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Narcissistic Personality Disorder & Substance Use Disorders

Narcissistic personality disorder (NPD) is characterized by an inflated sense of self, a lack of empathy, and a need to be admired by others.1, 3 It commonly co-occurs with substance use disorders.1 Someone who struggles with addiction and has a personality disorder should receive individualized treatment to help address both conditions and potentially improve treatment outcomes.2

What Is Narcissistic Personality Disorder (NPD)?

The definition of narcissistic personality disorder is “a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy.”1, 3, 4

Typically, people aren’t diagnosed with personality disorders until they are over 18 because they are still developing their personalities.4 In clinical settings, it’s found that anywhere from 1% to 15% of the U.S. population has NPD, and can often co-occur with other personality disorders like borderline personality disorder.4

Signs of Narcissistic Personality Disorder

Only a qualified mental health professional can diagnose personality disorders; however, if you suspect that you or a loved one are struggling with Narcissistic Personality Disorder ( NPD ), the following criteria may help you decide it’s time to get help.4

For someone to meet the criteria for narcissistic personality disorder ( NPD ), at least 5 of the following signs and symptoms must be present:1, 3

  • Has an inflated sense of importance, expects to be viewed as superior, and exaggerates their 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 suspect that others envy them
  • 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 personality disorders may display problematic behaviors, which can cause significant life impairment.1, 3

Narcissistic Traits

People with narcissistic personality disorder are often:1

  • Preoccupied with fantasies of success, power, love, and beauty.
  • Needs to be recognized for achievements, even if they didn’t complete them.
  • Believes they are more special than others.
  • Has a strong sense of entitlement and high expectations.
  • Uses others for their own means.
  • Not empathetic to others.
  • Arrogant and proud.

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

Narcissistic Personality Disorder and Addiction

Narcissistic personality disorder is associated with substance use disorders (SUDs).1 Those with co-occurring narcissistic and substance use disorders have been found to display aggression and hostility, which can make treatment more challenging.1

Narcissistic personality disorder with a co-occurring substance use disorder 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.2

Signs of Substance Use Disorders

Like NPD, SUDs can only be diagnosed by a qualified medical professional. If you are unsure if you or someone you know suffers from addiction, recognizing common signs of a SUD may help you decide when to seek help. If you experience 2 or more of the following in a 12-month period, you may consider getting support or treatment:3

  • More of the substance is consumed more often than the person 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 person has a strong craving to use the substance.
  • Substance use interferes with work, home, or school responsibilities.
  • The person continues to use the substance 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 it anyway.
  • The person develops tolerance, which is needing more of the substance to achieve the same effects they once achieved with smaller amounts.
  • The person experiences withdrawal symptoms when they try to stop using the substance.

Treatment for Co-occurring Disorders

When choosing a treatment center for narcissistic personality disorder and co-occurring substance misuse, you’ll want to consider several factors like:

  • Cost.
  • Location.
  • Qualifications of the staff.
  • Amenities offered in the program.
  • Insurance accepted.

A typical inpatient dual diagnosis program will include the following elements:5

  • 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.4
  • 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.
  • Medication management. In some cases, you may be prescribed medication to help decrease cravings and ease withdrawal symptoms. You may also be prescribed medication to treat co-occurring mental health conditions.
  • Behavioral 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 use disorders. They will work with you on understanding any negative thoughts, feelings, and behaviors while helping you develop 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:

Causes of Narcissistic Personality Disorder

The causes of NPD are not entirely known but are thought to be associated with several factors including genetic predisposition and environmental experiences in childhood.1 Children who are rejected or have negative experiences in developmental years may also present with NPD.1

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