Narcissistic personality disorder, or narcissism, is one of the mental disorders associated with a particularly strong and non-adaptable personality. The narcissist appears very self-absorbed, but in fact has very little self-esteem and is always looking for approval.


What is narcissism?

The personality disorder was named after the legend of Narciss, who is so in love with his reflection that he can neither recognize nor return the love of the nymph Echo. He dies over his despair of not being able to reach his reflection. See photionary for Cryoglobulinemia 101.

One could now assume that the narcissist is characterized by a great deal of self-love. However, it is not that simple, narcissistic personality disorder is a complex mental disorder with many symptoms.

Those affected suffer from a strong internal rejection of themselves, combined with very low self-confidence. Due to their constant search for admiration and recognition, this appears to the outside world as exaggerated self-confidence, arrogance and as if those affected take themselves very seriously.


Narcissistic personality disorder is a complex mental disorder that is largely similar to borderline symptoms.

However, narcissists differ from borderline sufferers in important ways. They usually have very good impulse control and do not suffer from self-destructive behaviors. However, the similarity of the two disorders is evident in their causes.

Both disorders are early childhood and arise from insufficient or excessive parental attention. These traumatic experiences are repeated in adulthood with a lack of self-confidence and an excessive search for recognition with a compulsion to perform and are passed on to the environment.

However, it must be said that those affected are usually not aware of their behavior and therefore cannot be said to have acted intentionally on the part of the individual.

Symptoms, Ailments & Signs

Narcissism shows itself primarily in a greatly increased self-esteem. The narcissist thinks of himself as special and unique. This results in him becoming very self-centered and trying to impress others. Lying and self-deception are often part of the image the narcissist tries to maintain of themselves.

Social skills are lost as a result. Thus, people with narcissistic personality disorder are less capable of empathy. In interpersonal relationships, they are unable or hardly able to return emotions. Narcissists therefore often come across as cool and arrogant to those around them.

The urge to be important can be expressed in two forms: the narcissist can either constantly flaunt his (supposed) ability or be very modest. Narcissistic people often have dreams and fantasies about money and status. Your behavior is designed accordingly.

Expectations of other people are based on the idea that they are there to meet the needs of the narcissist. Accordingly, narcissists take advantage of other people. They sometimes react maliciously when their expectations are not met. Outbursts of anger and revenge occur. Similarly, narcissists are easily angered. Narcissists are also prone to envy and believe that others are jealous of them.

Diagnosis & History

The diagnosis of narcissistic personality disorder follows the survey pattern for all mental disorders and takes place in the outpatient clinic of a psychiatric clinic.

Although self-tests can be found on the Internet, their validity can be doubted, especially since these tests can only cover a few facets of behavior and only a few symptoms. The detailed diagnosis of a personality disorder usually takes several hours and includes personal discussions with a therapist as well as filling out numerous questionnaires.

This exact diagnosis is important in order to make a specific diagnosis, to be able to identify the individually strong symptoms and thus the exact disorder. Because only then can an individual therapy be initiated. Like all severe personality disorders, narcissism cannot be completely treated; the affected person can only be helped to lead a symptom-free life.


Narcissistic personalities place high demands on themselves and those around them. Your grandiose demeanor and strong sensitivity to criticism make dealing with other people difficult. Above all, those affected with the grandiose expression of narcissism often offend or become angry if they do not receive the longed-for confirmation and recognition from those around them.

Although there is a desire to belong, a lack of empathy leads to recurring social conflicts. As a result, narcissists experience rejection from those around them and become isolated. Those affected with vulnerable narcissism, on the other hand, are often overadjusted and suffer from a lack of self-esteem. Dealing with other people is also a challenge for them due to social anxiety and the fear of rejection. They tend to exhibit avoidant behavior.

As a result of the social difficulties that arise as a result of this personality structure, those affected can develop depression or anxiety disorders. Not infrequently, they also tend to addictive behavior. Psychotherapy and psychoanalysis based on depth psychology help those affected to deal better with their specific problems.

The aim is to stabilize self-esteem. However, the behavioral patterns are pervasive and difficult to treat. Conflicts can also arise in therapy due to the experience of being hurt.

When should you go to the doctor?

The problem with narcissism is that the person affected has no insight into their narcissistic personality structure. He therefore does not consider them to be in need of treatment. Those around them often suffer significantly from the behavior of the narcissist. It is not uncommon for victims of narcissists to seek treatment.

Narcissistic personality disorder is considered untreatable. The psychological strain of a narcissist can be high. But most of the time he will still not see a therapist. Other people don’t dare to recommend therapy to him. You would have to expect corresponding reactions. One of the hallmarks of a narcissist is their complete lack of insight coupled with an unwillingness to change.

Treatment & Therapy

Narcissistic personality disorder is treated with psychotherapeutic measures and, depending on the severity and severity of the symptoms, psychotropic drugs. The treatment of accompanying symptoms and problems is also important. In those affected by the narcissistic personality disorder, these are primarily depression and drug abuse.

As a rule, the patient can determine which form of therapy suits him best: inpatient or outpatient. Depth psychology, psychoanalysis or behaviorism. However, the diagnosis and the assessment of the need for therapy made there plays a major role in finding the right therapy. If it is determined that the patient requires several weeks of inpatient therapy due to the severity of his symptoms, outpatient measures are usually not effective.

The search for a therapist is made more difficult by the fact that many psychologists find themselves overwhelmed by severe personality disorders and do not include those affected in their patient files, so that they actually have much less leeway in choosing the appropriate therapy than would be theoretically possible.

In order to be able to initiate a successful therapy, the person concerned must have a pronounced psychological strain that motivates him or her to cooperate. Forced therapy or psychological intervention against the will of the patient or in the case of insufficient motivation are not promising and are therefore not carried out.

Outlook & Forecast

Prognosis varies greatly for people with narcissistic personality disorder. Overall, people in therapy have a better prognosis. The key is the ability to learn proper self-awareness. Stable interpersonal relationships that allow a high degree of trust and reflection to develop, as well as a personal sense of achievement that arises from one’s own skills, are also considered helpful.

These factors have a positive effect on narcissism because they make the person concerned aware of his abilities and confront him with the consequences of his actions.

Inaccessible narcissists have a significantly poorer prognosis. This is especially true for people who experience many failures and are not amenable to therapy. Alcohol and other drugs often make matters worse in these cases. Accordingly, narcissism is experienced in the sense of a perceived high level of self-worth. But reality does not match this self-image.

Narcissists are also at risk of failing badly and frustrating them to the point of experiencing depressive episodes. On the other hand, these personal breakdowns are often cited by patients as a reason for seeing a therapist.


Narcissistic personality disorder cannot be prevented on your own. Parental love and care and, if necessary, timely intervention are the most important keys to prevention.


People who have narcissistic personality disorder often have to work on themselves throughout their lives to walk the fine line between normal and exaggerated narcissism. A high level of willingness on the part of the patient to actively participate in the treatment and aftercare often has a positive influence on further personal development.

In the final phase of psychotherapy, therapists often work out strategies for aftercare with their patients. It is often about how those affected can maintain the success of the therapy. After inpatient therapy, clinics offer special programs to support their patients in the period after discharge.

As a rule, these are outpatient offers that are intended to facilitate the transition from the clinic to everyday life. Within this framework, various therapeutic approaches can be used, for example discussion groups, psychoeducation programs or one-on-one talks with a psychiatrist or psychotherapist. Follow-up care can also include care or support from a social worker.

Narcissistic personality disorder is not equally severe in every patient. The aftercare can therefore also be designed with different degrees of intensity, for example by adjusting the frequency of the discussions.

You can do that yourself

Narcissists often have trouble empathizing with other people. Therefore, it can be helpful if you consciously deal with the topic of empathy. For example, if a person reacts differently than expected, they can stop and consider how the situation went from the other person’s perspective.

Often people feel offended by narcissists because they perceived a situation completely differently. The narcissist’s lack of understanding often makes it even more difficult for them or provokes anger. Narcissists often have to learn to recognize the legitimateness of such negative and hurt reactions from friends, acquaintances, and family members.

Some narcissists tend to manipulate other people. The influence doesn’t have to be malicious at all – it typically has the goal of pleasing others and putting yourself first. A commonly used tool is to make other people dependent on you. If a narcissist is prone to such behaviors, they should become aware of their own patterns. He can then consider why he is behaving a certain way and whether the intention is appropriate.

Support groups can help support this reflection. The Internet offers the opportunity to anonymously ask for opinions – for example on typical situations in which the person concerned cannot put themselves in other people’s shoes.