Can you overcome narcissistic personality disorder with therapy?

It is difficult, but not impossible. A therapist specially trained in working with people who have Narcissistic Personality Disorder (NPD) can, over a period of time that typically extends into multiple years, successfully help them find relief from the immediate stress their actions are causing them, develop new coping skills, address childhood experiences that may help drive their behavior, learn to empathize with themselves, and eventually, develop empathy for others. One of the greatest challenges to treatment is that people with NPD often quit therapy, as they may find self-reflection highly uncomfortable.

Who can diagnose narcissistic personality disorder?

A mental health professional can determine whether an individual has narcissistic personality disorder (NPD), based on a set of symptoms that include a grandiose sense of self-importance, a belief that they are special and a willingness to exploit others. The Narcissistic Personality Inventory is a widely available measure of narcissistic personality, but so-called “trait narcissism,” which is relatively common and can benefit people, is not the same as NPD, a disorder that affects as few as 1 percent of people. The real difficulty in diagnosing NPD is that few people who have it believe they have a problem and so tend to be unlikely to seek therapy.

What is the best therapy type for narcissistic personality disorder?

After determining if there are co-occurring conditions affecting a patient, such as anxiety or depression, and making sure those are being addressed, mental health professionals who treat NPD will rely on talk therapy approaches such as cognitive-behavioral therapy, dialectical behavior therapy, schema therapy, and gestalt therapy. The goal is the same: to help someone understand what drives their behavior and to learn new ways to relate to others.

Why is NPD so hard to treat?

Narcissistic personality disorder is very difficult for a therapist to treat because people with the disorder are highly reluctant to seek treatment and very likely to quit before it ends. Talk therapy often involves challenging patients, and people with NPD by their nature resist being challenged. As NPD makes them arrogant and condescending, they may not trust a therapist’s training or suggestions. But fundamentally, beneath the confident, swaggering surface, people with NPD may feel highly insecure and may push back against being guided to access their shame or vulnerability.