Narcissistic Personality Disorder (NPD) is a complex and often misunderstood condition. It affects not only the individual diagnosed but also those around them, especially close family members, friends, and romantic partners.
Many people struggle to understand how psychological treatment works for individuals with NPD and whether they can truly change their behavior and emotional patterns.
One of the biggest misconceptions about NPD is that those who have it cannot seek or benefit from treatment. While narcissistic traits often include a lack of self-awareness and an unwillingness to recognize personal flaws, therapeutic interventions have been proven effective for some individuals.
However, the journey toward change is not simple—it requires patience, consistency, and a strong therapeutic intervention tailored to the individual’s needs.
What is Narcissistic personality disorder?
Before exploring treatment, it’s important to understand what NPD is. According to the DSM-5, NPD is characterized by a pervasive pattern of grandiosity, a need for admiration, and a lack of empathy. Individuals with NPD may exhibit manipulative behaviors, an inflated sense of self-importance, and difficulties in maintaining healthy relationships.
Psychological theories suggest that narcissistic traits can develop due to a combination of genetic predisposition, childhood experiences, and environmental influences. For example, a person who experienced excessive praise or harsh criticism in early life may develop narcissistic defenses as a coping mechanism.
Although NPD is often seen as a rigid personality disorder, research shows that therapeutic intervention can help individuals gain emotional awareness and work towards change. However, treatment is complex and requires a skilled therapist who understands the nuances of narcissistic behavior.
The role of psychotherapy in NPD treatment
When it comes to treating Narcissistic Personality Disorder (NPD), psychotherapy is the most recommended approach. However, in clinical practice, no single therapeutic approach is universally accepted as the gold standard for treating NPD (REIS; GONÇALVES, 2020).
Studies indicate that different therapeutic modalities can be applied depending on the individual characteristics of the patient, their level of insight, and the presence of comorbid conditions (RONNINGSTAM, 2016).
Among the most widely used therapies is Cognitive Behavioral Therapy (CBT), which helps individuals with NPD identify maladaptive thought patterns, manage interpersonal conflicts, and develop healthier coping mechanisms. CBT has shown promising results in reducing dysfunctional behaviors, especially in those who exhibit high impulsivity and mood instability (LEONARD et al., 2021).
Another highly regarded approach is psychodynamic therapy, which focuses on uncovering deep-seated emotional wounds and unconscious defense mechanisms that contribute to narcissistic traits.
Unlike CBT, which is more structured and goal-oriented, psychodynamic therapy provides a long-term reflective space where individuals can explore their early attachment experiences and how they shaped their personality (LEVY et al., 2022).
This approach is particularly useful for individuals with coexisting borderline traits or those who experience intense emotional fluctuations.
Additionally, schema therapy has gained attention as an effective intervention for individuals with NPD who struggle with persistent maladaptive patterns and emotional dysregulation. By targeting deeply ingrained schemas related to self-worth and relationships, schema therapy can help patients develop healthier interpersonal skills and improve emotional awareness (YOUNG et al., 2020).
Regardless of the therapeutic approach, a key goal of treatment is developing empathy and helping individuals with NPD recognize the impact of their behavior on others. Increasing emotional awareness is crucial in allowing them to reshape dysfunctional interpersonal dynamics.
However, the therapist’s role is highly demanding, as individuals with NPD may resist treatment, manipulate sessions, or struggle with self-reflection. This is why an individualized and flexible therapeutic intervention is essential, adapting to the specific needs of each patient (KERNBERG, 2014).
Are medications effective in treating NPD?
Unlike depression or anxiety, there are no FDA-approved medications specifically for NPD. However, psychiatric medications can be prescribed to treat co-occurring conditions, such as depression, anxiety, or mood instability, which often accompany NPD.
For instance, antidepressants may help regulate mood fluctuations, while mood stabilizers can assist in controlling impulsive behaviors. In some cases, antipsychotic medications might be used to manage severe symptoms related to paranoia or distorted perceptions of reality.
That said, medication alone cannot “cure” narcissism. It is always recommended as a supplementary tool rather than a standalone treatment. The most effective approach remains psychological treatment, where individuals work on their self-perception, relationships, and developing empathy.
Challenges in treating narcissistic personality disorder
One of the biggest obstacles in treating Narcissistic Personality Disorder (NPD) is that individuals with the disorder often do not acknowledge the need for help. Many seek treatment only after experiencing significant personal loss, such as relationship breakdowns, professional setbacks, or social isolation (MILLON, 1996).
Additionally, because narcissistic traits include defensiveness, grandiosity, and a lack of self-awareness, many individuals resist self-reflection and struggle to engage in psychological treatment (RONNINGSTAM, 2016).
Difficulties in diagnosis and overlap with other disorders
Another significant challenge is the difficulty in diagnosing NPD accurately. Unlike mood or anxiety disorders, which have clear symptomatology, NPD presents in a spectrum of severity and often overlaps with other personality traits.
The DSM-5 criteria for NPD include grandiosity, a need for admiration, and a lack of empathy, but these traits can also be seen in individuals with Borderline Personality Disorder (BPD), Antisocial Personality Disorder, and even some cases of Bipolar Disorder (AMERICAN PSYCHIATRIC ASSOCIATION, 2013).
Furthermore, many individuals with narcissistic traits do not exhibit overt grandiosity; rather, they may display vulnerable narcissism, characterized by covert insecurity, hypersensitivity to criticism, and social withdrawal (PINCUS & LUKOWITSKY, 2010).
This makes traditional diagnostic methods less effective and requires a deeper psychological evaluation to distinguish NPD from other related disorders.
Common comorbidities: depression and anxiety
A critical but often overlooked aspect of NPD treatment is its high comorbidity with other mental health disorders. Studies have shown that individuals with NPD frequently experience depression, anxiety, and even substance use disorders (CALIGIURI & DAVIDSON, 2019).
One study found that approximately 40% of individuals diagnosed with NPD also met criteria for Major Depressive Disorder (MDD), while 36% had co-occurring anxiety disorders (GRANDE et al., 2012).
This overlap complicates therapeutic intervention, as treating only the narcissistic traits without addressing co-occurring conditions can lead to treatment resistance and higher relapse rates (CALIGIURI & DAVIDSON, 2019).
For example, a person with NPD and depression may engage in therapy to alleviate depressive symptoms, but without addressing their narcissistic defense mechanisms, they may fail to make meaningful behavioral changes.
Resistance and manipulation in therapy
Individuals with NPD often struggle with the therapeutic process due to deep-seated defense mechanisms. Some attempt to manipulate or control the therapist, while others intellectualize their emotions to avoid deep emotional work (RONNINGSTAM, 2016).
In severe cases, individuals may drop out of therapy prematurely, believing they do not need help or that the therapist “doesn’t understand them” (KERNBERG, 1993).
For therapy to be effective, clinicians must establish strong boundaries and use structured therapeutic approaches that help patients gradually build emotional awareness and practice developing empathy (RONNINGSTAM, 2016).
Additionally, treatment plans should include interventions for comorbid conditions, ensuring a comprehensive and holistic approach.
How can you support a loved one undergoing treatment?
Supporting someone with NPD can be emotionally exhausting. You may wonder: “Can a narcissist truly change?” While significant personality shifts are rare, small behavioral improvements can make a big difference in relationships.
If you have a loved one undergoing treatment, the best thing you can do is set clear boundaries. Do not tolerate emotional abuse, manipulation, or disrespect. Encourage them to stay committed to therapy and celebrate small victories in their journey.
Additionally, consider seeking therapy for yourself. Dealing with someone with NPD can cause emotional distress, and having professional guidance can help you navigate the relationship while maintaining your mental well-being.
Signs that treatment is working
How can you tell if someone with NPD is truly making progress? Here are some signs of successful treatment for narcissism:
- Increased emotional awareness – They begin to recognize and express their feelings in a healthier way.
- Less defensiveness – They become more open to feedback without reacting with anger or denial.
- Greater empathy – They start to consider other people’s emotions and perspectives.
- Improved relationships – They work towards building healthier, more meaningful connections.
- Commitment to therapy – They actively participate in sessions and apply therapeutic strategies in daily life.
While complete transformation is rare, incremental change can lead to better interpersonal relationships and emotional well-being.
Frequently asked questions (FAQs)
- What is the most effective treatment for Narcissistic Personality Disorder (NPD)?
The most effective treatment for NPD is psychotherapy, particularly Cognitive Behavioral Therapy (CBT) and psychodynamic therapy. These approaches help individuals develop emotional awareness, improve relationships, and address underlying insecurities (Ronningstam, 2016). - Can medication help treat NPD?
There is no specific medication for NPD. However, medications like antidepressants, mood stabilizers, or antipsychotics can be prescribed to treat co-occurring disorders such as anxiety, depression, or impulsivity (Caligiuri & Davidson, 2019). - How can I convince someone with NPD to seek therapy?
People with NPD often resist therapy. The best approach is to highlight personal benefits, such as improving leadership skills, relationships, or emotional control. Waiting for a personal crisis can also create motivation (Grande et al., 2012). - Is therapy for NPD short-term or long-term?
NPD therapy is usually long-term, as personality traits develop over many years. Progress depends on the individual’s willingness to change, the therapist’s expertise, and the presence of co-occurring conditions (Pincus & Lukowitsky, 2010). - Can a person with NPD develop empathy through therapy?
Yes, but it requires consistent effort. Therapy helps individuals with NPD understand emotions, recognize their impact on others, and gradually develop empathy. However, change is gradual and varies by individual (Kernberg, 1993). - How can I support a loved one with NPD during treatment?
Set clear boundaries, encourage therapy, and avoid enabling toxic behaviors. Seeking your own therapy can also help you manage the emotional challenges of dealing with someone with NPD (American Psychiatric Association, 2013).
Summary table
| Topic | Key Points |
|---|---|
| Definition of NPD | A personality disorder characterized by grandiosity, need for admiration, and lack of empathy (DSM-5). |
| Primary treatment | Psychotherapy is the most effective treatment, including Cognitive Behavioral Therapy (CBT) and psychodynamic therapy. |
| Role of medication | No specific medication for NPD, but antidepressants, mood stabilizers, or antipsychotics can help manage co-occurring conditions. |
| Challenges in treatment | Individuals with NPD resist therapy, have defense mechanisms, and often seek help only after a crisis. |
| Diagnosis difficulties | NPD symptoms overlap with Borderline Personality Disorder (BPD) and Bipolar Disorder, making diagnosis complex. |
| Common comorbidities | NPD frequently coexists with depression, anxiety, and substance use disorders, which must be treated simultaneously. |
| How to persuade someone to seek treatment | Focus on personal benefits, wait for a life crisis, use motivational questioning, and set firm boundaries. |
| Therapy duration | Treatment is long-term, requiring consistent effort and commitment to develop emotional awareness and improve relationships. |
| Signs of progress | Increased emotional awareness, reduced defensiveness, improved relationship skills, and willingness to commit to therapy. |
| Supporting a loved one with NPD | Set healthy boundaries, encourage therapy, and avoid enabling toxic behaviors while seeking self-care and professional guidance. |
Final thoughts
Understanding treatment for narcissism requires patience and an open mind. While NPD is a challenging disorder to treat, psychological treatment can help individuals develop emotional awareness, make behavioral improvements, and work towards developing empathy.
If you have a loved one with NPD, remember that you are not responsible for their change—only they can make that choice. Your role is to set boundaries, offer support, and seek help if needed.
Therapy is not a quick fix, but with the right therapeutic intervention, individuals with NPD can improve their self-awareness and interpersonal skills. If you or someone you know needs support, consider reaching out to a licensed mental health professional who specializes in personality disorders.
References
- AMERICAN PSYCHIATRIC ASSOCIATION. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. Washington, DC: American Psychiatric Association, 2013.
- KERNBERG, O. Severe Personality Disorders: Psychotherapeutic Strategies. Yale University Press, 1993.
- KERNBERG, O. Severe Personality Disorders: Psychotherapeutic Strategies. Yale University Press, 2014.
- LEONARD, N. R.; STEIGER, H.; YARON, R. Cognitive Behavioral Therapy for Personality Disorders. Clinical Psychology Review, 2021.
- LEVY, K. N.; YEOMANS, F. E.; CLARKIN, J. F. Transference-Focused Psychotherapy for Personality Disorders. Journal of Personality Disorders, 2022.
- MILLON, T. Disorders of Personality: DSM-IV and Beyond. Wiley, 1996.
- REIS, S.; GONÇALVES, R. Personality Disorders and Therapeutic Approaches: A Comprehensive Review. International Journal of Psychotherapy, 2020.
- RONNINGSTAM, E. Identifying and Understanding the Narcissistic Patient in Therapy. American Journal of Psychiatry, 2016.
- YOUNG, J.; KLOSKO, J.; WEISHHAAR, M. Schema Therapy: A Practitioner’s Guide. Guilford Press, 2020.