What is narcissistic personality disorder?

The term narcissist is used widely these days, especially on social media, often pertaining to people who are self-absorbed, attention-seeking, or unkind.

While those traits might be frustrating to deal with, they don't always reflect a clinical condition. Understanding the difference between everyday narcissistic behaviours and narcissistic personality disorder (NPD) can help clarify what’s really going on beneath the surface.

In this article, we'll explore how NPD presents, how it differs from normal personality traits, how covert narcissism can be overlooked, and what options exist for support.

What narcissistic behaviour looks like in everyday life

It's normal for people to sometimes want praise, feel important, or become defensive when challenged. Most of us have moments where we focus more on our own needs, expect recognition, or feel slighted when others don't notice our efforts.

These are narcissistic behaviours, but they're part of the general spectrum of human emotion and self-expression.

For example, a person might brag about a recent success, demand credit for a group project, or feel frustrated when they don't receive admiration. These actions can be annoying or even hurtful, but they're usually temporary, and people move on or self-correct over time.

People with NPD, by contrast, experience more extreme, persistent behaviours that affect their relationships and daily functioning. The issue isn't just how they behave, but the rigidity and frequency of the behaviour, and the impact it has on others and themselves.

When narcissism becomes a personality disorder

Narcissistic personality disorder is diagnosed when someone shows a consistent pattern of grandiosity, excessive need for admiration, and lack of empathy across different areas of life. 

These behaviours are inflexible, not just occasional responses to certain situations, and often begin in early adulthood. As such, they also become deeply rooted in how the person sees themselves and relates to others.

A person with NPD may genuinely believe they are superior to others. They may exploit relationships, struggle with criticism, and become preoccupied with success, power, or beauty. Importantly, these behaviours are not passing moods or reactions. They are chronic patterns that cause distress or make it hard to maintain stable relationships, jobs, or social connections.

Formal diagnosis involves a mental health professional assessing whether the person meets criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This includes not only the behaviours but their frequency, context, and the degree of impairment they cause.

According to HealthDirect, around 1 to 6 people out of 100 meet the diagnostic criteria for NPD.

Recognising overt and covert narcissism

When most people think of narcissism, they picture someone loud, boastful, and clearly self-important. This is what clinicians often refer to as overt narcissism. It's more obvious and often easier to identify.

However, narcissism can also present in quieter ways. Covert narcissism, also known as vulnerable narcissism, includes traits like hypersensitivity to criticism, social withdrawal, passive-aggressive behaviour, and a strong need for reassurance. On the surface, this person might appear modest or self-deprecating. But underneath, there may be a belief that others have failed to recognise their uniqueness or importance.

Someone with covert narcissism may feel wounded by minor slights and respond with resentment, silent treatment, or subtle manipulation. These behaviours can confuse loved ones, because they don’t match the usual image of narcissism.

Despite these differences, both forms can cause serious strain on relationships and inner emotional life. The outward expression may vary, but the core dynamics remain similar: difficulty with empathy, fragile self-esteem, and a reliance on others to reinforce a sense of worth.

What leads to narcissistic personality disorder

There is no single cause of NPD. Research suggests a combination of genetic, psychological, and environmental factors plays a role.

Some people may be more temperamentally sensitive to rejection or evaluation. Others may have experienced inconsistent parenting, excessive praise without limits, or emotional neglect.

A child who learns that their worth depends entirely on achievement, appearance, or status may grow into an adult who relies on admiration to feel secure. In this context, narcissistic traits become a coping mechanism - a way to avoid feelings of shame or vulnerability.

Cultural influences also matter. In societies where image, performance, and success are highly valued, narcissistic traits may be rewarded or overlooked until they become damaging.

NPD diagnosis and treatment

Diagnosing NPD requires a detailed psychological assessment. A psychologist or psychiatrist will explore the person's history, current behaviour patterns, and how these impact their relationships, work, and self-image.

The clinician will also consider other mental health conditions, as NPD often co-occurs with depression, anxiety, or substance use.

Treatment for NPD can be challenging, in part because many people with the disorder struggle to recognise the problem or see the need for change. However, therapy can be effective over time, particularly when it helps the person understand their emotional triggers, relationship patterns, and self-concept.

Approaches like schema therapy, psychodynamic psychotherapy, or specialised forms of cognitive behavioural therapy (CBT) may be used. The focus is not on changing personality as a whole, but on building emotional awareness, reducing harmful behaviours, and increasing relational capacity.

Medication is not used to treat NPD directly, but it may be helpful if the person also experiences depression, anxiety, or other related conditions.

Relating or living with someone with NPD

Being with someone who has NPD and who’s unwilling to get help can be emotionally exhausting.

The relationship may feel one-sided, with little emotional reciprocity or concern for others' needs. It can be difficult to assert boundaries or express your own feelings without being dismissed or criticised.

If you're in a relationship with someone who shows consistent narcissistic patterns, consider seeking support for yourself. Therapy can help you clarify your own needs and boundaries. It's also helpful to learn how to communicate assertively, avoid power struggles, and recognise when your own wellbeing is at risk.

It's worth remembering that not everyone who acts self-centred is living with NPD. And not everyone diagnosed with NPD is incapable of growth or insight. However, change often takes time, commitment, and skilled support.

Final thoughts

Narcissistic personality disorder is more than a label for difficult behaviour. It reflects a set of complex emotional and relational patterns that are often rooted in early experiences, identity struggles, and fragile self-worth.

While narcissistic traits show up in many people, NPD is less common and more deeply entrenched.

By understanding the difference between typical behaviour and disordered patterns, you can respond more thoughtfully and seek support when it's needed. Whether you're concerned about yourself or someone close to you, a mental health professional trained in NPD can offer insight and guidance tailored to your situation.