How to Treat Narcissistic Personality Disorder

Understanding and Treating Narcissistic Personality Disorder

Written by Super User
Category: Treatments & Interventions Created: Tuesday, 20 October 2020 15:57

Narcissistic Personality Disorder, commonly referred to as NPD, is officially recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), where it falls under the umbrella of personality disorders. But unlike casual references to narcissism that we often hear in everyday conversation, true NPD is a deeply rooted psychological condition that significantly affects a person’s inner world and how they relate to others.

Individuals diagnosed with NPD typically show:

  • A profound lack of empathy for the feelings and experiences of others

  • A persistent craving for admiration and validation

  • A deeply ingrained sense of grandiosity that colors most of their life interactions

It’s important to note that while many people may occasionally display narcissistic traits—such as arrogance, entitlement, or vanity—this does not automatically equate to a clinical diagnosis. A person might show a self-centered attitude now and then without meeting the full criteria for NPD.

True narcissistic personality disorder is much less common than pop culture might suggest. A comprehensive review of research published in 2018 affirmed that clinical NPD affects only a small portion of the population. Proper diagnosis requires a qualified mental health expert, such as a licensed psychologist or psychiatrist, to evaluate symptoms over time and rule out other conditions.

Treating NPD can be complex and slow-moving. The success of therapy often hinges on the individual’s openness to treatment and their ability to remain committed to the therapeutic process over time. That said, there are several evidence-based therapeutic approaches that can make a difference. We’ll explore them in detail, along with practical suggestions on how to find the right help.

Key Information About NPD You Should Know

Understanding NPD begins with acknowledging the fundamental way it shapes someone's entire psychological makeup. Unlike mood disorders that may come and go, personality disorders like NPD involve long-standing patterns of thought, emotion, and behavior. These patterns often start in adolescence or early adulthood and tend to remain relatively consistent throughout life unless actively addressed.

Here are several facts worth keeping in mind:

  • Narcissistic personality disorder is marked by chronic self-absorption. A person with this disorder is consumed by their own image, needs, and desires. These patterns color how they think, how they feel, and how they treat others.

  • Those with NPD can swing dramatically between feelings of superiority and worthlessness. This instability can strain their relationships and sense of self.

  • Studies estimate that up to 6% of the adult population may experience narcissistic personality disorder at some point in their lives, with a higher prevalence found in men than women.

  • As with other psychological conditions, NPD is believed to stem from a mix of biological, psychological, and environmental influences.

  • Individuals with this disorder tend to display consistent behaviors of exaggerated self-importance, an intense desire for admiration, and little to no regard for other people's emotions—usually beginning by early adulthood.

  • Although psychotherapy is the primary method of treatment, medications may sometimes be prescribed to manage overlapping symptoms such as depression or anxiety.

  • One of the greatest barriers to recovery in narcissistic individuals is their tendency to externalize blame—seeing others as the root of their problems rather than recognizing their own problematic behaviors.

Defining What NPD Really Is

To fully grasp what narcissistic personality disorder entails, it helps to first understand the nature of “personality.” Everyone develops a set of emotional patterns, beliefs, and behaviors that make up their personality—an internal blueprint that largely solidifies by early adulthood. When someone has NPD, this blueprint leans heavily toward self-obsession and distortion.

A narcissist is someone whose thoughts, emotions, and behaviors all revolve around an inflated self-image. This self-focus often shows up in manipulative relationships, emotional volatility, and a fragile ego that can't handle criticism or failure.

The word narcissism itself traces back to Greek mythology. Narcissus was a hunter famed for his beauty, but also cursed with an all-consuming love for his own reflection. So infatuated was he with himself that he wasted away beside a pool of water, unable to stop staring at his image. That myth remains a poetic illustration of modern-day narcissism—where excessive self-admiration leads to emotional disconnection and eventual isolation.

People with NPD often experience life through extremes—either feeling overly powerful and superior, or utterly rejected and devalued. This seesawing can leave their relationships strained and often short-lived. Children raised by narcissistic parents may carry a lasting sense of never being “good enough,” shaped by impossible standards and emotional neglect.

Statistically, NPD is diagnosed in roughly 1% to 6% of the population, depending on how the data is collected. Some reports suggest its occurrence more than doubled between the late 1990s and 2009, though this could also reflect changing diagnostic trends and cultural shifts.

Men are more frequently diagnosed with the disorder than women, and it often shows up in populations involved in legal proceedings or forensic systems. In many cases, NPD is accompanied by another mental health condition—particularly antisocial personality disorder.

What Contributes to the Development of NPD?

Like many complex mental health conditions, narcissistic personality disorder doesn't come from a single cause. Instead, it's typically the result of an intricate blend of biological makeup, psychological dynamics, and environmental experiences.

Biological influences may include structural differences in the brain. For instance, studies have shown that individuals with NPD often have a smaller volume of gray matter in areas linked to emotional empathy, which may explain why they struggle to connect with others’ feelings.

Psychologically, people with narcissistic tendencies often battle conflicting self-images. They may harbor feelings of deep inadequacy and shame, while simultaneously clinging to grandiose fantasies of perfection. This internal split fuels their extreme emotional sensitivity and tendency to either idolize or devalue the people in their lives.

Historically, early psychoanalysts looked at parental dynamics—especially between mothers and sons—as a root cause. The idea was that an overbearing or emotionally manipulative mother, coupled with a disengaged or critical father, could foster a sense of internal chaos and fragile self-worth in the child. While this theory has evolved, it laid the groundwork for understanding how upbringing impacts narcissism.

More current views suggest that either excessive praise or neglect during childhood can contribute to NPD. When a child is treated as flawless and superior, they may internalize unrealistic expectations of entitlement. On the flip side, if they are emotionally neglected or constantly criticized, they may overcompensate by building a false persona of invincibility.

Additional social risk factors include:

  • Emotional manipulation or abuse during formative years

  • Unpredictable or chaotic parent-child relationships

  • Caregivers who model controlling or deceptive behaviors

  • Overindulgence without healthy boundaries or accountability

These developmental influences can prime a child to rely on external validation and control, laying the groundwork for the rigid patterns seen in adult narcissists.

Recognizing the Signs and Symptoms of Narcissistic Personality Disorder

Diagnosing narcissistic personality disorder isn’t as simple as noticing someone is vain or self-absorbed. For a clinical diagnosis, a person must meet a specific set of criteria that reflect long-standing patterns of behavior. These patterns must begin by early adulthood and show up in multiple areas of life—such as work, relationships, and personal self-image.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the following signs and symptoms are essential in evaluating NPD. These characteristics are often intense, rigid, and persistent, rather than occasional or situational:

  • An inflated sense of self-importance, often without real achievements to back it up. They may expect others to see them as superior automatically.

  • A deep preoccupation with fantasies of greatness—imagining themselves achieving unmatched success, power, beauty, or love.

  • A belief that they are "special" or unique, and that they can only be understood by other high-status individuals or institutions.

  • A strong and persistent desire for admiration from others.

  • A belief that they are entitled to special treatment or unquestioning compliance with their expectations.

  • A pattern of exploiting others for personal gain or advancement, often without remorse.

  • A notable lack of empathy—difficulty recognizing or caring about how others feel.

  • Frequent feelings of envy toward others, or the belief that others are envious of them.

  • Arrogant attitudes or haughty behavior, often displayed through condescension or dismissiveness.

It’s important to note that someone may display some of these characteristics without meeting the full criteria for a diagnosis. In such cases, mental health professionals may say the individual shows narcissistic traits rather than full-fledged narcissistic personality disorder. Still, these traits can be disruptive and harmful—both to the person and to those around them.

Therapeutic Paths for Managing NPD

When someone begins treatment for narcissistic personality disorder, a licensed mental health provider will start by evaluating their overall psychological health. This assessment includes reviewing any other potential mental health issues and ruling out overlapping diagnoses that might complicate or mimic narcissistic traits.

Once a personalized treatment plan is developed, therapy typically focuses on:

  • Working through resistance or denial about the need for help

  • Identifying self-centered behaviors that cause real-life issues

  • Reflecting on past emotional wounds that shaped these behavioral patterns

  • Gaining awareness of how these patterns affect others

  • Challenging distorted, grandiose thinking

  • Learning new interpersonal behaviors and practicing them consistently

  • Recognizing the benefits of change and reinforcing those gains

Let’s break down some of the main therapeutic approaches used in treating NPD.

Talk Therapy (Psychodynamic Psychotherapy)

Traditional talk therapy—particularly in the psychodynamic tradition—offers individuals a safe space to explore the origins of their emotional difficulties. In these one-on-one sessions, the therapist helps the person connect past experiences to present behavior.

As clients begin to make these connections, they gain insights into how their current reactions are shaped by earlier wounds. With increased awareness, they can begin changing how they manage their feelings and respond to challenges, slowly reshaping their relationships and self-perception.

Cognitive Behavioral Therapy (CBT)

CBT helps clients uncover and challenge distorted beliefs. The emphasis is on replacing harmful mental habits with healthier, more balanced thinking patterns.

This therapeutic approach is practical and action-oriented. Clients work closely with their therapist to learn new emotional skills, which they practice both in sessions and in real-life situations through “homework.”

Common CBT methods include:

  • Keeping a thought journal

  • Practicing exposure to uncomfortable situations

  • Restructuring negative beliefs

  • Planning positive, rewarding activities

  • Engaging in guided questioning and behavioral experiments

Schema-Focused Therapy

Schema therapy blends traditional talk therapy with elements of CBT. It’s designed to help individuals break free from harmful psychological "schemas"—deep-rooted patterns of thinking and behavior developed during childhood.

These unhelpful patterns may have once served as coping mechanisms but now cause distress or dysfunction. Through this therapy, individuals learn to identify these schemas, understand their origin, and gradually replace them with more adaptive ways of thinking, feeling, and acting.

Gestalt Therapy

Gestalt therapy emphasizes the present moment. Rather than focusing primarily on past events or future worries, it encourages individuals to explore their current thoughts, feelings, and behaviors.

In this approach, self-awareness and personal responsibility take center stage. Clients are guided to notice patterns in how they relate to others and how they avoid or distort reality. The goal is to increase authenticity and alignment between one's internal experience and outward behavior.

Mentalization-Based Therapy (MBT)

MBT aims to help individuals develop a clearer understanding of their own emotions as well as those of others. This capacity—called mentalizing—is often underdeveloped in people with NPD.

Through MBT, clients learn to pause before reacting, reflect on their emotional responses, and consider others’ perspectives more deeply. This increased self-awareness supports more thoughtful and compassionate behavior.

Transference-Focused Psychotherapy (TFP)

In TFP, the therapist uses the emotional dynamics between themselves and the client to uncover unconscious patterns. As the client projects past experiences or feelings onto the therapist (a process known as “transference”), the therapist gently helps bring these patterns into conscious awareness.

This deep and structured method helps clients recognize the ways their inner world distorts relationships. With this insight, they can begin to shift how they interact with others.

Dialectical Behavior Therapy (DBT)

Originally developed for borderline personality disorder, DBT has also shown promise for individuals with narcissistic traits. It builds skills in four core areas:

  • Mindfulness: Staying grounded in the present moment

  • Emotional regulation: Managing overwhelming feelings

  • Distress tolerance: Navigating painful situations without self-destructive behavior

  • Interpersonal effectiveness: Improving relationship communication and boundaries

DBT often includes both individual therapy and group skills training.

Metacognitive Interpersonal Therapy (MIT)

MIT offers a structured, step-by-step approach to dismantling narcissistic thinking. It focuses on helping individuals:

  • See how their behaviors and attitudes play out in real-world problems

  • Recognize harmful patterns in how they relate to others

  • Build healthier, more adaptive responses over time

MIT therapists also help identify any resistance to therapy and work to reduce it gradually.

EMDR (Eye Movement Desensitization and Reprocessing)

EMDR is based on the premise that unresolved trauma contributes to many psychological issues, including narcissism. In this method, clients focus on distressing memories or emotions while simultaneously following the therapist’s directed eye movements.

This technique helps desensitize the emotional impact of past experiences. Over time, the client can process trauma in a healthier way and reduce the unconscious behaviors that stem from it.

How Long Does Therapy for Narcissistic Personality Disorder Take?

People often hope that therapy will bring quick relief, but when it comes to narcissistic personality disorder, healing is typically a long-term commitment. You might notice some early progress—like becoming more reflective or handling criticism a bit better—but these are just the first signs. Truly transforming the deeply embedded behaviors and emotional responses associated with NPD often requires years of consistent therapeutic work.

Therapy isn't just about resolving the disorder itself. Many individuals with narcissistic traits also experience other mental health challenges like depression, anxiety, or bipolar disorder. These overlapping conditions must also be addressed for therapy to be fully effective. As a result, treatment plans are often complex and need time to adapt and evolve with the person’s progress.

Patience is key. Walking away from therapy too soon can undo much of the progress made. Real change is gradual, built over time with repeated insight, practice, and emotional rewiring.

When to Reach Out to a Mental Health Professional

If you notice patterns in yourself that resemble narcissistic behavior—like using others to meet your needs, reacting poorly to criticism, or struggling with empathy—it’s worth considering a professional evaluation.

You don’t need to meet every single symptom of NPD to benefit from therapy. Even if you just recognize a few tendencies that are causing problems in your relationships or emotional well-being, counseling can be extremely helpful.

Research published in 2017 through case studies has shown that individuals with NPD are more prone to experiencing relationship breakdowns, workplace conflict, and even coexisting medical conditions. That’s why getting a professional perspective can be so important—not only for understanding what's happening internally but also for improving your quality of life in very real ways.

That said, narcissistic traits may sometimes be misidentified. Behaviors resembling narcissism can be caused by other mental health conditions, including:

  • Generalized anxiety disorder

  • Bipolar disorder

  • Major depressive disorder

  • Other types of personality disorders

  • Substance use disorders

In some cases, traits like covert narcissism (marked by introversion and insecurity) or malignant narcissism (which overlaps with antisocial traits and aggression) may also appear differently from the more overt patterns usually associated with NPD. That’s why a qualified clinician—such as a licensed psychiatrist, psychologist, or clinical social worker—is essential in making the correct diagnosis and recommending the right treatment plan.

If you’re ready to approach life differently, now is a good time to begin that process. The earlier you seek support, the more you can learn, grow, and build stronger connections with others.

Where to Find the Right Help

Self-diagnosing personality disorders isn’t advisable. These are complex conditions that require trained insight to properly evaluate. There’s also a high chance of symptom overlap between various disorders, which makes professional assessment critical.

Start by consulting your primary care doctor. They can guide you toward mental health professionals with experience in diagnosing and treating personality disorders. Often, your next step will be seeing a licensed psychologist or psychiatrist who is trained in personality assessment and therapeutic interventions.

Diagnosis and treatment are guided by the DSM-5 standards. A trained professional will look at your behaviors, thought patterns, emotional experiences, and history to determine whether NPD—or another condition—is present.

With the right provider and an open mindset, treatment can lead to meaningful change.

Summary of Key Points

Narcissistic personality disorder is a serious but treatable mental health condition. It typically involves:

  • An inflated sense of importance or uniqueness

  • Difficulty empathizing with others

  • A constant need for external admiration or approval

Though the term “narcissist” is often tossed around casually, the actual clinical disorder is far less common—and far more complicated—than the label suggests. Only a mental health professional can determine whether someone truly meets the diagnostic criteria for NPD.

Treatment can be life-changing but requires dedication. A variety of therapeutic approaches—including CBT, schema therapy, DBT, EMDR, and more—can help reduce narcissistic behaviors and support long-term personal growth.

This process takes time, self-reflection, and often, a willingness to confront some uncomfortable truths. But for those who stick with it, therapy can lead to healthier relationships, increased self-awareness, and a stronger sense of personal integrity.

If you're serious about change, seeking help today can set you on the path toward a more grounded and fulfilling life.