Alcoholism and Narcissistic Personality Disorder: How Are They Related?

Narcissism is a personality trait that can be part of narcissistic personality disorder (NPD) in some people and alcoholism is a substance use disorder (SUD). The two disorders are linked and share some similar features. Narcissists can become alcoholics and alcoholics can be especially narcissistic when drunk. When they’re sober, many alcoholics are not narcissists.

At Legends Recovery Center of Ohio, our rehab facility provides detox for various substances and other levels of care for people recovering from dual diagnoses, such as alcoholism and narcissistic personality disorder.

What is Narcissistic Personality Disorder?

NPD is a mental health disorder in which a person has an irrational high sense of their importance. They want to be admired and seek constant attention. It’s common for people with NPD not to have the ability to understand or care about other people’s feelings. However, behind their mask of confidence, they are usually not sure of their self-worth and can be easily upset by even the slightest criticism.

Symptoms of NPD

People with NPD can:

• Have an irrational high sense of self-importance and need constant admiration.
• Believe that they deserve special treatment and privileges.
• Expect to be viewed as superior even without any achievements.
• Exaggerate their achievements and talents.
• Be obsessed with fantasies about power, success, brilliance, beauty, or the perfect mate.
• Believe they’re superior to other people so they can only spend their time with or be understood by people who are equally special.
• Look down on and be critical of people they deem unimportant.
• Expect special favors and expect people to do whatever they want without question.
• Take advantage of others to get what they want.
• Envy other people and believe that others envy them.
• Behave arrogantly, brag, and appear to be conceited.
• Demand the best of everything.

On the other hand, people with NPD can’t handle anything they view as criticism. They can:

• Become angry or impatient when they don’t get special attention.
• Have major difficulty interacting with others and feel slighted easily.
• React with contempt or rage and try to belittle others to make themself appear superior.
• Have problems managing emotions and behavior.
• Experience problems coping with stress and adapting to changes.
• Avoid or leave situations where they might fail.
• Feel moody and depressed because they aren’t perfect.
• Have secret feelings of shame, insecurity, humiliation, and fear of being exposed as a failure.

What Is Alcohol Use Disorder?

Alcohol use disorder (AUD) is the medical term for alcoholism or alcohol abuse. When a person has an uncontrolled problem drinking they may have a health condition called alcohol use disorder. It points to the individual’s inability to control their alcohol consumption despite the adverse social, health, financial, or other effects such as a growing dependence and tolerance.

AUD is considered a brain disorder and may be mild, moderate, or severe. Criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) are used to determine the severity of the disorder is present. Severity is based on the number of criteria the person meets:

• 2 to 3 criteria–mild
• 4 to 5 criteria–moderate
• 6 or more–severe

Criteria for Assessing AUD

In the past year, have you:

• Had times when you drank more or longer than you meant to?
• Tried to cut down or stop drinking more than once but couldn’t?
• Spent a lot of time drinking, or being sick from drinking, or getting over other the after-effects of drinking?
• Craved a drink so badly you couldn’t think of anything else?
• Often found that drinking or being sick from drinking interfered with taking care of your family and home. Or brought on job problems? Or problems at school?
• Continued your drinking even though it was causing problems with your friends or family?
• Give up or cut down on activities that were important, interesting, or gave you pleasure so you could drink.
• Gotten into situations more than once during or after drinking that increased your likelihood of getting hurt (driving, swimming, running machinery, walking in a dangerous area; unprotected sex)?
• Kept drinking, even though it was making you feel anxious, depressed, or adding to another health problem? Or after having a memory blackout?
• Had to drink a lot more than you used to to get the effects you want? Or you found that your usual amount of drinking had much less effect than previously?
• Found that when the alcohol’s effects were wearing off you experienced withdrawal symptoms such as:
• Sleeping problems
• Shakiness
• Nausea
• Restlessness
• Racing heartbeat
• Seizure
• Hallucinations (sensing things that weren’t there)?

Any of these symptoms should make you concerned. The more symptoms, the more serious the need for change.

Narcissism and Alcoholism

• Individuals with a narcissistic personality disorder may use alcohol to help them cope with some of the features of their disorder.
• Alcohol use disorder may trigger a person to develop narcissistic personality traits.

Overlapping Characteristics

Alcoholism and narcissistic personality disorder share various characteristics. Both may:

• be self-absorbed: The alcohol addiction limits their outlook until it’s all about them getting alcohol, paying for alcohol, consuming alcohol, etc.
• have an overblown sense of entitlement: They feel entitled to alcohol, to other people’s alcohol, or personal belongings, including their money, time, and home.
• have a lack of empathy for other people: This is because they are preoccupied with their addiction and have no shame in manipulating others to get what they want.
• have trouble recognizing when they need to get help.

Overlapping signs and behaviors may include:

• an exaggerated feeling of importance
• avoiding emotions like guilt or shame
• blaming other people or shifting responsibility to someone else
• being destructive to themself and others
• mood swings
• persistent relationship problems (empty promises, breakups, and makeups)
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Diagnosis Difficulty

The overlapping traits of denial, lack of self-awareness, and refusal to take responsibility for their actions can make it especially challenging to diagnose these co-occurring disorders (also known as a dual diagnosis). It may also mean that one or both disorders may go undiagnosed. Because of the link between personality disorders and AUD, researchers have recommended that healthcare providers screen for both disorders when one is present.

Does One Cause the Other?

The relationship between alcoholism and narcissistic personality disorder is too complicated to say that either caused the other. Individuals with personality disorders have problems coping with daily stress and may use alcohol to escape their feelings. The association between mental health conditions and substance misuse is strong. Several national surveys have discovered that about 50% of the population with one disorder will also experience the other.

Personality also plays a role, even when a clinical personality disorder is not evident. Personality is a factor that contributes to whether or not someone is liable to develop an AUD. In 2019, a study of 345 college students found both grandiose (overt) and vulnerable (covert) forms of narcissism to be useful predictors of alcohol use and problems related to alcohol use.

Causes

No one knows what causes NPD. The cause is complicated and may be linked to:

• Environment

Parent-child relationships with either too much adoration or too much criticism don’t fit with the child’s actual achievements and experiences.

• Genetics

Characteristics that are inherited like certain personality traits.

• Neurobiology

The connection between the brain, behavior, and thinking.

Complications of NPD

The complications of narcissistic personality disorder and other conditions that may happen at the same time include:

• Difficulties in relationships
• Problems at school or work
• Anxiety and depression
• Additional personality disorders
• Anorexia (eating disorder)
• Physical health issues
• Misuse of drugs or alcohol
• Suicidal thoughts or behavior

Is it Overt or Covert?

Another complication is making the right diagnosis. Two types of narcissism must be recognized.

1. Overt narcissism is the stereotypical form of narcissism– overly confident, vain, and arrogant.
2. Less well-known is covert narcissism. It is the introverted, playing the victim for attention, self-doubting type of narcissism.

What is a Narcissist Alcoholic?

A narcissist alcoholic, or alcoholic with narcissist traits, has narcissist tendencies co-occurring with AUD. It’s not known for sure how likely someone is to have both disorders, but an analysis of 16 studies found lifetime prevalence for AUD and personality disorders is estimated at 38.9%. (This does not include antisocial personality disorder and borderline personality disorder, which have higher rates.)

Displaying narcissistic behavior when drunk doesn’t inevitably mean a person has a narcissistic personality disorder. Narcissistic attitudes including arrogance, self-importance, and an inflated sense of self-esteem and superiority may be exhibited that aren’t there when the person is sober.

Displaying narcissistic behavior when drunk doesn’t inevitably mean a person has a narcissistic personality disorder. Narcissistic attitudes including arrogance, self-importance, and an inflated sense of self-esteem and superiority may be exhibited that aren’t there when the person is sober.

Environmental Factors

Additionally, common environmental factors may contribute to co-occurring NPD and AUD. They include:

• Childhood trauma, such as sexual, physical, or emotional abuse or neglect
• Living with a person with AUD or other addiction in the home
• Living with someone who has any mental illness including NPD

Being a Narcissist When Drunk

Narcissism appears like a drunk person is monopolizing all conversations, exaggerating their stories to get admiration from others, and making bad choices such as:

• Lying
• Cheating
• Manipulating to get their way at any cost.

Prevention

Since the cause of narcissistic personality disorder is not clear at this time, there is no known way to prevent it. However, it might help to:

• Get treatment for childhood mental health problems as soon as possible
• Take part in family therapy to learn to communicate in healthy ways or to cope with emotional distress or conflicts
• Go to parenting classes and get guidance from a social worker or therapist if necessary

Starting Treatment

People with NPD don’t want to think that anything could be wrong so they don’t usually get treatment. But if they do, it’s more likely to be for symptoms of drug or alcohol abuse, depression, or another mental health problem. What an individual with NPD sees as insults to their self-esteem may be what makes it difficult to accept and follow through with treatment.

If you recognize some traits of your personality that are common to narcissistic personality disorder, or if you’ve been feeling overwhelmed by sadness, consider contacting a mental health provider or a trusted health care provider.

Recovery and Relapse

A relapse, or a return to drinking, can be seriously challenging for someone with NPD and AUD and those who care about them. By definition, narcissists have a hard time accepting criticism and admitting when they’re wrong. They may deny, hide, or minimize if they start drinking again, particularly since they may have made their sobriety the new focus of attention for their family and friends.

Although relapse is common for people with AUD, it is possible to recover. Getting professional help early can help prevent relapse to drinking. In addition, treating both conditions simultaneously is advised as a way to reduce the risk of relapse.

Dual Diagnosis Treatment is Available at Legends Recovery Center

If you or someone you care about is struggling with AUD and NPD, please consider starting the conversation about treatment. Although it may seem intimidating, these two conditions are best treated together. AUD is a progressive disease, meaning it will only get worse over time without treatment. AUD can also be fatal (for example, increased risk of accidents, suicidal behavior, assault, and the physical effects of excessive alcohol consumption and withdrawal).

Legends Recovery Center is uniquely equipped to deal with this dual diagnosis. An individual with a dual diagnosis must treat both conditions at the same time, preferably by the same treatment team. For the treatment to be effective, the use of alcohol must be stopped. Legends have an alcohol detox program to help you get through the withdrawal symptoms safely, comfortably, and successfully.

After detoxing, we have three levels of care where you can focus on your recovery and learn the skills needed to prevent relapse. The levels are:

• Residential Treatment Program
• Partial Hospitalization Program (PHP)
• Intensive Outpatient Program (IOP)

Each successive level offers the opportunity to continue care at a lower intensity. Alcoholism can be a fatal disease that can be difficult to recognize, especially when it co-occurs with a mental illness such as ​​narcissistic personality disorder. If you suspect someone you love needs help, contact us today.