How to Treat Narcissistic Personality Disorder

Category: Treatments & Interventions Created: Tuesday, 20 October 2020 15:57

Narcissistic personality disorder (NPD) is a personality disorder included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) under the “personality disorders” category.

NPD is characterized by a:

• lack of empathy
• strong need for admiration
• pervasive pattern of grandiosity

We often hear the word “narcissist” used in general conversation. In this context, people are usually referring to one who exhibits some self-centered, vain behavior.

But having the tendency toward narcissistic behaviors doesn’t mean you have NPD. Either way, change is possible.

A 2018 research review showed that true NPD is not common. It requires a diagnosis by a mental health professional, such as a psychiatrist or psychologist.

Treatment for NPD can be challenging. Much depends on the person’s willingness to enter therapy and to stick with it.

There are several forms of therapy that can be used to treat NPD. Let’s take a look at some of them, plus tips on where to find help.

 

• Narcissistic personality disorder (NPD) is a mental disorder that is characterized by an established pattern of being fixated on oneself, permeating the thoughts, feelings, and actions of the sufferer, and their relationships with other people.
• People with NPD tend to alternate between feeling omnipotent and devalued.
• Narcissistic personality disorder occurs as often as in 6% of adults, more often in men than in women.
• Like most mental illness, narcissistic personality disorder tends to have biological, psychological, and environmental risk factors that contribute to its development.
• Narcissists demonstrate a pervasive pattern of the external appearance of having significantly inflated self-esteem, a need for admiration, and lack of empathy for others that begins by early adulthood and manifests in a number of different aspects of their life.
• While the primary treatment for narcissistic personality disorder is talk therapy rather than medication, medication may be appropriate to address some co-occurring symptoms.
• One of the major obstacles to a good prognosis for narcissistic individuals is their perception that other people are the cause of their problems rather than their own self-centered tendencies.

 

In order to understand narcissistic personality disorder, the concept of personality is important. As with normal personality, that of the person with narcissistic personality disorder (NPD) has a pervasive way of thinking, feeling, and interacting with other people that tends to be fairly established and fixed by the time the individual reaches adulthood. A narcissist is someone who has therefore established a long-standing pattern of being fixated on him- or herself that permeates their thoughts, feelings, actions, and relationships.

The word narcissism comes from the story of Narcissus, a hunter in Greek mythology well known for his beauty and for being completely in love with himself. His all-consuming self-love resulted in his eventual death, caused by his becoming so attracted to his own reflection in a pool that he was unable to stop staring at his image.

People with narcissism tend to interact with others and the world in general by distorting things such that they alternate between feeling omnipotent or devalued. Children of a narcissistic parent often feel like they are never good enough. Narcissistic personality disorder has an average occurrence rate of about 1% of the population occurs as often as in 6% of adults. Some research indicates that the incidence of NPD more than doubled from 1999 to 2009.

Medical professionals diagnose NPD more often in men than in women. It is also more often found in people who are involved with the court system compared to the public. Antisocial personality disorder is an illness that commonly co-occurs with narcissistic personality disorder.

 

What are causes and risk factors for narcissistic personality disorder?

As with most mental health disorders, narcissistic personality disorder does not have one single definitive cause. Rather, people with this illness tend to have biological, psychological, and environmental risk factors that contribute to its development. Biologically, narcissists have a tendency to have a smaller part of the brain that is related to having empathy for others.

Psychologically, individuals with narcissism tend to have trouble having opposing self-images of excessive admiration and devaluing in their minds and in their relationships. They are excessively emotionally sensitive.

Early psychoanalytic theory on the emotional motivations for the development of NPD focused on the relationship between mothers and sons. Specifically, medical professionals believed that men develop this disorder as the result of having an excessively close relationship with their mother that is contingent upon always doing what she wants, with a resulting paranoid fear of retaliation by their father and humiliation or abandonment by their mother. Since those early theories, the social risk factors for developing NPD have been expanded to include excessive admiration or neglect by either parent.

In addition to receiving excessive, unrealistic admiration, praise, and overindulgence, or excessive criticism for misbehavior during childhood, theories about other social risk factors of narcissistic personality disorder include emotional abuse, unpredictable parental care and parent-child interactions, as well as learning manipulation from caregivers.

 

What are narcissistic personality disorder symptoms and signs?

In order to be assessed with the diagnosis of narcissistic personality disorder, an individual must demonstrate a pervasive pattern of significantly inflated self-esteem (grandiosity), a need to be admired and lack of empathy for others that begins by early adulthood and is present in a number of different aspects of their life. According to the DSM-5/DSM-V (the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), the diagnostic reference that is written and endorsed by the American Psychiatric Association, specific symptoms and signs of this illness have remained consistent from the previous edition (DSM-IV-Text Revision) and include the following:

• An excessive sense of self-importance, with an expectation of being seen as superior for no reason
• Preoccupation with self-aggrandizing fantasies: unlimited success, power, brilliance, beauty, or love
• Excessive belief that he or she is special or unique and therefore should only associate with other high-status people
• A need for excessive admiration
• A sense of entitlement to receiving especially favorable treatment or compliance with their wishes
• A tendency to take advantage of others to achieve their own ends
• Lacking empathy for the needs and feelings of people
• Frequently envious of others or thinking others are envious of him or her
• Exhibits haughty, arrogant thoughts or behaviors

Mental health professionals describe individuals who have some symptoms of narcissistic personality disorder but not enough for the full-blown diagnosis as having narcissistic personality traits.

 

Types of therapy for narcissistic personality disorder

Your mental health provider will begin by assessing your psychological functioning. They’ll also consider differential diagnoses and coexisting conditions before recommending a plan for treatment.

Therapy for NDP will likely involve:

• helping you overcome resistance to therapy
• identifying narcissistic behaviors that are causing problems in your life
• examining past experiences and assumptions that led to narcissistic behaviors
• acknowledging how these behaviors affect others
• replacing grandiose thoughts with more realistic ones
• exploring new patterns of behavior and practicing them
• seeing the benefits of newly learned behaviors

Psychotherapy

Psychoanalysis is a form of talk therapy. Through one-on-one sessions, you’ll explore the reasons behind your feelings and behaviors.

As you begin to understand your past, current emotions and behaviors come into focus. This can help you better manage your thoughts and feelings. Then, you can start changing the way you react to them.

Cognitive behavioral therapy (CBT)

The focus of CBT is to identify unhealthy patterns of thought and behavior and replace them with healthier ones.

You’ll practice new skills with your therapist. You’ll also have homework assignments to put these skills into action between sessions.

There are many CBT techniques, such as:

• journaling
• situation exposure
• cognitive restructuring
• scheduling positive activities
• guided discovery and questioning

Schema therapy

Schema therapy is an integrative approach to therapy. It combines elements of psychotherapy and CBT.

The aim is to help you identify and understand unhelpful patterns and coping mechanisms that formed from early childhood experiences.

Once you uncover these maladaptive schemas, you can learn to modify them. With practice, you’ll find new ways to help meet your emotional needs and change your behavior toward others.

Gestalt therapy

Gestalt therapy is a form of psychotherapy. You’ll focus more on the present than the past or the future. Earlier life experiences are considered in the context of how they affect you today.

You’ll be encouraged to reflect on what’s happening in your life now. You’ll work on improving self-awareness and self-responsibility.

Mentalization-based therapy (MBT)

MBT works on improving your ability to reflect on yourself, as well as the thoughts and emotions of others. Then, you’ll learn to connect emotions to behavior patterns.

You’ll explore the intent behind other people’s behavior and work on thinking things through before reacting.

Transference-focused psychotherapy (TFP)

In TFP, you take your emotions about someone else and direct them toward the therapist. This may make it easier to talk things through. The therapist can help you gain insight into your thoughts and feelings.

Dialectical behavior therapy (DBT)

DBT is a form of CBT with a focus on:

• mindfulness
• emotion regulation
• distress tolerance
• interpersonal effectiveness (relationship skills)

DBT may involve individual and group therapy sessions where you’ll learn and practice new coping strategies.

Metacognitive interpersonal therapy (MIT)

MIT is a step-by-step treatment designed to:

• dismantle narcissistic processes by looking at problems as they pertain to your own life
• recognize maladaptive patterns and interpersonal functioning
• promote change by distancing from old behaviors and building new adaptive patterns

The therapist will also look for barriers to effective therapy and work to help improve them.

Eye movement desensitization and reprocessing (EMDR) therapy

In EMDR therapy, the assumption is that narcissism is based on difficult early life experiences or traumas.

EMDR therapy is a step-by-step process divided into eight distinct phases. As you progress, you’ll be encouraged to address:

• negative memories
• traumatic events
• emotional triggers

As you do, the therapist will direct eye movements to divert your attention. The goal is to lessen the impact of traumatic memories.

 

When to contact a medical professional

If you’re concerned that you exhibit narcissistic behaviors, consider contacting a medical or mental health professional for evaluation.

Even if you only have a few tendencies toward narcissistic behavior, therapy can help you look at things differently.

According to a small 2017 review of case studies Trusted Source, people who have NPD experience significant social problems and multiple medical conditions, so it’s worth seeking help.

Also, what appears to be narcissistic behavior could very well be due to another condition. Other causes of similar symptoms include:

• anxiety disorders
• bipolar disorder
• depressive disorders
• other personality disorders
• substance use disorder

NPD doesn’t always present the same way. A broad spectrum may exist that includes covert narcissism and malignant narcissism. A qualified doctor or therapist can help determine the best approach.

If you’re ready for change, now is the time to take that first step toward improving your life.

 

Where to find a provider

You shouldn’t try to diagnose yourself or anyone else with a personality disorder. Symptoms of personality disorders can overlap, and there are often coexisting conditions that play a role.

That’s why it’s best to seek help from a licensed mental health professional. The diagnosis will be made based on the DSM-5.

You can start with your primary care doctor. They can refer you to a qualified psychiatrist or psychologist experienced in the treatment of NPD. 

 

Takeaway

Narcissistic personality disorder is a mental health condition. It’s typified by:

• grandiose ideas
• a lack of empathy
• a deeply rooted need for admiration

Despite frequent use of the word “narcissism” to describe self-centered behaviors, the actual disorder is not common. It takes a mental health professional to make the diagnosis.

Narcissistic behaviors can affect your relationships and your quality of life. But a variety of therapies can help you learn to change these behaviors for the better.

These are usually long-term treatments that depend on a willingness to continue over the long haul.

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