Intriguingly, the editors of The Diagnostic and Statistical Manual of Mental Disorders (DSM) once considered discontinuing narcissistic personality disorder (NPD) due to variations in how the condition was being diagnosed. Instead, NPD remains in the guide as a Cluster B personality disorder, along with antisocial personality disorder, histrionic personality disorder, and borderline personality disorder. People with cluster B personality disorders often manifest emotional and unpredictable behavior.
Although NPD often bodes poorly for mental health, how does it relate to morbidity and mortality? Moreover, how does one’s level of the trait of narcissism—as opposed to NPD—relate to their health? The answers may surprise you.
The DSM-5 classifies narcissism as a personality disorder distinguished by grandiosity, need for admiration, and lack of empathy. It hampers one’s ability to work and impairs relationships. In the world of psychiatry, narcissism coexists with various other mental illnesses. There are 3 forms of NPD: grandiose/oblivious; vulnerable/hypervigilant; and high-functioning. Both biological and psychological factors are at work, but the true cause of pathological narcissism has not been elucidated.
NPD has been linked to a bevy of negative health consequences. It impacts health conditions, treatment adherence, and interactions with healthcare workers, as well as increasing the risk for somatic disease. Individuals with NPD are more likely to engage in substance misuse and risky sexual behavior. Moreover, these individuals tend to use medical services more and pursue cosmetic and plastic surgery.
Results from a cohort study published in the Canadian Journal of Psychiatry quantify how detrimental NPD can be to longevity. In the study, Quebec residents aged 14 or older with Cluster B personality disorders were compared with the general population. The prevalence of Cluster B personality disorders was 2.6%, with mean years lost in life expectancy 13 for men and 9 for women. Notable causes of death included suicide (20.4%); cardiovascular disease (19.1%); and cancer (18.6%). A considerable proportion of patients with Cluster B personality disorders saw a psychiatrist, were admitted to an emergency department (ED), or hospitalized at some point.
Risk of suicide
As a group, patients with Cluster B disorders tend to receive special attention because of their increased risk of suicide. Specific recommended psychotherapy approaches include Dialectical Behavior Therapy (DBT) and Mentalization Based Therapy (MBT). Treatment, however, is difficult because it is hard to engage these patients in psychotherapy.
“Suicide is a leading cause of death among this population,” wrote the authors of the Canadian study. “Borderline PD (BPD) and narcissistic PD may be the higher contributors. Suicide among BPD patients may be more impulsive than among narcissistic patients, which has led some authors to consider different psychotherapeutic strategies. Moreover, if impulsivity decreases with age, elderly patients with narcissistic disorder may remain vulnerable to suicide.”
According to the author of a review published in the Annals of General Psychiatry, suicide risk is greatest in those with NPD in the wake of a severe narcissistic injury, when the individual feels shamed or vilified. “Patients with narcissistic personality disorder are often thought to be less likely to make the kind of random non-lethal suicide attempts typical of the impulsivity associated with attempts made by patients with borderline personality disorder,” the author wrote. “However… NPD patients are at high risk for completed suicides or highly lethal attempts without warning signs or self-disclosures. Indeed, they are made with the intention to end their lives. Therefore, professionals involved in their treatment must assume that an impulsive behavior designed to end their lives is always a possibility.”
In an opinion piece published in Frontiers in Psychiatry, Italian researchers take exception to how the DSM characterizes NPD. They argue that the DSM’s approach is reductionistic, results in an underestimation of the frequency of the condition, and pays little heed to the vulnerable manifestation of the disease.
The authors also note that, as a trait, narcissism can be constructive, Carrying the trait generally means an enhanced ability to keep a positive self-image via self-regulation and interpersonal regulation.
Trait narcissism may be especially helpful in those who survive cancer. Cancer is often distressing and can be disfiguring. The authors pointed out that the effects can be especially worrisome to women who, in the wake of cancer treatment, tend to value aesthetics more than men. (Men tend to focus their body awareness on functioning.)
Healthy levels of narcissism can benefit the cancer patient, per the authors. “In general, maintaining a high level of self-esteem predicts better psychological adjustment to cancer and its treatment, in terms of a higher quality of life and reduced levels of distress, anxiety, and depression,” they wrote. “Therefore, in addition to the best possible medical therapy, the improvement of patients’ quality of life must be a standard of care in oncology, as it promotes compliance to treatment. In this perspective, psychosocial interventions should be combined with standard oncological care.”
The authors highlighted research pointing to the long-term benefits of programs centered on improving appearance in female cancer patients. These programs taught patients about skin, make-up, wigs, and nutrition, with contributions from make-up artists, photographers, nutritionists, and dermatologists. Psychological evaluation performed at the conclusion of the intervention and 3 months afterward demonstrated that self-esteem improved and depressive symptoms, anxiety, and body-image issues attenuated.
In its most pathological form—NPD—narcissism is likely no good for health. Not only is NPD tied to various health detriments but it also increases the risk of suicide. Individuals with NPD should receive appropriate psychiatric care. Nevertheless, the narcissistic trait can be helpful in boosting health after diseases such as cancer.
If you’re contemplating suicide, please know that there is help and hope out there. You are not alone. A good place to start the process of healing is the National Suicide Prevention Lifeline, where 24-hour help is only a phone call away: 1-800-273-8255.