Top Narcissistic Personality Disorder Symptoms - Dr. Axe

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Narcissistic Personality Disorder: How to Deal with Family, Friends & Co-Workers Showing Symptoms


Narcissistic personality disorder - Dr. Axe

The terms narcissist and narcissistic personality disorder are thrown around rather loosely today. While a touch of self-centeredness, need for admiration or difficulty being criticized may seem narcissistic, it doesn’t necessarily warrant a diagnosis of true narcissistic personality disorder. (And here’s an important point to remember: Narcissism is not the same as confidence.) But when traits of being self-centered, egotistical and manipulative are exhibited to the extreme, it can become the basis for the psychological disorder. Like all similar conditions, being diagnosed with narcissist personality disorder means a person must meet a certain diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5). (1)

You can find true narcissists at every level of society. In its more extreme form and used for nefarious reasons, the results of narcissistic personality disorder can be devastating. The combination of an inability to empathize, coupled with high-level grandiosity, can lead to harming others without remorse. Many psychology experts believe Hitler suffered from narcissistic personality disorder, along with many dangerous cult leaders like Jim Jones David Koresh. Polygamist leader Warren Jeffs is believed to be a true narcissist, too. Aside from initially possessing charming traits that draw followers in, these people demanded perfect loyalty from followers, overvalued themselves and devalued those around them. (2, 3)

Those examples of famous narcissists are extreme cases. Chances are, though, you’re dealing with a much less sinister form of narcissism every day. Maybe you encounter this at your own dinner table, where a charming but emotionally unavailable parent or spouse puts you down in order to elevate himself or herself. Perhaps it’s someone in the office or cubicle next to you who makes a habit and big production out of storming into meetings late. Or your best friend who constantly interrupts you while you’re talking, always turning the conversation back to him- or herself and rarely listening to what you have to say. Narcissists are known for putting perfectionist-like expectations on others and then berating others when those expectations aren’t met. Maybe you even see some of these traits in yourself.

What we have to realize is that many of us are dealing with narcissistic personalities every day.

Narcissistic personality disorder isn’t just a challenge for the person living with it condition. This disease casts a wide net, negatively impacting people in the narcissist’s life. The words and actions of a true narcissist can cause high stress and leave lasting damage on parents, siblings, children, other family members, friends and co-workers. That’s why it’s so important to learn how to ID and properly deal with a narcissist. And if you show signs and symptoms of narcissism, there are ways you can seek help, too.


Here, former FBI profiler Joe Navarro, author of “Dangerous Personalities: An FBI Profiler Shows How to Identify and Protect Yourself from Harmful People,” breaks down a narcissist: (4)

“Narcissistic personalities care only for themselves, their needs and their priorities. While you and I appreciate attention, the narcissist craves it and manipulates people and situations to get it. While you and I work hard to be successful, the narcissistic personality connives to succeed and may cheat, lie, embellish the truth or scheme to get ahead, uncaring of how others are affected.”

What Is Narcissistic Personality Disorder?

So what is a narcissist? First, let’s be clear. It goes way beyond someone who loves looking in the mirror. A true narcissist acts in ways that are toxic and dangerous. And this can greatly impact relationships, putting strain on family members, friends and co-workers of a narcissist.

This narcissist definition helps break it down: Narcissistic personality disorder is a mental disorder in which people have an inflated sense of their own importance, a deep need for admiration and a lack of empathy for others. But behind this mask of ultra-confidence lies a fragile self-esteem that’s vulnerable to the slightest criticism, according to the Mayo Clinic. It may be hard for a true narcissist to seek medical help for this condition, though, because mental illness may not fit with the individual’s image of power, image and perfection. (5)

Symptoms of Narcissistic Personality Disorder + Diagnosing the Condition

According to the DSM-5, narcissistic personality disorder is characterized as a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration and lack of empathy, beginning by early adulthood and present in a variety of contexts, indicated by five or more of the following:

  1. Has a grandiose sense of self-importance (for example, exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
  2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love
  3. Believes 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)
  4. Requires excessive admiration
  5. Has a sense of entitlement, for example, unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
  6. Is interpersonally exploitative, for example, takes advantage of others to achieve his or her own ends
  7. Lacks empathy and is unwilling to recognize or identify with the feelings and needs of others
  8. Is often envious of others or believes that others are envious of him or her
  9. Shows arrogant, haughty behaviors or attitudes

But to diagnose narcissistic personality disorder, a psychologist must makes sure other criteria involving personality disorders must be met. Some of these involve an excessive need for admiration or setting personal standards unreasonably high to see oneself as exceptional (or too low based on a sense of entitlement).

 Narcissistic Personality Disorder - Dr. Axe

To be diagnosed with narcissistic personality disorder, a person also needs to show problems with relationships. This can translate as a lack of empathy or having mostly superficial relationships dominated by a need for personal gain.

Other things mental health professionals look for are antagonisms, grandiosity (feelings of entitlement) and attention-seeking behavior. For someone with true narcissistic personality disorder, these personality impairments can be seen consistently over time and throughout different situations. Mental health professionals are also instructed to make sure the personality traits aren’t normal based on the person’s developmental stage, social-cultural environment, drug use, medication or medical conditions (such as severe head trauma). (6)

Critics of the DSM-5 methods for diagnosing narcissistic personality disorder say it fails to cover some core psychological features of the disorder, including: (7)

  • vulnerable self-esteem
  • feelings of inferiority
  • emptiness and boredom
  • affective reactivity and distress

Depression, anxiety, pain, fear and perfectionism often plague people living with narcissistic personality disorder, too. (8)

And while much as been written about the extrovert-like qualities of a narcissist, scientists now know that subtypes of more introverted narcissists also exist. While they possess many of the qualities of a classical narcissist, they may operate in more subtle ways. For example, some introverted narcissists deal with disagreeable people or situations using passive-aggressive methods. (9)

A One-Question Test for Narcissism?

Testing for narcissism usually involves, among other things, asking a series of 40 questions known as the Narcissistic Personality Inventory. But in a study looking at 2,200 of all ages, scientists recently found they could reliably ID narcissistic people by asking them this exact question:

To what extent do you agree with this statement: “I am a narcissist.” (Note: The word “narcissist” means egotistical, self-focused and vain.)


Participants rated themselves on a scale of 1 (not very true of me) to 7 (very true of me). (10)

“People who are willing to admit they are more narcissistic than others probably actually are more narcissistic. People who are narcissists are almost proud of the fact. You can ask them directly because they don’t see narcissism as a negative quality — they believe they are superior to other people and are fine with saying that publicly. — Brad Bushman, PhD, study co-author and professor of psychology at The Ohio State University. (11)

Narcissist Definition: Defining Two Different Types

While all narcissists are self-absorbed, lack empathy and are self-entitled, thinking they are more important than others, the condition can be further broken down into two categories:

1. The Grandiose/Overt Narcissist 

Grandiose narcissism includes a desire to maintain a pretentious self-image, an exhibitionistic tendency and a strong need for the admiration of others. (12) These narcissists tend to be truly confident and are known to be dominant. Self-esteem isn’t an issue with this type.

The grandiose type is more likely to be part of what psychologist call “The Dark Trio.” This trio includes narcissism, Machiavellianism (the manipulation and exploitation of others for personal interest, with no remorse) and psychopathy, a condition characterized by impulsiveness, antisocial behavior, selfishness, callousness and lack of remorse. (13)

2. The Vulnerable/Covert Narcissist

Vulnerable narcissists tend to be more emotional, sensitive, and “feel helpless, anxious and victimized when people don’t treat them like royalty,” according to a description by Randi Kreger and Bill Eddy of the High Conflict Institute.

“Vulnerable narcissists appear to be over-compensating for low self-esteem and a deep-seated sense of shame that may date back to early childhood. They developed the behaviors as a coping mechanism to deal with neglect, abuse or a dismissive style of parent-child attachment (meaning the parents never developed a close bond with their child, so he never felt safe and secure in his parents’ love).” — Randi Kreger and Bill Eddy, High Conflict Institute (14)

Characterized by preoccupation with grandiose fantasies, this type of narcissist fluctuates between feelings of superiority and inferiority and fragile self-confidence. This type of narcissist is plagued by self-esteem issues, no matter how perfect his or her life may seem.

A 2016 study found that vulnerable narcissists are more vulnerable to social media addiction compared to grandiose narcissists and non-narcissists. The study, published in the journal Cyberpsychology, Behavior, and Social Networking, found that social media sites like Facebook and Instagram tend to be “safe” ways for vulnerable narcissists to gain attention by controlling their images and sharing them with a wider audience. (15, 16)

Narcissistic Personality Disorder Causes and Risk Factors

Genetic or Learned? Maybe Both

The exact cause of narcissistic personal disorder is not known. According to Cleveland Clinic, many professionals believe that a combination of biological and genetic factors, along with individual temperamental patterns, play a part. Another possible cause of narcissism involves early life experiences, such as excessive pampering or, on the flip side, harsh or negative parenting. (17)

It’s very common for children and teenagers to display signs of narcissism, but most grow out of this over time and don’t progress into narcissistic personality disorder. The condition does affect males more than females and tends to start emerging during the teenage or early adult years. (18)

The Narcissist’s Brain

Interestingly, in 2013, scientists used MRI brain imaging to show actual brain variations in people who lack empathy, a key feature of narcissistic personality disorder. In the study, researchers studied 34 people, 17 of whom were diagnosed with narcissistic personality disorder. Although people living with this disorder are well able to recognize what other persons feel, think and intend, they display little compassion.

Scientists found that people diagnosed with narcissistic personality disorder exhibited structural abnormalities in the cerebral cortex part of the brain responsible for processing and generating compassion. For people with the disorder, the brain’s external nerve cell layer of the cerebral cortex region was significantly thinner compared to the control group. (19, 20)

“Our data shows that the amount of empathy is directly correlated to the volume of gray brain matter of the corresponding cortical representation in the insular region, and that the patients with narcissism exhibit a structural deficit in exactly this area. Building on this initial structural data, we are currently attempting to use functional imaging to understand better how the brains of patients with narcissistic personality disorder work.” — Dr. Stefan Röpke, lead study author

Your Parents’ Paychecks

Growing up wealthy seems to make people more narcissistic when they take on leadership roles later in life. A study published in 2016 looking at military leaders found that those displaying narcissistic traits were more likely to have grown up in families with higher income levels.

The researchers say growing up among wealth may lead to the false belief that higher-income people are more talented or special than other people. This also may lead to the feeling that the narcissistic leader doesn’t require help, input or ideas from other people. Growing up among higher parental income indirectly impaired leadership performance by fostering narcissism, which in turn reduced engagement in important leadership behaviors, the researchers found. (21)

Classic Signs of a Narcissist

In “Dangerous Personalities,” author and FBI profiler Joe Navarro lists five common narcissism traits. They include:

1. Egocentric

Looking good in every sense is vital to someone with narcissistic personality disorder. Other egocentric signs of narcissism include:

  • A childlike need to be the center of attention
  • Arriving late to meetings and parties
  • Name dropping
  • Presenting themselves as highly accomplished, even if they haven’t accomplished much, sustaining an image of perfection
  • Placing blame on others when there’s a setback
  • Holding grudges

2. Overvalues Self, Devalues Others

Because narcissists view themselves as special and unique, narcissistic personalities tend to see everyone else as either marginal or inferior. Narcissists are classical bullies. And get this, as the number of narcissists is on the rise in the general population, bullying is on the rise, too.

Sometimes the digs are subtle. Navarro points out an example: At a cookout, a narcissist might say things like, “No steaks; only hamburgers?” loudly enough for all your guests to hear. That person doesn’t care how you feel; narcissists thrive by belittling others. Other signs include:

  • Putting other people down to elevate themselves (aka, bullying)
  • Belittling spouses or children in front of people
  • Frequently berating waiters, waitresses, serving staff publicly

3. Instead of Empathy, You’ll Find Arrogance and Entitlement

Navarro explains that while most of us learn as children how to understand others’ feelings and how our actions impact people, narcissists tend to have little ability to sympathize or understand the feelings of others. The more you talk to someone with narcissistic personality disorder, the more you get the impression that person doesn’t care much about you. Other signs of narcissism include:

  • Lacking of empathy
  • Viewing needs, sickness or mistakes in others as weakness

4. Takes Shortcuts, Bends the Rules and Violates Boundaries

People with narcissistic personality disorder often feel they don’t have to work as hard as others or that they don’t have to play by the rules. Other signs of a narcissist include:

  • Lying about past accomplishments or credentials (or embellishing them)
  • Having affairs without remorse
  • Pushing the envelope with people, laws, rules and social norms
  • Often don’t apologize (or have trouble apologizing sincerely) when they’re caught breaking the rules or hurting others

5. Needs Control

A narcissist often lands in a profession like law, medicine, politics or a high-level executive position, Navarro points out. Other narcissistic signs include:

  • Often seeking jobs that bring power and authority
  • Seeking positions where they can control others
  • Controlling a spouse by managing all finances

Narcissism expert Preston Ni, notes: (22)

“Narcissism is often interpreted in popular culture as a person who’s in love with him or herself. It is more accurate to characterize the pathological narcissist as someone who’s in love with an idealized self-image, which they project in order to avoid feeling (and being seen as) the real, disenfranchised, wounded self.” — Preston Ni

Narcissistic Personality Disorder Treatments

Because people with a narcissistic personality disorder diagnosis are often living with other conditions, including bipolar disorder, depression and anxiety, it’s important to see a health care provider to make sure all existing conditions are diagnosed and treated. (Natural stress relievers can also help.)

About 5 percent of people with bipolar disorder/manic depression also have narcissistic personality disorder. Sometimes it’s difficult for practitioners to differentiate between the two conditions, too. (23) So if you’re diagnosed with one, it’s a good idea to get a second or even third opinion.

Natural Treatments for Narcissistic Personality Disorder

While there are no drugs approved specifically to treat narcissistic personality disorder, some conventional treatment involves using drugs to treat any coexisting conditions that may exists, like depression, anxiety or bipolar disorder.


Talk therapy is the treatment of choice for people dealing with narcissistic personality disorder. It’s difficult to change traits associated with narcissistic personality disorder, so often years of treatment are required. According to Mayo Clinic, psychotherapy may help people:

  • Better relate with others to improve relationships, in the hopes of makuing them more intimate, enjoyable and rewarding
  • Understand the causes of emotions and what drives competition and distrust
  • Accept and maintain real personal relationships and collaboration with co-workers
  • Recognize and accept your actual competence and potential so you can tolerate criticisms or failures
  • Increase your ability to understand and regulate your feelings
  • Understand and tolerate the impact of issues related to your self-esteem
  • Release your desire for unattainable goals and ideal conditions and gain an acceptance of what’s attainable and what you can accomplish (24)

Other studies show us that emotional distress (often internalized so others don’t see it), vulnerability in relationships, fear, pain, anxiety, a sense of inadequacy and depression may occur with narcissistic personality disorder. (25)

Improve Your General Health

As with any disease prevention, improving your health and exercising are key. And because the gut-brain connection is so strong, I recommend figuring out if you have leaky gut symptoms and fixing them, along with eating anti-inflammatory foods

Get on a Mat

If you’ve ever wondered how yoga changes your brain, consider this interesting finding. While yoga hasn’t been definitely proven to help ease narcissistic personality disorder, it has been shown to improve gray matter in the brain, areas that are not as robust in narcissistic people. While yoga may not count as exercise in a technical sense, there are mountains of studies showing it helps ease depression and anxiety, two conditions that often impact people with narcissistic personality disorder.

How to Deal with a Narcissist

Dealing with a narcissist can be draining. Here are some tips for dealing with a narcissist:

ID the Type

Try to figure out which type you’re dealing with: grandiose or vulnerable. Vulnerable narcissists have low self-esteem issues, so providing some reassurance (just not too much to stoke their egos too much) may keep them happy and less prone to stir up trouble. Grandiose narcissists can be a great allies on projects, if you can get them excited and onboard about your idea.

Stay Cool

A narcissist gains pleasure in working other people up. Try to stay calm, remain positive and avoid talking about others in a negative way when in the presence of a narcissist.

Call Them Out (Here and There)

Sometimes, it’s best to ignore a narcissist. But sometimes, without being cruel or negative, call out the narcissist’s inappropriate behavior or remarks in a lighthearted way. If a narcissist is constantly interrupting you when you talk, point out your frustration with that so you feel more empowered. (26)

Keep Your Distance

If you’re a child and have a narcissistic parent, for instance, this may not be possible. But if you’re distressed by narcissistic symptoms of friends and more distance relatives, try to avoid them whenever possible.

Avoid Conflict

For people whom you have to deal with and have severe forms of narcissism, keep things very simple. Avoid arguing or trying to reason with them. When you need to communicate with them, keep things basic and brief about what you’re doing and when. (27)

Understand Narcissistic Parents

Being raised by a narcissistic parent can lead to problems for children. Narcissistic parents often degrade their children and don’t give them validation children need. A narcissistic mother, for instance, may be charismatic in public but make a child feel like a failure at home. Children of narcissistic parents often grow up to be clingy and depressed but can often make great progress in therapy.

Understand You Are Not the Problem

While you may feel like a victim, it’s important to know you’re not deserving of the harmful and abusive treatment narcissists often dish out. When you’re wracking your brain trying to figure out why they are doing things a certain way, remember that people with this disorder have been shown to have a different brain structure. You can try to aid them in getting treatment, but ultimately, you have to live your life and not allow the tactics of a narcissist in your life to define you or get under your skin.

Precautions When Dealing with Narcissistic Personality Disorder

It’s clear that narcissistic personality disorder is a complex mental disorder that we’re still trying to fully understand. What’s evident is that the person living with the condition — and those in his or her life — is faced with pain and struggle.

Do not try to diagnose yourself or others. Like all mental illnesses, if you suspect you’re dealing with narcissistic personality disorder, it’s important to seek the help and, if necessary, treatment from a medical professional.

Final Thoughts on Narcissistic Personality Disorder

  • Signs of narcissistic personality disorder include lack of empathy and egotistical and entitled behavior.
  • Scientists say there are two types of narcissism. Grandiose narcissism involves people who have very high confidence levels and think they’re better than others. (Often these people do achieve high status and positions of power.) Vulnerable narcissism is rooted more in poor self-esteem, although the person living with the condition often appears confident on the outside.
  • While the cause of narcissism personality disorder is not known, some believe genetic factors mixed with certain parenting styles may lead to narcissism in predisposed children.
  • Researchers discovered people with narcissism personality disorder tend to have thinner areas in the cerebral cortex part of the brain (the part responsible for compassion) compared to non-narcissistic people.
  • The go-to therapy for narcissism is psychotherapy. Treating possible coexisting conditions like depression, anxiety and bipolar disorder is also warranted.

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