Interestingly, the editors of The Diagnostic and Statistical Manual of Mental Disorders (DSM) once considered removing narcissistic personality disorder (NPD) due to variations in diagnosis. However, NPD remains in the manual as a Group B personality disorder, alongside antisocial, histrionic, and borderline personality disorders. Individuals with Group B personality disorders often exhibit intense and erratic behavior.
Although NPD often negatively impacts mental health, how does it relate to illness and mortality? And how does one's level of self-interest rather than NPD connect to their health? The answers might surprise you.
Understanding NPD
The DSM-5 defines narcissism as a personality disorder characterized by arrogance, a need for admiration, and lack of empathy. It impairs one's ability to function and hinders relationships. In psychiatric terms, narcissism overlaps with various other mental illnesses. There are three types of NPD: grandiose/exhibitionistic, vulnerable/hypervigilant, and high-functioning. Both biological and psychological factors play a role, though the exact cause of pathological narcissism remains unclear.
Physical health
NPD has been associated with a range of negative health outcomes. It affects illnesses, adherence to treatment, interactions with healthcare providers, and increases the risk for physical diseases. People with NPD are more likely to engage in substance abuse and risky sexual behaviors. Additionally, they tend to utilize medical services frequently and pursue superficial and cosmetic surgeries.
Findings from a recent study published in the Canadian Journal of Psychiatry demonstrate the significant impact of NPD on longevity. The study compared Quebec residents aged 14 and older with Group B personality disorders to the general population. The prevalence of Group B personality disorders was 2.6%, with an average reduction in lifespan of 13 years for men and 9 years for women. Leading causes of death included suicide (20.4%), cardiovascular disease (19.1%), and cancer (18.6%). A substantial proportion of patients with Group B personality disorders had seen a psychiatrist, been to an emergency department (ED), or been hospitalized at some point.
Risk of suicide
Collectively, patients with Group B disorders receive heightened attention due to their increased risk of suicide. Recommended psychotherapy approaches include Dialectical Behavior Therapy (DBT) and Mentalization-Based Therapy (MBT). However, treatment is challenging due to difficulties in engaging these patients in psychotherapy.
"Suicide is a leading cause of death among this population," wrote the authors of the Canadian study. "Borderline personality disorder (BPD) and narcissistic personality disorder are likely the main causes. Suicide among BPD patients may be more impulsive than among narcissistic patients, prompting some authors to consider different psychotherapeutic strategies. Moreover, if impulsivity diminishes with age, elderly patients with narcissistic disorder may remain vulnerable to suicide."
According to a review published in the Archives of General Psychiatry, the risk of suicide is highest in those with NPD following a severe narcissistic injury, when the individual feels shamed or criticized. "The author noted that individuals with narcissistic personality disorder (NPD) tend to avoid impulsive, non-lethal suicide attempts seen in borderline personality disorder (BPD). Instead, those with NPD are more prone to sudden, high-lethality suicide attempts or completed suicides, often without prior warning signs. Indeed, they may have premeditated their suicides. Therefore, clinicians involved in their care should anticipate that an impulsive act intended to take their lives is often a possibility."
The flip side
In an opinion piece published in Advances in Psychiatry, Italian researchers criticize how the DSM characterizes NPD. They argue that the DSM's approach is oversimplified, leads to an underestimation of the frequency of the disorder, and pays little attention to its subtle manifestations.
The authors also note that, as a trait, narcissism can be beneficial. Expressing the trait generally means an improved ability to maintain a positive self-image through self-regulation and interpersonal regulation.
Healthy levels of narcissism can be particularly beneficial in individuals coping with illness. Cancer, for instance, is often distressing and can be disfiguring. The authors pointed out that the effects can be especially distressing to women who, after cancer treatment, often place a high value on appearance. (Men typically focus their body awareness on functionality.)
Moderate levels of narcissism can aid the cancer patient, according to the authors. "In fact, maintaining a high level of self-esteem predicts better psychological adjustment to cancer and its treatment, resulting in a higher quality of life and reduced levels of distress, anxiety, and depression," they wrote. "Therefore, besides providing the best medical care, improving patients' quality of life should be a fundamental aspect of oncology practice because it encourages adherence to treatment. In this regard, psychosocial interventions should be integrated with standard oncological care."
The authors highlighted research indicating the long-term benefits of programs focused on improving appearance in female cancer patients. These programs included skincare, makeup, wigs, and nutrition, with contributions from makeup artists, photographers, nutritionists, and dermatologists. Psychological assessment conducted at the end of the intervention and 90 days later showed improved self-esteem and reduced depressive symptoms, anxiety, and body image issues.
Conclusion
In its most pathological form NPD narcissism can be detrimental to health. Not only is NPD associated with various health burdens, but it also increases the risk of suicide. Individuals with NPD should receive appropriate mental health care. However, the narcissistic trait can be beneficial in promoting health after illnesses such as cancer.