What is narcissistic personality disorder? Types and treatment options

Narcissism, otherwise known as narcissistic personality disorder (NPD), is a serious mental health condition. There are several different types of narcissism. While they aren’t formally recognized (meaning you can’t get diagnosed with a specific NPD subtype), these labels can help people describe their unique experiences with the condition. These categories can help explain the many ways that narcissistic traits can show up. And by increasing awareness, we can take an important step toward reducing the stigma that often keeps people from seeking help.

What is narcissistic personality disorder?

People with narcissistic personality disorder have an over-the-top sense of superiority. They prefer to be the center of attention and fantasize about amassing power and success. At the same time, they’re typically highly sensitive to rejection and criticism. They may also experience a variety of physical symptoms, like headaches or digestive issues. 

Narcissistic personality disorder causes extreme mood swings, an overinflated sense of self-importance, and deep insecurity. These characteristics can make it difficult to form healthy, balanced relationships. In addition, people with this condition typically also lack awareness of the impact of their behavior. Sadly, their aversion to change and sense of self-righteousness often prevents them from seeking help.

So where does narcissistic personality come from? Researchers have uncovered two factors that may cause someone to develop the condition.

• Genetics: Several studies have confirmed that personality disorders may have a genetic component. Having a close relative, like a sibling or parent, with narcissistic personality disorder may increase your risk.
• Environment: Adults with narcissistic personality disorder often experience abuse or neglect in childhood. This can include high parental expectations, a chaotic home life, rejection from caregivers, or other forms of trauma.

Keep in mind that people can show narcissistic traits without having a clinical mental health condition. Sometimes this is referred to as having “narcissistic tendencies.” However, you don’t need an official diagnosis to ask for help.

What are the different types of narcissism?

Please note that the types of narcissism listed below are not officially recognized mental health conditions. For example, you cannot be diagnosed with covert narcissism. However, organizing narcissistic traits by type can help us better understand the condition.

Classic narcissism 

This form of narcissism, also known as overt narcissism, is considered a “typical” presentation of the condition. It causes an overinflated ego, a sense of superiority, and profound insecurity. Often, it leads to bullying, manipulation, and other abusive behaviors toward others.

Covert narcissism

Covert narcissism, also known as vulnerable narcissism, may be harder to detect than other presentations. Rather than a sense of grandiosity, covert narcissism causes introversion. People with covert narcissistic traits have an exaggerated sense of self-importance. But they may appear passive-aggressive or exhibit low self-esteem.   

Communal narcissism

Communal narcissism leads a person to see themselves as fair, generous, and deeply concerned about others. People who have this form of narcissism want to be viewed as selfless. On the surface, they may appear to be altruistic. But deep down they’re motivated by a desire for control. They believe in their own superiority and feel entitled to power and admiration from others.

Malignant narcissism

Malignant narcissism is one of the most challenging presentations of narcissistic personality disorder. It causes feelings of self-importance and a desire to dominate and control. But people with malignant narcissism also find joy in other people’s suffering. They may blatantly disregard other people’s needs and show antisocial behaviors.

How is narcissistic personality disorder treated?

There are several recommended therapies for narcissistic personality disorder, including:

• Transference-focused psychotherapy (TFP) is a form of psychodynamic therapy. It focuses on uncovering the unconscious thoughts that drive behavior. In TFP, the therapeutic relationship helps the client examine their relationships with others. 
• Schema-focused therapy combines elements of psychodynamic therapy and cognitive behavioral therapy (CBT). It emphasizes short-term goals and solutions related to behavior change. This approach can help people change how they feel about their unhealthy patterns.  
• Mentalization-based therapy (MBT) encourages people to consider their view of how other people think and feel. This can help counteract the sense of superiority and entitlement that many people living with narcissistic personality disorder feel.
• Dialectical behavioral therapy (DBT) is a form of CBT that supports mindfulness, emotional regulation, stress management, and interpersonal skills. DBT can be especially helpful for people whose narcissistic traits have negatively affected their relationships.
• Metacognitive interpersonal therapy (MIT) was specifically designed to support people living with narcissistic personality disorder. It has two stages: setting and change promotion. These stages help foster empathy by deepening a person’s understanding of how others think, feel, and behave. 
• Supportive psychotherapy includes elements of both psychodynamic therapy and CBT. Goals for this type of therapy include fostering stability, addressing co-occurring mental health conditions, and improving functioning overall. 

Note that there is no medication that is approved to treat narcissistic personality disorder. However, medication may be used to treat common co-occurring conditions, like anxiety or depression. Your provider can help you decide on the best treatment options for your needs.

Find care with Rula

With the right support, people who have narcissistic personality disorder can manage their condition. At Rula, we believe that everyone — including people living with personality disorders — deserves access to timely, compassionate care. 

So if you or someone you care about needs mental health support, we invite you to explore our therapist-matching program. In just a few seconds, you can find a therapist who takes your insurance and offers the specialized treatment you deserve. Explore our digital platform and diverse provider network today to access care from the comfort of home as soon as tomorrow.

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