Narcissistic Personality Disorder

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Narcissistic Personality Disorder

One of the psychological disorders todays is Narcissistic personality disorder. It is characterized by a continuous system of grandiosity, fantasizing about unlimited power and the urge and need to be admired and be given special treatment (Kacel, Ennis & Pereira, 2017). People who have narcissistic personality disorder would normally experience physical comorbidities, mental health issues and social problems (Kacel, Ennis & Pereira, 2017). This is evident from the high prevalence of the condition with these factors. For example, there is a 40.6% prevalence of abuse of substance, 28.6% in mood disorder and 40% prevalence rate in anxiety disorders (Kacel, Ennis & Pereira, 2017). In the whole of United States population, the prevalence of the condition is between 1% and 15% (Mitra & Fluyau, 2020). There is also a high occurrence of the condition among African American men and women and also among the Hispanic women (Mitra & Fluyau, 2020). It is important to note that narcissistic personality disorder can coexist together with other psychiatric disorders making it difficult to make the diagnosis (Mitra & Fluyau, 2020). This paper shall focus on the diagnostic criteria, psychotherapy and psychopharmacologic interventions and clinical features of narcissistic personality disorder.

Diagnostic Criteria

The DSM-5 diagnostic criteria for narcissistic personality disorder includes presence of a prevalent pattern or system of grandiosity, the need to be admires, and lacking empathy by the early years of adulthood (APA, 2013). The individual should present at least five of the following list of features. The first is having a fantasy of self-importance which can be seen by the individual exaggerating his or her own achievements and accomplishments (APA, 2013). The other feature is being preoccupied by their own fantasy or imagination concerning unending success, power and love among other attractive things (APA, 2013). The individual has a belief of being special and should be associated with people that are of high status and can be able to understand him (APA, 2013). Additionally, this individual possesses a sense of being entitled, is exploitative, does not have any empathy, is envious and jealous of other people and believes that they are jealous of him and is very arrogant with haughty attitudes (APA, 2013). The individual should present at least five of the listed symptoms.

There are additional features that can be used to support diagnosis of the condition. One of these features is that they are very vulnerable when it comes to their self-esteem and thus can be really sensitive to hurt caused by criticism or loss (APA, 2013). This would cause them to be humiliated and can react back with rage or withdraw from the social life (APA, 2013). Therefore, they are easily hurt by criticism or defeat and this can break them.

Evidence-based Psychotherapy and Psychopharmacologic Treatment

There is no established treatment of narcissistic personality disorder, both psychopharmacologic and psychological or psychotherapy. This is mainly because it often presents itself together with other disorders (Mitra & Fluyau, 2020). This leads to the focus of treatment being the management of the presented symptoms of the comorbid disorders (Mitra & Fluyau, 2020).

There are however a couple of therapeutic approaches that can be used in the treatment of narcissistic personality disorder. One of these approaches is long term therapy. This approach explores and uses the patient and therapist’s relationship (Mitra & Fluyau, 2020). Another therapeutic approach is psychodynamic psychotherapy that works on the defenses that have been present and identified during the therapy sessions (Mitra & Fluyau, 2020).therapists have also suggested the use of ongoing therapy for the patients who have diagnosis of narcissistic personality disorder that has already been established (Mitra & Fluyau, 2020). Another approach is transference focused therapy. This approach takes place two times every week and deals with how the patient expresses emotions to the therapist (Mitra & Fluyau, 2020). This approach is important because NPD individuals can be easily provoked by their own perception of how other people treat them. There is also a new approach called schema focused therapy that concentrates and uses alternative aspects of cognitive behavioral therapy (Mitra & Fluyau, 2020).

There is lack of any psychopharmacologic interventions for NPD that have been approved any FDA (Mitra & Fluyau, 2020). However, patients with NPD can be helped by treating the symptoms like anxiety, issues of impulse control, depression and transient psychosis. For example, antidepressants like selective serotonin reuptake inhibitors can be used and antipsychotic like risperidone have benefited patients (Mitra & Fluyau, 2020). The medications are therefore for the purposes of treating symptoms and not the disorder itself.

Clinical Features

The clinical features of narcissistic personality disorder include having an exaggerated sense of being important, being entitled, needing admiration and praises continuously, exaggerating his or her own accomplishments, feeling higher or superior than others, being jealous of other people, being arrogant, requires and needs to be given special favors and is preoccupied with dreams and fantasies concerning his or her own power, success, beauty and being smart among others.


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Kacel, E. L., Ennis, N., & Pereira, D. B. (2017). Narcissistic personality disorder in clinical health psychology practice: case studies of comorbid psychological distress and life-limiting illness. Behavioral Medicine43(3), 156-164.

Mitra, P., & Fluyau, D. (2020). Narcissistic Personality Disorder. In StatPearls [Internet]. StatPearls Publishing.

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