Narcissus, by Caravaggio
**Narcissistic personality disorder** (**NPD**) is a personality disorder derived from trauma, as all cluster B disorders are. It comes from extreme neglect and criticization in their childhoods, leading them to adapt to a certain survival instinct, and to shut down their emotions completely. People with NPD find it difficult to show empathy to others because of the lack of empathy they've been shown as children. They may have a sense of self-righteousness, and may defend themselves if they are in the wrong as a defense mechanism to past criticization. 

The American Psychiatric Association’s *Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition* (*DSM-5*) categorizes NPD as Cluster B personality disorder, with antisocial personality disorder, borderline personality disorder and histrionic personality disorder.[*source?*]

Cluster B personality disorders are also known as "dramatic" personality disorders. Common to these is very emotional behavior which creates problems in relationships. Studies have found that up to 6.3% of the general population suffers from narcissistic personality disorder and it is more prevalent in men than it is in women.

History
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Before the introduction of narcissistic personality disorder, the term narcissism was used to explain a person's extreme self-love and self-admiration. The word *narcissism* comes from Greek mythology. A handsome young man named Narcissus saw his own reflection in a pool of water and fell in love with himself. Narcissus' love could not be returned back and therefore he became a flower, which was named after him. 

In 1925 Robert Waelder introduced the term *narcissistic personality* and by 1968 the term narcissistic personality disorder was used by Heinz Kohut.

Signs and traits
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In order to be diagnosed with Narcissistic Personality Disorder, The American Psychiatric Association’s DSM-5 says that a person must show at least five of the following problematic behaviors:

1. Having a heightened sense of self-importance in order to isolate themselves to protect their mental well-being. People with NPD feel a lot of the time as though everyone is against them, and therefore feel like they're the only one they can truly trust.
2. Have a deep-rooted belief that others are out to get them, and will selectively choose people who are on their side in order to feel safer around others. This is called an "equal". They consider these equals as on the same level as them, and trust & respect them.
3. May require frequent admiration and affirmation in order to fill the lack of it in their childhoods.
4. Have a strong sense of justice, and will often become aggressive if what they believe to be true or right in their eyes is gone against.
5. May act in a manipulative manner unknowingly to persuade others, that is how they've been taught as children to get what they want.
6. Struggles with empathizing with others.
7. Envies anyone who they fear might be better than them.

  

It is important to note that there is a difference between narcissistic personality disorder and narcissistic traits. People with narcissistic personality traits show some of the behavior discussed above, but to a lesser degree than those with full-blown NPD.[*source?*]

Psychopathology
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People with NPD act very confident as a façade. A lot of people with NPD have deep-rooted self esteem issues, due to the criticization they received in their childhoods. They often need admiration and support from others in order to feel confident in themselves, and they tend to rely on other people to give them confidence. They may be obsessed with fantasies of power in order to make up for the lack of control they had during their abuse in childhood. They consider themselves to be in the right a lot of the time, because they feel they cannot trust anyone else, and are very wary about who they let into their life. They do strive for connection with others, and bonding. They are not inherently manipulative people, unless they're significantly unhealed or do not realize some of their behaviors can be abusive. In reality, these people can be very loving and attentive to their partners, as they don't want them to leave and strive to bond and make genuine connections with others, however, they tend to struggle with showing or expressing empathy to others, which makes it hard to connect. They may also struggle to maintain healthy relationships due to abandonment issues, and they become wary as the relationship goes on, insecurities fill their head, and they struggle to communicate their emotions with romantic partners. This can lead to misunderstandings, arguments, and problems during relationships. Due to a lot of the demonization on the internet and from therapists and community, a lot of people with NPD struggle asking for help, as a lot of the time they can be so deep into a mindset of survival they feel they do not need help, and that if they healed, or in their eyes, "became weaker", they may not be able to survive in the world. Listening to people with NPD can help demolish this stigma that they are manipulative, so that more people with this trauma disorder can reach out for help, and not feel afraid.

According to the DSM-5 narcissistic characteristics are often seen in successful people, but an individual can be diagnosed with NPD only when these traits affect their every day life by making it harder.

People with NPD often also have additional psychological disorders such as depression, bipolar disorder and substance abuse, as well as other disorders from the second cluster of personality disorders.

Types of NPD
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Narcissistic personality disorder can take many forms. These are the three general categories and their descriptions:

-       Overt narcissism: likely to be outgoing, arrogant, competitive, and struggle with empathy.

  

-       Covert narcissism: likely to express low self esteem, introversion, avoidance, and a tendency to victimize themselves.

  

- Antagonistic narcissism: likely to try to assert power, disagreeability or proneness to arguing, and tendency to compete with others

  

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Causes
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Narcissistic Personality Disorder is the result of a mix of genetic and environmental factors. Studies have suggested that there is 45-80% heritability, meaning that these traits are passed on from a parent to a child, supporting the genetic cause of the disorder. However it is important to remember that what is inherited is not the disorder per se, but a genetic predisposition (genotype) to developing this or any other type of mental disorder. This is where nurture comes in, because it is the environment that the person is living in that activates (or does not activate) the genotype. 

A lot depends on the dynamics within the family[*source?*]. If the child is neglected or constantly criticized, they may develop narcissistic personality disorder as a way of compensating for the lack of love and attention. In all cases the child has suffered damage to their psyche that is called a narcissistic injury. 

Finally, from a neurological view, studies have found that NPD is connected to a change in the brain, making it hard to express and control emotions such as empathy.

Treatment
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There is no strong evidence of treatment or managing options that work. However, as with many personality disorders, the most common and used option is psychotherapy and psychodynamic methods.These options seem to be the ones most likely to control narcissism. Mental conditions that often come with narcissistic personality disorder, such as depression or anxiety disorder can be treated, but there is no evidence that medicine can treat narcissistic symptoms.