Updated on December 22, 2025
Your partner cancels dinner plans again because something “more important” came up. When you express disappointment, they turn it around until you’re apologizing for being needy. Later, when they need support, they expect you to drop everything. You find yourself constantly walking on eggshells, wondering if this time you’ll get warmth or coldness.
If this sounds familiar, you might be dealing with someone who has narcissistic traits or narcissistic personality disorder (NPD). While the term “narcissist” gets thrown around casually, true NPD is a complex mental health condition that profoundly affects relationships and causes real suffering for everyone involved.
What Is Narcissistic Personality Disorder?
Narcissistic personality disorder isn’t about someone who takes too many selfies or loves getting compliments. It’s a pattern of behavior and inner experience that causes significant problems in relationships, work, and daily life.
A large-scale study published in the Journal of Clinical Psychiatry examined over 34,000 adults and found that about 6.2% will experience NPD at some point in their lives. Rates are notably higher among men (7.7%) than women (4.8%). The disorder typically emerges in early adulthood and affects how someone sees themselves, relates to others, and responds to life’s challenges.
People with NPD have a pervasive pattern that includes:
- Grandiosity – An inflated sense of their own importance, talents, or achievements. They exaggerate accomplishments or expect recognition without corresponding achievements.
- Need for admiration – A constant requirement for praise, validation, and special treatment from others. This need can feel insatiable, with compliments from last week meaning nothing today.
- Lack of empathy – Difficulty recognizing or caring about how others feel. They may intellectually understand that their actions hurt people, but struggle to feel genuine concern.
- Interpersonal exploitation – Using others to achieve their own goals without guilt or remorse. They might ask for favors, but rarely return them.
- Entitlement – Expecting favorable treatment and automatic compliance with their wishes, even when it’s unreasonable.
The Two Faces of Narcissism
Recent research has identified two main presentations of narcissistic personality disorder that can look quite different on the surface. Studies show these presentations often coexist, especially in people with high levels of grandiosity.
Grandiose Narcissism
This is what most people picture when they think of narcissism. Someone with grandiose narcissism appears confident, charming, and socially dominant. They’re often charismatic and easily attract people. They may pursue status, engage in constant social comparison, and feel envious when others succeed.
Grandiose narcissists often show off achievements and expect admiration. They dominate conversations and redirect focus to themselves. When criticized or challenged, they may react with anger or withdraw their affection entirely. Some take credit for others’ work without apparent guilt.
Vulnerable Narcissism
This presentation is less recognized but equally problematic. Research from McLean Hospital and Harvard Medical School shows that people with vulnerable narcissism appear anxious, insecure, and hypersensitive to criticism. They may seem shy or withdrawn, but beneath the surface, they harbor the same sense of entitlement and lack of empathy.
Vulnerable narcissists often play the victim and seek sympathy. They feel easily slighted or misunderstood. They hold grudges and express resentment that can last years. Many experience depression and anxiety alongside narcissistic traits.
Recent studies reveal that many people with NPD alternate between these presentations depending on the situation and whether their needs are being met. Those with high levels of grandiosity are particularly likely to experience vulnerable episodes marked by shame and self-consciousness.
How Narcissistic Personality Disorder Affects Relationships
Maria (name and details changed from a composite of common relationship patterns) had been dating Alex for eight months when concerning patterns began to emerge. Early on, Alex was attentive and generous, making her feel incredibly special. He’d show up with her favorite coffee order and remember obscure details from conversations weeks earlier.
But gradually, he began criticizing her clothing choices. “That dress makes you look heavier.” Her friends? “They seem kind of boring.” Even how she loaded the dishwasher became a problem.
When Maria got a promotion at work, instead of celebrating with her, Alex spent the evening complaining that his boss was overlooking his talents. When she tried to discuss her hurt feelings, he accused her of “always being dramatic” and “making everything about you.” She found herself apologizing constantly, though she wasn’t sure what she’d done wrong. Her confidence eroded as she tried harder and harder to make him happy.
This pattern is typical in relationships where one person has NPD.
Warning Signs in Your Relationship
- Emotional manipulation – You constantly second-guess your own feelings and perceptions. Conversations get turned around, so you’re always the problem. You might find yourself thinking, “Maybe I am too sensitive,” even when you’re responding to genuinely hurtful behavior. This pattern of making you question your reality often intensifies over time.
- Lack of accountability – They rarely apologize genuinely or take responsibility for their actions. When they do apologize, it often comes with conditions: “I’m sorry you felt hurt” rather than “I’m sorry I hurt you.”
- Boundary violations – Your needs, time, and feelings consistently matter less than theirs. They may read your texts or emails without permission, demand access to your phone, or show up unannounced and expect you to drop everything.
- Shifting dynamics – The relationship feels like an emotional rollercoaster. Periods of warmth and connection give way to coldness or criticism without clear reasons. You never quite know which version of them you’ll get.
- Isolation tactics – They subtly or overtly discourage your relationships with family and friends, especially those who might question the relationship dynamic. Comments like “Your sister never liked me anyway” or “Do you really need to see your friends every week?” start adding up.
Understanding the Internal Struggle
While NPD behavior can be harmful to others, people with this disorder often experience significant internal pain. Dr. Elsa Ronningstam, a clinical psychologist at McLean Hospital and associate professor of psychology at Harvard Medical School, who has studied narcissistic personality for over 30 years, explains that these individuals struggle with unstable self-esteem and difficulty regulating emotions.
Beneath the grandiose exterior or victim presentation lies profound insecurity. Their need for constant validation stems from an inability to maintain a stable sense of self-worth internally. When that external validation disappears, they may experience intense shame, anxiety, or depression. Some describe it as feeling like they’re falling apart inside while trying to hold themselves together.
This doesn’t excuse harmful behavior, but it helps explain why change is so difficult. Their defensive strategies, while damaging to relationships, feel necessary for psychological survival.
What to Do If You’re in a Relationship With Someone Who Has NPD
If you recognize these patterns in your relationship, you have options.
Set Clear Boundaries
Decide what behavior you will and won’t accept. Communicate these boundaries clearly and follow through with consequences when they’re violated. People with NPD often test boundaries repeatedly, so consistency matters more than eloquence.
Example: “I won’t continue conversations where you call me names. If that happens, I’ll leave the room, and we can talk later when we’re both calmer.”
Don’t Engage in Circular Arguments
When someone tries to provoke you into an argument or make you feel guilty, recognize the pattern and disengage. You don’t have to defend yourself against unreasonable accusations. Sometimes the healthiest response is “I see this differently,” followed by ending the conversation.
Maintain Your Support System
Keep your relationships with friends and family strong. Having outside perspectives helps you keep your bearings when you’re dealing with someone who distorts reality. These relationships also remind you that a healthy connection doesn’t require walking on eggshells.
Focus on Observable Facts
In conversations, stick to observable facts rather than feelings or interpretations that can be twisted. “You cancelled our dinner plans three times this month” is harder to argue with than “You don’t care about me.”
Consider Professional Support
Individual therapy can help you develop coping strategies, rebuild your self-esteem, and figure out whether the relationship is salvageable. A therapist can also help you recognize patterns and regain your sense of power in the relationship.
Can Someone With NPD Change?
Change is possible but requires genuine motivation, which is rare in NPD. Research shows that most people with narcissistic personality disorder don’t seek treatment because they don’t see their behavior as problematic. From their perspective, other people are the problem.
When they do enter therapy, it’s often to address depression, anxiety, or relationship breakdowns rather than the personality disorder itself. Treatment typically involves long-term psychotherapy (often 1-2+ years) focused on developing empathy, improving emotion regulation, and building more stable self-esteem. Progress is usually gradual and requires the person to tolerate significant discomfort as they examine behaviors they’ve used to protect themselves.
When to Consider Leaving
Not every relationship with a narcissistic person needs to end, but some situations warrant serious consideration of leaving:
- Physical, emotional, or verbal abuse
- Refusal to acknowledge problematic behavior when confronted directly
- Patterns that worsen over time despite your efforts
- Negative impact on your mental health, self-esteem, or well-being that persists for months
- Involvement of children who are being harmed
- Your sense of reality is becoming increasingly distorted
Trust your instincts. If the relationship consistently leaves you feeling diminished, anxious, or worthless, those feelings are telling you something important about your situation.
Understanding NPD in Your Life
Recognizing narcissistic personality disorder is just the beginning. If you’re in a relationship with someone who exhibits these patterns, it is helpful to understand how such relationships typically progress through predictable stages. Understanding the cycle can help you make informed decisions about your next steps.
At Firefly Therapy Austin, we understand the complex emotional toll these relationships can take. Our therapists can help you sort through your experiences, rebuild your confidence, and develop strategies for healthier relationships moving forward, whether that means working on the current relationship or preparing to leave. Reach out today to start that conversation.