What is narcissism?
Narcissism refers to a very specific pattern of thinking and behaving. A narcissist is defined as someone who has an unhealthy obsession with themselves. Narcissists are incredibly self-absorbed and typically lack empathy.
On the surface, people with narcissism can appear confident. In reality, they’re masking fragile self-esteem. Their desperate need for validation means they behave in ways that can be difficult for those around them.
Narcissism and Narcissistic Personality Disorder
Society uses the label of ‘narcissist’ to refer to anyone who behaves in a narcissistic manner. This includes people with narcissistic traits and people with diagnosed Narcissistic Personality Disorder (NPD).
It can be helpful to think of narcissism as a spectrum. At one end there are people who have mildly narcissistic traits. At the other end there are people with Narcissistic Personality Disorder.
Narcissistic Personality Disorder usually causes much more dramatic patterns of thought and behaviour. As a result, people with NPD typically encounter problems in a range of areas in their lives. There are specific criteria for diagnosing Narcissistic Personality Disorder, and only a trained mental health clinician can make the diagnosis.
So what is Narcissistic Personality Disorder?
Personality disorders are mental health conditions that change the way our brains work. People with personality disorders perceive the world differently. This leads them to think and act in ways that are different from how others think and act.
There are ten recognised personality disorder types. Each is characterised by certain thought processes and patterns of behaviour.
Narcissistic personality disorder is typically characterised by:
- An inflated sense of self worth
- An extreme desire for admiration and attention
- A lack of empathy for others
- A tendency to exploit others for personal gain
Types of Narcissistic Personality Disorder
Narcissistic Personality Disorder can present in a few different ways, known as subtypes. Two of the most well-known subtypes are:
Grandiose or Overt narcissism
People with overt narcissism are usually the ones at the centre of attention. They typically appear extroverted and confident. Behind this lies deep insecurity and low self-esteem.
Vulnerable or Covert narcissism
People with covert narcissism tend to stay out of the limelight. This behaviour can make them appear almost shy. Despite this, they still harbor an unhealthy need for attention and admiration.
How do narcissists behave?
A narcissist’s self-obsession can lead to some unhealthy behaviours. People with narcissistic personality disorder will usually demonstrate more extreme behaviours than those with mild narcissistic tendencies.
The following behaviours are commonly seen in narcissists:
An excessive preoccupation with physical appearance
Narcissists can be very fixated on their own appearance. They might spend hours getting ready, and endlessly check their reflection throughout the day.
An obsession with wealth, fame, or power
We all daydream about success from time to time. But narcissists can be unhealthily preoccupied with the idea of becoming rich and powerful..
Narcissists crave admiration from others. To gain this admiration, they might stretch the truth and even blatantly lie about their achievements.
A belief that they are special
People with narcissism feel that they are special and more extraordinary than others. They believe because of this they deserve certain privileges.
A tendency to behave in a jealous manner
Narcissists feel threatened by the achievements of others. They want to maintain their self-belief that they are special. Because of this, they may try to undermine the achievements of people around them.
A sense of entitlement
People with narcissism feel entitled to respect, attention and opportunities. In some cases, narcissists can even feel as if they are entitled to love or friendship from others
A self-esteem that is easily threatened
Narcissists may appear confident, but they are masking low self esteem. They will get upset if something threatens their beliefs about themselves.
A craving for attention and admiration
People with narcissim rely on validation from others to maintain their self-esteem. This means they are constantly demanding attention and admiration.
A lack of empathy
Narcissists often act with a total disregard for the happiness of others.
Manipulative and exploitative characteristics
Narcissists at the more extreme end of the spectrum may manipulate and exploit to get what they want.
Is a narcissist more likely to develop addiction?
Yes, narcissists are more likely to develop a substance use disorder. In fact, one study showed that 40% of people with narcissistic personality disorder also had a substance use disorder.1
Why do narcissists develop addiction?
There are several theories why narcissists develop addiction to drugs and alcohol.
One theory is based on underlying issues with impulse control. People with narcissistic personality disorders struggle with impulse control.2 Without impulse control, it is easier to fall into a pattern of substance abuse and addiction.
Another theory is that narcissists use substances or activities to escape negative feelings. Certain substances and activities can trigger our brains to release feel-good signalling molecules. These cause a temporary feeling of euphoria. We know that narcissists struggle with feelings of inadequacy so it’s possible that they turn to substances/activities to temporarily escape these feelings.
As the medical community learns more about narcissism and addiction to drugs and alcohol, we may see a clearer link.
What addictions might a narcissist have?
Several studies have demonstrated an overlap between narcissism and certain addictive tendencies.
Narcissism and alcohol
In one study group, 18% of people with alcohol dependency also had narcissistic personality disorder.3
Narcissism and cocaine
Another study showed that people who used cocaine behaved in more narcissistic ways than people who did not use cocaine.4
Narcissism and cannabis
In another study group, researchers showed that 1 in 5 people who used cannabis had narcissistic personality disorder.5
Narcissism and smoking
In a different study group, 26% of people with narcissistic personality disorder had a nicotine addiction.1
Narcissism and social media
Other studies have suggested that there may be a link between narcissism and unhealthy use of social media.6
Other addictions in narcissists
We need more studies looking at the link between narcissistic personality disorder and addiction. But given the link between narcissism and impulse control it is possible that narcissists may also struggle with the following addictions:
- Food addiction
- Gambling addiction
- Video game addiction
- Love addiction
- Spending or shopping addiction
Living with a narcissist with addiction problems
Living with a narcissist can be challenging. If you live with a narcissist you may find it helpful to try the following:
Make sure to look after your own mental health
Sometimes we can get so focused on other people, that we forget to take care of ourselves. Narcissists have a way of shifting our attention onto them. It’s important that you make your own mental health a priority.
Spend time with people who care about you
When you live with a narcissist their behaviour can start to affect how you see yourself. Spending time with people who value you can remind you of your worth.
- Attend support groups
Spending time with other people that live with narcissists can be really helpful. Support groups allow you to talk about how the narcissistic behaviour is affecting you. They are safe and empathetic spaces for you to share and receive advice and support.
- Set firm boundaries
People with narcissism lack empathy and are often unaware of the effect of their behaviour. If you live with a narcissist, setting boundaries is crucial. This might be boundaries in the way they speak to you, what they ask of you, or how they act.
Narcissists and addiction rehab
Narcissistic traits and symptoms of narcissistic personality disorder can make the road to recovery from alcoholism and drug addiction recovery challenging. But, with the right help, narcissists can recover from addiction.
When treating alcohol and drug addiction, it’s crucial to address all underlying issues. This includes identifying mental health problems as well as negative thought patterns and behaviours. This is true for anyone with an addiction problem.
In people with narcissism, it’s crucial to address psychological and emotional thought patterns and behaviours such as lack of empathy and self importance. Properly addressing these gives the best chance of recovery.
Can narcissism affect someone’s chances of recovery?
Some narcissistic traits are identified by therapy staff because they come out in their time at residential rehab, often in the group therapy settings. This can typically be seen in the following ways:
- Exhibitionism and boasting about drug use or sexual conquests in group settings
- Attention seeking behaviours
- Unrealistic expectations of the therapist or of management
- Unreasonable demands of others in the programme
- Lack of empathy
- Lack of personal responsibility and guilt when discussing past actions that have hurt others.
During therapy this would be highlighted to the patient by their therapist and together they would work together to address some of the issues that have arisen, with a focus on how the narcissistic mindset is affecting their addiction and recovery.
How do we treat addiction and dual diagnosis at Castle Craig?
At Castle Craig, we create personalised treatment plans for all our patients. Everyone’s path to recovery is unique, and requires individualised, professional support.
All our patients undergo a biopsychosocial assessment on arrival and this is reviewed by a Consultant Psychiatrist. Sometimes when people attend rehab they have additional mental health problems, some are diagnosed by a psychiatrist before they come into treatment. Treating these co-occurring problems and helps our patients to gain deeper insight into their thoughts and actions.
You might have come across the phrase “dual diagnosis” or “co occurring disorders”. This means that someone has more than one mental health condition alongside addiction. For example addiction and depression, or addiction and narcissism. When looking for a rehab centre, it is important to check that they provide treatment for dual diagnosis.
Following assessment, we create a unique treatment programme. For patients showing signs of narcissism we provide addiction therapy that is suited to their needs.
How to get help for a narcissist with an addiction
It can be harder to convince narcissists to seek support and admit they have a problem with drugs and alcohol. Often you may suspect a family member is a narcissist because they are displaying narcissistic traits, but have no diagnosis and you are not sure how to convince them they need help for their addiction.
The good news is that comprehensive dual diagnosis treatment for addictions is available at Castle Craig. If you’re worried that your friend or loved one is struggling from addiction, get in touch. We can provide you with advice and support.
Medically reviewed with the following references:
- Stinson FS, Dawson DA, Goldstein RB, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. 2008;69(7):1033-1045. doi:10.4088/jcp.v69n0701
- Kisa C, Yildirim SG, Göka E. Ataklik ve Ruhsal Bozukluklar [Impulsivity and mental disorders]. Turk Psikiyatri Derg. 2005;16(1):46-54.
- Preuss UW, Johann M, Fehr C, et al. Personality disorders in alcohol-dependent individuals: relationship with alcohol dependence severity. Eur Addict Res. 2009;15(4):188-195. doi:10.1159/000228929
- Yates WR, Fulton AI, Gabel JM, Brass CT. Personality risk factors for cocaine abuse. Am J Public Health. 1989;79(7):891-892. doi:10.2105/ajph.79.7.891
- Hasin D, Fenton MC, Skodol A, et al. Personality disorders and the 3-year course of alcohol, drug, and nicotine use disorders. Arch Gen Psychiatry. 2011;68(11):1158-1167. doi:10.1001/archgenpsychiatry.2011.136
- Casale S, Banchi V. Narcissism and problematic social media use: A systematic literature review. Addict Behav Rep. 2020;11:100252. Published 2020 Jan 28. doi:10.1016/j.abrep.2020.100252
Medically reviewed by Dr Felicity Sasada and Dr India Duane.