxford University Press |language=en |doi=10.1093/med-psych/9780190246846.003.0003 |isbn=978-0-19-024684-6 |url-access=subscription}}</ref><ref name=":3">{{Cite book |last=Mitchell |first=Kevin J. |title=Innate: how the wiring of our brains shapes who we are |date=2018 |publisher=Princeton University Press |isbn=978-0-691-17388-7 |location=Princeton |pages=84–86, 54}}</ref><ref name=":4" /> According to a 2018 review, twin studies of NPD have found little or no influence from the shared environment, and a major contribution of genes and the non-shared environment:<ref name=":2">{{Citation |last1=Luo |first1=Yu L. L. |title=The Etiology of Narcissism: A Review of Behavioral Genetic Studies |date=2018 |work=Handbook of Trait Narcissism |page=150 |editor-last=Hermann |editor-first=Anthony D. |url=https://rdcu.be/dKfyO |access-date=2024-06-08 |place=Cham |publisher=Springer International Publishing |language=en |doi=10.1007/978-3-319-92171-6_16 |isbn=978-3-319-92170-9 |last2=Cai |first2=Huajian |editor2-last=Brunell |editor2-first=Amy B. |editor3-last=Foster |editor3-first=Joshua D. |url-access=limited}}</ref>
-In ''Gabbard's Treatments of Psychiatric Disorders'' (2014), the following factors are proposed as promoting the development of narcissistic personality disorder:<ref>{{Cite book|url=|title=Gabbard's treatments of psychiatric disorders|date=2014| vauthors = Gabbard GO |authorlink=Glen. O. Gabbard|publisher=[[American Psychiatric Association]]|location=Washington, D.C.|isbn=978-1-58562-442-3|edition=Fifth/DSM-5|doi=10.1176/appi.books.9781585625048.gg72|oclc=872383308}}</ref>
+{{Quote|text=Taken together, these studies have consistently demonstrated that genetic influence constitutes a major source of NPD. Non-shared environments also exert substantial influence on NPD. Notably, shared environments had no significant influence on NPD in any of these studies. |author=Lu & Cai, 2018<ref name=":2" />}}
-* An oversensitive temperament (individual differences of behavior) at birth
-* Excessive admiration that is never balanced with realistic criticism
-* Excessive praise for good behaviors, or excessive criticism for bad behaviors in childhood
-* Overindulgence and overvaluation by family or peers
-* Being praised by adults for perceived exceptional physical appearance or abilities
-* Trauma caused by [[psychological abuse]], [[physical abuse]] or [[sexual abuse]] in childhood
-* Unpredictable or unreliable parental caregiving
+According to neurogeneticist Kevin Mitchell, a lack of influence from the shared environment indicates that the non-shared environmental influence may be largely non-social, perhaps reflecting innate processes such as randomness in brain growth.<ref name=":3" />
-Moreover, the research reported in "Modernity and Narcissistic Personality Disorders" (2014) indicates that cultural elements also influence the prevalence of NPD, because narcissistic personality traits more commonly occur in [[Modernity|modern]] societies than in [[Traditionalist conservatism|traditionalist conservative]] societies.<ref name="Paris_2014" />
+Neuroscientists have also studied the brains of people with NPD using structural imaging technology.<ref name=":5">{{Cite journal |last1=Jauk |first1=Emanuel |last2=Kanske |first2=Philipp |date=2021 |title=Can neuroscience help to understand narcissism? A systematic review of an emerging field |journal=Personality Neuroscience |volume=4 |pages=e3 |doi=10.1017/pen.2021.1 |issn=2513-9886 |pmc=8170532 |pmid=34124536}}</ref> A 2021 review concluded the most consistent finding among NPD patients is lowered gray matter volume in the medial prefrontal cortex.<ref name=":5" /> Studies of the occurrence of narcissistic personality disorder identified structural abnormalities in the brains of people with NPD, specifically, a lesser volume of [[gray matter]] in the left, anterior [[insular cortex]].<ref name="Schulze">{{cite journal |display-authors=6 |vauthors=Schulze L, Dziobek I, Vater A, Heekeren HR, Bajbouj M, Renneberg B, Heuser I, Roepke S |date=October 2013 |title=Gray matter abnormalities in patients with narcissistic personality disorder |journal=Journal of Psychiatric Research |publisher=[[Elsevier]] |volume=47 |issue=10 |pages=1363–1369 |doi=10.1016/j.jpsychires.2013.05.017 |pmid=23777939}}</ref> The results of a 2015 study associated the condition of NPD with a reduced volume of gray matter in the [[prefrontal cortex]].<ref>{{cite journal |vauthors=Nenadic I, Güllmar D, Dietzek M, Langbein K, Steinke J, Gaser C |date=February 2015 |title=Brain structure in narcissistic personality disorder: a VBM and DTI pilot study |journal=Psychiatry Research |publisher=Elsevier Ireland |volume=231 |issue=2 |pages=184–186 |doi=10.1016/j.pscychresns.2014.11.001 |pmid=25492857 |s2cid=17073607}}</ref>  The regions of the brain identified and studied – the insular cortex and the prefrontal cortex – are associated with the human emotions of [[empathy]] and [[compassion]], and with the mental functions of [[cognition]] and [[emotional regulation]]. The neurological findings of the studies suggest that NPD may be related to a compromised capacity for emotional empathy and emotional regulation.<ref>{{cite journal |vauthors=Ronningstam E |date=19 January 2016 |title=Pathological Narcissism and Narcissistic Personality Disorder: Recent Research and Clinical Implications |url=http://bostonneuropsa.net/wp-content/uploads/2016/03/CBNsR-NPD-ER-in-Print-01-20-2016-2-1.pdf |url-status=live |journal=Current Behavioral Neuroscience Reports |volume=3 |issue=1 |pages=34–42 |doi=10.1007/s40473-016-0060-y |s2cid=49575408 |archive-url=https://web.archive.org/web/20180817021647/http://bostonneuropsa.net/wp-content/uploads/2016/03/CBNsR-NPD-ER-in-Print-01-20-2016-2-1.pdf |archive-date=17 August 2018}}</ref>
-=== Pathophysiology ===
-Studies of the occurrence of narcissistic personality disorder identified structural abnormalities in the brains of people with NPD, specifically, a lesser volume of [[gray matter]] in the left, anterior [[insular cortex]].<ref name="Schulze">{{cite journal | vauthors = Schulze L, Dziobek I, Vater A, Heekeren HR, Bajbouj M, Renneberg B, Heuser I, Roepke S | display-authors = 6 | title = Gray matter abnormalities in patients with narcissistic personality disorder | journal = Journal of Psychiatric Research | volume = 47 | issue = 10 | pages = 1363–1369 | date = October 2013 | pmid = 23777939 | doi = 10.1016/j.jpsychires.2013.05.017 | publisher = [[Elsevier]] }}</ref><ref name="PsychCentral">{{cite web|url=https://psychcentral.com/news/2013/07/06/narcissists-lack-of-empathy-tied-to-less-gray-matter/56907.html|title=Narcissists' Lack of Empathy Tied to Less Gray Matter| vauthors = Pedersen T |date=6 October 2015|publisher=[[PsychCentral]]|archive-url=https://web.archive.org/web/20140424210941/http://psychcentral.com/news/2013/07/06/narcissists-lack-of-empathy-tied-to-less-gray-matter/56907.html|archive-date=24 April 2014|url-status=live|access-date=2014-04-24|df=dmy-all}}</ref> The results of a 2015 study associated the condition of NPD with a reduced volume of gray matter in the [[prefrontal cortex]].<ref>{{cite journal | vauthors = Nenadic I, Güllmar D, Dietzek M, Langbein K, Steinke J, Gaser C | title = Brain structure in narcissistic personality disorder: a VBM and DTI pilot study | journal = Psychiatry Research | volume = 231 | issue = 2 | pages = 184–186 | date = February 2015 | pmid = 25492857 | doi = 10.1016/j.pscychresns.2014.11.001 | publisher = Elsevier Ireland | s2cid = 17073607 }}</ref> The regions of the brain identified and studied – the insular cortex and the prefrontal cortex – are associated with the human emotions of [[empathy]] and [[compassion]], and with the mental functions of [[cognition]] and [[emotional regulation]]. The neurologic findings of the studies suggest that NPD may be related to a compromised (damaged) capacity for emotional empathy and emotional regulation.<ref>{{cite journal| vauthors = Ronningstam E |date=19 January 2016|title=Pathological Narcissism and Narcissistic Personality Disorder: Recent Research and Clinical Implications|url=http://bostonneuropsa.net/wp-content/uploads/2016/03/CBNsR-NPD-ER-in-Print-01-20-2016-2-1.pdf|url-status=live|journal=Current Behavioral Neuroscience Reports|volume=3|issue=1|pages=34–42|doi=10.1007/s40473-016-0060-y|s2cid=49575408|archive-url=https://web.archive.org/web/20180817021647/http://bostonneuropsa.net/wp-content/uploads/2016/03/CBNsR-NPD-ER-in-Print-01-20-2016-2-1.pdf|archive-date=17 August 2018}}</ref>
+Evolutionary models of NPD have also been proposed.<ref name=":0" /> According to psychologist Marco Del Giudice, [[cluster B]] traits including NPD, predict increased mating success and fertility. NPD could potentially be an adaptive evolutionary phenomena, though a risky one that can sometimes result in social rejection and failure to reproduce.<ref name=":0" /> Another proposal is that NPD may result from an excess of traits which are only adaptive in moderate amounts (leadership success increases with moderate degrees of narcissism, but declines at the high end of narcissism).<ref name=":0" />
+Research on NPD is limited, because patients are hard to recruit for study.<ref name=":5" /> The cause of narcissistic personality disorder requires further research.<ref name=":4" /><ref name=":0" />
 == Management ==
@@ Line 235: / Line 231: @@
 == Prognosis ==
 {{As of|2020}}, no treatment guidelines exist for NPD and no empirical studies have been conducted on specific NPD groups to determine efficacy for [[Psychotherapy|psychotherapies]] and [[pharmacology]].<ref name="King_2020" /><ref name="Yakeley_2018"/>
-Though there is no known single cure for NPD, there are some things one can do to lessen their symptoms. Medications such as antidepressants, which treat depression, are commonly prescribed by healthcare providers; mood stabilizers to reduce mood swings and antipsychotic drugs to reduce the prevalence of psychotic episodes.
+Though there is no known single cure for NPD, there are some things one can do to lessen its symptoms. Medications such as antidepressants, which treat depression, are commonly prescribed by healthcare providers; mood stabilizers to reduce mood swings and antipsychotic drugs to reduce the prevalence of psychotic episodes.
 The presence of NPD in patients undergoing psychotherapy for the treatment of other mental disorders is associated with slower treatment progress and higher dropout rates.<ref name="Caligor_2015" /> In this therapy, the goals often are examining traits and behaviors that negatively affect life, identifying ways these behaviors cause distress to the person and others, exploring early experiences that contributed to narcissistic defenses, developing new coping mechanisms to replace those defenses, helping the person see themselves and others in more realistic and nuanced ways, rather than wholly good or wholly bad, identifying and practicing more helpful patterns of behavior, developing interpersonal skills, and learning to consider the needs and feelings of others.<ref>{{Cite web |date=17 December 2017 |title=Can Narcissists Change? |url=https://psychcentral.com/disorders/narcissistic-personality-disorder/treatment |website=Psych Central}}</ref>

Classification	D ICD-10: F60.8 ICD-9-CM: 301.81 MeSH: D010554
External resources	MedlinePlus: 000934

v t e Narcissism
Similar personality concepts	Egomania Egotism God complex Healthy narcissism Hubris Machiavellianism Messiah complex Narcissus (mythology) Superiority complex
In society	Collective narcissism Don Juanism In the workplace Leadership Me generation Parents
Pathological narcissism	Narcissistic personality disorder history Dark triad Malignant narcissism Manipulation (psychology) Narcissistic injury neurosis elation mortification supply withdrawal Narcissistic Personality Inventory
Related psychology concepts	Compensation Empathy Entitlement Grandiosity
Category

v t e Digital media use and mental health
Proposed or recognised diagnostic categories	Computer addiction Internet addiction disorder Internet sex addiction Online problem gambling Problematic smartphone use Nomophobia Problematic social media use Television addiction Video game addiction
Disciplines involved	Digital anthropology Digital sociology Ergonomics Cognitive ergonomics Computer-mediated communication Cyberpsychology Engineering psychology Human–computer interaction Media naturalness theory Neuroergonomics Neuroscience Psychiatry Evolutionary Psychology Clinical Cognitive Evolutionary Social
Associated psychiatric conditions	Anxiety disorder Generalized anxiety disorder Obsessive–compulsive disorder Social anxiety disorder Attention deficit hyperactivity disorder Autism Bipolar disorder Depression Eating disorder Anorexia nervosa Body image disturbance Insomnia Narcissistic personality disorder
Related topics	Behavioral addiction Behavioral modernity Body image Criticism of Facebook 2021 Facebook company files leak Cyberbullying Cyberpathology Digital detox Digital zombie Evolution of cognition Evolutionary mismatch Fear of missing out Mobile phones and driving safety Promotion of anorexia Psychological effects of Internet use Screen time Binge-watching Social aspects of television Television consumption Smartphones and pedestrian safety Social media and suicide Spaving Suicide and the Internet Technophilia Technophobia Technostress Texting while driving