Narcissistic Personality Disorder Treatment

Narcissistic personality disorder (NPD) affects every area of a person’s life, in a host of undesirable ways. People with NPD have problematic and unstable relationships, struggle to find satisfying or enduring careers, and experience significant inner turmoil because of their delusions of greatness and their unrealistic approach to life. But people with narcissistic personality disorder can overcome the most debilitating and life-altering of their symptoms, with the able assistance of mental health professionals who understand how and why NPD sufferers think and behave the way they do.

Narcissistic Personality Disorder Defined


Men and women with narcissistic personality disorder (NPD) have a distorted view of themselves and their place in the world. They are convinced they possess superior qualities that set them apart and are completely focused on their own needs and perspectives to the exclusion of all else.

Despite their overwhelming self-confidence and apparent self-love, NPD sufferers are secretly motivated by repressed insecurities and self-esteem issues. Their narcissistic traits are a form of overcompensation, adopted as a cover for their pervasive self-doubts.

As a reflection of the divided and contradictory nature of their mental states, people with narcissistic beliefs still need constant praise and approval from others, and when they don’t get it they may react with hostility, petulance, defensiveness, aggressiveness, or vindictiveness.

Approximately one in every 16 adults demonstrate enough narcissistic traits to be diagnosed with narcissistic personality disorder, and between 60 and 65 percent of these individuals are men. Estimates for the prevalence of NPD have risen in recent years, as diagnostic techniques for the detection of personality disorders have improved.

Causes of Narcissistic Personality Disorder


All personality disorders are inheritable, at least to some degree. One 2008 study involving twins found that hereditary influences were about 25 percent responsible for narcissistic traits in adults, with the remaining percentage determined by specific environmental influences, meaning mainly experiences during childhood.

Among the environmental causes of NPD, the impact of parenting stands out:

  • Parenting styles that are overly authoritarian and perfectionist. This can damage a child’s self-esteem, putting them under constant pressure to meet unrealistic standards for performance. When this happens, the child may eventually retreat into narcissism, supporting his or her fragile ego with assumptions of infallibility and superiority.
  • Inconsistent parenting that veers back and forth between neglectful or critical and overly indulgent. Immersion in such an unpredictable environment can cause confusion and insecurity in a child. To bring clarity, they may don a cloak of narcissism to create a grand and important self-image.
  • Exposure to any type of physical, emotional, or sexual abuse in childhood from any source. This can include actions by parents or other adult caregivers, or excessive bullying or teasing by peers. If no therapeutic intervention to deal with the abuse is offered, the victim may adopt narcissistic attitudes to help suppress the traumatic memories and counteract their devastating effects.

In the end, a retreat into narcissism is an ineffective strategy for coping with trauma. The low self-esteem, lack of self-confidence, and damaged self-image that are fundamental to narcissism will remain repressed and denied, creating an internal split between conscious beliefs and unconscious motivations that cause the suffering and dysfunction to continue.

Diagnosing NPD


To receive a diagnosis of narcissistic personality disorder from a mental health professional, patients must demonstrate each of the following:

Impairments in personality function, relating to either identity or self-direction

Distorted identity characteristics may include an exaggerated sense of self-importance, or fluctuations between extreme self-confidence and personal crisis. Problems with self-direction may involve perfectionism that leads to constant frustration, or entitlement so pervasive it destroys the person’s motivation to pursue real accomplishments. In general, people with NPD have an unhealthy obsession with the opinions and judgments of others, since they need constant validations to prop up their assumptions of superiority.

Impairments in interpersonal function, revealed through problems with intimacy and/or empathy

From the perspective of a narcissist, the interests of other people seem unreal or insignificant. The only time they show concern over issues that affect others is if those issues affect them as well. In their intimate relationships, people with strong narcissistic traits experience frequent chaos and conflict. The impact of their self-centeredness is so strong it inevitably compromises the quality of their interpersonal interactions, which are usually brief and superficial.

Possession of pathological personality traits

Identifying the distinctive traits of excessive narcissism is a core element in the NPD diagnostic process. Familiar narcissistic traits include feelings of specialness or uniqueness, a strong sense of entitlement and privilege, extreme thinking that divides people into allies or enemies, vindictiveness and envy toward anyone classified as an enemy, and contempt or dismissal of others deemed inferior.

Consistency of symptoms over time, with no reason to suspect other causes

To be officially diagnosed with NPD, other potential causes for its symptoms (different personality or mental health disorders, brain injuries or abnormalities) must be ruled out. Advanced narcissistic tendencies are stable over time, and patients who suffer from full-blown NPD should be able to trace their symptoms back to adolescence or young adulthood.

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Therapy for Narcissistic Personality Disorder


Most mental health conditions are treated with a combination of therapy and medication. But personality disorders, including NPD, do not respond to medication. If drugs are prescribed, they will be used to treat the symptoms of any co-occurring disorders that might be present.

For people with narcissistic personality disorder, a program that offers individual, group, and family therapy offers the best possibility for recovery.  Ongoing and intensive long-term therapy can help NPD sufferers come to grips with how their condition has damaged their lives and kept them from reaching their full potential, and the input of peers and loved ones can add context, depth, and reinforcement to these realizations.

Because narcissism functions as an organizing principle of personality for NPD sufferers, mental health therapists will not attack the condition openly or aggressively. The therapeutic process must be approached deliberately and with caution, so the patient is not pushed too far too fast.  

Working together, therapists and narcissistic patients will identify the attitudes and behaviors that create stress, conflict, and dissatisfaction in the patient’s life. As recovery progresses, therapists will encourage NPD sufferers to take constructive action to ameliorate the negative impact of their narcissistic symptoms, providing practical advice and instruction that can help them do so.

Therapists working with narcissistic patients must strive to create an atmosphere where judgmental attitudes are excluded and the focus is strictly solution-oriented. This is important, since a positive approach in therapy can build trust and contribute to a more effective dialogue between doctor and patient.

Evidence-based therapy programs for patients diagnosed with narcissistic personality disorder often include:

  • Cognitive behavioral therapy. Through multiple sessions of CBT, narcissistic personality disorder sufferers can learn to replace grandiose and distorted thoughts with more positive and realistic ideas and self-assessments.
  • Psychodynamic therapy. In psychodynamic therapy sessions, patients with NPD will plumb the depths of their past experiences, to evaluate the effects of problematic relationships on their lives and to examine unconscious assumptions about themselves and others that support narcissistic attitudes.
  • Family therapy. Narcissistic behavior impacts families as much as it impacts individuals, and involving loved ones in the healing and recovery process can help NPD sufferers understand the true ramifications of their self-centered behavior.

Since people with narcissistic personality disorder are often resistant to therapy, especially in the early stages, mental health professionals must work overtime to ensure their NPD patients are fully on board with every aspect of their treatment plan. Cooperation doesn’t come naturally for narcissists, but it is something they must learn to do if they are to have any hope of recovery.

The Value of Inpatient Treatment for NPD and Co-Occurring Conditions


While outpatient therapy can be effective as a long-term option, NPD sufferers new to recovery should start treatment in a residential mental health treatment facility. Inpatient recovery programs for narcissistic personality disorder offer an intense and focused therapeutic experience, where counselors are available on a daily basis to provide customized treatment services and continuous encouragement and moral support.

Narcissistic patients in residential facilities can also receive intensive treatment for the symptoms of any co-occurring emotional or behavioral health conditions that might be present, which is not a small concern: the rates of incidence for substance use disorders, anxiety disorders, and mood disorders among NPD sufferers are 40.6 percent, 40 percent, and 28.6 percent respectively.

When co-occurring conditions develop, people with NPD need comprehensive, integrated treatment services that will target their narcissistic traits and other mental health issues simultaneously and in a fully coordinated manner. Residential treatment programs, possibly preceded by a period of hospitalization if symptoms of the co-occurring disorder are especially severe, are essential for NPD sufferers dealing with complications caused by other serious health conditions.

It is often claimed that recovery rates for narcissistic personality disorder are low. But inpatient treatment programs are a highly effective solution to this problem, since they put NPD sufferers in a calm, non-judgmental environment where they won’t be distracted by rocky relationships, an unstable home life, job or school requirements, or friends and neighbors asking too many questions about the progress of their therapy.

Residential treatment centers have helped a significant number of people with personality disorders overcome distorted and self-destructive patterns of thinking and behavior. They offer enormous hope for people with narcissistic personality disorder who’ve finally found the courage to admit they have a problem they cannot solve all on their own.

Long-term Recovery from Narcissistic Personality Disorder


People with NPD are often in denial about the depth and nature of their problems, even after they’ve agreed to seek treatment.

But after their initial resistance to treatment wanes, and they start listening to their therapists and reflecting on the consequences of their attitudes and behaviors, a positive outcome can be anticipated.

Once they acknowledge they have a problem, narcissistic personality disorder sufferers can begin to analyze themselves more objectively. This is an important step forward, and as they confront their past and imagine a better future the possibility of a new way of thinking and living emerges.

Narcissistic personality disorder is a stable condition that will not change or evolve over time without treatment. But NPD sufferers who decide to give treatment a chance have great hope—and room—for improvement. Narcissism is adopted as a shield by those who feel a need to deny their true feelings, and once that shield has been cast aside clarity and enlightenment can finally shine through.