A narcissist is someone who has an inflated sense of their own importance, a deep need for excessive attention and admiration, troubled relationships, and a lack of empathy for others. But a narcissist is not the only type of person who exhibits these traits. There are several other personality types and disorders that are similar to narcissism in terms of symptoms and characteristics. Understanding the similarities and differences between a narcissist and other self-centered personality types can help in identifying narcissistic behaviors in relationships, as well as finding appropriate treatment options.
Narcissistic Personality Disorder
Narcissistic personality disorder (NPD) is a mental health condition characterized by an exaggerated sense of self-importance, a lack of empathy, and a need for admiration. People with NPD believe they are superior to others and have little regard for other people’s feelings. They tend to exaggerate their own achievements and talents and expect constant praise and admiration. Their sense of superiority leads them to monopolize conversations and belittle or look down upon people they perceive as inferior. They often take advantage of others to get what they want. Their arrogance, need for envy, and excessive need for attention often impair their ability to have healthy, long-lasting relationships.
According to the DSM-5 diagnostic criteria, someone with NPD possesses at least 5 of the following traits:
- Has a grandiose sense of self-importance and exaggerates achievements and talents
- Dreams of unlimited success, power, brilliance, beauty, or ideal love
- Believes he or she is special and can only be understood by other special people or institutions
- Requires excessive admiration
- Has a sense of entitlement and unreasonable expectations of favorable treatment
- Takes advantage of others to get what he or she wants
- Lacks empathy for others’ needs and feelings
- Is often envious of others or thinks others are envious of him or her
- Exhibits arrogant, haughty behaviors and attitudes
These traits cause significant impairments in relationships and day-to-day functioning. People with NPD often struggle to maintain healthy, long-lasting relationships and frequently belittle, exploit, or mistreat others. Their need for admiration and feelings of superiority lead them to display egotistical and arrogant behaviors that inhibit genuine, equal relationships. Their lack of empathy also makes it difficult for them to recognize how their behaviors impact others. About 1% of the population is estimated to have narcissistic personality disorder.
Histrionic Personality Disorder
Histrionic personality disorder (HPD) is characterized by excessive emotionality, attention-seeking, and inappropriate seductiveness. People with HPD are constantly drawing attention to themselves and engage in provocative behavior to ensure they remain the center of attention. They may be perceived as overly dramatic, intensely reactive, charming, manipulative, and lively.
About 2-3% of the general population is estimated to have HPD, with women presenting at higher rates than men. According to the DSM-5 diagnostic criteria, someone with HPD shows at least 5 of the following:
- Is uncomfortable in situations where he or she is not the center of attention
- Interacts with others in inappropriately seductive ways
- Displays rapidly shifting and shallow expression of emotions
- Consistently uses physical appearance to draw attention
- Has a style of speech that is excessively impressionistic and lacking in detail
- Shows self-dramatization, theatricality, and exaggerated expression of emotion
- Is suggestible, easily influenced by others
- Considers relationships more intimate than they actually are
While people with HPD crave attention like narcissists do, the intention behind the behavior differs. Unlike narcissists, people with HPD rely on others for validation and self-esteem. Their attention-seeking stems from feeling inadequate versus from a place of superiority. HPD can overlap with some narcissistic traits, but the underlying psychological motives differ.
Antisocial Personality Disorder
Antisocial personality disorder is characterized by a pattern of disregard for others’ rights and the violation of those rights. People with antisocial personality disorder (ASPD) tend to exploit, deceive, and manipulate others for their own gain. They may also display impulsive behavior and irresponsible decision making without regard for consequences.
About 3% percent of men and 1% of women are estimated to have ASPD. Diagnostic criteria per the DSM-5 requires someone to exhibit 3 or more of the following:
- Disregards and violates the rights of others
- Lies, deceives others, uses false identities
- Is impulsive or fails to plan ahead
- Is irritable and aggressive, gets into physical fights
- Disregards safety of self and others
- Irresponsible, cannot sustain consistent employment
- Lacks remorse for behaviors that hurt others
Like narcissists, people with ASPD often manipulate and exploit others for personal gain. Both personality disorders reflect a lack of empathy for others’ feelings. However, unlike narcissists, people with ASPD don’t feel a need to be admired. Their violation of others’ rights is driven by impulsivity, irresponsibility, and a lack of remorse as opposed to a sense of superiority, entitlement, or vanity. People with ASPD tend to live more erratically and recklessly, while narcissists are more prone to cunning manipulation in their quest for status.
Borderline Personality Disorder
Borderline personality disorder (BPD) is characterized by unstable moods, behavior, and relationships. People with BPD struggle to control their emotions, often experience mood swings, impulsivity, and can display unpredictable behavior. They may also struggle with a poor self-image and fear of abandonment. About 1.6% of adults in the U.S. population have BPD. Diagnostic criteria per the DSM-5 requires at least 5 of the following traits:
- Intense fear of abandonment, even going to extreme measures to avoid real or imagined separation or rejection
- Unstable, intense personal relationships characterized by alternating between extremes of idealization and devaluation
- Disturbed sense of self and lack of sense of self-identity
- Impulsivity, risk taking behaviors
- Recurring suicidal thoughts or self-harming behavior
- Emotional instability in reaction to day-to-day events and interpersonal stresses
- Chronic feelings of emptiness
- Inappropriate, intense anger or problems controlling anger
- Transient, stress-related paranoid thoughts or severe dissociative symptoms
People with BPD and narcissists both fear abandonment. However, for narcissists the fear is rooted in a need for validation of their perceived greatness. Borderlines, on the other hand, have a fractured sense of self and rely on others to provide a sense of identity. Borderlines also display self-destructive impulses as opposed to narcissists’ tendency toward self-enhancement. People with BPD are emotionally fragile versus narcissists who typically exude grandiosity and confidence, albeit fragile deep down.
Obsessive Compulsive Personality Disorder
Obsessive compulsive personality disorder (OCPD) is characterized by excessive perfectionism, orderliness, and need for control. People with OCPD are preoccupied with rules, schedules, organization, details, procedures, and morals. They have unrealistically high standards for themselves and others, and adhere strictly to their principles of right and wrong.
About 2.3% of people have OCPD. Diagnostic criteria per the DSM-5 requires 4 or more of the following traits:
- Preoccupied with details, order, organization, schedules, rules, lists, etc.
- Perfectionism that interferes with completing tasks
- Excessive devotion to work and productivity, neglecting leisure activities and friendships
- Overconscientious and inflexible about matters of ethics or morality
- Unable to discard worn-out or worthless objects, even when they have no sentimental value
- Reluctant to delegate tasks unless others agree to do things his or her way
- Adopts a miserly spending style toward self and others
- Shows rigidity and stubbornness
While narcissists and those with OCPD both exhibit a strong need for control, OCPD control is driven by adherence to rules and order, not from a place of superiority. Narcissists control people and situations to maintain feelings of power and self-importance. People with OCPD impose order and rigidly adhere to schedules to quell anxiety about imperfection, not to boost their self-esteem. Their perfectionism is internally motivated versus narcissists who use perfectionism to secure external validation.
Self-Esteem Issues
While low self-esteem doesn’t constitute a personality disorder in itself, people with chronically low self-esteem may develop some behaviors similar to narcissism as a way to compensate or overcompensate for painful feelings of inadequacy. Exhibiting arrogant, self-absorbed behaviors can be an attempt to cover up and overcompensate for profoundly low self-worth.
However, there is a difference between situational displays of arrogance to mask self-doubt versus the pervasive impaired thinking and dysfunctional behavior patterns characterizing NPD. People with low self-esteem may occasionally act selfish, conceited, or entitled, but do not display these traits chronically. Nor do they exhibit the full scope of symptoms denoting NPD.
Signs Displaying Similarities
There are some key signs and symptoms that may appear common between narcissism and related personality disorders:
- Need for control – Trying to control people and situations. Imposing order, rules, and structure.
- Attention-seeking – Excessively drawing attention to oneself. Craving recognition and praise.
- Manipulation – Exploiting, deceiving, or taking advantage of others for personal gain.
- Lack of empathy – Inability to understand others’ needs or connect emotionally.
- Difficulty with relationships – Troubled interpersonal relationships. Tendency to undermine intimacy and connection.
- Anger issues – Irritability, aggression, or rage, especially when challenged or confronted.
However, while these signs may superficially overlap between disorders, the underlying psychology driving them differs. The context and full spectrum of symptoms must be considered to identify the specific condition. A mental health professional can provide an expert assessment to pinpoint what issue may be at hand in someone displaying these behaviors.
Differentiating NPD
There are also some distinguishing features that can help differentiate NPD from related conditions:
- Grandiose sense of superiority – Believing one is more important and deserving than others.
- Preoccupation with fantasies of success, power, beauty, etc.
- Needs constant praise and admiration – Excessive need for validation of self-perceived greatness.
- Strong belief that one is special and unique – Only other special people can appreciate or understand them.
- Ruthless exploitation of others for personal gain.
- Habitual lying, exaggeration, or manipulation.
- Feelings of unjustified entitlement – Expects favorable treatment without reciprocation.
- Envious of others or suspects others envy them – Views the world as envious and competitive.
- Arrogant and haughty behaviors or attitudes.
These distinguishing features reflect narcissists inflated, yet fragile egos and excessive preoccupation with themselves versus just attention seeking or rule adherence. The underlying sense of superiority and entitlement differentiates NPD from other disorders involving selfish, manipulative, or aggressive behaviors.
Treatment Options
Treatment for narcissism can involve psychotherapy and medication:
Psychotherapy
Therapy provides a setting to build self-awareness, challenge distorted thinking, understand the impact of behaviors on others, and practice genuine empathy and vulnerability. Therapeutic approaches may include:
- Cognitive Behavioral Therapy (CBT) – Identifies and challenges unhealthy thought patterns that form the foundation of narcissistic traits.
- Schema Therapy – Addresses long-held, dysfunctional coping behaviors rooted in unmet childhood needs.
- Transference-Focused Therapy – Uses the therapy relationship itself to reveal narcissistic issues while providing a healthier relational experience.
- Group Therapy – Provides feedback on dysfunctional relational behaviors through a direct exchange with peers.
- Family Therapy – Mends strained family relationships that often arise from destructive narcissistic patterns.
Finding a therapist well-versed in treating narcissism is key. Therapy can feel threatening to narcissists at first. But with time and skillful treatment, self-awareness and empathy can grow.
Medication
There are no pharmacological treatments specifically for NPD. However, certain medications may help manage associated symptoms like depression or anxiety that often co-occur with narcissistic traits. Medication can potentially augment therapy progress by stabilizing mood disorders.
In Summary
While narcissism shares common ground with other personality disorders, there are distinctive traits that set NPD apart. Gaining clarity on the differences through education and professional evaluation enables appropriate identification and treatment. With commitment and compassion, those struggling with narcissism can find relief from its painful effects. There are many paths to heal and bring out one’s inherent empathy, self-compassion, and humanity.