Narcissistic Personality Disorder

A heightened sense of self-importance and uniqueness, coupled paradoxically with a fragile self-esteem that is sensitive even to minor criticism. Prevalence is roughly 1–6%; children of an affected parent are more likely to develop the disorder themselves.

Clinical features

• Grandiose sense of self-importance — may be preoccupied with fantasies of unlimited fame, success, brilliance, or beauty.
• Expects to be recognised as superior without corresponding achievement, and expects special treatment.
• Cannot tolerate criticism, and may become enraged when criticised.
• Tenuous relationships, with exploitative behaviour.
• Lacks empathy, and shows sympathy only instrumentally, to achieve their own goals.
• Susceptible to depression, given the fragility of their underlying self-esteem.
• Suicide attempt risk is around 2.4× lower than in non-NPD patients within mood-disorder samples, after controlling for aggression, hostility and substance use — not a general-population comparison.
• NPD is not protective against attempt lethality.
• NPD carries a higher risk of suicide death compared with other personality disorders when patients do attempt.

Management

Difficult to treat. Psychotherapy may help, as can treating any concurrent depression.