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Is your teen unhappy, lacking in close friends and totally self obsessed? Is this a normal developmental stage of adolescence or do these symptoms indicate narcissistic personality disorder (NPD)? How can you tell the difference?

Firstly, don’t panic! Many teens seem totally self obsessed at some stage and most simply grow-out of their behaviors. As time passes and teens mature – and as responsibilities increase – you may notice that the worrisome behaviors diminish. Perhaps you will observe the formation of healthy interpersonal relationships and behaviors which demonstrate increased awareness, empathy and compassion.

  • In effect, these egotistical adolescent ‘narcissistic’ indicators may merely represent a developmental stage in a teen’s personal growth and maturity – and nothing more.

It should be pointed out that – contrary to popular notion -- those with NPD actually do not love and adore themselves excessively rather they are void of self-love and self-worth and can be dangerous to both themselves and others.

NPD is much darker:

  • Those diagnosed with NPD often suffer depression, have thoughts of suicide, and exhibit a pattern of repeated failed interpersonal relationships. A swirl of trouble and high conflict at work and at school constantly surrounds them.  

Diagnosing Narcissist Personality Disorder

The DSM-IV-TR defines narcissistic personality disorder as:

  • “An all-pervasive pattern of grandiosity (in fantasy or behavior), need for admiration or adulation, and lack of empathy, usually beginning by early adulthood and present in various contexts.”1

A list of traits associated with NPD are listed below. In order for an individual to be diagnosed as NPD at least five (5) of the traits identified must be present.

  1. Is assuredly convinced that he or she is special, unique and can only interact and associate with other special, uniquely qualified or high-status people (or institutions).
  2. Insists on being treated with excessive adulation, admiration, attention and  affirmation.  Or, if not, then desires instead to be feared and viewed as infamous or notorious.
  3. Demonstrates a sense of grandiosity and self-importance (e.g., grossly exaggerates skills, accomplishments, talents, connections and personality traits to the point of lying; demands to be recognized as superior without demonstrating actual achievement to support the claim.)
  4. Exploits personal relationships focusing only on his or her own goals at the expense of others.  
  5. Demonstrates characteristics of at least one of the two narcissistic types: 'The Cerebral Narcissist' is driven with fantasies of boundless success, notoriety, tremendous power or omnipotence and incomparable brilliance. 'The Somatic Narcissist' is obsessed with his or her bodily beauty or sexual performance or ideal, everlasting, all-conquering love or passion.
  6. Believes he or she is “above the law” and all knowing (omnipresent). Behaves in a superior, invincible, immune way, and when questioned or frustrated by people he or she views as either inferior or unworthy – rages.
  7. The individual presents as arrogant and haughty, possessing a strong sense of entitlement and demanding full and unquestionable compliance with his or her unreasonable expectations for special favor and exemplary treatment.
  8. Possesses a severe lack of empathy. Cannot accept - or even acknowledge - the  needs, feelings, desires, choices, preferences or priorities of another.
  9. Demonstrates continuous examples of envy and jealously. Sets out to hurt and demolish the source of his or her frustration. Experiences paranoid delusions believing that others feel identically about him or her and will act in the same manner toward them.

To further determine whether or not an adolescent suffers NPD, consider these developmental and environmental factors, which are thought to contribute to NPD:

  • Unreliable or unpredictable caregiving from parents 
  • Experiences in childhood, such as loss of a father figure
  • Suffers severe childhood emotional abuse 
  • Excessively condescending or critical environment - Is overindulged and over-praised by her parents
  • Possesses an oversensitive temperament from birth 
  • Learned manipulative behaviors as a way to get what she wanted

Note that chronic insomnia, over-work, ongoing exposure to high levels of stress, substance abuse, medical problems, and difficulties with family or other interpersonal relationships can exacerbate the symptoms of a personality disorder.

Treating Teen Narcissistic Personality Disorder

As teens are generally in a fragile mental state it makes it especially difficult to treat teens who suffer narcissistic personality disorder. Treatment attempts are often met with disdain making it impossible to develop the proper and necessary therapeutic therapist-client alliance. The teen’s own self-perception often interferes with this essential process.

  • A therapeutic objective is to teach the teenager to value him or herself on a more realistic level and to adjust one's thinking about others' value in relation to his or her own. Exercises designed to assist the teen in developing empathy for others would be an aspect of treatment of this personality disorder.
  • In general, medication is not part of the treatment plan, except in those cases where depression and anxiety emerge as the teen struggles to cope with his or her new reality of self.
  • Group therapy (such as Dialectical Behavioral Therapy), somatic experiencing, anger management, sleep management, psycho-education and individual psychotherapies can help.
  • Neuro-feedback techniques can also be utilized in conjunction with the other therapies.
  • Holistic remedies such as yoga, meditation, acupuncture and massage therapy can support and enhance treatment and healing.
  • Family therapy groups that incorporate family members and significant others into the therapeutic treatment plan are advantageous.

This combination of treatments can show good result in dealing with personality disorders.

Factors That Slow Recovery

Keep in mind, though, that:

  1. Narcissists rarely enter treatment and when they do they often view it as a ‘waste of time’. Depression – as well as substance abuse, specifically alcohol, marijuana or cocaine -- are prevalent among persons with this disorder and negatively impact psychological and medical treatment.
  2. Individuals with NPD typically have interpersonal problems with family, loved ones, classmates and co-workers – therefore, their impaired social support structure adds another layer of difficulty regarding their entrance into and continuation of treatment.
  3. NPD’s who are excessively impulsive or self-destructive will require more intensive therapy and resolution will come at a slower pace.

Friends and Family Can Accelerate Treatment

It may be very difficult and challenging for friends, family and loved ones to help and support because persons with NPD have great difficulties with interpersonal relationships.

  1. Family and friends can help by educating themselves about NPD in order to interact emphatically and with compassion for the person who has NPD.
  2. Family and friends are an indispensable resource when it comes to monitoring symptoms and watching for dangerous maladaptive behaviors.
  3. There are some treatment centers that specialize in working with individuals with NPD and friends and family can provide emotional support and financial resources.

The Prognosis

  1. NPD is generally a chronic life-long disturbance with periods of remission and exacerbation (worsening) dependent on changing life circumstances.
  2. Psychotherapy over time, coupled with sleep and stress management, and psycho-education, can address related problems.
  3. When a person with NPD develops depression or substance abuse, treatment becomes imperative.
  4. Clients who do receive effective treatment will experience significant improvement in their ability to function normally in their daily lives, with improvement in their interpersonal relationships.
  • 1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: Author.
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Page last updated Jul 13, 2014

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