Causes, Risk Factors, And Complications Of Narcissistic Personality Disorder

January 17, 2024

The psychological name for self-centered behavior and those who show little care for others around them is narcissistic personality disorder (NPD). This condition involves a person with an inflated sense of self-importance. Individuals with this disorder may lack the ability to empathize with others and may take advantage of others to reach their own goals. Yet this inflated ego is often a cover for low self-esteem and a psyche unable to handle criticism or failure. While there is not a full understanding of the origins of narcissistic personality disorder, several factors seem to be involved.


Recent twin studies have pointed to genetics as a factor in the emergence of narcissistic personality disorder. However, it is not clear how strong a role genetic factors play in the disorder's manifestation. One issue with current studies is many individuals with narcissistic personality disorder do not see themselves as having an issue, so study participant numbers are limited. It may be certain individuals have a genetic predisposition to this disorder.

When such individuals experience external factors such as childhood trauma or a negative parenting style, they may be more apt to develop narcissistic personality disorder than individuals who do not have a genetic predisposition. While an individual's genes may influence the development of the disorder, there is not yet a direct correlation between genetic factors and narcissistic personality disorder.


Studies of the neurobiology of individuals with narcissistic personality disorder have one of the same issues as genetic studies. The suggestion to an individual with this condition that their personality is abnormal is a threat to an already fragile self-esteem. This fact limits the pool of volunteers, limiting study sizes. However, there is some evidence patients with narcissistic personality disorder have deficits in the grey matter in prefrontal areas, which may lead to lack of control in emotional reactions. Functional MRI scans on individuals show less activity in the anterior insular cortex, the area of the brain where empathy arises, when asked to deal with the emotions of others. This indicates these individuals are predisposed to have a limited ability to feel, much less express, empathy.

Certain Parenting Styles

One of the factors leading to a high risk of narcissistic personality disorder is exposure to certain parenting styles as a child. Two of these styles seem to be in opposition: over-indulgent parenting and neglectful parenting. Over-indulgent parenting involves a parent who constantly praises a child and protects them from experiencing failure. When the child does fall short, the parent blames someone or something else.

The child grows with a sense of entitlement and becomes convinced they are inherently special, feelings that can later manifest as narcissistic personality disorder. On the other hand, neglectful parenting, where the child is ignored or actively criticized, can lead to a situation where a child is constantly trying to prove the neglectful parent wrong. The child learns to cope with the parent's rejection by convincing themselves of being special and important. The constant desire to avoid being a loser can manifest as narcissistic personality disorder in later life.

Risk Of Gender

Because of the lack of self-reporting, the risk of gender in narcissistic personality disorder is not entirely clear. It does, however, seem men are more likely to develop this disorder than women. This may be, in part, due to cultural factors that encourage men to avoid strong emotion, leading them to see expressions of emotion as weak. It is also suggested this cultural training often happens around the teenage years, a time when most young individuals are prone to a natural level of narcissism. If narcissistic tendencies are encouraged rather than challenged, it may lead to narcissistic personality disorder in predisposed individuals.

Mismanagement Of Setbacks

The mismanagement of the setbacks of life is a strong factor in the development of narcissistic personality disorder. Everyone experiences failure and criticism as they grow. Part of becoming a mature person is developing the resiliency to handle such disappointments; to learn and grow through them. When an individual is taught, either through parenting or culture, these setbacks are not a normal part of life and are always someone else's fault, it can lead to a narcissistic view of the world. Because narcissism is often a product of low self-esteem, the narcissist is most comfortable when they can blame others for misfortune, maintaining the illusion they are too special and important for failure or shortcomings. This habitual pattern of thinking can then develop into narcissistic personality disorder.

Significant Relationship Difficulties

Narcissistic personality disorder patients often experience significant relationship difficulties not only in their romantic relationships, but also in their familial relationships, friendships, and work relationships. An individual with untreated NPD will often prioritize themselves above all else and expect others to do the same, but they may not offer support for others in return.

They have difficulty recognizing the needs of others and may consciously or unconsciously manipulate others to get what they want. One of the most important things to do in any relationship is to set healthy boundaries. This becomes doubly vital for individuals with narcissistic personality disorder and those close to them, as healthy boundaries give the affected individual rules to live by that they may not instinctively know.

Increasing Issues At Work Or School

When narcissistic personality disorder isn't treated, the affected individual often experiences increasing issues at work or school. This condition can cause self-absorbed and grandiose behavior that may be inappropriate for the work setting. They may demand things of coworkers and other students without offering anything in return. They may manipulate their bosses or teachers and misuse any power they have over other employees or students. A patient with this condition may act out in class to be the center of attention, and they may vie for the spotlight in collaborative meetings at work. This behavior can cause friction between individuals and potentially serious consequences including disciplinary action, suspension, expulsion, or firing.

Other Mental Health Issues

While narcissistic personality disorder is a mental disorder by itself, it also often occurs with other mental health issues. An individual with NPD may be simultaneously diagnosed with antisocial, histrionic, or borderline personality disorders. Histrionic personality disorder involves patterns of increasingly dramatic attention-seeking, volatile emotions, and seduction. Borderline personality disorder involves fractured interpersonal relationships, alternating codependence and hatred of others, and a sense of extreme panic when alone.

Antisocial personality disorder is a condition that causes affected individuals to feel no empathy for others, show no regard for morals, and to ignore the feelings and rights of others. In addition to these personality disorders, narcissistic personality disorder patients often self-medicate through substance abuse. They may also develop depression and a sense of hopelessness related to their ongoing relationship and attention issues.

Issues with Physical Health

Individuals with narcissistic personality disorder who abuse substances may experience any number of physical health issues related to alcohol or drug abuse. Prolonged alcohol abuse can lead to liver failure, and drug overdose can cause death or organ damage. Substance abuse also has a measurable impact on an individual's brain chemistry over time. Another study showed a correlation between narcissistic traits and cortisol levels. During the study, students were told they would be giving a presentation to an audience of experts.

Before the presentation, their notes were taken away. These circumstances caused increased physical stress, which the researchers measured. Though many individuals expected those with NPD wouldn't react with stress due to their confidence, the opposite was true. Instead, these patients reacted with much greater cortisol levels. Cortisol is the body's stress hormone, and in high doses, it can cause chronic physical issues. The implication is narcissists experience performance-related stress much more acutely, which can lead to health problems.

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