Upbringing and childhood environment may be key factors in what causes NPD, but genetics could play a role, too.

Narcissistic personality disorder (NPD) is a complex personality disorder that’s often misunderstood. When you think of NPD, a grandiose sense of self, deep need for admiration, and difficulty empathizing may come to mind.

Someone with NPD can appear charming and self-assured on the surface. While these charismatic traits may look like confidence, they’re often masking insecurities rather than coming from a place of self-esteem.

If you live with NPD, you might be highly sensitive to criticism or have strong reactions to speech or behaviors you see as an insult.

It’s likely that narcissistic personality disorder is caused by several factors, such as environmental circumstances (including the child-parent relationship) and genetics.

You’ve likely heard the phrase “He’s such a narcissist!” thrown around. But where does narcissistic personality disorder factor in?

While most people show behaviors that could be seen as “narcissistic” — like selfishness or entitlement — narcissistic personality disorder is different.

When narcissistic traits disrupt many areas of your life (like your relationships or career), it could mean you meet the criteria for a personality disorder.

In general, NPD consists of patterns that show up in two or more of these areas:

  • thinking
  • emotions
  • interactions with others
  • impulse control

A clinician may diagnose narcissistic personality disorder if someone has five or more of these signs and symptoms:

  • feelings of self-importance or superiority
  • frequent thoughts about being good looking, powerful, or successful
  • beliefs that they’re separate, special, or above other people
  • a need to be looked up to by others
  • feelings of entitlement to special treatment or an expectation that others should cater to what they want
  • a tendency to take advantage of or exploit others
  • difficulty empathizing with other people’s needs, desires, or emotions
  • feelings of envy toward others, or beliefs that other people envy them
  • behaviors that seem arrogant or proud

In general, there are at least two subtypes of narcissism: grandiose and vulnerable.

  • Grandiose narcissism is what most people may think of as narcissism. People with grandiose narcissism may be more extraverted, have low levels of neuroticism, and openly express feelings of superiority.
  • Vulnerable narcissism shares the same basic traits of NPD, but may involve more hidden thoughts and behaviors. Those with vulnerable narcissism tend to have higher levels of neuroticism and need more reassurance.

While they may still feel superiority, people with a vulnerable narcissism subtype tend to be fearful of criticism. In some cases, they may stay away from others as a result.

Environmental factors — such as culture and parenting — could contribute to the development of narcissistic personality disorder.

Some research suggests that narcissism scores were higher in individualistic cultures (which focus more on each person’s rights and goals) compared with collectivistic cultures (which focus more on what’s best for the group).

In the same study, researchers compared narcissistic traits among people who had grown up in former West Germany (an individualistic culture) to those who’d grown up in former East Germany (a more collectivistic culture).

The findings showed that narcissism was higher and self-esteem was lower in those who grew up in West Germany compared to East Germany.

In addition to culture, research suggests that childhood experiences could play an important role in causing NPD.

Negative childhood experiences, like being rejected or criticized by parents, may contribute to NPD in adulthood. At the same time, too much praise from parents could also lead to NPD.

Research suggests there’s a link between different parenting styles and narcissistic traits in adult children.

Still, there’s no “one” parenting behavior that always leads to narcissism.

Instead, combinations of parenting styles and other contributing factors (like genetics) may come together to cause NPD.

In general, these parenting factors are connected to higher levels of narcissism in children:

  • overprotective, or “helicopter” parenting
  • lack of warmth
  • setting few limits or boundaries (leniency)
  • praise that promotes perfection or unrealistic expectations (overvaluation)
  • maltreatment or abuse

One study found that overprotection was linked to both vulnerable and grandiose narcissism in young adults. And while too much praise was linked to grandiosity, setting too few boundaries was tied to vulnerable narcissism.

Genetics may also play a role in contributing to narcissistic personality disorder.

In a 2014 study involving 304 pairs of twins, researchers found that some NPD traits were somewhat heritable (aka able to be passed on through genetics):

  • grandiosity was 23% heritable
  • entitlement was 35% heritable

Still, these traits seemed to exist independently from each other.

Older research indicates that NPD could be slightly more heritable than other cluster B personality disorders.

Personality traits may also play a role in how NPD presents.

Grandiose narcissism is generally connected to traits like:

  • a sense of entitlement
  • open focus on the self
  • overpowering or domineering behaviors

On the other hand, vulnerable narcissism is marked by traits including:

  • introversion, but self-focused
  • high neuroticism (moodiness)
  • alternating feelings of extreme pride and deep shame

Risk factors for narcissistic personality disorder are somewhat complex. NPD has been linked to a number of things, including parenting and environmental factors, as well as genetics — but all in a variety of combinations.

Certain parenting styles could be a risk factor for higher levels of narcissism in children. But they’ve often been studied in isolation or in different combinations, and with mixed findings.

Simply being male may be a slight risk factor, as narcissistic personality disorder is diagnosed more often in men. It’s estimated that NPD affects 7.7% of men and 4.8% of women in the United States.

In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), narcissistic personality disorder is a cluster B personality disorder.

Other cluster B personality disorders include:

When a person with NPD seeks therapy, it may often be for different reasons other than managing NPD.

A person with NPD might seek therapy due to feelings of emptiness or periods of depression. In some cases, family or loved ones encourage them to seek help for relationship issues caused by NPD.

Diagnosis of NPD can be tricky, as it often coexists with other conditions. And on top of that, NPD can share symptoms with these conditions.

Some common co-occurring conditions for people with NPD include:

  • substance use disorder
  • anxiety disorders
  • mood disorders
  • other cluster B personality disorders

If you talk with a mental health pro about a diagnosis, they’ll likely start the process by asking you some questions. These questions may involve your:

  • coping skills
  • defense mechanisms
  • relationships with others
  • long-term patterns of behavior
  • childhood

There aren’t any FDA-approved medications for NPD. But if you experience another condition alongside NPD, you might take medication for:

  • anxiety
  • depression
  • mood episodes
  • psychosis
  • impulse control issues

Certain types of therapy could help people with NPD recognize maladaptive, or unhelpful, thoughts and behaviors that are causing distress to themselves and others.

Transference focused psychotherapy (TFP) is one form of therapy that’s shown some promise for helping people with NPD.

Narcissistic personality disorder is a complex mental health condition that’s not always easy to diagnose.

It can also be tricky to narrow down exactly what causes NPD or predict who’s likely to experience it.

Research has shown there are many environmental and genetic factors — from childhood upbringing to culture to genetics — that contribute to NPD.

But when someone with NPD decides they want to make a change, help is available.

Some types of therapy can help people with NPD accept responsibility for their actions, learn about their feelings and thoughts, and build secure relationships. You can learn more about getting help for NPD here.