What Causes Narcissistic Personality Disorder?

A need for excessive admiration is a characteristic of narcissistic personality disorder.

Narcissistic personality disorder is psychiatric disorder characterized by a pervasive pattern of self-importance (grandiosity), a constant need for admiration and attention, and a lack of empathy for others.

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines narcissistic personality disorder as one that has

• a pervasive pattern of grandiosity (in fantasy or behavior),
• a constant need for admiration, and
• a lack of empathy.

The above personality traits begin by early adulthood and are manifested by at least five of the following nine criteria:

• An extreme sense of self-importance
• While in the throes of grandiosity, a person may also show signs of hypomania or mania
• A preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
• A belief that he or she is special and unique and can only be understood by, or should associate with, other special or high-status people or institutions
• A need for excessive admiration
• A sense of entitlement
• Exploitive behavior of others
• A lack of empathy
• Envy of others or a belief that others are envious of him or her
• Arrogance and haughty behaviors or attitudes

A person with narcissistic personality disorder may also have difficulties in two or more of the following four areas:

• Identity
• Self-direction
• Empathy
• Intimacy

Medical professionals do not know the cause of narcissistic personality disorder. They believe it may stem from a combination of biological, psychological, social, and environmental factors. There does not seem to be a genetic link to the disorder.

Some theories point to an unhealthy early parent-child relationship as a significant factor in the development of the disorder.

The diagnosis of narcissistic personality disorder is usually made with a psychological evaluation.

In order to diagnose narcissistic personality disorder, other types of personality disorders with similar characteristics must first be ruled out, including:

• antisocial personality disorder, which is pattern of behavior in which individuals consistently exploit, manipulate, and violate others;
• borderline personality disorder, which results in unstable emotions, impulsive actions, and chaotic relationships with others; and
• histrionic personality disorder, which involves constant attention-seeking, an excessive need for approval, and inappropriate seductive behavior.

There are no specific lab tests that diagnose narcissistic personality disorder, however, medical professionals may order a toxicology screen to rule out use/abuse of drugs and alcohol as the cause of the behaviors.

Medical professionals may administer the following personality tests to help make the diagnosis of narcissistic personality disorder:

• Personality Diagnostic Questionnaire–4 (PDQ-4)
• Millon Clinical Multiaxial Inventory III (MCMI-III)
• International Personality Disorder Examination (IPDE)

Treatment for narcissistic personality disorder usually involves a combination of psychotherapy and medication.

Psychotherapy for narcissistic personality disorder may include the following:

• Individual psychotherapy
• Group therapy
• Family therapy
• Couples therapy
• Cognitive-behavioral therapy (CBT; in particular, schema-focused therapy)
• Short-term objective-focused psychotherapy

If a person with narcissistic personality disorder becomes a danger to self or others, inpatient treatment may be needed.

There are no specific medications used to treat narcissistic personality disorder, but medicines may help relieve some symptoms or treat other mental illnesses that may accompany the narcissistic personality disorder.

Medications that may be used include the following:

• Serotonin reuptake inhibitor (SSRI) antidepressants
• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Fluoxetine (Prozac)
• Antipsychotics
• Risperidone (Risperdal, Risperdal Consta IM Injection, Risperdal M-Tab)
• Mood stabilizers
• Lamotrigine (Lamictal)
• Valproic acid, divalproex sodium (Depakote, Depakene, Depacon, Stavzor)
• Lithium (Lithobid)

Complications of narcissistic personality disorder include the following:

• Higher risk for suicide
• Increased risk for substance abuse, particularly cocaine and alcohol
• Interpersonal relationship difficulties
• Other mental health problems such as depression and anxiety
• Problems at work or school