My Loved One has Symptoms of Narcissistic Personality Disorder


August 29, 2022

Presented by Dr. Ron Mottern – Executive Director – Mottern Institute for Mind-Body Wellness. He has 22 years experience in-person and worldwide virtual treatment in:

  • Cognitive Restructuring
  • Behavioral Modification
  • Emotional Regulation
  • Physical Improvement

He is a published author of the following: Living Well: A Guide to Cognitive Behavioral Skills Exercises

Download Dr. Motton’s slides in PDF format here:

What is Narcissistic Personality Disorder (NPD)?

  • Cluster B Personality Disorder (Antisocial Personality Disorder, Borderline Personality Disorder, Histrionic Personality Disorder, Narcissistic Personality Disorder)
  • A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
  • 1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
    • May assume that others attribute the same value to their efforts and may be surprised when the praise they expect and feel they deserve is not forthcoming.
    • Often implicit in the inflated judgements of their own accomplishments is an undervaluation or devaluation of the contributions of others.
  • 2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
    • May ruminate about “long overdue” admiration and privilege and compare themselves favorably with famous or privileged people.
  • 3. Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
    • They can be surprised or even devastated when the recognition of acclaim they expect and feel they deserve from others is not forthcoming.
    • They may feel that they can only be understood by, and should only associate with, people of high status and may attribute “unique,” “perfect” or “gifted qualities to those with whom they associate.
    • They believe that their needs are special and beyond the ken of ordinary people.
    • Their own self-esteem is mirrored by the idealized value that they assign to those with whom they associate.
  • 4. Requires excessive admiration
    • Their self-esteem is almost invariably very fragile, and their struggle with severe internal self-doubt, self-criticism, and emptiness results in their need to actively seek others’ admiration.
    • They may be preoccupied with how well they are doing and how favorably they are regarded by others.
    • They may expect their arrival to be greeted with great fanfare and are astonished if others do not covert their possessions.
    • They may fish for compliments, often with great charm.
  • 5. Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).
    • They expect to be catered to and are puzzled or furious when this does not happen. For example, they may assume that they do not have to wait in line and that their priorities are so important that others should defer to them, and they get irritated when others fail to assist “in their very important work.”
    • They expect to be given whatever they want or feel they need, no matter what it might mean to others. For example, they may expect great dedication from others and may overwork they without regard for the impact on their lives.
  • 6. Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).
    • Their sense of entitlement, combined with a lack of understanding and sensitivity, may result in the conscious or unwitting exploitation of others.
    • They tend to form friendships or romantic relationships only if the other person seems likely to advance their purposes or otherwise enhance their self-esteem.
    • They often usurp special privileges and extra resources that they believe they deserve.
    • May intentionally and purposefully take advantage of others emotionally, socially, intellectually, or financially for their own purposes and gains.
  • 7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
    • They tend to have some degree of cognitive empathy (understanding another person’s perspective on an intellectual level) but lack emotional empathy (directly feeling the emotions that another person is feeling).
    • They may be oblivious to the hurt their remark inflict.
    • When recognized, the needs, desires, or feelings of others are likely to be viewed disparagingly as signs of weakness or vulnerability.
    • Those who relate to individuals with NPD typically find an emotional coldness and lack of reciprocal interest.
  • 8. Is often envious of others or believes that others are envious of him or her.
    • May begrudge others their successes or possessions, feeling that they better deserve those achievements, admiration, or privileges.
    • They may harshly devalue the contributions of others, particularly when those individuals have received acknowledgement or praise for their accomplishments.
  • 9. Shows arrogant, haughty behaviors or attitudes.

Types of Narcissism

There are many types and sub-types of narcissism, according to the literature at which one looks. There are as few as two types and as many as 13 types. Note that none of these are a part of the diagnostic criteria in the DSM-5-TR for NPD.

Two types that are sometimes seen are:

  1. Adaptive narcissism refers to aspects of narcissism that can actually be helpful, like high self-confidence, self-reliance, and the ability to celebrate yourself.
  2. Maladaptive narcissism is connected to traits that don’t serve you and can negatively impact how you relate to yourself and others. For example, entitlement, aggression, and the tendency to take advantage of others. This would be associated with symptoms of narcissistic personality disorder.

6 Types of Narcissists

  1. Cerebral–I’m smarter than you.
  2. Somatic–I’m more beautiful and physically talented than you.
  3. Overt–I’m in control of you and you’ll know it.
  4. Covert (Closet)–I’m in control of you but I act like you’re in control of me.
  5. Parasitic–You need to take care of me. 
  6. Boomerang–You need me, again, and again, and again.

Narcissistic Rage

  • Uses anger as a weapon.
  • Intense anger, aggression, or passive-aggression when a narcissist experiences a setback or disappointment, which shatters his (or her) illusions of grandiosity, entitlement, and superiority, and triggers inner inadequacy, shame, and vulnerability.
  • Narcissistic rage occurs in many forms. They all share, however, a specific psychological flavor which gives them a distinct position within the wide realm of human aggressions. The need for revenge, for righting a wrong, for undoing a hurt by whatever means, and a deeply anchored, unrelenting compulsion in the pursuit of all these aims, which gives no rest to those who have suffered a narcissistic injury – these are the characteristic features of narcissistic rage in all its forms and which set it apart from other kinds of aggression.
  • The following includes good general advice for navigating another person’s narcissistic rage:
    • Become familiar with narcissistic personality disorder so that you can recognize triggers and outcomes.
    • Seek therapy for yourself when warranted based on past events.
    • Avoid giving direct criticism or feedback that may trigger a narcissistic reaction.
    • Don’t escalate conflicts that could lead to personal harm.
    • Don’t take things personally or seek out revenge.
  • Avoid sharing too much personal information that could be used against you.
  • If you feel as though the person is a threat to themselves or anyone else (including you), call 911 or the emergency number in your area.
  • Recognize that you are not to blame and are not responsible for their moods or behaviors.
  • Recognize that they are not behaving or acting in a rational manner, their judgment is impaired, and they are not thinking straight.
  • Don’t try to use logic or get into a debate with the person or try to argue that they are overreacting.
  • Don’t apologize or accept their behavior, which may just lead to more abuse.
  • Don’t become angry yourself; try to stay calm, cool, and collected.
  • If you are given the silent treatment, do your best to ignore it.
  • If their anger becomes explosive, leave the situation to protect your own safety.
  • Validate their feelings without going along with bad behavior; for example, say “you are entitled to feel that way.”
  • Set personal boundaries to be clear about what is acceptable behavior for you.
  • Find support for yourself such as a support group or person you can confide in.
  • If you feel like you might be being gaslighted, find an outside perspective.
  • Protect your self-esteem and self-worth from being affected by the narcissist.
  • Recognize your qualities that may make you a target for narcissists (e.g., being overly agreeable and accepting).
  • Rage will tend to show up when the narcissist is stressed by circumstances, so it’s best to avoid them during these times as a form of self-protection.

Narcissistic Supply

  • Narcissists get their basic needs met by manipulating others.
  • This manipulation may be hard, e.g., overt aggression, or soft, e.g., emotional and psychological manipulation.
  • Just like an drug addict needs their supply of drugs, narcissists need their supply of emotional support. They need their emotional fix.
  • You may be the narcissist’s supply, i.e., you may be the means through which the narcissists gets their needs met.

Characteristics of Narcissistic Supply

  • Identity Disorder:
    The longer the relationship with the Narc continues, the less you feel, act, look and talk like you. This comes from the Narc dictating who you are. If you tell them how you feel, the Narc will twist it and say ‘no that’s now who you are’ or ‘I know who you really are’. A lot of victims after a Narc relationship will say “I don’t know who I am”.
  • Exhaustion and Adrenal Fatigue:
    The longer the relationship exists the more responsibility you take in the relationship and the less the Narc takes on. As difficulties in the relationship arise, you are expected to overcome them. Because the narc is so exploitive, they are stepping back in everything and you are taking on more and more. Financial, children, home, etc…the responsibilities lie on the shoulders of the Narc Sup and yet the Narc will complain as if it’s never enough. You give and give and assumer more and more responsibility to show them that you are trying to do your part and worth their love, you don’t even realize that they aren’t doing anything anymore.
  • Cognitive Dissonance:
    A condition when your mind experiences two contrary or opposing thoughts. For example, they love you but they don’t want to see you happy. Then if you ask them “how can you love me if you don’t want me to be happy” they respond with something like “How can you accuse me of that? I’ve never accused you of that despite what we’re been through”. They flip it back on you and twist things to keep you in a constant state of confusion. Nothing seems to make sense and you live in a constant state of confusion because your brain is struggling with what’s true and what’s not.
  • Constantly Thinking:
    Your mind is so occupied with thoughts about why things are happening they way they are, why you can’t make sense of it, why they treat you the way they do, why it seems to be one way but the Narc says it’s not that way, that you can’t enjoy the things around you. You are so worried about not setting the Narc off, trying to figure out how to make them happy and wondering what is going to happen next, that you miss out on friends, family and the joys of daily life.
  • Brain Fog:
    Your ability to concentrate is gone, your memory is failing and you can’t understand the simple things about relationships that you used to. You can’t see clearly: you don’t feel centered and nothing makes sense.
  • You begin Doubting your Sanity:
    Narcs are emotional manipulators are attracted to peaceful, kind and generous people. However, their desire is to systematically erase these qualities from that person and create a mirror of themselves. Over time, as they manipulate your feelings and the rollercoaster of blowups continues, the brain makes associations and the Narc Sup will begin to think that they are losing their mind.
  • Suffer from PTSD:
    You have been in emotional warfare for so long that your emotions are unpredictable. You never know what bomb is going to go off…you never know when the Narc has received injury (even if that injury is only in their mind) so you can never relax. There is no emotional downtime. Little by little you learn that the minute you relax is the minute that the bomb goes off, so you never allow yourself to relax.
  • Depression:
    Who you were is not who you are anymore. The simple joys that you used to have in the things that you are passionate about are gone. That’s the definition of depression: you no longer enjoy the things that once made you happy. Over time, as you engage in the things that make you happy, the Narc will make comments like “I just want to spend time with you, but you’re too busy with ____”. You don’t realize that they are attacking your passion, you just think that they want to spend more time with you. Over time, your brain makes these negative associations with those things that make you happy, and systematically you stop doing them.
  • You Look or Feel like an Empty Shell:
    Because the Narc has been slowly erasing who you are, you no longer feel like yourself. It affects the tone of your voice, the light in your eyes and how you look, but often it’s not realized until after the relationship is over.
  • Emotional Disconnect:
    It’s almost like someone has turned a switch off inside of you. You have been conditioned to not experience very many positive emotions because the Narc feels threatened by your positive emotions. Your negative emotions are rewarded by the Narc by giving you peace without the unpredictable explosions and you end up in a grey area of emotional disconnect.
  • Low Self-esteem:
    While you may have had low self-esteem prior to this relationship, this is problematic because it’s continually being chipped away at by your abuser until it becomes dysfunctional to your daily life.
  • Addicted to the Abuser:
    Even if you realize that you are in an abusive relationship (friends, family or therapist has helped you to see it), instead of really owning it you feel an obsessive need to gain this person’s approval. Nothing else matters.
  • Sense of Shame:
    The Narc projects their negative emotions on to you, and even pass it on at a subconscious level. For example, if you actually have a good time with friends and enjoying yourself, the Narc will see that as a threat to them and shoot you a glance that makes you wonder what you have done to upset them. You will retreat into the confusion and mental anguish that surrounds you in wondering what you have done and why they are upset.
  • Nightmares:
    Frequent disruptive nightmares that symbolize the upset and lack of control in your relationship. These may be symbolic of the turmoil in your waking life.
  • Dissociation:
    This coping mechanism is often put in place by our brains to lessen the effect of the abuse. This is prevalent in many different psychological conditions and results from being emotionally overwhelmed. We are removed and distant from our experiences and separates us from the turmoil and anguish. You have to retrain your brain that you can handle intense emotions and stress.
  • Easily Triggered:
    Your dominant stress response (flight, fight, freeze or fawn) is easily triggered. When things get difficult your immediate trauma response is easily set off. When things get difficult, you immediately have this trauma response. You are living with an emotional manipulator that teach you that you have to live at a 9 in anxiety: they never let you relax, constantly cause turmoil and have you constantly walking on eggshells. They do this because they feed off of the explosive reactions, so they want to keep you at heightened anxiety because it means that they don’t have to work as hard to get a response. Being easily triggered to react with a trauma response in combination with a difficultly in turning off that response, is a big red flag.
  • Addictions:
    Whether it’s alcohol, drugs, eating, watching tv, shopping or gambling, you are prone to addictions that are destructive in nature. (leads into destructive behavior)
  • Destructive behavior:
    Sabotaging one area of your life. This may be relationships with friends or career success,the Narc Sup will take over the abuse and slowly destroy what is important to them.
  • Panic Attacks:
    The natural progression of anxiety can be to turn into panic attacks. While this is not always the case, when the brain is dissociated and the body is under continual stress, the mind is constantly learning new negative pathways and creating those based on experience.
  • Anxiety:
    Over time, under these abusive conditions, anxiety levels within the Narc Sup increase to damaging levels. Continued anxiety can give way to other psychological issues, for example, Phobias. The pattern of Narc abuse is that any social event will be precipitated by a massive blowup so that the Narc can release their negative emotions. So, at the event, the Narc looks great, while the Narc Sup is a mess. This creates a negative association in our brains surrounding being in social situations which, over time, can manifest into a social phobia. These changes in the Narc Sup’s personality are ultimately used against them.

How to Deal with a Narcissist

  1. Cut off all communication with them.
  2. Define clear boundaries and stick to them.
  3. Insist that things be done immediately and do not accept delays or promises.
  4. Understand that the narcissist will try to destroy all boundaries.
  5. Develop a support group.
  6. Get help for yourself.
  7. Remember that you are not the one at fault.


  • Dr. Ron Mottern & Area Agency on Aging of North Central Texas, hosted by Marty Mascari.
  • American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Association.
  • Furnham, A., Richards, S. C., & Paulhus, D. L. (2013). The dark triad of personality: A 10 year review. Social and Personality Psychology, 7(3), 199- 216. Retrieved from
  • Ni, P. (2018, July 8). 8 signs of narcissistic rage. Retrieved from
  • Author Unknown. (2008, April 20). A structural theory of narcissism and psychopathy. Retrieved from
  • Cuncic, A. (2021, November 13). What is narcissistic rage? Retrieved from
  • Murphy, K. (2019, July 30). 20 signs of narcissistic supply (victimology). Retrieved from

We hope this information is helpful to you in the important work you do as a family caregiver.
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