Scott Olsen Getty Image Trump[Scott Olsen/Getty Images]


The word “narcissist” has been bandied about quite a bit this past year. More than a politically divisive term, however, narcissistic personality disorder is a legitimate mental condition defined in The Diagnostic and Statistical Manual of Mental Disorders (commonly called the DSM-5).

“Narcissistic personality disorder is a cluster of personality traits that exhibit certain symptoms,” explains Maria Droste therapist Lorraine Lipson, LPC.  According to the DSM-5, she says, the classic diagnostic criteria include a pervasive pattern of grandiosity in fantasy or behavior, a consistent need for admiration and a marked lack of empathy.

In today’s culture, traits such as high self-esteem, confidence, decisiveness and assertiveness are often valued, encouraged and rewarded. People who strongly exhibit these characteristics may be thought of as having a big ego. This is not the same as narcissistic personality disorder. In fact, those with the disorder often have fragile egos and a need for constant reassurance of their ‘exceptionalism’.

People with narcissistic personality disorder have a grandiose sense of self-importance. They exaggerate talents or achievements. They expect to be recognized as superior without any actual achievements to back up their claims. 

They are preoccupied with fantasies of their unlimited success, power, brilliance, beauty or ideal love.

They believe they possess special status (“I am unique”) and seek out others they regard as special or having high status. They regard people as extensions of themselves, therefore, they are likely to confer that high status on those who are close to them, regardless of actual merit. The flip-side of that is the tendency to deride, mock or shame those who go against them. Someone who was once held in high esteem by an individual with narcissistic personality disorder can quickly be on the outs by crossing or criticizing that individual in some way.

“People with narcissistic personality disorder have a constant and pressing need for others to reflect glory on them and mirror their ‘fantastic-ness,’” Lipson explains. “They require admiration out of proportion to what is realistic. They depend on it to bolster their hidden, fragile sense of self.”

Narcissistic personality disorder typically begins in early adulthood. It affects more males than females (between 50 and 75% are male). Individuals with the disorder:

  • Have a sense of entitlement and unrealistic expectations of compliance or loyalty by others
  • Are interpersonally exploitative; see people as objects and act in their own self-interests with little consideration for the interests of others
  • Lack empathy; are unwilling or unable to identify with the feelings or needs of others
  • Are often envious of others or believe others are envious of them
  • Show arrogant, haughty behaviors or attitudes
  • Have fantasies of being superior in all ways and often act to convey this message

While narcissistic personality disorder may appear as an outsized sense of bravado, behind that is a very broken person, Lipson says, “like a baby with unmet needs.” Sometimes, there is a chink you can see a vulnerability or manipulative side. When the individual is treated contrary to his expectations of others, when he is contradicted or challenged, he might respond with rage that is in proportion to his sense of hurt and vulnerability.

People with narcissistic personality disorder can be charming and successful, and as a consequence their partners are often unaware of a deeper issue. They may be drawn into a relationship as a spouse or partner where they might unconsciously serve the ends of the person with this disorder while putting aside their own needs, opinions or desires in order to do so.  If they act contrary to the wishes or perceptions of their spouse, they may become the object of rage, disparagement or even abuse.

Is narcissistic personality disorder treatable?

Researchers have not definitively identified the causes of narcissistic personality disorder, but a widely held belief is that it results from a combination of biological, genetic, social and psychological factors shaped by early interactions with family and friends as well as by environment and ability to cope with stress. (Bressert, 2017)

As with any personality disorder, narcissistic personality exists on a continuum. A person may have some narcissistic features but not meet all of the criteria for a full-blown diagnosis. Those at the extreme end of the continuum are not likely to benefit from therapy because they lack the capacity to take responsibility for any negative consequences of their actions or behavior, or because of their grandiosity, be unable to acknowledge that there is anything amiss.  “The efficacy of treatment depends on ownership. The whole process of therapy is based on personal growth and awareness,” notes Lipson. “Those who exhibit most or all of the diagnostic criteria are extremely difficult to treat, while those with only a few of the traits may be more available for therapy.” She adds that those with the disorder might seek out therapy to address accompanying issues, such as depression, mood disorder or anxiety.

Those in personal or professional relationships with someone who has this disorder and experience difficulty may benefit from therapy, however. “We work with the need of the person to be in the relationship. We focus on their desire  to be in such a relationship, how they subjugate their own needs and explore what keeps them there,” says Lipson. “Together we would look at their self-esteem and work to mobilize their ability to recognize what is going on. We look at choices and how a different choice might be available.”

If you have questions about narcissistic personality disorder, or would like to speak to a therapist, contact Maria Droste Access Center at 303-867-4600.

**Thank you to Lorraine Lipson, LPC, for her contributions to this blog.**

Bressert, S. (2017). Narcissistic Personality Disorder. Psych Central. Retrieved on February 6, 2018, from