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Narcissistic Personality Disorder and Substance Abuse: Signs, Symptoms, and Treatment

Getting Help for Narcissistic Personality Disorder and Addiction

Narcissistic personality disorder (NPD) is characterized by an inflated sense of self and a lack of empathy. It commonly co-occurs with an addiction to drugs or alcohol.1 Someone who has a substance addiction and personality disorder must receive individualized treatment to address both conditions.

Narcissistic Personality Disorder Definition

The definition of narcissistic personality disorder is “a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy.”1 The onset must be by early adulthood.1

The prevalence of narcissistic personality disorder ranges from 0% to a little more than 6% of the general population.1

Signs and Symptoms 

For someone to meet the criteria for narcissistic personality disorder, at least 5 of the following signs and symptoms must be present:1
  • Has an inflated sense of importance, expects to be viewed as superior, and exaggerates own skills
  • Obsesses over boundless success, intelligence, beauty, power, or ideal love
  • Believes that they are unique and “special” and shouldn’t associate with others who aren’t
  • Needs an inordinate amount of admiration and attention
  • Feels entitled and expects better treatment than others
  • Takes advantage of others for personal gain
  • Fails to display empathy
  • Displays envy or suspects that others envy him or her
  • Has an arrogant or pompous attitude

It’s important to distinguish between people with some narcissistic traits and those with narcissistic personality disorder. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), many high-functioning people display some of these personality traits. However, those with the personality disorder display maladaptive and problematic behaviors that cause significant life impairment.1

Narcissistic Traits

People with narcissistic personality disorder are often:1
  • Pretentious.
  • Boastful.
  • Devaluing of others.
  • Preoccupied with how they are regarded by others.
  • Furious when they are not catered to.
  • Contemptuous when others discuss their own troubles or feelings.
  • Oblivious to the pain they inflict on others.
  • Emotionally cold.
  • Jealous.
  • Patronizing.
  • Snobbish.
  • Extremely sensitive to criticism.

Not every person suffering from this mental health disorder will display all of these traits. Narcissistic personality disorder presents itself differently from person to person.

Narcissistic Personality Disorder and Addiction

Narcissistic personality disorder is associated with substance addiction—particularly cocaine.1 In one study consisting of about 35,000 participants, nearly 12% of those diagnosed with a substance addiction also met the criteria for narcissistic personality disorder. A little more than 64% of participants with the disorder had also abused a substance.2

Narcissistic personality disorder with a co-occurring substance addiction requires a comprehensive treatment plan that will improve the person’s relationships with others, while uncovering the underlying reasons for substance addiction and helping the person build coping skills.

Signs of Addiction

If you are unsure if you or someone you know suffers from addiction, some common signs of a substance abuse disorder include:1

  • More of the substance is consumed and more often than the user initially intended.
  • The person has many failed attempts to quit using the substance.
  • An excessive amount of time is spent buying and using the substance and recuperating from its effects.
  • The user has a strong craving to use the substance.
  • Substance use interferes with work, home, or school responsibilities.
  • The person continues to use regardless of the consequences.
  • The person chooses the substance over previously enjoyed activities.
  • The person uses the substance in dangerous situations such as driving.
  • The person is aware of psychological or physical problems caused or worsened by the substance but chooses to use anyway.
  • Develops tolerance, which is needing bigger amounts of the substance to get the same desired effects they once achieved with smaller amounts.
  • Experiencing withdrawal symptoms once use is stopped; they may also use the substance to prevent or alleviate withdrawal symptoms.

Treatment for Both Disorders

When choosing a treatment center for narcissistic personality disorder and co-occurring substance abuse, some things to think about include the cost, the location, the qualifications of the staff, and the amenities offered at the program.

A typical inpatient dual diagnosis program will include the following elements:

  • Intake evaluation. Mental health professionals will evaluate you for any additional psychiatric diagnoses and will assess the nature of your addiction and narcissistic personality disorder. It’s important that you are evaluated before establishing a treatment plan so that the plan can be tailored to your unique situation.3
  • Detox. Before beginning any therapy or counseling, you will need to detox from drugs or alcohol in a safe and comfortable setting. The treatment center will provide you with 24-hour comfort care as well as medication, if necessary.
  • Medical maintenance. In some cases, you may be prescribed medication to help prevent relapse and decrease cravings.
  • Therapy. You want to make sure the recovery center employs therapists who are experienced in treating those with narcissistic personality disorder and co-occurring substance abuse disorders. They will work with you on any negative thoughts, feelings, and behaviors, while teaching you healthy coping skills.
  • Group counseling. Certified mental health professionals will facilitate group counseling sessions where you can learn how to interact with others in a positive manner and use sober social skills.
  • Aftercare planning. Your treatment team will collaborate on a helpful plan for you to follow once you complete your inpatient stay. The plan will contain relapse prevention tactics and ongoing recovery programs. Examples of aftercare options include:

Challenges of Treating Narcissistic Personality Disorder

Treating narcissistic personality disorder may be challenging at first because the person may not value the therapist’s opinion or views. People with this disorder tend to value others only as much as others can fulfill their needs. This characteristic may be a roadblock for therapists who have difficulty tolerating these behaviors long-term before beginning to build trust.5

The best therapists will be patient and understanding of the person’s vulnerability while helping them to develop a more stable sense of self-identity and self-worth.3

Causes of Narcissistic Personality Disorder

Narcissistic personality disorder has no known cause, but it is thought to have roots in how a person was socialized as a child. Recent research suggests that narcissistic traits in children are often developed when parents have an inflated view of the child and treat them as if they are more important than others.4 The children who demonstrate these characteristics tend to absorb these beliefs about themselves.4

These findings can pave the way for the development and application of parental training interventions.4

Another point of view is that people with narcissistic personality disorder fail to develop a stable, secure sense of self-worth and identity. So their behavior tries to compensate for an internal “emptiness”—needing the approval of others to maintain high self-esteem.

  1. Diagnostic and statistical manual of mental disorders: DSM-5. (2013). Washington, D.C.: American Psychiatric Association.
  2. Stinson, F. S., Dawson, D. A., Golstein, R. B., Chou, P., Huang, B., Smith, S. M., . . . Grant, B. F. (2008). Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Narcissistic Personality Disorder. The Journal of Clinical Psychiatry, 69(7), 1033–1045.
  3. Links, P. S. & Prakash, A. (2013). Strategic Issues in the Psychotherapy of Patients with Narcissistic Pathology. Journal of Contemporary Psychotherapy, 44(2), 97–107.
  4. Brummelman, E. & Thomaes, S. (2015). Origins of narcissism in children. Proceedings of the National Academy of Sciences of the United States of America, 112(12), 3659–3662. 
  5. Meissner W.W. (1996). The Therapeutic Alliance. Yale University Press, New Haven, CT.