Can A Narcissist Ever Change?

Is It Possible For The Narcissist To Change?

Oh, Lord it’s hard to be humble, when you’re perfect in every way.
I can’t wait to look in the mirror, ‘cos I get better looking each day!
To know me is to love me, I must be a hell of a man.
Oh Lord It’s hard to be humble, But I’m doing the best that I can!
Mac Davis

Given the recent noise in the Twittersphere of a certain person “Over the Pond” and particularly the column inches in social and the printed media suggesting that the POTUS may indeed be suffering from Narcissistic Personality Disorder, the need for an answer to this question is probably a burning one for many people. Theoretically at least, it is possible, as psychologically literate people we should never say never, but it is extremely hard for a person who has NPD to change and the reason for this can be traced back to an old psychology joke told by one of my professors:

“How many psychologists does it take to change a lightbulb?
“just one” but then comes the killer line
“But the lightbulb has to want to be changed”

Unlike physical medicine where the offending bodily is readily offered for manipulation by surgery physical therapy or drugs, psychological therapy is dependent upon the patient recognising that they have a problem and then accepting the help offered. Now, whilst a person with anxiety, depression may recognise that their present state is not functional and seek change, other psychological dysfunctions amongst them anorexia nervosa and various personality disorders are, according to the cognitive theory of personality disorders, maintained by a process called schema congruent biases

What is schema congruent bias?

Schemas are the brain’s way of organising pieces of information into a whole. It is a mental shortcut which reduces the “load” on our brains. For example, a mature adult has a schema for “what we do at work” or “a party”. Children too have schema but they are less well developed so a schema for “Christmas” might be predominantly about presents. As we grow older we develop more schemas and unfortunately, whilst schemas save processing energy and act as shortcuts, they are also the basis of fixed ideas and “self-fulfilling prophecy” about ourselves and others. In cognitive terms, they help us, but in mental health and personality disorders they can make successful treatment harder.

The schemas behind personality disorders are termed Early Maladaptive Schemas and according to Jeffrey Young of the Schema Therapy Institute the definition is:

“broad, pervasive themes regarding oneself and one’s relationship with others, developed during childhood and elaborated throughout one’s lifetime, and dysfunctional to a significant degree.”

These schemas then are developed because of early childhood experience and as such they become central to the personality of the child and then the adult. The maladaptive scheme maps perfectly onto the sense of self. Because this schema is central to the identity of the person they will seek to defend it.

Defence mechanisms on a simple level involve looking for evidence which supports the status quo and rejecting evidence which challenges it. This is known as schema congruent biases. And although Anorexia is not a personality disorder, an anorexic also has schema congruent bias which is easy to understand and may help improve our understanding of NPD.

Their schema congruent bias is to do with their body dysmorphia – they literally cannot see the problem which is so patently obvious to everyone else that they are dangerously underweight and they will defend their perspective, even violently if necessary. This mentality and strong defensiveness is common to people with NPD too. They cannot see that their behaviour is damaging themselves and those around them. In a social life, this is difficult.

There have been 18 maladaptive early schemata defined. Research into maladaptive schema and narcissism suggests that there is a strong correlation between narcissism and entitlement / grandiosity schema, which Jeffrey Young defines as:

“The belief that one is superior to other people; entitled to special rights and privileges; or not bound by the rules of reciprocity that guide normal social interaction. Often involves insistence that one should be able to do or have whatever one wants, regardless of what is realistic, what others consider reasonable, or the cost to others; OR an exaggerated focus on superiority (e.g., being among the most successful,  famous,  wealthy)  — in order to achieve power or control (not primarily for attention or approval).  Sometimes includes excessive competitiveness toward, or domination of, others:  asserting one’s power, forcing one’s point of view, or controlling the behaviour of others in line with one’s own desires—without empathy or concern for others’ needs or feelings.”

Schema Therapy for Narcissistic Personality Disorder

Narcissists may have a “fragile entitlement” which is a description not about their sense of entitlement but its origins in their self-worth developed as a response to conditional love (as opposed to the essential “unconditional love” described by Carl Rogers) Schema therapy then needs to concentrate on two schemas:

Emotional Deprivation – the expectation that one’s need for a normal degree of emotional support will not be adequately met by others. In particular, they feel lack of nurture, empathy and protection from their early parenting experience

Defensiveness and Shame – the feeling of inadequacy, defectiveness and as if they are unlovable. They are hypersensitive to criticism, being rejected. They also carry a sense of shame about their flaws. It can reveal itself in anger and violence and unacceptable drives and social awkwardness.

Treatment for narcissists who have a sense of entitlement caused by over indulgence as a child have no fragility in their schema. This type of narcissism is much more difficult to treat since there are no early maladaptive schema just strong defence mechanisms.