Understanding Narcissistic Personality Disorder: Therapy and Challenges

The majority of mental health disorders are addressed with a mix of psychotherapy and pharmacotherapy. However, personality disorders, such as Narcissistic Personality Disorder (NPD), are unresponsive to pharmacological treatment. If medications are provided, they will be used to address the symptoms of any concurrent conditions that may exist. Individuals with narcissistic personality disorder may achieve optimal rehabilitation via a program that provides individual, group, and family treatment. Continuous and rigorous long-term treatment may assist individuals with Narcissistic Personality Disorder in understanding the detrimental effects of their illness on their lives and hindering their potential, while the contributions of peers and loved ones can provide context, depth, and reinforcement to these insights. Narcissism serves as a fundamental organizing component of personality for individuals with Narcissistic Personality Disorder (NPD); hence, mental health professionals will not confront the disease overtly or forcefully. The therapeutic procedure should be undertaken with intentionality and prudence to prevent the patient from becoming overwhelmed prematurely. Therapists and narcissistic patients will collaboratively identify the attitudes and behaviors that generate stress, conflict, and unhappiness in the patient’s life. During rehabilitation, therapists will motivate individuals with NPD to engage in constructive behaviors to mitigate the adverse effects of their narcissistic traits, offering practical guidance and training to facilitate this process. Therapists treating narcissistic individuals must endeavor to establish an environment devoid of judgmental attitudes, concentrating only on solutions. A positive therapeutic approach is crucial, as it fosters trust and enhances the efficacy of communication between physician and patient. Therapeutic approaches based on empirical evidence for individuals diagnosed with narcissistic personality disorder often encompass:

Cognitive Behavioral Therapy. Through several sessions of cognitive behavioral therapy, individuals with narcissistic personality disorder may learn to substitute grandiose and erroneous thinking with more constructive and realistic beliefs and self-evaluations.

Psychodynamic psychotherapy. During psychodynamic treatment sessions, individuals with Narcissistic Personality Disorder will explore their prior experiences to assess the impact of dysfunctional relationships on their lives and to scrutinize unconscious beliefs about themselves and others that reinforce narcissistic behaviors.

Familial psychotherapy. Narcissistic conduct affects families as significantly as it affects people, and including loved ones in the healing and rehabilitation process might assist those with NPD in comprehending the genuine consequences of their self-centered actions. Given that individuals with narcissistic personality disorder often exhibit resistance to therapy, particularly in the first phases, mental health practitioners must exert considerable effort to ensure that NPD patients are completely engaged with all components of their treatment regimen. Narcissists do not inherently possess cooperative tendencies; nonetheless, it is a skill they must acquire to have any prospect of rehabilitation.

The DSM-5 defines dependent personality disorder (DPD) as characterized by a pervasive and excessive need for care, resulting in submissive and clingy behavior, along with fears of separation. Individuals with DPD struggle to make routine decisions without extensive advice and reassurance from others. Individuals must take responsibility for the majority of aspects of their life. Individuals with Dependent Personality Disorder may struggle to articulate dissenting views due to a fear of losing support or acceptance. They exhibit a deficiency in self-confidence on their judgment and capabilities, resulting in challenges when initiating initiatives or doing tasks independently. They exhibit hypersensitivity to criticism. They experience discomfort or helplessness in alone. Upon the conclusion of a close relationship, individuals promptly seek another connection to fulfill their need for care and support. DPD often coexists with depression and anxiety disorders, exhibiting some overlap with avoidant personality disorder. Despite being one of the most often diagnosed personality disorders and being in the DSM for over four decades, DPD has garnered little attention in the academic literature. Moreover, Division 12 of the American Psychological Association, which delineates therapies with robust or moderate empirical evidence, does not include a therapy for Dependent Personality Disorder (DPD). Psychotherapy is the primary treatment modality, enabling individuals with DPD to develop healthy connections with others and themselves. Research on psychotherapy for dependent personality disorder (DPD) is limited, with few contemporary data available. Previous research often amalgamated DPD with other Cluster C personality disorders, namely avoidant personality disorder and obsessive-compulsive personality disorder. A 2009 meta-analysis of the three cluster C personality disorders indicated that social skills training, cognitive behavioral therapy, and psychodynamic therapies were efficacious. Social skills training (SST) instructs people in interpreting verbal and nonverbal signs during encounters, engaging in discussion, and communicating assertively. It may include strategies such as modeling, role-playing, and soliciting feedback. SST is often included into several therapeutic modalities. Cognitive behavioral treatment (CBT) may assist patients with Dependent Personality Disorder (DPD) in altering their self-perception and capabilities, while also confronting and modifying detrimental, entrenched ideas. It may assist people in achieving more independence and enhancing their self-confidence. A 2013 review article indicated that Depersonalization Disorder (DPD) is frequently addressed through cognitive therapy, which prioritizes the modification of distorted and unproductive thoughts: “Cognitive Therapy (CT) may be particularly efficacious for DPD as it targets patients’ self-perceptions and their apprehension of judgment.” It aims to “restructure self-perceptions of weakness and ineffectiveness.” Nonetheless, the same article mentions that some experts argue for integrated approaches, suggesting they “may more effectively encapsulate the intricacies of DPD by conceptualizing the individual from diverse perspectives.” In 2014, a substantial multi-site randomized controlled trial investigated the efficacy of schema therapy (ST), clarification-oriented psychotherapy, and standard treatment for individuals with various personality disorders, including DPD. ST proved to be the most efficacious therapy, exhibiting the lowest attrition rate. ST amalgamates cognitive, behavioral, experiential, and interpersonal methodologies. It posits that people possess diverse schemas (fundamental themes or patterns recurring throughout their life) and coping mechanisms that may be either adaptive or maladaptive. ST seeks to rectify maladaptive schemas, diminish unhealthy coping mechanisms, and enhance adaptive coping strategies. ST emphasizes restricted re-parenting, whereby the therapist partially addresses the client’s unfulfilled childhood needs while adhering to good therapeutic limits. A therapist, for instance, delivers commendation, establishes a secure bond, and imposes boundaries. ST encompasses psychoeducation about fundamental requirements and both functional and dysfunctional behaviors. A mindfulness-based approach may serve as a potential remedy for DPD. A 2015 exploratory randomized controlled trial demonstrated that a five-session mindfulness-based treatment effectively addressed dysfunctional interpersonal dependence (MID). MID is a personality condition that significantly influences DPD and other illnesses, including depression, social anxiety, drug use, and borderline personality disorder. MID is defined by the tendency to depend on others for direction, assistance, and validation. Individuals see themselves as feeble and powerless, while viewing others as robust and authoritative. They anticipate adverse assessment and potential abandonment. They exhibit passivity and submissiveness. The mindfulness-based method included approaches that enabled dependent persons to recognize their self-worth and esteem their internal sensations. They specifically learnt to cultivate greater awareness of their thoughts, emotions, and social relationships. Mindfulness may assist people in recognizing that sentiments like “I’m helpless” or “I’m weak” are only perceptions and not definitive truths about their identity. A 2018 report from SANE Australia indicates that the objectives of psychotherapy for treating dependent personality disorder (DPD) may encompass enhancing self-expression, assertiveness, decision-making, and independence. Medications are generally not prescribed for DPD, and no medication has received approval from the U.S. for this condition. Food and Drug Administration. Pharmaceuticals are often recommended for concurrent diseases, including depression and anxiety disorders. Self-help strategies for the therapy of dependent personality disorder (DPD) represent the most effective treatment. The following recommendations may enhance treatment or provide assistance while awaiting a therapist, depending upon the disorder’s severity. Participate in solitary pursuits. Become used to appreciating your own company. Reflect on activities that you really appreciate and engage in them consistently. This might include activities such as participating in a restorative yoga session, meditating for ten minutes, or reading at a café during your lunch break. Cultivate your own hobbies. Contemplate the interests you want to engage in. What topics are you interested in exploring? What elicited joy for you throughout childhood? Which topics did you like in school? What seems intriguing? Commence fostering your autonomy. Consider little duties you can begin to assume. For instance, start a list of tasks you now neglect but are performed by others on your behalf. Subsequently, choose a little activity you can do. Regard this as a chance for personal development, education, skill enhancement, and confidence building. Foster a positive connection with oneself. Numerous methods exist for this, but you may start with little gestures, such as: offering oneself a praise (about any aspect); engaging in a self-compassion meditation; ensuring enough relaxation; obtaining sufficient sleep; and identifying one attribute you like about yourself. Here are 22 further recommendations. Explore other resources. It might assist in locating books and workbooks on managing excessive reliance. For instance, consider examining the book: Dependent Personality Disorder Cognitive Behavioral Therapy Self-Help Guide. Additionally, get advice from your therapist.

Individuals with narcissistic personality disorder (NPD) have an inflated self-image, demonstrate a deficiency in empathy, and want incessant adulation. They see themselves as exceptional or unique and have delusions of boundless power and achievement. They may embellish their achievements and abilities. They possess unrealistic expectations of others and often utter derogatory comments. However, they struggle to manage any kind of criticism and may respond with fury. An article in BJPsych Advances suggests the existence of two subtypes of Narcissistic Personality Disorder (NPD): grandiose (or overt) narcissism and vulnerable (or covert) narcissism. Individuals with the former subtype may exhibit traits such as arrogance, pretentiousness, dominance, self-assurance, exhibitionism, or aggression, while those with the latter may display excessive sensitivity, insecurity, defensiveness, and anxiety stemming from an underlying sense of shame and inadequacy. Regardless of their specific manifestations, both subtypes are characterized by a preoccupation with fulfilling their own needs, often at the expense of others. NPD frequently co-occurs with antisocial personality disorder, borderline personality disorder, substance use disorder, mood disorders, and anxiety disorders. Narcissistic Personality Disorder may be difficult to address, since persons with the condition often lack insight into their issues and often attribute blame to others. Nonetheless, therapy may be beneficial. The primary and most effective treatment for Narcissistic Personality Disorder (NPD) is psychotherapy. In extreme instances, pharmacotherapy may be used for NPD symptoms, but it is often utilized for concurrent disorders. Research on targeted psychotherapy therapies for narcissistic personality disorder (NPD) is limited. Certain interventions for Narcissistic Personality Disorder have been modified from those used for Borderline Personality Disorder and need therapists to possess specific training. Transference-focused psychotherapy (TFP) is a psychodynamic intervention that starts with a verbal treatment contract, describing the roles and obligations of both the client and the doctor. Individuals with Narcissistic Personality Disorder (NPD) delineate their objectives, which therapy targets. TFP underscores the significance of the client-clinician connection, since this is where the individual’s symptoms manifest and may be addressed. A chapter in Contemporary Psychodynamic Psychotherapy states, “The therapist meticulously observes the patient’s immediate experiences and behaviors during therapy sessions, particularly focusing on maladaptive interpersonal behaviors, both concerning the therapist and the patient’s existing relationships.” Schema-focused therapy (SFT) integrates psychodynamic psychotherapy with cognitive behavioral therapy, assisting individuals with Narcissistic Personality Disorder (NPD) in substituting detrimental schemas. These are widespread, enduring unfavorable judgments about oneself and others. In Narcissistic Personality Disorder (NPD), these schemas include defectiveness and entitlement. Mentalization-based therapy (MBT) is a psychodynamic intervention designed to assist persons with Narcissistic Personality Disorder (NPD) in appropriately self-reflecting and contemplating the thoughts and emotions of others, as well as recognizing the relationship between these mental states and action. Dialectical behavior therapy (DBT), a kind of cognitive behavioral therapy, emphasizes mindfulness, emotional control, distress tolerance, and interpersonal skills. One expert stated that DBT “aids the client in recognizing their own thought processes and acknowledging the necessity for heightened attention. However, it also enables the individual to understand that there are instances when the focus is not solely on them.” Metacognitive interpersonal therapy (MIT) was explicitly designed to address NPD. The process has two phases: stage setting and change facilitation. Stage setting involves acquiring a comprehensive knowledge of an individual’s interpersonal interactions via the examination of various events, memories, and recurring patterns. A 2012 article in the Journal of Clinical Psychology states, “They must recognize that expectations of hostility or obstruction from others are primarily schema-driven and utilize this understanding to develop strategies for modification.” Additionally, individuals with Narcissistic Personality Disorder (NPD) acquire the ability to identify their emotions and comprehend their underlying triggers. Change promotion involves demonstrating to individuals that their perceptions may not accurately reflect reality and that circumstances can be interpreted differently from alternative perspectives, while also fostering new and healthier cognitive, emotional, and behavioral patterns (as stated in the aforementioned article). Supportive psychotherapy is an additional strategy applicable to Narcissistic Personality Disorder (NPD). According to UpToDate.com, “In our clinical experience, a psychotherapeutic approach grounded in the objectives and techniques of supportive psychotherapy tailored to the needs of NPD patients may be most beneficial.” Supportive psychotherapy integrates psychodynamic and cognitive behavioral therapies, in conjunction with medication when deemed appropriate. The objectives encompass: ensuring the individual is stabilized; addressing concurrent conditions (e.g., depression); and assisting the individual in achieving the optimal level of functioning within the limitations of their personality pathology. Supportive psychotherapy frequently involves instructing on affect regulation and social skills, as well as managing destructive impulses and distorted cognitions. It often encompasses the individual’s family and/or partners. No drug has received approval from the U.S. Food and Drug Administration (FDA) for the treatment of narcissistic personality disorder (NPD). UpToDate.com indicates that medication may be used when persons with NPD exhibit significant symptoms that jeopardize their safety. This entails prescribing a mood stabilizer or antidepressant for pronounced affective instability; a mood stabilizer or antipsychotic for impulsive anger and aggression; or an antipsychotic for cognitive-perceptual disturbances (e.g., paranoid ideation, hallucinatory symptoms, depersonalization). Pharmaceuticals may be used to address concurrent ailments, including mood disorders and anxiety disorders. Individuals with Narcissistic Personality Disorder sometimes report heightened sensitivity to side effects, leading to discontinuation of their prescription. It is essential for patients with NPD to consult their physician and together choose the most effective strategies to mitigate or manage distressing symptoms. Self-Help Strategies for Narcissistic Personality Disorder Having a loved one with narcissistic personality disorder (NPD) may be exasperating, burdensome, and perplexing. The intensity of NPD symptoms differs across people. Certain people may exhibit entitlement and selfishness, while others may display outright abusiveness. Consequently, in many instances, establishing boundaries suffices, but in others, terminating the connection is imperative. Establish limits. It is essential to establish boundaries, advocate for oneself, and articulate what is permissible and impermissible. The essential principle is to articulate your limits with clarity, specificity, and assertiveness. This also entails establishing repercussions if the individual disregards your request or blatantly violates your boundary, and ensuring the enforcement of those repercussions. The individual with Narcissistic Personality Disorder is likely to attempt to violate your limits, particularly if this is your first effort in establishing them. They may attempt to induce feelings of guilt or manipulate the circumstances. Consequently, it is essential to exhibit confidence and assertiveness. Engage in self-care practices. Interacting with an individual with Narcissistic Personality Disorder may be very difficult and burdensome. Ensure you are practicing self-compassionate care. Ensure enough rest and sleep. Participate in pleasurable pursuits. Engage in meditation. Engage in physical movement. Surround yourself with those who cultivate supportive and healthy connections. Request assistance for your own well-being. Engaging with a therapist is another method of self-care. Engaging in this practice may facilitate the establishment and preservation of boundaries, as well as enhance your ability to manage stress efficiently. It might provide validation and reassurance that you are not alone. It may assist you in exiting the relationship, should you choose that it is necessary. Terminate the partnership. Although many relationships with narcissistic persons may be rescued and enhanced, others cannot, especially in cases of abuse. Be truthful with yourself and evaluate your emotional health. Departing may perhaps be the optimal decision for you. This essay and the Psych Central post provide thoughts on exiting a relationship with a narcissist.