What are the causes of npd, and are people born that way?

Nature and Nurture: Twin studies are suggestive of a heritable pattern, although sparse, as narcissists do not seek treatment unless forces by a family member. Theories on cause vary from permissive parenting to severe childhood emotional abuse. Skills training and group therapy may be effective. Therapists advice for one involved with a narcissist is almost universally the same, avoid contact at all cost.

Narcissist: Therapy for narcissists is often arduous, painful for both patient and therapist, as the narcissist is eventually brought to a place of what is known as profound narcissistic injury, which is the beginning of his poor self esteem that the narcissism resolutely defends against. I would opt for psychoanalysis. There may be a genetic component but largely the causes are environmental/interpersonal.