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.
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.
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
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:
- situation exposure
- cognitive restructuring
- scheduling positive activities
- guided discovery and questioning
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 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:
- 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.
Therapy for NPD is a long process.
You may feel like you’re improving early on, but it’s important not to leave therapy early. It’s likely to take several years — or even longer — to truly make meaningful change.
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.
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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
If you’re ready for change, now is the time to take that first step toward improving your life.
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. You can learn more about finding a provider at these sites:
Centers for Disease Control and Prevention MentalHealth.gov
- National Alliance on Mental Illness
National Institute of Mental Health
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.