Therapy For Narcissistic Personality Disorder

Medically reviewed by Andrea Brant, LMHC

Updated November 21, 2024by BetterHelp Editorial Team

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You may have heard the term “narcissist” used to describe someone who is excessively vain or arrogant, but clinical narcissism goes beyond just being self-centered. Narcissistic personality disorder (NPD) is a mental health condition that can have serious impacts, both on those who are living with it and their loved ones. In this article, we will explore the key narcissistic personality disorder symptoms, different types of therapy that can be used for treating NPD, and how therapy can serve as a treatment and help those with NPD improve their relationships and develop a healthy sense of self-esteem.

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DSM-V definition of narcissistic personality disorder

Narcissistic personality disorder, also known as NPD, is one of a wide range of personality disorders: mental health conditions affecting personality, or how individuals think, feel, and behave. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) by the American Psychiatric Association (APA), personality disorders are long-lasting patterns of behavior and experience that differ from what would typically be expected and may cause distress or problems functioning in daily life.

Narcissistic personality disorder is defined in the Diagnostic and Statistical Manual of Mental Disorders as an exaggerated sense of self-importance, reduced concern for the feelings of others, and a strong desire to be admired.

Symptoms of narcissistic personality disorder

It is important to note that not everyone who exhibits narcissistic tendencies has narcissistic personality disorder. Almost everyone experiences difficult feelings such as jealousy and frustration when things don’t turn out as planned, and many people’s outward expressions of self-centered behaviors may stem from strong self-criticism. That being said, it is important to learn to recognize and treat NPD to improve these people’s quality of life and their relationships with others.

NPD may present as a sense of excessive superiority, often accompanied by problems interacting with others. Those with NPD may see other people more as a means of getting what they want, which can lead to conflict—especially with friends and family members.

Some of the symptoms of narcissistic personality disorder include the following narcissistic traits:

An inflated sense of self-importance (also called a grandiose sense of self)
Frequent thoughts of being perceived as “better” than others
A sense of entitlement to favorable treatment or special favors
Taking advantage of others to increase personal gain
Envy of others
Lack of understanding of the needs and feelings of others

Conversely, NPD may also be associated with secret feelings of insecurity or low self-esteem (about both physical appearance and personality traits) as well as trouble with personal relationships. It is not uncommon for people with NPD to have coexisting mental health conditions such as depression, bipolar disorder, or substance use disorders.

According to the American Journal of Psychiatry, These conflicting symptoms can make it hard to get narcissistic personality disorder diagnosed, as other mood and personality disorders can present similar symptoms. It’s usually best to contact a mental health professional for official diagnosis if you are looking to seek treatment.

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The best therapy for narcissistic personality disorder

Like other personality disorders, NPD is a mental health condition that can cause significant distress to both those who have it and the people in their lives. That being said, it is possible to treat NPD.

Currently, there are no medications specifically designed to treat NPD, that said, there are a variety of options available for treating NPD, including therapy for narcissistic personality disorder. In cases where NPD is accompanied by another mental health condition, like depression or anxiety, medication may be useful in treating the symptoms of those conditions. However, counseling (particularly individual therapy) remains the primary treatment to address the symptoms of narcissistic personality disorder.

Several types of treatment exist that may help those with NPD improve their self-esteem and learn to connect with others in a healthier, more constructive way. This is because, as with other medical conditions, not every person with NPD is going to respond well to the same treatment.

Therapy may be given in an individual or group therapy format. The types of therapy for narcissistic personality disorder include:

Schema therapy

The goal of schema therapy is to identify and change “schemas,” or negative feelings around traumatic events and thoughts, that may be causing a person distress. Schema therapy is a modality that has similarities with cognitive behavioral therapy, or CBT.

Transference-focused psychotherapy (TFP) for narcissistic personality disorder

Transference-focused psychotherapy concentrates on the therapeutic relationship between an individual and their therapist, with the goal of improving behavior and communication. During this therapy a person may direct their own feelings and emotional distress towards a therapist. Doing this enables a person with NPD to practice emotional control and may improve relationship skills.

Gestalt counseling

Gestalt therapy is a modality of talk psychotherapy that focuses on the person’s life in the present moment and circumstances rather than their past experiences or early childhood trauma. The goal of gestalt therapy is to improve self-awareness, reduce harmful behaviors, and gain a new perspective on one’s thoughts and feelings.

Mentalization-based counseling

Also known as MBT, this is a form of counseling focused on understanding one’s mental state and how it can influence behavior and perception. It may focus on relaxation techniques and distress tolerance.

Metacognitive interpersonal therapy

Metacognitive interpersonal therapy focuses on helping an individual better understand how they view their thoughts and ways of thinking and interpersonal effectiveness skills. Metacognitive interpersonal therapy (MIT) works by dismantling narcissistic thought patterns at their base by improving a patient’s access to their “inner states” or the emotional and mental states that lead to these patterns. It generally works toward being able to recognize, pause, and restructure these patterns for a healthier worldview. Undertaking metacognitive interpersonal therapy requires regular supervision by a mental health professional.

Eye movement desensitization and reprocessing therapy

Eye Movement Desensitization and Reprocessing therapy, also called EMDR, is a psychotherapeutic approach primarily designed to alleviate distress associated with traumatic memories. EMDR therapy is commonly used for individuals who have experienced trauma, such as post-traumatic stress disorder (PTSD). While EMDR is not a primary treatment for personality disorders like Narcissistic Personality Disorder (NPD), it may be used by a mental health provider to indirectly impact certain symptoms or issues related to trauma.

Dialectical behavior therapy for narcissism

Dialectical-behavioral therapy, also known as DBT, this modality concentrates on helping individuals manage their emotions and improve their behaviors while learning to accept challenging situations with realistic expectations for their outcomes. DBT is based on cognitive behavioral therapy, CBT, and it’s also a common option for borderline personality disorder. Sessions for dialectical behavior therapy (DBT) may focus on changing certain traits and maladaptive patterns using healthy coping mechanisms to build better interpersonal relationships and increase healthy thought patterns.

Like other personality and mental conditions, the best NPD treatment will vary from person to person. If you are seeking treatment to help with NPD, your mental health professional may recommend a range of approaches depending on your individual needs, background, and situation.

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How therapy for narcissistic personality disorder can help loved ones

Narcissistic personality disorder doesn’t just affect those who experience it; it can also immensely impact that person’s friends and family. Loved ones may feel isolated or taken advantage of by those with NPD. They may experience narcissistic abuse, frustration, anger, and distress at the person’s perceived lack of empathy or compassion. In fact, a 2021 study found a 69% rate of depression and an 82% rate of anxiety among those who were living with someone with NPD.

Counseling may also be beneficial in helping the loved ones of individuals who develop NPD to cope with these and other mental health and emotional impacts. For situations in which a loved one’s NPD has led to symptoms of anxiety and depression, which can make leaving the house difficult, it may be beneficial to seek treatment online. Through a platform like BetterHelp, individuals who seek therapy can attend sessions from the comfort of their own homes.

Online counseling has been found to be an effective alternative to in-person counseling when it comes to treating symptoms of depression, anxiety, and various other mental health conditions. A study from 2013 found that an internet-based intervention for depression was “equally beneficial to regular face-to-face therapy.”

Whether you seek help in person or online, counseling can be an invaluable tool for helping the friends and family of those with NPD navigate their loved one’s condition, gaining support, and developing constructive coping skills.

Takeaway

According to the Diagnostic and Statistical Manual of Mental Disorders, narcissistic personality disorder (NPD) is a mental health condition that can involve feelings of self-importance, difficulty managing emotions, jealousy, and a disregard for the emotions and well-being of others. There are many forms of counseling that can be used to try to improve the symptoms of NPD, such as dialectical behavior therapy, schema therapy, and mentalization-based therapy. If you or a loved one is experiencing challenges related to NPD, you can connect with a licensed therapist online to begin unpacking the condition, developing healthy coping skills, and finding a path forward using effective therapy.

Frequently asked questions

Read more below for answers to questions commonly asked about this topic.

Treating narcissistic personality disorder: Can counseling help a person with narcissistic personality disorder change?

Yes, while it’s not successful in all instances, therapy can help a person with NPD gain insight and cultivate healthier relationships.

Understanding narcissistic personality disorder: What is the root cause of narcissism?

Narcissistic personality disorder is recognized by the American Psychiatric Association's Diagnostic and Statistical Manual as a mental health disorder. Researchers do not know the exact cause of NPD, but key factors likely include a combination of early life experiences and genetic factors. Narcissists care immensely about people seeing them positively, which is different from antisocial personality disorder, in which people don’t care how others see them. In order to be diagnosed with NPD, a person must meet nine criteria. These include lack of empathy, grandiosity, difficulty with attachment in relationships, and excessive need for admiration, among others.

Therapy for narcissism: Can someone with narcissistic personality disorder be treated with therapy?

Yes, a treatment plan that includes psychotherapy can help a person with NPD learn emotional regulation and increase self awareness. However, certain symptoms can make people with NPD difficult to treat. Haughty behaviors can hinder the therapeutic relationship, and unwillingness or inability to engage in self reflection can hinder the therapeutic process. Also, because people with NPD have fragile ego structures, questions the therapist might ask might challenge a person's sense of self worth and either make them defensive or try to please the therapist. Severe NPD, sometimes called malignant narcissism or sociopathy, is very difficult to treat.

What type of treatment is most effective for narcissistic personality disorder?

Once a person has received a formal diagnosis, talk therapy is often used to treat narcissistic personality disorder. The therapist may choose to use a specific therapy modality such as cognitive behavioral therapy or dialectical behavioral therapy during therapy sessions. They may discuss interpersonal relationships or early childhood experiences in sessions. In some cases, medication such as mood stabilizers or antipsychotic medications can be helpful too.

What is the most effective way to help someone with narcissistic personality disorder?

The best way to help someone with NPD is to encourage them to see a therapist. They may resist, since they may not believe they need therapy and may have a deep fear of being vulnerable. But only a qualified mental health professional can help them with therapeutic interventions and diagnosing narcissistic personality disorder. Be kind and clear, but be sure to set boundaries for yourself when talking to them.

What happens to a person with narcissistic personality disorder in counseling?

During narcissistic personality disorder treatment mental health professionals will engage a person with NPD with techniques designed to help them become more self-aware and modify their behaviors. However, a person with NPD may not be totally responsive to the therapist’s interventions, sometimes becoming angry, not taking responsibility, or dropping out of counseling altogether.

Understanding narcissistic personality disorder: What are coping mechanisms of a narcissist?

Narcissists use a number of coping mechanisms to protect their sense of self worth. These coping mechanisms may include putting others down to elevate themselves, playing the victim and blaming others for their mistakes and shortcomings, and distorting facts to suit their positive view of themselves, as well as lying, gaslighting, and manipulating others to gain control.

Can a person with NPD love someone else?

A person with NPD can have feelings of love for another person, but their love is often superficial and conditional.

Does a narcissist know they are a narcissist?

Some narcissists know that they are narcissistic, while others remain unaware or deny the fact if they are made aware of it.

Narcissistic personality disorder impact: Can a narcissist ever live a normal life?

While change can be challenging for a narcissist, it is possible, with therapeutic help, for a narcissist to change and lead a more normal life.

How do narcissists affect the mental health of the people around them?

Being involved with a narcissist can negatively affect one's mental health. Narcissistic behaviors affect others by making them feel disrespected and diminished, and often by making them lose confidence in their own abilities, feelings, and ideas. If you have a narcissist in your life, it is important to maintain healthy boundaries.

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