When Confidence Becomes a Disorder: A Deep Dive into NPD
- Ada Özel
- Sep 30
- 3 min read
Narcissistic Personality Disorder (NPD) is a mental health condition in which people have an exaggerated sense of self-importance. They constantly seek admiration and attention from others but lack the ability to understand or care about others’ feelings. This disorder affects about 1–2% of the population, with men being diagnosed more often than women. NPD usually emerges during adolescence or early adulthood and is strongly associated with substance abuse, suicide risk, legal problems, and difficulties in relationships and marriage.
People with NPD often struggle with distorted self-images related to power, beauty, or intelligence. Their fantasies are so grandiose and unrealistic that failure to achieve them may contribute to depression or suicidal behavior. They tend to believe they are entitled to constant praise, affection, and admiration, which can severely damage their social relationships.
It is important to note that everyone has some degree of narcissism. A healthy level of narcissism can promote confidence, independence, and ambition, while still allowing empathy and strong relationships. Pathological narcissism, however, exists when a person’s behavior harms others. In these cases, the people around the narcissist are treated as mere extensions of the individual’s self-image. Those closest to them are often pressured to maintain perfection because they contribute to the narcissist’s fragile sense of self.
The exact causes of NPD are not fully understood, but most experts believe it results from a complex interaction of environmental, genetic, and neurobiological factors. Risk factors may include childhood environments marked by excessive criticism or excessive praise that does not match the child’s actual experiences. Genetics and brain differences may also play a role in how NPD develops.
One study comparing 17 NPD patients with 17 healthy individuals found no significant differences in overall gray matter, white matter, cerebrospinal fluid, or intracranial volume. However, NPD patients showed smaller gray matter volumes in the left anterior insula, a region of the brain involved in empathy and emotional awareness. A similar pattern was also found in the right anterior insula, highlighting the possible neurological underpinnings of NPD.
NPD is often underdiagnosed and undertreated due to several challenges. There is limited research to guide effective treatment, and clinicians often find NPD patients difficult to work with. Many individuals with NPD rarely seek help voluntarily and may drop out of therapy due to their self-centered nature. Additionally, NPD symptoms frequently overlap with antisocial personality disorder and borderline personality disorder, which complicates diagnosis.
The main treatment for NPD is psychotherapy, which may include metacognitive therapy, group therapy, family or couples therapy, dialectical behavioral therapy (DBT), and cognitive behavioral therapy (CBT). While it is unrealistic to expect complete personality change, therapy can help patients build greater self-awareness, improve their relationships, and reduce harmful behavior. However, the lack of motivation and reluctance to collaborate often make therapy difficult, leading some clinicians to avoid working with NPD patients altogether.
NPD is not simply arrogance; it is a complex and deeply rooted disorder that often resists healing and causes patients to relapse into old patterns. In my opinion, effective treatment requires a balance of firm guidance and empathy, providing both structure and understanding to help patients develop healthier ways of relating to themselves and others.
References:
Nenadić, I., Lorenz, C. & Gaser, C. Narcissistic personality traits and prefrontal brain structure. Sci Rep 11, 15707 (2021). https://doi.org/10.1038/s41598-021-94920-z
Mitra P, Torrico TJ, Fluyau D. Narcissistic Personality Disorder. [Updated 2024 Mar 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556001/
Weinberg, I., & Ronningstam, E. (2022). Narcissistic Personality Disorder: Progress in Understanding and Treatment. Focus (American Psychiatric Publishing), 20(4), 368–377. https://doi.org/10.1176/appi.focus.20220052
Schulze, L., Dziobek, I., Vater, A., Heekeren, H. R., Bajbouj, M., Renneberg, B., Heuser, I., & Roepke, S. (2013). Gray matter abnormalities in patients with narcissistic personality disorder. Journal of Psychiatric Research, 47(10), 1363–1369. https://doi.org/10.1016/j.jpsychires.2013.05.017.
Muir, O., Weinfeld, J. N., Ruiz, D., Ostrovsky, D., Fiolhais, M., & MacMillan, C. (2021). Mental health clinicians' attitudes toward narcissistic personality disorder. Personality disorders, 12(5), 389–399. https://doi.org/10.1037/per0000510
Zalman, H., Doorn, K. A., & Eubanks, C. F. (2019). Alliance challenges in the treatment of a narcissistic patient: the case of Alex. Research in psychotherapy (Milano), 22(2), 351. https://doi.org/10.4081/ripppo.2019.351
https://www.healthdirect.gov.au/narcissistic-personality-disorder-npd
https://sarateller.com/differences-healthy-narcissism-pathological-narcissism/
https://my.clevelandclinic.org/health/diseases/9742-narcissistic-personality-disorder
