Core traits
Narcissism and Narcissistic Personality Disorder
Explore what narcissism really means, the signs of NPD, and how therapy helps men develop empathy, self-awareness, and stronger connections.
Cultural expectations can make narcissistic traits more visible, tolerated, and even encouraged in men.
What is Narcissism?
Narcissism refers to a personality trait that concerns self-investment. “Normal” narcissism involves a healthy, positive sense of self-worth characterized by self-acceptance, curiosity, and compassion, including pride and enjoyment. It also relates to directions and goals in life, to capability and aspirations, and to ownership and appreciation of real accomplishment. Interpersonally, healthy narcissism motivates concern for and connection with others, with genuine interest in others’ thoughts and feelings, i.e., commitment and empathy. There is also an ability to tolerate both criticism and defeats.
In contrast, more problematic aspects of narcissism concern a distorted sense of self-worth and self-regard – feeling special or exceptional, or alternatively, feeling fundamentally flawed or “not good enough” – and maladaptive efforts to support a special or amplified self-image, or protect and hide their “not good enough” self. These efforts manifest as being absorbed in one’s self, self-inflation, compromised empathic abilities, and attitudes involving envy and entitlement.
Spectrum of Narcissism
Narcissism is viewed as dimensional (i.e., existing on a spectrum) rather than something someone “has” or “doesn’t have”, with features becoming more extreme and problematic at the pathological end.
Although a degree of self-enhancement may be considered normal and healthy, individuals with narcissistic problems seem driven by such needs, often reacting with either despair or rage upon the frustration or failure of self-enhancement efforts.
Healthy narcissism
Realistic degree of self-confidence, ambition, and resilience while allowing for empathy, reciprocity, and compromise in relationships, genuine interest in others’ thoughts and feelings.
Examples / Features:
Taking pride in achievements, setting ambitious goals, bouncing back from setbacks, being confident in leadership roles while still respecting others and supporting others’ goals and ambitions.
Problematic narcissism
Frequent focus on one’s self, self-promotion, often making efforts to solicit praise and acknowledgement from others, attention-seeking, competitiveness, critical or condescending attitudes toward others, social maneuvering.
Examples / Features:
Tends to react angrily to criticism, relationships characterized as being one-sided, need to “win” in disagreements, feelings of emptiness or “not being good enough” without praise and recognition from others.
Pathological narcissism
Persistent, rigid patterns of self-investment and self-enhancement, exaggerated validation needs, grandiosity, an entitlement to success and recognition without having expended the necessary efforts to achieve it, sense of being above the usual conventions and norms that bind society, lack of empathy.
Examples / Features:
Constantly seeking praise, exploitative, manipulative, or abusive relationships, inability to recognize others’ needs, chronic emptiness or rage when not admired, fantasies of “destroying” or triumphing over others after perceived injury or insult.
Narcissistic Personality Disorder (NPD)
Narcissistic Personality Disorder (NPD) is a formal mental health diagnosis. It involves pervasive patterns of grandiosity, need for admiration, and lack of empathy, usually beginning in early adulthood and present across different contexts (home, work, school, with friends, family etc.).
It’s important to remember that NPD is a real mental illness with genetic and environmental factors playing a part in its development, and requires professional treatment in the form of psychotherapy.
Core diagnostic features include:
- Exaggerated sense of self-importance
- Preoccupation with success, power, beauty, or brilliance
- Belief in being unique or special
- Strong need for excessive admiration
- Pervasive sense of entitlement
- Exploitative or manipulative relationships
- Lack or absence of empathy
- Envy and jealousy of others or belief others are envious
- Arrogant behaviour
A diagnosis usually requires five or more of these features to be present.
Narcissistic Subtypes
Pathological narcissism can be considerably problematic without necessarily constituting a diagnosis of full-blown NPD. Furthermore, contemporary perspectives on narcissism suggest a broader range of self-regulation difficulties than the arrogance and exploitativeness typically associated with the term.
Research has demonstrated that there are two general subtypes of narcissistic dysfunction:
- Grandiose narcissism is linked to aspects like dominance, entitlement, and self-confidence.
- Vulnerable narcissism is related to defensiveness, sensitivity to criticism, and feelings of inadequacy.
Grandiose Narcissism
Vulnerable Narcissism
Exaggerated sense of confidence, entitlement, dominance, attention-seeking
Shame, insecurity, hypersensitivity to criticism/insult
Self-esteem
Inflated or exaggerated sense of self-worth, feelings of being special or superior to others
Feelings of shame and inadequacy, fragile self-esteem, easily wounded
Social style
Outgoing, assertive, often dominating, sometimes charming, exploitative, lack of empathy
Withdrawn, shy, constrained, avoidant, defensive, self-sacrificing
Emotional regulation
Anger when challenged, dismissive of others, risk-taking
Anxious, feelings of helplessness, anger, shame, and envy are common
Narcissism Self Check
We have a self-check tool that can screen for narcissistic traits, but an evaluation by a mental health professional such as a psychiatrist or psychologist is required for a formal diagnosis.
How Common is NPD?
- The prevalence of NPD in the general population is estimated to be around 1-6%.[1]
- Studies consistently find higher prevalence in men than women. One U.S. epidemiological survey found 7.7% of men vs. 4.8% of women met lifetime criteria for NDP.[2]
- Subclinical narcissistic traits are more common than full-blown NPD.
- People tend to display more narcissistic traits in early adulthood, and may become slightly less narcissistic with older age.[2]
Narcissism in Men
Cultural expectations can make narcissistic traits more visible, tolerated, and even encouraged in men. Traits like dominance, competitiveness, and self-promotion may be socially reinforced, while vulnerability or sensitivity may be overlooked.[3]
- Men are more likely to present with grandiose narcissism (overt confidence, entitlement, pursuit of power).
- Though women may more often present with vulnerable narcissism (defensiveness, shame, hypersensitivity), it is still fairly common among men.
Impacts of Pathological Narcissism
- Mental health: High levels of narcissism often occur with depression, anxiety, and feelings of emptiness and dissatisfaction with life.
- Work and functioning: Can lead to burnout, job loss, or unstable career trajectories despite periods of high achievement.
- Relationships: Difficulty with empathy and reciprocity, cycles of conflict, and instability in romantic or work settings. Relationship dysfunction and loneliness are common.
If narcissistic traits are impacting your interpersonal relationships, our course on improving communication skills may help.
When to Seek Help
Narcissistic traits become a concern when they:
- Cause repeated conflicts or loss of relationships
- Lead to isolation or depression
- Result in risky, impulsive, or harmful behaviours
- Create persistent feelings of emptiness, shame, or anger
Seeking help is not about “fixing” or completely “changing one’s personality”, but about developing a better understanding of one’s one mind and what drives your behaviour, building healthier patterns, improving relationships, and reducing distress. If you’re concerned that you may be experiencing narcissistic traits that cause problems in your life, our self-check for narcissistic personality disorder is a quick screener that can give you immediate feedback and point you in the right direction if intervention is needed.
Treatment for Pathological Narcissism
While no medication directly treats narcissism, research has shown that psychotherapy is the primary treatment for helping people overcome difficulties associated with high levels of narcissism. Therapy can help with:
- Breaking rigid self-beliefs and improving emotional awareness
- Exploring patterns of engagement with others
- Improving emotion regulation and perspective-taking
Cognitive behavioural therapy (CBT) can help to change maladaptive thoughts and behaviours. Mouse over or tap on the boxes below to see what reframing these thoughts might look like:
Unhelpful Thought“Other people should admire me.”
Reframing“I’d like recognition, but relationships are stronger when I also show interest and appreciation for others.”
Unhelpful Thought“If someone disagrees with me, they’re against me.”
Reframing“Disagreement doesn’t equal disrespect. People can value me and still see things differently.”
Unhelpful Thought“If I show weakness, people will take advantage of me.”
Reframing“Being open about struggles can build trust and connection. People aren’t out there waiting to attack or humiliate me”
Unhelpful Thought"Apologizing makes me look weak."
Reframing“Owning up to my mistakes shows strength and character. It earns respect instead of taking it away.”
Research has consistently demonstrated that therapy can reduce distress and improve functioning, but progress may be slower due to difficulties with self-awareness and openness to feedback. Truly wanting to change, honesty, and a strong, trusting relationship with one’s therapist are key.
References:
- Yakeley, J. (2018). Current understanding of narcissism and narcissistic personality disorder. BJPsych Advances, 24(5), 305-315. https://doi.org/10.1192/bja.2018.20
- Stinson, F. S., Dawson, D. A., Golstein, R. B., Chou, 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. The Journal of Clinical Psychiatry, 69(7), 1033-1045. https://doi.org/10.4088/JCP.v69n070
- Grijalva, E., Newman, D. A., Tay, L., Donnellan, M. B., Harms, P. D., Robins, R. W., & Yan, T. (2015). Gender differences in narcissism: A meta-analytic review. Psychological Bulletin, 141(2), 261-310. https://doi.org/10.1037/a0038231