What is narcissistic personality disorder

The word narcissism gets tossed around a lot in the selfie-obsessed, celebrity-driven culture, often to describe someone who seems excessively vain or full of themselves. But in psychological terms, narcissism doesn’t mean self-love—at least not of a genuine sort. Narcissistic personality disorder — one of several types of personality disorders — is a mental condition in which people have an inflated sense of their own importance, a deep need for excessive attention and admiration, troubled relationships, and a lack of empathy for others. But behind this mask of extreme confidence lies a fragile self-esteem that’s vulnerable to the slightest criticism. Narcissistic personality disorder can mean you have a high sense of self-importance. It’s more accurate to say that people with narcissistic personality disorder are in love with an idealized, grandiose image of themselves. And they’re in love with this inflated self-image precisely because it allows them to avoid deep feelings of insecurity. But propping up their delusions of grandeur takes a lot of work—and that’s where the dysfunctional attitudes and behaviors come in.

Narcissists or people with narcissistic personality disorder have an exaggerated sense of self-importance, are absorbed by fantasies of unlimited success, and seek constant attention. The narcissistic personality is oversensitive to failure and often complains of multiple physical symptoms. Prone to extreme mood swings between self-admiration and insecurity, these people tend to exploit interpersonal relationships.

You may fantasize about unlimited success and want attention and admiration. You may feel you are more entitled to things than other people are. You might act selfishly to gain success. You may do this because inside, you don’t feel significant or important.

A narcissistic personality disorder causes problems in many areas of life, such as relationships, work, school or financial affairs. People with narcissistic personality disorder may be generally unhappy and disappointed when they’re not given the special favors or admiration they believe they deserve. They may find their relationships unfulfilling, and others may not enjoy being around them.

People with narcissistic personality disorder are extremely resistant to changing their behavior, even when it’s causing them problems. Their tendency is to turn the blame on to others. What’s more, they are extremely sensitive and react badly to even the slightest criticisms, disagreements, or perceived slights, which they view as personal attacks. For the people in the narcissist’s life, it’s often easier just to go along with their demands to avoid the coldness and rages.

Everyone has different ways of thinking, feeling, and behaving. It is these thoughts, feelings, and behaviors that make up your ‘personality’. These are often called your traits. They shape the way you view the world and the way you relate to others. By the time you are an adult, your personality traits will make you part of who you are. You can think of your traits as sitting along a scale. For example, everyone may feel emotional, get jealous, or want to be liked at times. But it is when these traits start to cause problems that you may be diagnosed as having a personality disorder. A person with a personality disorder thinks, feels, behaves or relates to others very differently from the average person.

Narcissistic traits may be particularly common in adolescents and do not necessarily indicate that the individual will go on to have narcissistic personality disorder. Individuals with narcissistic personality disorder may have special difficulties adjusting to the onset of physical and occupational limitations that are inherent in the aging process.

A person with narcissistic personality disorder may display the following traits:

• React to criticism with rage, shame, or humiliation
• Take advantage of other people to achieve his or her own goals
• Have excessive sense and feelings of self-importance
• Exaggerate achievements and talents
• Be preoccupied with fantasies of success, power, beauty, intelligence, or ideal love
• Have unreasonable expectations of favorable treatment
• Need constant attention and admiration
• Disregard the feelings of others, and have little ability to feel empathy
• Have obsessive self-interest or an extreme preoccupation with themselves
• A lack of empathy for others
• Pursue mainly selfish goals.

Prevalence estimates for narcissistic personality disorder, based on the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders: DSM-4 definitions, range from 0% to 6.2% in community samples ¹. Of those diagnosed with narcissistic personality disorder, 50%-75% are male.

Treatment of narcissistic personality disorder typically involves long-term psychotherapy (talk therapy) with a therapist that has experience in treating this kind of personality disorder. Psychotherapy (talk therapy) may help the person with narcissistic personality disorder relate to other people in a more positive and compassionate way. Medications may also be prescribed to help with specific troubling and debilitating symptoms.

Possible complications of narcissistic personality disorder

A narcissistic personality disorder can affect how you cope with life, manage relationships, and feel emotionally. You may find that your beliefs and ways of dealing with day-to-day life are different from others and that you find it difficult to change them. You may find your emotions confusing, tiring, and hard to control. This can be distressing for you and others. Because it is distressing, you may find that you develop other mental health problems like depression or anxiety. You may also do other things such as drink heavily, use drugs, or self-harm to cope.

Complications may include:

• Alcohol or other drug use
• Relationship, work, school and family problems
• Relationship difficulties
• Depression and anxiety
• Physical health problems
• Suicidal thoughts or behavior

Characteristics of a narcissist

Narcissistic Personality Disorder Diagnostic Criteria (American Psychiatric Association – Diagnostic and Statistical Manual of Mental Disorders: DSM-5) ¹:

A pervasive pattern of grandiosity (in fantasy or behavior) , need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
3. Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
4. Requires excessive admiration .
5. Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).
6. Is interpersonally exploitative ( i.e., takes advantage of others to achieve his or her own ends).
7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
8. Is often envious of others or believes that others are envious of him or her.
9. Shows arrogant, haughty behaviors or attitudes.

The essential feature of narcissistic personality disorder is a pervasive pattern of grandiosity, need for admiration, and lack of empathy that begins by early adulthood and is present in a variety of contexts.

Individuals with narcissistic personality disorder have a grandiose sense of self-importance (Criterion 1). They routinely overestimate their abilities an d inflate their accomplishments, often appearing boastful and pretentious. They may blithely assume that others attribute the same value to their efforts and may be surprised when the praise they expect and feel they deserve is not forthcoming. Often implicit in the inflated judgments of their own accomplishments is an underestimation (devaluation) of the contributions of others. Individuals with narcissistic personality disorder are often preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love (Criterion 2). They may ruminate about “long overdue” admiration and privilege and compare themselves favorably with famous or privileged people.

Individuals with narcissistic personality disorder believe that they are superior, special, or unique and expect others to recognize them as such (Criterion 3). They may feel that they can only be understood by, and should only associate with, other people who are special or of high status and may attribute “unique,” “perfect,” or “gifted” qualities to those with whom they associate. Individuals with this disorder believe that their needs are special and beyond the ken of ordinary people. Their own self-esteem is enhanced (i.e., “mirrored”) by the idealized value that they assign to those with whom they associate. They are likely to insist on having only the “top” person (doctor, lawyer, hairdresser, instructor) or being affiliated with the “best” institutions but may devalue the credentials of those who disappoint them.

Individuals with narcissistic personality disorder generally require excessive admiration (Criterion 4). Their self-esteem is almost invariably very fragile. They may be preoccupied with how well they are doing and how favorably they are regarded by others. This often takes the form of a need for constant attention and admiration. They may expect their arrival to be greeted with great fanfare and are astonished if others do not covet their possessions. They may constantly fish for compliments, often with great charm. A sense of entitlement is evident in these individuals’ unreasonable expectation of especially favorable treatment (Criterion 5). They expect to be catered to and are puzzled or furious when this does not happen. For example, they may assume that they do not have to wait in line and that their priorities are so important that others should defer to them, and then get irritated when others fail to assist “in their very important work.” This sense of entitlement, combined with a lack of sensitivity to the wants and needs of others, may result in the conscious or unwitting exploitation of others (Criterion 6). They expect to be given whatever they want or feel they need, no matter what it might mean to others. For example, these individuals may expect great dedication from others and may overwork them without regard for the impact on their lives. They tend to form friendships or romantic relationships only if the other person seems likely to advance their purposes or otherwise enhance their self-esteem. They often usurp special privileges and extra resources that they believe they deserve because they are so special.

Individuals with narcissistic personality disorder generally have a lack of empathy and have difficulty recognizing the desires, subjective experiences, and feelings of others (Criterion 7). They may assume that others are totally concerned about their welfare. They tend to discuss their own concerns in inappropriate and lengthy detail, while failing to recognize that others also have feelings and needs. They are often contemptuous and impatient with others who talk about their own problems and concerns. These individuals may be oblivious to the hurt their remarks may inflict (e.g., exuberantly telling a former lover that “I am now in the relationship of a lifetime!”; boasting of health in front of someone who is sick). When recognized, the needs, desires, or feelings of others are likely to be viewed disparagingly as signs of weakness or vulnerability. Those who relate to individuals with narcissistic personality disorder typically find an emotional coldness and lack of reciprocal interest.

These individuals are often envious of others or believe that others are envious of them (Criterion 8). They may begrudge others their successes or possessions, feeling that they better deserve those achievements, admiration, or privileges. They may harshly devalue the contributions of others, particularly when those individuals have received acknowledgment or praise for their accomplishments. Arrogant, haughty behaviors characterize these individuals; they often display snobbish, disdainful, or patronizing attitudes (Criterion 9). For example, an individual with this disorder may complain about a clumsy waiter’s “rudeness” or “stupidity” or conclude a medical evaluation with a condescending evaluation of the physician.

Associated features supporting the diagnosis of narcissistic personality disorder

Vulnerability in self-esteem makes individuals with narcissistic personality disorder very sensitive to “injury” from criticism or defeat. Although they may not show it outwardly, criticism may haunt these individuals and may leave them feeling humiliated, degraded, hollow, and empty. They may react with disdain, rage, or defiant counterattack. Such experiences often lead to social withdrawal or an appearance of humility that may mask and protect the grandiosity. Interpersonal relations are typically impaired because of problems derived from entitlement, the need for admiration, and the relative disregard for the sensitivities of others. Though overweening ambition and confidence may lead to high achievement, performance may be disrupted because of intolerance of criticism or defeat.

Sometimes vocational functioning can be very low, reflecting an unwillingness to take a risk in competitive or other situations in which defeat is possible. Sustained feelings of shame or humiliation and the attendant self-criticism may be associated with social withdrawal, depressed mood, and persistent depressive disorder (dysthymia) or major depressive disorder. In contrast, sustained periods of grandiosity may be associated with a hypomanic mood. Narcissistic personality disorder is also associated with anorexia nervosa and substance use disorders (especially related to cocaine). Histrionic, borderline, antisocial, and paranoid personality disorders may be associated with narcissistic personality disorder.

How to deal with a narcissist

Are you in a frustrating relationship with someone who expects constant attention and admiration, but doesn’t seem able to take your needs and feelings into consideration? Someone who thinks they’re better than everyone else and should be treated accordingly? Who dishes out insults and condescension, but flies off the handle at the slightest disagreement or whiff of criticism? If so, you may be dealing with a narcissist. Learn what you need to know about narcissistic personality disorder so you can spot the narcissists in your life, protect yourself from their power plays, and establish healthier boundaries.

Narcissistic personality disorder involves a pattern of self-centered, arrogant thinking and behavior, a lack of empathy and consideration for other people, and an excessive need for admiration. Others often describe people with narcissistic personality disorder as cocky, manipulative, selfish, patronizing, and demanding. This way of thinking and behaving can be seen in every area of the narcissist’s life: from work and friendships to family and love relationships.

Don’t fall for the fantasy

Narcissists can be very magnetic and charming. They are very good at painting fantastical, flattering pictures that draw us in. We’re attracted to their apparent confidence and lofty dreams—and the shakier our own self-esteem, the more seductive the allure. It’s easy to get caught up in their web, thinking that they will fulfill our longing to feel more important, more alive. But it’s just a fantasy, and a costly one at that.

Your needs won’t be fulfilled (or even recognized). It’s important to remember that narcissists aren’t looking for partners; they’re looking for obedient admirers. Your sole value to the narcissist is as someone who can tell them how great they are to prop up their insatiable ego. Your desires and feelings don’t count.

Look at the way the narcissist treats others. If the narcissist lies, manipulates, hurts, and disrespects others, he or she will eventually do the same to you. Don’t fall for the fantasy that you’re different and will be spared.

Take off the rose-colored glasses. It’s important to see the narcissist in your life for who they really are, not who you want them to be. Stop making excuses for bad behavior or minimizing the hurt it’s causing you. Denial will not make it go away. The reality is that narcissists are very resistant to change, so the true question you must ask is whether you can live like this indefinitely.

Focus on your own dreams. Instead of losing yourself in the narcissist’s delusions, focus on the things you want for yourself. What do you want to change in your life? What gifts would you like to develop? What fantasies do you need to give up in order to create a more fulfilling reality?

Set healthy boundaries

Healthy relationships are based on mutual respect and caring. But narcissists aren’t capable of true reciprocity in their relationships. It isn’t just that they’re not willing; they truly aren’t able. They don’t see you. They don’t hear you. They don’t recognize you as someone who exists outside of their own needs. Because of this, narcissists regularly violate the boundaries of others. What’s more, they do so with an absolute sense of entitlement.

Narcissists think nothing of going through or borrowing your possessions without asking, snooping through your mail and personal correspondence, eavesdropping on conversations, barging in without an invitation, stealing your ideas, and giving you unwanted opinions and advice. They may even tell you what you think and feel. It’s important to recognize these violations for what they are, so you can begin to create healthier boundaries where your needs are respected.

Make a plan. If you have a long-standing pattern of letting others violate your boundaries, it’s not easy to take back control. Set yourself up for success by carefully considering your goals and the potential obstacles. What are the most important changes you hope to achieve? Is there anything you’ve tried in the past with the narcissist that worked? Anything that hasn’t? What is the balance of power between you and how will that impact your plan? How will you enforce your new boundaries? Answering these questions will help you evaluate your options and develop a realistic plan.

Consider a gentle approach. If preserving your relationship with the narcissist is important to you, you will have to tread softly. By pointing out their hurtful or dysfunctional behavior, you are damaging their self-image of perfection. Try to deliver your message calmly, respectfully, and as gently as possible. Focus on how their behavior makes you feel, rather than on their motivations and intentions. If they respond with anger and defensiveness, try to remain calm. Walk away if need be and revisit the conversation later.

Don’t set a boundary unless you’re willing to keep it. You can count on the narcissist to rebel against new boundaries and test your limits, so be prepared. Follow up with any consequences specified. If you back down, you’re sending the message that you don’t need to be taken seriously.

Be prepared for other changes in the relationship. The narcissist will feel threatened and upset by your attempts to take control of your life. They are used to calling the shots. To compensate, they may step up their demands in other aspects of the relationship, distance themselves to punish you, or attempt to manipulate or charm you into giving up the new boundaries. It’s up to you to stand firm.

Don’t take things personally

To protect themselves from feelings of inferiority and shame, narcissists must always deny their shortcomings, cruelties, and mistakes. Often, they will do so by projecting their own faults on to others. It’s very upsetting to be blamed for something that’s not your fault or to be characterized with negative traits you don’t possess. But as difficult as it may be, try not to take it personally. It really isn’t about you.

Don’t buy into the narcissist’s version of who you are. Narcissists don’t live in reality, and that includes their views of other people. Don’t let their shame and blame game undermine your self-esteem. Refuse to accept undeserved responsibility, blame, or criticism. That negativity is the narcissist’s to keep.

Don’t argue with a narcissist. When attacked, the natural instinct is to defend yourself and prove the narcissist wrong. But no matter how rational you are or how sound your argument, he or she is unlikely to hear you. And arguing the point may escalate the situation in a very unpleasant way. Don’t waste your breath. Simply tell the narcissist you disagree with their assessment, then move on.

Know yourself. The best defense against the insults and projections of the narcissist is a strong sense of self. When you know your own strengths and weaknesses, it’s easier to reject any unfair criticisms leveled against you.

Let go of the need for approval. It’s important to detach from the narcissist’s opinion and any desire to please or appease them at the expense of yourself. You need to be okay with knowing the truth about yourself, even if the narcissist sees the situation differently.

Look for support and purpose elsewhere

If you’re going to stay in a relationship with a narcissist, be honest with yourself about what you can—and can’t—expect. A narcissist isn’t going to change into someone who truly values you, so you’ll need to look elsewhere for emotional support and personal fulfillment.

Learn what healthy relationships look and feel like. If you come from a narcissistic family, you may not have a very good sense of what a healthy give-and-take relationship is. The narcissistic pattern of dysfunction may feel comfortable to you. Just remind yourself that as familiar as it feels, it also makes you feel bad. In a reciprocal relationship, you will feel respected, listened to, and free to be yourself.

Spend time with people who give you an honest reflection of who you are. In order to keep perspective and avoid buying into the narcissist’s distortions, it’s important to spend time with people who see you as you really are and who validate your thoughts and feelings.

Make new friendships, if necessary, outside the narcissist’s orbit. Some narcissists isolate the people in their lives in order to better control them. If this is your situation, you’ll need to invest time into rebuilding lapsed friendships or cultivating new relationships.

Look for meaning and purpose in work, volunteering, and hobbies. Instead of looking to the narcissist to make you feel good about yourself, pursue meaningful activities that make use of your talents and allow you to contribute.

Narcissistic personality disorder symptoms

Signs and symptoms of narcissistic personality disorder and the severity of symptoms vary.

People with narcissistic personality disorder can:

• Have an exaggerated sense of self-importance
• Have a sense of entitlement and require constant, excessive admiration
• Expect to be recognized as superior even without achievements that warrant it
• Exaggerate achievements and talents
• Be preoccupied with fantasies about success, power, brilliance, beauty or the perfect mate
• Believe they are superior and can only associate with equally special people
• Monopolize conversations and belittle or look down on people they perceive as inferior
• Expect special favors and unquestioning compliance with their expectations
• Take advantage of others to get what they want
• Have an inability or unwillingness to recognize the needs and feelings of others
• Be envious of others and believe others envy them
• Behave in an arrogant or haughty manner, coming across as conceited, boastful and pretentious
• Insist on having the best of everything — for instance, the best car or office

At the same time, people with narcissistic personality disorder have trouble handling anything they perceive as criticism, and they can:

• Become impatient or angry when they don’t receive special treatment
• Have significant interpersonal problems and easily feel slighted
• React with rage or contempt and try to belittle the other person to make themselves appear superior
• Have difficulty regulating emotions and behavior
• Experience major problems dealing with stress and adapting to change
• Feel depressed and moody because they fall short of perfection
• Have secret feelings of insecurity, shame, vulnerability and humiliation

Grandiose sense of self-importance

Grandiosity is the defining characteristic of narcissism. More than just arrogance or vanity, grandiosity is an unrealistic sense of superiority. Narcissists believe they are unique or “special” and can only be understood by other special people. What’s more, they are too good for anything average or ordinary. They only want to associate and be associated with other high-status people, places, and things.

Narcissists also believe that they’re better than everyone else and expect to be recognized as such—even when they’ve done nothing to earn that recognition. They will often exaggerate or outright lie about their achievements and talents. And when they talk about work or relationships, all you’ll hear is how much they do, how great they are, and how lucky the people in their lives are to have them. They are the undisputed star and everyone else is at best a bit player.

Lives in a fantasy world that supports their delusions of grandeur

Since reality doesn’t support their grandiose view of themselves, narcissists live in a fantasy world propped up by distortion, self-deception, and magical thinking. They spin self-glorifying fantasies of unlimited success, power, brilliance, attractiveness, and ideal love that make them feel special and in control. These fantasies protect them from feelings of inner emptiness and shame, so facts and opinions that contradict them are ignored or rationalized away. Anything that threatens to burst the fantasy bubble is met with extreme defensiveness and even rage, so those around the narcissist learn to tread carefully around their denial of reality.

Needs constant praise and admiration

A narcissist’s sense of superiority is like a balloon that gradually loses air without a steady stream of applause and recognition to keep it inflated. The occasional compliment is not enough. Narcissists need constant food for their ego, so they surround themselves with people who are willing to cater to their obsessive craving for affirmation. These relationships are very one-sided. It’s all about what the admirer can do for the narcissist, never the other way around. And if there is ever an interruption or diminishment in the admirer’s attention and praise, the narcissist treats it as a betrayal.

Sense of entitlement

Because they consider themselves special, narcissists expect favorable treatment as their due. They truly believe that whatever they want, they should get. They also expect the people around them to automatically comply with their every wish and whim. That is their only value. If you don’t anticipate and meet their every need, then you’re useless. And if you have the nerve to defy their will or “selfishly” ask for something in return, prepare yourself for aggression, outrage, or the cold shoulder.

Exploits others without guilt or shame

Narcissists never develop the ability to identify with the feelings of others—to put themselves in other people’s shoes. In other words, they lack empathy. In many ways, they view the people in their lives as objects—there to serve their needs. As a consequence, they don’t think twice about taking advantage of others to achieve their own ends. Sometimes this interpersonal exploitation is malicious, but often it is simply oblivious. Narcissists simply don’t think about how their behavior affects others. And if you point it out, they still won’t truly get it. The only thing they understand is their own needs.

Frequently demeans, intimidates, bullies, or belittles others

Narcissists feel threatened whenever they encounter someone who appears to have something they lack—especially those who are confident and popular. They’re also threatened by people who don’t kowtow to them or who challenge them in any way. Their defense mechanism is contempt. The only way to neutralize the threat and prop up their own sagging ego is to put those people down. They may do it in a patronizing or dismissive way as if to demonstrate how little the other person means to them. Or they may go on the attack with insults, name-calling, bullying, and threats to force the other person back into line.

Narcissistic personality disorder causes

Cause of narcissistic personality disorder is unknown and is likely complex. Most professionals subscribe to a biopsychosocial model of causation — that is, the causes are likely due to biological and genetic factors, social factors (such as how a person interacts in their early development with their family and friends and other children), and psychological factors (the individual’s personality and temperament, shaped by their environment and learned coping skills to deal with stress). This suggests that no single factor is responsible — rather, it is the complex and likely intertwined nature of all three factors that are important.

If a person has narcissistic personality disorder, research suggests that there is a slightly increased risk for this disorder to be “passed down” to their children. While some of this has to do with genetics, some of is also likely due to the child’s personality, as well as the parenting behavior of one or both of the parents.

Narcissistic personality disorder may be linked to:

• Environment ― mismatches in parent-child relationships with either excessive adoration or excessive criticism that is poorly attuned to the child’s experience
• Genetics ― inherited characteristics
• Neurobiology — the connection between the brain and behavior and thinking

Risk factors for narcissistic personality disorder

Narcissistic personality disorder affects more males than females, and it often begins in the teens or early adulthood. Keep in mind that, although some children may show traits of narcissism, this may simply be typical of their age and doesn’t mean they’ll go on to develop narcissistic personality disorder.

Although the cause of narcissistic personality disorder isn’t known, some researchers think that in biologically vulnerable children, parenting styles that are overprotective or neglectful may have an impact. Genetics and neurobiology also may play a role in development of narcissistic personality disorder.

Narcissistic personality disorder prevention

Because the cause of narcissistic personality disorder is unknown, there’s no known way to prevent the condition. However, it may help to:

• Get treatment as soon as possible for childhood mental health problems
• Participate in family therapy to learn healthy ways to communicate or to cope with conflicts or emotional distress
• Attend parenting classes and seek guidance from therapists or social workers if needed

Narcissistic personality disorder diagnosis

Personality disorders such as narcissistic personality disorder are typically diagnosed by a trained mental health professional, such as a psychologist or psychiatrist. Some features of narcissistic personality disorder are similar to those of other personality disorders. Also, it’s possible to be diagnosed with more than one personality disorder at the same time. This can make diagnosis of narcissistic personality disorder more challenging.

Family physicians and general practitioners are generally not trained or well-equipped to make this type of psychological diagnosis. So while you can initially consult a family physician about this problem, they should refer you to a mental health professional for diagnosis and treatment. There are no laboratory, blood, or genetic tests that are used to diagnose personality disorder.

Many people with narcissistic personality disorder don’t seek out treatment. People with personality disorders, in general, do not often seek out treatment until the disorder starts to significantly interfere or otherwise impact a person’s life. This most often happens when a person’s coping resources are stretched too thin to deal with stress or other life events.

Diagnosis of narcissistic personality disorder typically is based on:

• Signs and symptoms
• A physical exam to make sure you don’t have a physical problem causing your symptoms
• A thorough psychological evaluation that may include filling out questionnaires
• Criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Narcissistic personality disorder test

• Please visit Psychcentral to take the narcissistic personality disorder test there (https://psychcentral.com/quizzes/narcissistic-personality-quiz/)

Narcissistic personality disorder treatment

Treatment for narcissistic personality disorder is talk therapy (psychotherapy). Medications may be included in your treatment if you have other mental health conditions.

Psychotherapy

Narcissistic personality disorder treatment is centered around talk therapy, also called psychotherapy. Psychotherapy can help you:

• Learn to relate better with others so your relationships are more intimate, enjoyable and rewarding
• Understand the causes of your emotions and what drives you to compete, to distrust others, and perhaps to despise yourself and others

Areas of change are directed at helping you accept responsibility and learning to:

• Accept and maintain real personal relationships and collaboration with co-workers
• Recognize and accept your actual competence and potential so you can tolerate criticisms or failures
• Increase your ability to understand and regulate your feelings
• Understand and tolerate the impact of issues related to your self-esteem
• Release your desire for unattainable goals and ideal conditions and gain an acceptance of what’s attainable and what you can accomplish

Therapy can be short term to help you manage during times of stress or crisis, or can be provided on an ongoing basis to help you achieve and maintain your goals. Often, including family members or significant others in therapy can be helpful.

Individual Psychotherapy for Narcissistic Personality Disorder

Most clinicians will, as a practical matter, treat most of their severely narcissistic patients for symptoms related to crises and relatively external diagnoses, rather than address the personality disorder itself. The therapist must be aware of the importance of narcissism to the contiguity of the patient’s psyche, refrain from confronting the need for self-aggrandizement, and help the patient use his or her narcissistic characteristics to re-develop an intact self-image. Positive transference and therapeutic alliance should not be relied upon, since the patient may not be able to acknowledge the real humanness of the therapist but may have to see him/her as either superhuman or devalued.

Those patients who do not terminate treatment after relieving their symptoms may wish help for some of the problems related to their personality disorder, such as interpersonal difficulties or depression. The therapist must have a good understanding of the principles of the narcissistic personality style, both for interpretation to the patient and for use in combating counter-transference. Goals for ordinary psychotherapy should not be too great, since the source of these patients’ difficulties lies deep in pathological development.

Group Psychotherapy

The goals are to help the patient develop a healthy individuality (rather than a resilient narcissism) so that he or she can acknowledge others as separate persons, and to decrease the need for self-defeating coping mechanisms.

The first step toward developing a working alliance is empathy with the surprise and hurt that the patient experiences as a result of confrontations within the group. Group therapy can provide external structuring, which can control destructive behavior in spite of ego weakness. In groups, the therapist is less authoritative (and less threatening to the patient’s grandiosity), intensity of emotional experience is lessened, and regression is more controlled, creating a better setting for confrontation and clarification.

Outpatient analytic-expressive group therapy requires a concomitant individual relationship for most patients, which should be somewhat supportive. The need for this additional support, the likelihood of the patient’s leaving the group at the first sign of psychic insult, and proneness to disorganized thinking are all found more often in the borderline patient. The patient with a narcissistic personality disorder does not appear as vulnerable to separation anxieties as the borderline patient, but is instead involved in issues centered around maintaining a sense of self-worth.

Hospitalization

The hospitalization of patients with severe narcissistic personality disorder may occur with some frequency. For some, such as those who are quite impulsive or self-destructive, or who have poor reality-testing, this is the result of additional symptoms from a co-existing mental disorder that are overlaid on the personality disorder. In general, hospitalizations should be brief and the treatment specific to the particular symptom involved.

If long-term residential treatment is available, another group of patients for whom hospitalization is indicated are those who have poor motivation for outpatient treatment, fragile object or social relationships, chronic destructive acting-out behaviors, and/or chaotic life-styles. An inpatient program can offer an intensive environment, which includes individual psychotherapy, family involvement, and a specialized residential environment. The structure is physically and emotionally secure enough to sustain the patient with severe ego weakness throughout the course of expressive, conflict-solving psychotherapy.

Small staff/patient groups within the wards, as well as large community meetings, can make the hospital a “holding” environment rather than merely a containing one. These groups and meetings should facilitate an environment where patients are encouraged to share their feelings with staff that allow patients’ comments to be taken seriously. The groups may also include constructive work assignments, recreational activities, and opportunities to sublimate painfully conflictual impulses. The ultimate goals are to effect a better-integrated internal world, more cohesive and modulated self-object representation, and a self-concept less vulnerable to narcissistic injury.

Medications

There are no medications specifically used to treat narcissistic personality disorder. However, if you have symptoms of depression, anxiety or other conditions, medications such as antidepressants or anti-anxiety drugs may be helpful.

Home remedies

You may feel defensive about treatment or think it’s unnecessary. The nature of narcissistic personality disorder can also leave you feeling that therapy is not worth your time and attention, and you may be tempted to quit. But it’s important to:

• Keep an open mind. Focus on the rewards of treatment.
• Stick to your treatment plan. Attend scheduled therapy sessions and take any medications as directed. Remember, it can be hard work and you may have occasional setbacks.
• Get treatment for alcohol or drug misuse or other mental health problems. Your addictions, depression, anxiety and stress can feed off each other, leading to a cycle of emotional pain and unhealthy behavior.
• Stay focused on your goal. Stay motivated by keeping your goals in mind and reminding yourself that you can work to repair damaged relationships and become more content with your life.

1. American Psychiatric Association, DSM-5 Task Force. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. American Psychiatric Association: Arlington, VA; 2013.