Is It Self-Esteem or Self-Importance? Exploring Narcissistic Personality Disorder

Available with English captions and subtitles in Spanish.

There’s no question that healthy self-esteem serves us well. It helps us navigate everything from our personal growth to our relationships and careers. And while exaggerated self-esteem can lead to interpersonal and other challenges, even such inflation tends not to indicate psychiatric illness.

However, when someone develops an excessive and pervasive sense of self-importance, becomes extremely preoccupied with themselves, and shows a lack of empathy for others, they might very well be struggling with a mental health condition known as narcissistic personality disorder, or NPD.

So how can one tell the difference between healthy self-esteem, occasional narcissism, and NPD? When should professional help be sought? And what does effective treatment look like?

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Audience Questions

Igor Weinberg, PhD, breaks down both the healthy and problematic ways we can see ourselves and the impacts of those perceptions, explores why NPD remains so stigmatized today, and answers questions about the disorder’s treatment and commonly co-occurring conditions.

  • From a psychological perspective, what does “self-esteem” refer to?
  • How would you define the term “narcissism”?
  • Is there such a thing as “healthy” narcissism?
  • Is there a distinction between pathological narcissism and narcissistic personality disorder (NPD)?
  • What are some of the common misconceptions about NPD?
  • Is vulnerable narcissism the same as the recently popular term “covert narcissism”?
  • What do we know about the prevalence of NPD?
  • Has the NPD diagnosis changed much over the years?
  • Can you walk us through the two primary types of NPD: grandiose and vulnerable?
  • How do shifts between grandiose and vulnerable presentations of NPD typically occur?
  • Does NPD present differently depending on whether someone is introverted or extroverted?
  • Is there a genetic component to NPD?
  • What does the diagnostic process look like for NPD?
  • What are some basic signs that someone might be dealing with NPD?
  • Do you see a change in presentation as a person ages from childhood to adolescence and into adulthood?
  • What are some of the most common conditions that co-occur with NPD?
  • Can you talk a bit about differential diagnosis involving NPD and autism, specifically around traits such as social cues and not picking up on emotions?
  • Are there roadblocks to seeking treatment for NPD?
  • What do treatment modalities for NPD look like?
  • Can you speak to the evolving research and discussions around this topic?
  • After someone is diagnosed with NPD, what is typically the next step?
  • What recent research advancements in the neurobiology of NPD could influence future treatments?
  • What are some strategies for individuals looking to support a loved one who has NPD?
  • Do you find that educators are equipped with tools to recognize potential NPD in younger students?
  • Some researchers have proposed communal narcissism, where individuals act entitled and superior because they are supposedly helping others (through charity, academia, science, etc.). Is this just a form of grandiose narcissism or is it fair to categorize it separately?
  • Do environmental factors such as childhood trauma play a role in NPD?
  • Does gender tend to impact how NPD presents?
  • What has your research taught you about healthy self-esteem and healthy narcissism?

The information discussed is intended to be educational and should not be used as a substitute for guidance provided by your health care provider. Please consult with your treatment team before making any changes to your care plan.

Resources

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About Dr. Weinberg

Igor Weinberg, PhD, specializes in the assessment and treatment of personality disorders, especially borderline and narcissistic personality disorders. His additional areas of expertise include treatment of suicidal behaviors and substance use disorders in patients with personality disorders.

Dr. Weinberg has published peer-reviewed papers and book chapters as well as presented at professional conferences and delivered workshops on understanding and treatment of suicidal patients and patients with personality disorders.

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