Theraverse . April 29, 2025

When we think of narcissism, we often imagine a loud, self-important figure dominating every room, hungry for admiration and praise. While this portrayal reflects some core features of Narcissistic Personality Disorder (NPD), it’s far from the whole picture, especially when we take gender into account.

Psychological research and clinical observation reveal that NPD may manifest differently in men and women, shaped not only by personality dynamics but also by social norms, gender roles, and cultural expectations. A man’s narcissism might show up in overt arrogance and entitlement, while a woman’s could emerge through social comparison, appearance-focused self-worth, or covert manipulation. These nuanced differences can influence everything from diagnosis and treatment to the way NPD impacts relationships and professional life.

Here are some factors that outline the gender differences in presentation.

Prevalence Rates
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), NPD is more frequently diagnosed in males than in females. Epidemiological studies suggest that about 50–75% of individuals diagnosed with NPD are male (American Psychiatric Association, 2013).

Expression of Narcissistic Traits
Research through a large meta-analysis, found that men score significantly higher than women on narcissism, particularly on the dimensions of exploitativeness/entitlement and leadership/authority. Women, while also capable of displaying narcissistic traits, may exhibit these traits in more covert or relationally oriented ways (e.g., social comparison, appearance-focused self-enhancement).

Grandiosity vs. Vulnerability
There is some evidence that grandiose narcissism characterized by overt arrogance, dominance, and attention-seeking is more prevalent in men, whereas vulnerable narcissism marked by hypersensitivity, defensiveness, and shame may be more commonly expressed or reported by women. But these traits are commonly present interchangeably in both genders.

Interpersonal Strategies and Relational Styles
Men with NPD tend to engage in more dominance-oriented and status-seeking behaviors in relationships. They may also be envious of others’ successes and achievements, and they can exhibit a competitive and combative nature, particularly when they perceive themselves as being challenged. Women may fluctuate between idealizing and devaluing their partners, leading to unstable and unpredictable relationships but both may share common traits such as lack of empathy, manipulation and attention seeking behaviours. This aligns with broader gender socialization patterns, where male self-worth may be linked to power, and female self-worth to relational desirability.

Comorbidities
Studies suggest gendered patterns in comorbidity. Men with NPD show higher rates of antisocial behavior and substance use disorders, while women with NPD show elevated rates of mood disorders and eating disorders.

Help-Seeking Behavior
Men are generally less likely to seek help for personality disorders due to stigma and social expectations around emotional expression, lack of self-awareness. Women with narcissistic traits may be more likely to enter therapy due to comorbid conditions like depression or anxiety, which are more socially acceptable to acknowledge. Sometimes they may seek help for symptomatology such as anger management, competitiveness or perfectionism as well.

Why understanding gender differences becomes relevant?

Understanding how gender shapes the expression of NPD invites us to move beyond one-dimensional stereotypes of narcissism. While grandiosity, entitlement, and a fragile sense of self may lie at the heart of NPD, these traits are not expressed in a vacuum. They are filtered through cultural scripts, gender expectations, and deeply personal coping strategies developed over time.

Psychologically, it’s essential to recognize that narcissism, whether overt or covert is often a defense against profound feelings of inadequacy, shame, or emotional injury. For men, this may look like dominance and denial of vulnerability and for women, it might emerge as relational control or perfectionistic self-presentation. Neither presentation is more or less valid, they are simply different adaptations to psychological pain.

By embracing a more nuanced, gender-informed lens, clinicians, educators, and even the general public can better understand the lived experiences of individuals with NPD. This not only enhances diagnostic accuracy and empathy but also opens the door to more effective, compassionate interventions, ones that affirm the humanity behind the pathology.

In the end, a more inclusive understanding of narcissism doesn’t just serve the science, it serves the people behind the diagnosis.

Gender inclusivity

That said, it is important to acknowledge that gender exists on a spectrum, and not all individuals identify within the binary framework of “male” or “female.” However, for the purposes of psychoeducation and the interpretation of existing empirical data, most of which utilizes binary gender categories, this article has primarily focused on men and women. Future research must move toward more inclusive methodologies that better represent non-binary and gender-diverse individuals, whose experiences of narcissism may further enrich our understanding of the condition.

Helpful worksheets,

• Exploring roles and systems
• Dealing with a partner/family member diagnosed with NPD
• CBT worksheet for NPD

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By,

Jensita Grace

In-house Psychologist, Theraverse

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Resources

https://pubmed.ncbi.nlm.nih.gov/25546498/

https://pubmed.ncbi.nlm.nih.gov/18557663/

https://pmc.ncbi.nlm.nih.gov/articles/PMC2669224/?utm_source

https://www.sciencedirect.com/science/article/abs/pii/S0191886920304360?utm_source

https://my.clevelandclinic.org/health/diseases/9742-narcissistic-personality-disorder

https://pubmed.ncbi.nlm.nih.gov/12674814/