According to the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV), narcissistic personality disorder is characterized by an obsessive pattern of grandiosity, excessive need for admiration and praise, and lack of empathy which usually starts by early adulthood. The narcissist is obsessed with himself and seeing himself as perfect so rarely ever thinks he has a problem.
For years personality disorders were thought to be basically untreatable and incurable. The thinking has changed, but narcissists may be among the most difficult and challenging cases. Stereotypically, an unhappy narcissist believes that his main problem is that other people just don’t treat him the way he deserves. After all, when you think you are perfect and the best (and other people defer to you), why would you want to change?
People with this disorder seldom seek out treatment. They are either dragged in by a spouse or family member, they have feelings of emptiness, or have symptoms associated with Narcissistic Personality Disorder (NPD) that need treatment such as depression or anxiety. They go in to the therapist’s office wondering, “If I am so accomplished and wonderful, why does life seem so empty?” Because they have built a life based on lies and deceit, they are stuck on, “I’m wonderful” and their personality doesn’t allow them to grow and develop on their own.
Is There a Treatment for Narcissistic Personality Disorder?
Yes, there is! However, treatment usually involves long term psychotherapy with a therapist that has had experience with this kind of personality disorder. The process can be difficult and time consuming. The complexity of treatment is made even more difficult by the fact that most insurance companies are focused on short-term treatments that decrease symptoms such as depression or anxiety, ignoring the underlying problem.
They must want to change!
In order to treat narcissism, the narcissist himself must desire change. He must be willing to look at his weaknesses which is very hard for a narcissist to do. Narcissists are described as arrogant, conceited, jealous, controlling and exploitive. Admitting to himself that he has these traits creates conflict with his idealized image of himself. If they are helped to realize that NPD is a mental disorder that causes them to act in ways that hurt themselves as well as others, they can often be motivated to change.
Treatment options for narcissistic personality disorder
Treatment for NPD is centered around psychotherapy. The earlier he receives therapeutic intervention, the better the outcome. There are no medications on the market which treat NPD although medications are utilized to treat symptoms that are often associated with narcissism such as depression, anxiety or other conditions. Many individuals with narcissistic traits or full blown NPD have found the use of anti-depressants or anti-anxiety medications very effective.
What therapy works best
Types of therapy that are effective for NPD include:
- Cognitive Behavioral Therapy: Cognitive behavioral therapy can help to identify unhealthy, dysfunctional and negative beliefs and behaviors and replace them with healthy, positive ones.
- Individual Therapy: Individual therapy simply means that the sessions are with just the therapist and the client. It might involve cognitive behavior therapy, dynamic or expressive therapy, or other related therapies.
- Family Therapy: Family therapy involves bringing in the whole family for the therapy session. Together with the narcissist they explore relationship problems such as conflicts, communication difficulties and problem solving.
- Group Therapy: This therapy entails the narcissist meeting with a group of people with similar conditions. It is helpful for teaching the person with NPD how to relate better with others. It is recommended for teaching a narcissist how to genuinely listen to other people, learning about their feelings, and how to offer support.
- Dynamic Psychotherapy/Expressive Therapy: Expressive therapy is another type of frequently used therapy that helps reveal conflicts (such as feeling extremely insecure but covering this up by acting superior).
- Hospitalization: It is not uncommon for patients with severe NPD to need hospitalization. For some, it is due to their impulsivity, poor reality testing, or self-destructive tendencies. Those hospitalizations should be brief and treatment geared to the particular symptoms. For others, they require long term residential treatment. These people would include those who have poor motivation for outpatient treatment, chronic destructive acting out and chaotic lifestyles.
Personality traits took many years to develop and are difficult to change, so it is not surprising that therapy may take several years to change the narcissist’s behavior and attitudes to make them more positive and healthy. However, psychotherapy also has short-term goals to address immediate issues that are often associated with NPD such as substance abuse, depression, low self-esteem or shame.
Psychotherapy’s goal is to reshape the narcissist’s personality via changing patterns of thinking that distorts his self-image to a pattern of thinking that affords a more realistic self-image. Furthermore, psychotherapy helps the individual with NPD to relate better to other people so that his relationships become more intimate and rewarding. It can help him understand his emotions, what drives him to compete, why he distrusts others and help him to understand the dynamics behind his self-loathing.
The nature of narcissistic personality disorder can leave the individual feeling that the therapy or the therapist is not worth his time and attention, and he may be tempted to quit. His family members, partner or spouse need to encourage him to keep an open mind and help him focus on the rewards of treatment.