PSYCHOLOGY WORKS Fact Sheet: Narcissism

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What is Narcissism?

Narcissism is part of an individual’s personality organization and is the way people maintain a positive self-image, regulate their self-esteem, and manage their needs for affirmation and validation from others. It is normal for people to possess a healthy amount of self-esteem where they are accepting of their strengths and limitations while maintaining a positive self-image. It is normal and healthy for individuals to seek adaptive and realistic ways to improve their self-concept and feel good about who they are.

Clinical narcissism, on the other hand, reflects unhealthy strategies to cope with disappointments and threats to positive self-image. Persistent difficulty in this area is what typically constitutes a clinical diagnosis of narcissistic personality disorder (NPD). Clinicians diagnose NPD when a person meets 5 or more of the following DSM-5 criteria:

  • A grandiose sense of self-importance
  • Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
  • Beliefs of being special and unique
  • A need for excessive admiration
  • A sense of entitlement
  • Taking advantage of others for personal gain
  • A lack of empathy
  • Arrogant and haughty behaviours or attitudes

How is Clinical Narcissism Expressed?

When we think of narcissism, we usually picture someone who displays narcissistic grandiosity, or a pattern of entitled, domineering, and attention-seeking behaviour. These traits align with certain aspects of NPD, including excessive self-enhancement strategies, diminished empathy, and a disagreeable demeanor. However, impairment in the ability to regulate the emotions and behaviours associated with one’s needs for self-enhancement is at the root of pathological narcissism – understood as narcissistic vulnerability. Narcissistic vulnerability is characterized by a fragile self-image and low self-esteem reliant on external validation. It involves heightened sensitivity to threats to self-concept, leading to anxiety, helplessness, persistent negative emotions, distrust of others, and social withdrawal. Clinical narcissists oscillate between states of grandiosity and vulnerability. As the two occur in tandem, there are no officially recognized subtypes of clinical narcissism or NPD.

The representation of narcissism in the DSM-5 has received scrutiny for describing primarily grandiose and overt manifestations while overlooking the important and inevitable vulnerable aspects. Recent research suggests that vulnerability can be conceptualized as “primary narcissism”, as internalised feelings of shame, low self-worth, and difficulty processing criticism or failure are at the core of all narcissistic behaviours. Genuine grandiosity that is not an attempt to conceal feelings of low self-worth may be better understood as a manifestation of psychopathy.[1]

Moreover, narcissism can be expressed overtly (i.e., behaviours, attitudes, and emotions) or covertly (i.e., internal cognitions, motives, needs, and feelings). People often incorrectly associate overt expressions with grandiosity and covert expressions with vulnerability. However, individuals with NPD tend to exhibit both overt and covert grandiose and vulnerable traits at different times or even simultaneously. For example, overtly arrogant behaviour can mask underlying feelings of inadequacy and vulnerability.

How Can We Identify Narcissism?

Recognizing the signs that someone may have narcissistic tendencies, regardless of severity, can help us understand and address them with empathy and accuracy.

Key characteristics of narcissism include:

  • Self-perception and Emotional Regulation Challenges
    • An exaggerated sense of self-importance, often coupled with feelings of insecurity, shame, or fear of being exposed as a failure.
    • A relentless drive for perfection and external validation to uphold a fragile self-image.
    • Extreme sensitivity to criticism or rejection, leading to defensive behaviours like withdrawal, aggression, or projection of blame.
  • Interpersonal Challenges
    • Decreased social inhibitions, allowing for displays of entitlement and unreasonable expectations for favourable treatment or recognition.
    • Difficulty with empathy and valuing the needs and emotions of others, which may manifest as controlling, manipulative, or dismissive behaviours.
    • Trouble maintaining friendships and relationships, leading to increased isolation over time.
  • Emotional and Behavioural Dysregulation
    • Persistent negative affectivity, such as depression, anxiety, or anhedonia, while often denying any feelings of depression or weakness.
    • High emotional reactivity, including intense anger, embarrassment, jealousy, or mood instability, especially when self-enhancement and reassurance needs are unmet.
    • Poor impulse control and increased thrill-seeking behaviour.

There are some complications that may arise with an NPD diagnosis that are important to be aware of:

  • NPD can occur along with other conditions such as substance use disorders, mood and anxiety disorders, and other personality disorders. This can make it difficult to accurately diagnose NPD.
  • A higher risk of death by suicide.
  • A greater presence of hostility and aggression, increasing interpersonal difficulties and creating challenges with treatment.

What Are the Risk Factors for Developing NPD?

  • Early childhood experiences including parental overvaluation, excessive admiration, praise, and beliefs that the child has exceptional abilities have been associated with narcissism in adulthood. Conversely, adverse experiences in early childhood including parental coldness, parental abuse, feeling rejected, and a fragile ego during childhood may also predict narcissism in adulthood.
  • Narcissistic individuals may be genetically predisposed to developing the disorder.
  • NPD is more likely to occur among individuals experiencing other personality disorders including antisocial personality disorder, histrionic personality disorder, borderline personality disorder, and schizotypal personality disorder.
  • Research demonstrates that the prevalence of narcissism tends to be higher among young adults relative to older adults.
  • NPD is typically more common among men than women, with research finding a lifetime prevalence of 7.7% in men and 4.8% in women.[2]

How Can You Support a Loved One with NPD?

Supporting a loved one with narcissism is a compassionate goal, but it can also be emotionally challenging. Here are some ways to provide support while prioritizing your own well-being:

  • Educate yourself about NPD to understand the nuances of the disorder and possible treatment or symptom management options.
  • Communicate to your loved one with NPD that you accept them. Remind yourself that their behaviours are a result of the pain they are experiencing due to their mental illness. Making them feel loved and supported can help guide them towards the proper treatment.
  • Encourage your loved one to seek treatment but recognize that you cannot force change. While it can be frustrating if they are resistant to help, remember that their behaviour is their responsibility, not yours.
  • Try to set and maintain healthy boundaries. Individuals with NPD may rely on others to meet their needs or expectations in ways that can feel overwhelming. Clearly express what you are willing and able to do and stay consistent in respecting your own limits.
  • Make sure to take care of your own needs and mental health. Avoid letting your loved one’s disorder take over your life. Try your best to maintain other social connections and support systems. Consider attending therapy or joining a support group.
  • People with NPD have an increased risk of suicide. If you notice signs of withdrawal or suspect your loved one is considering self-harm, address your concerns directly and compassionately. If they are in immediate danger, contact emergency services right away.

How Can Psychology Help?

There is no standardized treatment that exists for narcissism, but psychologists can help individuals with narcissism manage their symptoms with psychotherapy. Psychotherapy, or talk therapy, is a long-term approach to treatment focused on building a strong patient-therapist relationship.

  • Transference-focused therapy (TFT) is a twice-weekly approach that focuses on the patient’s feelings towards the therapist. This method proposes that people with narcissism separate positive and negative self-perceptions as a defence mechanism. The goal is to help them understand their emotions and integrate these self-perceptions in a healthy way.
  • Schema-focused therapy aims to help patients identify and adjust cognitive and behavioural patterns (i.e., schemas) that drive narcissistic traits. Narcissistic schemas, such as an inflated sense of self-importance, are enduring beliefs that develop early in life. This approach is especially useful for those who do not respond well to standard cognitive therapies.[3]

There are no medications currently available to treat personality disorders like NPD. However, many NPD patients benefit from the use of medications (e.g., antidepressants) to manage symptoms such as anxiety and depression.

In addition to treating those with NPD, psychologists play a critical role in supporting individuals affected by narcissistic behaviours, such as family members or friends. Psychoeducation can help these individuals understand the complexities of narcissism, set healthy boundaries, and develop effective coping strategies.

Psychologists can also continue to conduct research on narcissism to further our understanding and improve treatment approaches. By studying the underlying mechanisms and various expressions of narcissism, psychologists can refine existing therapeutic methods and develop new, evidence-based interventions tailored to individuals’ needs.

You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial, and some municipal associations of psychology may make available a referral list of practicing psychologists that can be searched for appropriate services. For the names and coordinates of provincial and territorial associations of psychology, go to  https://cpa.ca/public/whatisapsychologist/PTassociations/.

This fact sheet has been prepared for the Canadian Psychological Association by Erin Vine, MA.

Revised: January 2025

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[1] Kowalchyk, M., Palmieri, H., Conte, E., & Wallisch, P. (2021). Narcissism through the lens of performative self-elevation. Personality and Individual Differences, 177, Article 110780. https://doi.org/10.1016/j.paid.2021.110780

[2] Stinson, F. S., Dawson, D. A., Goldstein, R. B., Chou, S. P., Huang, B., Smith, S. M., Ruan, W. J., Pulay, A. J., Saha, T. D., Pickering, R. P., & Grant, B. F. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: Results from the wave 2 national epidemiologic survey on alcohol and related conditions. Journal of Clinical Psychiatry, 69(7), 1033-1045. https://doi.org/10.4088/jcp.v69n0701

[3] Bernstein, D. P. (2005). Schema therapy for personality disorders. In S. Strack (Ed.), Handbook of personology and psychopathology (pp. 462-477). John Wiley & Sons, Inc. https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=cdde7fb2a0b22decd35971ef82fd4473b1eb8837