Which of the following is least likely to involve making unrealistic demands on the person?

A personality disorder affects how a person feels, thinks, acts, and relates to others. A high sense of self-importance can mask low self-esteem in a person with a narcissistic personality disorder.

Someone with narcissistic personality disorder (NPD) may have an excessive concern with prestige and power and a lack of empathy for others.

To others, a person with NPD may seem to:

• act selfishly
• be manipulative and demanding
• have difficulty empathizing or considering others’ needs or feelings
• be arrogant

These behaviors often stem from a need to cover up deep feelings of insecurity.

Health professionals group personality disorders into different clusters. NPD is a cluster B personality disorder. People with cluster B disorders find it hard to manage emotions and may have unpredictable behavior.

NPD gets its name from a Greek myth in which a hunter named Narcissus saw his reflection in a pool of water and fell in love with it.

A person with NPD may have an idealized self-image and an unrealistic sense of superiority. These traits can mask a lack of self-confidence and a deep sense of insecurity. A person with NPD may be unaware that they have a disorder.

The following are key features of NPD:

• a need for admiration
• a pattern of grandiosity
• a lack of empathy for others

Research suggests that NPD affects between 0.5–5% of people in community samples in the United States. Across the whole population of the U.S., NPD may affect between 1–15% of people.

How people with NPD see themselves can be very different from how others see them.

Features of the condition that may be noticeable to others include:

• craving attention and admiration
• having fragile self-esteem and feeling disappointed when admiration is not forthcoming
• having an excessive feeling of superiority
• exaggerating intimacy with others, especially those with wealth or VIP status
• overestimating achievements and talents
• undervaluing the achievements of others
• having a preoccupation with success, power, brilliance, beauty, or ideal love
• believing in their uniqueness and that only “special” people can understand it
• having a sense of entitlement
• taking advantage of others to achieve their own goals
• being unable or unwilling to identify with the feelings or needs of others
• feeling jealous and believing that others are jealous of them
• behaving in a way that seems arrogant or haughty to others
• showing great charm but quickly becoming irritated or angry
• talking at length about their concerns but lacking interest in the concerns of others
• showing aggression when faced with a threat to their ego

Other features may have a less obvious link with narcissism, such as:

• a sense of shame, humiliation, and emptiness when disappointed
• unwillingness to try something for fear of defeat
• difficulty maintaining relationships
• a sense of alienation or emotional disconnect from others
• high achievement due to overconfidence but poor performance in the face of defeat or criticism
• suspiciousness
• social withdrawal
• difficulty managing emotions

In some cases, other disorders such as depression and anxiety can accompany NPD.

Diagnosing NPD can be challenging, as it is one of several types of personality disorders, and some features may overlap. A person may also have NPD alongside another condition that affects their mood and behaviors.

In addition, a person with NPD may not recognize that problems in their life stem from their behavior and may blame others instead.

Someone with NPD may be highly sensitive to perceived criticisms or slights, making it difficult for others to talk with them about their behavior and how it can be harmful.

To diagnose NPD, a clinician needs to find at least five of the following criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition:

• a grandiose sense of self-importance
• a preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
• a belief that they are unique and can only be understood by, or should only associate with, other special or high-status people or institutions
• a need for excessive admiration
• an increased sense of entitlement
• a tendency to take advantage of others to achieve their own ends
• a lack of empathy and unwillingness to recognize or identify with the feelings and needs of others
• envy of others and the belief that others are envious of them
• arrogant, haughty behaviors or attitudes

NPD is a spectrum disorder, and the symptoms can range from mild to severe.

When diagnosing NPD, there are two subtypes health professionals look for:

• The grandiose subtype: This includes overt grandiosity, aggression, and boldness.
• The vulnerable subtype: This involves hypersensitivity and defensiveness, which may be easier to miss during a diagnosis.

There is no standard treatment for NPD. However, certain therapies may help a person manage the condition and replace negative behavioral patterns with more positive ones.

Medications may help certain symptoms if NPD occurs with another disorder, such as depression or anxiety.

Currently, the most useful treatment method seems to be psychotherapy. This can help a person:

• create a more realistic self-image
• become more aware of the condition
• understand what underlies their behavior
• manage their emotions more effectively
• learn to take responsibility for their actions
• learn to build healthier relationships
• build up their self-esteem
• adjust their expectations of themselves and others
• understand the impact of their behavior on others

Cognitive behavioral therapy (CBT), family therapy, or group therapy are other types of psychotherapy that may also help.

CBT aims to identify unhealthy or harmful beliefs and behaviors and replace them with healthy, more adaptive ones. Family or couples therapy can help the loved ones of a person with NPD. Sessions may involve improving communication, dealing with any relationship issues, and problem-solving.