Causes and Treatments of Narcissistic Personality Disorder


In our last post, we considered signs that Elliot Rodger had narcissistic personality disorder (NPD), according NPD’s DSM-5 criteria. Researchers estimate that 1% of the general population has lifelong NPD. That’s one person in one hundred. And the prevalence of narcissism may be increasing. (Twenge et al, 2014) That means you and I encounter NPD often, in other people and perhaps in ourselves.

Not all narcissism is pathological. Besides those with a disorder, many of us present narcissistic behaviors less frequently or intensely than constitutes a disease. We may even go through phases of being more narcissistic, such as in adolescence. Some even argue there are benefits to a little narcissism. Still, if someone experiences the three Ds (dysfunction, distress, and deviance) from five or more NPD behaviors, psychologists consider that person ill. To treat a mental illness, it’s important to understand its possible causes.

CAUSES: Most psychologists today understand mental illness through the biopsychosocial model. The biopsychosocial model (BPS) assumes a mixture of factors contributes to a person’s physical and mental wellbeing. These factors may be biological (e.g. a genetic predisposition), psychological (e.g. thought patterns) or social (e.g. the family environment). Here are just a few possible factors that support NPD.

  • Biological: Researchers have found that part of the brain associated with empathy, the left anterior insula, has less gray matter in those with NPD. Gray matter is made up of neuron cell bodies and non-neuron brain cells, which provide nutrients and energy to neurons. Neurons send and receive information in the nervous system. Researchers have found the degree to which people empathize with others is related to the size of gray matter in this region. MEDIUM_429_2010_260_Fig5_HTML
  • Psychological: In NPD, the disease can also be one of its causes. By practicing self-absorbed thinking, people may be more likely to have self-absorbed thoughts in the future. By not attending to other people’s feelings and interests, people don’t strengthen their ability to empathize or make empathizing a habit. In the case of Elliot Rodger, he repeatedly told himself that people have wronged him and are unworthy of respect. This may have solidified those beliefs, making him feel justified in treating his victims as objects rather than as individuals with rights.
  • Social: There’s a list of ways researchers have found that parents may contribute to NPD. This list could be applied to any caregiver and not just parents. There are also societal contributors to narcissism. Individualistic cultures, like the United States, coach people to strive to be special or better than our peers. Jean Twenge, a professor of psychology at San Diego State University, says that parenting, celebrity culture and the internet are among causes of increasing cases of NPD.

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Elliot Rodger’s Narcissism

Last Saturday morning, the U. S. found out that Elliot Rodger, a 22-year-old, went on a murderous rampage Friday night in Isla Vista, CA. Isla Vista is a pretty, beach town, filled with seemingly immortal, young students with lives of sunshine and partying. My brother lives there, two blocks from where the chaos ensued. I became interested in the story as I waited for Jim to call me back to say he was okay.

The first video I saw was this, Rodger’s pretentious announcement for the “Day of Retribution.” It shows a great example of someone with narcissistic personality disorder, who specifically hates women. I was struck by Rodger’s hackneyed script, fake laugh, and rehearsed delivery. Though Rodger was young, 22 years is old enough to understand the meaning of ‘cliche.’

“Well, now“— a theatrical pause—”I’ll be a god compared to you.”

In April, Rodger’s mother warned Santa Barbara authorities about her son. In response, officers visited Rodger but decided he was “quiet and timid . . . polite and courteous.” They left and only followed up post-tragedy. Had the police researched Rodger more, they could have viewed his YouTube channel. Until yesterday, it showed a series of disturbing, self-pitying rants. Had the police been able to search Rodger’s apartment, they might have found a 137-page manifesto, which presents grandiose fantasies and persecutory delusions.


They might have found guns and ammo, which were in the apartment as they questioned Rodger.

If this is in fact Rodger’s actual Facebook page, it also hints at Rodger’s motivation. Nowhere does he act pleased by or interested in other people, although it’s social media. Rodger valued his car and his looks. In photos, he didn’t relax into a smile but posed, mostly in selfies. I only found one picture of him with someone else, and he doesn’t look happy in it.

“You girls have something against me. I don’t know what it is,” Rodger complains in one video. If Rodger wanted to be loved, it might have helped if he had shown love for other people.

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Let’s Talk about Sexual Dysfunctions

It might seem like having continuous, spontaneous orgasms throughout the day would be fun, but to those with persistant genital arousal disorder (PGAD) it’s hellish. For sufferers, continual arousal means, “Being on the edge of an orgasm 24 hours a day, to the point where you can’t sleep, you can’t function, you can’t even think straight – that’s not fun.” It can destroy their deliberate sex lives, since having intercourse may exasperate their discomfort. PGAD is a particularly disruptive but rare sexual dysfunction.

The Sun's story about Kim Ramsey

The media may present cases of PGAD as entertainment, but PGAD is NOT entertaining for those who have it. The Sun’s story about Kim Ramsey from August 2012. Taken from http://www.theguardian.com/lifeandstyle/2014/apr/14/women-persistent-genital-arousal-disorder-orgasm-pgad-pain.

According to the DSM-5, sexual dysfunctions are a varying group of disorders which have in common a “disturbance in a person’s ability to respond sexually or to experience sexual pleasure.” While causes of sexual dysfunctions might sometimes be physical,  sexual experience is profoundly connected with one’s psychological wellbeing. Like other drives, if one’s sex drive is hyperactive, hypoactive or in other ways malfunctioning, this can upset a person’s love life and other areas of her life.

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Colored Pain: An Unusual Case of Synesthesia

Dr. Brit and I also write on a blog for Psychology Today as well as the blog for our lab, the Brogaard Lab for Multisensory Research. Below is a post I wrote a while ago. It’s not directly about romantic love. But it is about perception, which certainly plays an important role in one’s experience of romantic love. In any case, we wanted to share it. 

In a 1913 article in the The Journal of Abnormal Psychology, Isador Coriat describes a case of “colored pain,” which is still considered a rare form of synesthesia. These synesthetes perceive colors as they experience pain. Coriat’s subject is an intelligent forty-year-old woman suffering from anxiety, sleepwalking and headaches. As far back as she can remember she’s seen different colors when she feels pain. Pain produces clear, distinct colors and a certain “kind of pain” consistently produces a certain color.

“Each type of pain produced its individual and invariable color, for instance: Hollow pain, blue color; sore pain, red color; deep headache, vivid scarlet; superficial headache, white color; shooting neuralgic pain, white color.”

The woman sees colors as masses with no recognizable shape, except when pain “involved a jagged, longitudinal or round area, the color stimulated by this particular type of pain had a corresponding geometrical figure.” I’m guessing by this Coriat means that the woman’s pain might have a certain shape, depending on where it is on her body. But I’m not sure. This made me wonder what exactly is it to experience pain. What exactly makes a kind of pain onto which certain colors map? Read more »

New ebook pricing

Notice that the new pricing of the ebook listed in the right column won’t take effect until tomorrow.

Final Version of Manus

Today I submitted the final version of On Romantic Love to Oxford University Press. It’s going into production on Tuesday.


The Breakup Cleanse App is FREE in April


For the rest of April, we’re offering The Breakup Cleanse App for FREE on iTunes. Download it HERE and let us know what you think. We appreciate reviews, especially since this is our first therapeutic love app. We hope even those who have not recently broken up can get something out of it.

Adolescents are Prone to Love Addiction

Adolescence spans from roughly age twelve to as late as twenty-five, with the late teens and early twenties sometimes called ‘emerging adulthood.’ During this important and exciting phase of life, individuals transition from being children to being adults. Specific aspects of physical, social, and personality maturation affect the thoughts, emotions, and behaviors of adolescents. Here I briefly consider how the adolescent brain makes young people susceptible to love addiction. By ‘love,’ I mean the physiological and psychological experience associated with one’s judgment that she has “fallen in love.” I mean the thrilling, intoxicating stage of new love.

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Q&A: Dear Social Actor

Dear Social Actor,

While your main question is how to kill your libido, you might benefit from addressing issues that make you want to do that: (1) feeling disconnected from people and (2) obsessing about women and compulsively acting on these obsessive thoughts. 

One form of self-therapy to consider is cognitive behavioral therapy (CBT). CBT can be helpful to those with mild cases of depression or anxiety. If you weren’t being facetious about being a “self-diagnosed schizoid” and believe you have a severe mental illness, you should set up an appointment with a clinical psychologist. 

You say: “I’m a loner and used to being ignored by people who have no practical use for me…I’ve accepted that and have decided to become a recluse.”

You say only those who want to use you pay attention to you. How do you know that’s true? Unless your social interactions always involve someone trying to overtly, or subtly, manipulate you, you must have interactions in which people don’t try to manipulate you. In those cases, if you think people still have an angle, you might be having a cognitive distortion called ‘mind reading.’ Read more »

Can Animals Love?

cat-loveWhether animals can experience romantic love is unknown. But there is some evidence that they are capable of experiencing the same range of emotions as we can. The brains of many mammals are surprisingly similar to the human brain. Take as an example the brain of a cat. A cat’s brain is small compared to ours, occupying only about one percent of their body mass compared to about two percent in an average human. But size doesn’t always matter. Neanderthals, the hominids that went extinct more than twenty thousand years ago, had bigger brains than Homo sapiens, but they probably weren’t smarter than the Homo sapiens that beat them in the survival game. Surface folding and brain structure matter more than brain size. The brains of cats have an amazing surface folding and a structure that is about ninety percent similar to ours. This suggests that they could indeed be capable of experiencing romantic love. But we will probably never know for sure. Read more »

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