As-Salamu ‘Alaykum Sister,

 

Narcissistic Personality Disorder (NPD) is truly a challenging disorder, but not one that is hopeless. As you did not indicate whether it was a spouse, other family member or a friend who was diagnosed, or if you were just interested in learning about the topic, I will do my best to answer your questions in a general sense. 

I will begin by giving you clinical perspectives of NPD in the hope that in sha’ Allah it will help you better understand its presentation, etiology, and treatment as well as its significance in relation to Islam. 

NPD is more common in males and is usually diagnosed in early adulthood. People with NPD exhibit an exaggerated sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements). They are preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love. They believe that they are "special" and can only be understood by, or should associate with, other special or high-status people (or institutions). They require excessive admiration; they selfishly take advantage of others to achieve their own ends; they have a sense of entitlement; they lack empathy and are often envious of others or believe that others are envious of them. They are often arrogant, haughty, patronizing, or contemptuous behaviors or attitudes.

In regards to Islam, it is important to note that grandiosity and an inflated sense of self are prominent in people with NPD. There are two types of grandiosity (a) a grandiose state of mind in young adults that can be corrected by life experiences, and (b) the stable disorder described in DSM-IV, which is defined less by grandiosity than by severely disturbed interpersonal relations.

Grandiosity and an inflated sense of self are prominent in NPD. It is contradictory to our Islamic characteristics which we strive for in sha’ Allah such as being humble, submitting to Allah (SWT), helping others, having intention that is striving to please Allah as well as other Islamic traits. NPD can be challenging for the Muslim as there may be brief periods of clarity wherein the person with NPD can see how their thought processes are in contradiction to serving Allah (SWT).  In the brief realization, however fleeting it is, it may only serve to exacerbate the underlying clinical depression which is also a feature of NPD.

MedicineNet states that the word narcissism comes from the story of Narcissus, “a hunter in Greek mythology, who was well known for his beauty and for being completely in love with himself. His all-consuming self-love resulted in his eventual death caused by his becoming so attracted to his own reflection in a pool that he was unable to stop staring at his image.”

People with narcissistic personality disorder tend to interact with others and the world in general by distorting things. This distortion leads to an alternating between feeling omnipotent or devalued. In Islam, we know that Allah (SWT) is the only omnipotent and one worthy of being worshiped. In the period of feeling devalued, however, the person with NPD may in sha’ Allah gain some clarity, although this has not been proven as studies yield conflicting results. However, if during these times, the person can be in touch with his/her true intention and pray to Allah (SWT) for forgiveness, healing and guidance, Allah will most surely hear the person's plea, for He is Most Merciful and Most Forgiving.

 

The causes of NPD are not clearly understood. Possible models of development come from longitudinal studies wherein researchers conduct studies on people with NPD that can last years in order to get valid and reliable outcomes or hypothesis. Inherited genetic defects are thought to be responsible for up to 50 percent of cases. Contributing environmental factors may include childhood abuse or neglect, excessive pampering, or unrealistic expectations from parents. Other causes may include sexual promiscuity, peer influence, and cultural role models (i.e. from TV). The condition usually appears in early adulthood.

As there are varying models regarding the cause of NPD, the biopsychosocial model is one that is most widely accepted. The biopsychosocial model of causation combines biological and genetic factors with social factors in early growth and development like how one related to others such as family and friends. Psychological factors relate to how a person's personality and emotions are shaped by the environment as well as how the person learned to utilize coping mechanisms to deal with stress.

 

In regards to a person's responsibility to Allah (SWT) as a Muslim and one with NPD, Islamic Law rules that the “insane” are excused and they will have no reckoning and all their sins will be forgiven. Allah burdens not an individual more than his capability.

The definition of ‘insane’ is not one I would like to use for NPD; however, in general if a person has an illness, mental or physical, which results in that the person is unable to think rational, is grandiose, delusional, and this prohibits him or her from being able to think or act in a rational fashion, perhaps this may apply to those with NPD. But I am not an Islamic Scholar, therefore I do encourage you to post this question to our “Ask the Scholar” section.

With the verse in mind “Allah does not charge a soul except [with that within] its capacity…” (Surat Al-Baqarah 2:286) as well as the clinical literature and research pointing to a biopsychosocial illness, if the person with NPD cannot help it due to a defect, in sha’ Allah may be excused by Allah (SWT) and will not taste the hellfire as a sinner would. However, if deep down the person has a mild form of NPD and refuses treatment and addressing the problem, it may be a different issue if the person is aware. Allah knows best. As stated previously sister, I am not an Islamic scholar, so please do submit to our “Ask the Scholar” section.

 

You also asked about id, ego and superego. “They are dysfunctional in NPD as in some other psychopathology. There is an imbalance. The id is the most primal part of the personality; it is instinctual and is present at birth. It is interested in instant gratification and is primal without restraints. It is interested in filling its needs such as thirst, hunger, or sex and is associated with rage, fear, fight or flight responses and it avoids pain.

The super ego is like the moral monitor. It has intellectual and perceptual functions. It develops within the framework of societal norms ingrained from parents, teachers, religion, and controls our sense of guilt and remorse. It seeks to endorse socially appropriate behaviors and criticizes the id with its primal needs.

The ego is the organized part of the personality that includes defensive, perceptual, intellectual-cognitive, and executive functions. It is the balancer of the id and superego, and the reality check. The ego is a person's personality integrated. It is the “I” in self-presentation to society; it is what we believe and how we act. If successfully integrated, it presents a mentally balanced and socially acceptable person. The Ego remembers, evaluates, plans, and responds to the world and acts in it and on it. It is able to maintain balance between the primal id, the superego and society delaying gratification.

People with a strong ego can objectively comprehend both the world and themselves. In other words, they are possessed of insight. They are able to contemplate longer time spans, plan, forecast and schedule. They choose decisively among alternatives and follow their resolve. They are aware of the existence of their drives, but control them and channel them in socially acceptable ways. They resist pressures – social or otherwise. They choose their course and pursue it.”

A person with NPD is said to have a fake, substitute Ego. This is why his energy is drained. He spends most of it on maintaining, protecting and preserving the warped, unrealistic images of his (false) self and of his (fake) world. “The narcissist is a person exhausted by his own absence.” It would appear that people with NPD have low self-esteem due to their over inflated ego, poor reaction to criticism, and their grandiose sense of self-worth (over compensation). However, new research shows that people with NPD have high self-esteem. “In fact, a person with NPD can be secure to the point of aggressiveness. It is important to note that high self-esteem and NPD are not the same thing. People with high self-esteem are usually humble, while narcissists almost never are.”

 

Treatment of NPD is usually is long-term psychotherapy with a clinician who is experienced with personality disorders. Medication is usually not utilized unless there is con-existing illness such as depression or anxiety that is debilitating. Even then there are mixed research studies showing certain medications used to treat these existing illnesses can exaggerate NPD, so they must be used cautiously. The over-all recommended therapy is  Kernberg’s object-relations approach and Kohut’s self-psychology approach which includes individual psychotherapy (specifically, psychoanalytic psychotherapy).These approaches also utilizes group therapy, family therapy, couples therapy cognitive-behavioral therapy, schema-focused therapy, and short-term objective-focused psychotherapy.

During treatment, one of the goals is to modify the person's perception so they can begin to take responsibility for their thoughts and behaviors as well as fostering empathy. In addition, cognitive restructuring is also sometimes used. MedScape states in regards to treatment: “The natural history of NPD, like those of all personality disorders, is unfavorable, and the condition is typically life-long.”

However, many patients can and do show improvement with appropriate treatment. Research also suggests that corrective life events such as new achievements, stable relationships, and manageable disappointments, can lead to considerable improvement in the level of pathological narcissism over time.

Also, in sha’ Allah make du’aa’ for this person. As the hadith by Muslim says “The supplication of a Muslim for his brother in his absence will certainly be answered. Everytime he makes a supplication for good for his brother, the angel appointed for this particular task says: `Ameen! May it be for you, too.” [Muslim]

Du’aa’ is good for the person with NPD and for you as well. Continue staying in prayer over this matter and ask Allah (SWT) to grant ease and heal in sha’ Allah.   As Muslims, we know that an affliction of an illness also relieves sins. Pray, stay in a supportive circle of family and friends, recite Qur'an and trust in Allah (SWT).

 

Also, concerning da’wah, keep calling the ones with NPD as we never know Allah's divine will or who Allah (SWT) will heal through da’wah and du’aa's.   “And he who brings the Truth and he who confirms (and supports) it—such are the men who do right. They shall have all that they wish for, with their Rabb (Only Cherisher and Sustainer). Such is the reward of those who do good: so that Allah will remit from them (even) the worst in their deeds and give them their reward according to the best of what they have done.” (Qur’an 39:33-35)

As far as Islamic treatments for NPD, please refer to this link of Qur’anic Healing and read the book: “Scientific Commentary of Suratul Faateḥah” which may give you further insight. In my studies, the prevailing treatment I found Islamically was, as outlined above, the supplications to Allah as well as special Qur'anic verses to be read to the person, however this would best be addressed by an Islamic Scholar.

 

For further guidance, kindly check out the following links:

He’s Incapable of Love, He’s Narcissistic

I'm Narcissistic, How Can I Love Allah?

Follow-up: Life at the Young Adult Stage

Prophet Mohammed's Advices of Healing with Prayers

Healing by the Qur'an: Regulations and Precautions

Is Quran a Cure for Every Illness?

 

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Aisha Mohammed-Swan received her BA from Buffalo State College, MA from Norwich University, and a PhD in psychology from the University of Integrative Learning in 2000.  She also has a certificate in Spiritual Counseling, and a MS in Public Health (Community Development) from Walden University (2009). Aisha worked as a Psychologist/Counselor for 12 years for Geneva B. Scruggs Community Health Care Center in New York with a focus on Depression, Anxiety, Marriage/Relationships, Family, Community-Cultural Issues, and Life Stages-Death Dying. She is preparing to attend an Islamic university in order to further her work within Muslim communities and is currently a freelancer with interests in Holistic Healing, Life Coaching, Conflict Resolution, Individual Community Development, Spiritual Counseling, as well as Stress Assessment Reduction.

Disclaimer: The conceptualization and recommendations stated in this response are very general and purely based on the limited information that was provided in the question. You are strongly advised to seek face-to-face counseling and consult your physician or therapist when making a drastic change in your lifestyle in terms of behavior, medication or diet etc.