Help for Narcissistic Personality Disorder

Getting professional help for narcissistic personality disorder is essential for making positive changes that lead to more empathy, greater self-esteem, and more rewarding relationships. There are many barriers to treatment for narcissistic personality disorder, including denial. But once these barriers are overcome and a patient commits to treatment, therapy can help one relate better to others, accept limitations, and function better in all aspects of life.

Narcissistic personality disorder (NPD) is a mental health condition characterized by a lack of empathy, an inflated sense of self-importance, an extreme need for admiration and recognition, and difficult relationships. These traits cause significant impairments in a person’s life and can lead to problems at work or school, a difficult home life, and a lack of rewarding, intimate relationships.

Helping someone with NPD is challenging, because the condition makes it very difficult for someone to admit to having any problems. Resistance to treatment is high, but there are ways to encourage someone to get evaluated for a diagnosis and to get professional help. Doing so requires persistence, a focus on how the disorder is impacting relationships, and overcoming defense mechanisms. Once in treatment, therapy helps narcissists change their thought patterns, recognize that they cause problems with their behaviors, develop empathy, and enjoy better relationships. Treatment can help if the patient is committed and willing.

The Challenges of Treating NPD

Narcissistic personality disorder is notoriously difficult to treat, because patients are often unwilling to or incapable of admitting that anything they think, say, or do is wrong. They believe that their own patterns of thoughts and behaviors are normal and that it is other people who are wrong and whose thoughts and behaviors are causing problems in their lives.

Another big challenge is that people with NPD have very little empathy, the ability to recognize and understand the feelings of others. They are focused on their own needs, their own feelings, and their own ambitions and desires and often see other people as stepping stones to their own wants and needs. For these reasons, even getting someone with NPD characteristics to be evaluated by a mental health professional is difficult.

Overcoming Narcissistic Defenses

One barrier to treatment in NPD is that people with this personality disorder use a number of defenses. These defense mechanisms allow the patient to avoid admitting to having any issues or taking blame in any situations, and makes change-focused treatment difficult. The defenses employed by narcissists are varied, but they are generally related to maintaining self-esteem and denying any limitations. Figuring out what an individual’s defense mechanisms are and trying to overcome them can aid treatment.

Some examples of defense mechanisms include criticizing others and blaming problems on other people, creating fantasies of grandiosity, angry outbursts directed at others, acting detached and as if nothing can cause one harm or pain, and even abusing other people. These are only a few examples, and every person with NPD is different, with his or her own unique defenses that have to be uncovered in order to aid treatment.

Focusing on Relationships to Encourage Treatment

Research has found that narcissists are unlikely to submit to treatment based solely on the symptoms they experience as a result of the disorder. This is probably because the disorder makes it difficult or even impossible for a person to recognize that their own thinking is unhealthy or abnormal. Instead, they think that other people are the issue or are causing problems.

What research has found is that narcissists are more likely to seek specialized treatment to help manage or improve interpersonal relationships. People with NPD have troubled relationships because they struggle with empathy and put their own needs ahead of those of others. It is a failure in relationships with other people that is most likely to push someone with NPD to get treatment. This is a fact that family members or partners can use to help motivate a loved one to seek professional help.

Diagnosing NPD

The first important step in helping someone with NPD is to get an evaluation and diagnosis. A psychiatrist or other mental health professional uses interviews, survey questionnaires, observations, and other examinations to determine if a person meets the criteria for narcissistic personality disorder. The criteria include:

  • Significant impairment in self-direction and identity, in areas relying on the approval of others for self-esteem, goal setting, and other factors
  • Impairment in relationships, including lack of empathy and intimacy
  • Feelings of entitlement and grandiosity, contrary to one’s actual abilities or accomplishments
  • Attention-seeking behaviors, including looking for admiration from others

These criteria have to be stable across time and cannot be explained by developmental stage, substance abuse, or another illness. When a person gets a diagnosis of NPD, it is then possible to encourage and begin treatment that can have a real impact on changing unhealthy behaviors and thoughts.

Treatment for Narcissistic Personality Disorder

If a person with NPD can be convinced to go through treatment, psychotherapy is the most typical strategy. Medications are not usually helpful, unless the patient has other mental health issues that can benefit from medical treatment, such as depression or anxiety. Psychotherapy is usually one-on-one, but couples or family therapy can also be useful in helping patients work on improving relationships.

Different types of psychotherapy may be used to treat narcissistic personality disorder, including cognitive behavioral therapy, dialectical behavior therapy, or relational therapy. The goals of treatment for NPD are to first help the patient recognize his or her own negative and skewed thoughts and behaviors. Therapy can also help the patient figure out what underlies these thoughts, such as distrust of others, low self-esteem, or even childhood trauma.

Therapy for NPD is also goal-oriented, helping patients to make concrete changes in how they think and react, how they relate to other people, how they treat other people, and how they regulate their own feelings and behaviors. Therapy may also help someone with NPD relinquish the need to achieve impossible goals, to be the best, or to have more material things. Instead, they can learn to value intangible things, like relationships and family, rather than material and external success.

Improving Empathy in Narcissists

The lack of empathy is one of the biggest barriers to making changes for someone with NPD. It is very hard for someone with this disorder to be able to understand how other people feel. They struggle to see how their behaviors and what they say impact others. Increasing empathy in people with NPD has long been considered almost impossible, but some researchers have found strategies that are proving effective.

In one study of people with high degrees of narcissistic personality traits, being guided to take the perspective of another person helped improve empathy. The participants were split into two groups. Both groups watched a short video about a woman who suffered from domestic violence. One group was told to watch it as if it were a fictional program, while the other group was told to put themselves in the woman’s shoes, to imagine what it would feel like to be in her position.

The group that was directed to take up the woman’s perspective scored higher on an empathy test that all participants took after viewing the video. Other investigations confirmed that this guidance helped improve empathy. What this means for helping people with NPD is that if the patient is willing, using guided empathy exercises, a person can actually begin to recognize and understand the feelings of others. In other words, there is hope for narcissists to be able to develop genuine empathy.

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Other Ways to Help a Narcissist

Getting professional treatment is the most important way to help someone with NPD, but there are other things that loved ones can do to support a narcissist. The patient can also do things that will make treatment more effective. Keeping an open mind about treatment is one of the best things a patient can do. Resistance is a big barrier to getting better, but for patients with an open mind, therapy can really have positive impacts. Also important is sticking with treatment. Patients must commit to therapy, and loved ones need to support and encourage that commitment.

Getting treated for other mental health or behavioral issues is another way to support treatment for NPD. Identifying and managing any substance abuse or co-occurring mental illnesses, like depression, will help the patient get even more out of therapy and make more positive life changes.

Outlook for Narcissistic Personality Disorder

Professional help for NPD can be useful and can help patients feel better, live more satisfying lives, be happier, and enjoy better relationships. However, the outlook for treatment depends highly on each individual. This is a difficult disorder to treat because of resistance. The more willing a person is to accept help, the better the prognosis. When a person with NPD is ready to accept help, is willing to admit to needing help, and is committed to a treatment plan and making positive changes, treatment really can make a difference.