Treatment strategies for narcissistic personality disorder
Narcissistic Personality Disorder (NPD) is a complex condition characterized by a long pattern of grandiose self-importance, an elevated need for admiration, lack of empathy, fantasies of unlimited power, and either cool indifference or feelings of humiliation or rage in response to defeat, criticism, or indifference.
While there are no specific medications approved by the Food and Drug Administration (FDA) for the treatment of NPD, doctors may use medications to treat co-occurring mood conditions such as anxiety or depression. Antidepressants such as selective serotonin reuptake inhibitors, antipsychotics such as Risperidone, and anxiety medications may be used in such cases.
The main intervention for NPD is psychotherapy. This involves working with a therapist to learn to take responsibility for actions, build healthier relationships, and develop emotional intelligence. Common types of psychotherapy used to treat NPD include Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), Psychodynamic Therapy, Schema-Focused Therapy, Metacognitive Interpersonal Therapy (MIT), and Family Therapy.
CBT focuses on identifying and restructuring distorted thought patterns fueling narcissistic behaviors, fostering empathy, and developing adaptive coping strategies. It challenges rigid beliefs such as entitlement or grandiosity. DBT, a form of CBT incorporating mindfulness, helps patients regulate intense emotions, reduce impulsivity, and increase awareness of how their actions affect others. It promotes distress tolerance and interpersonal effectiveness.
Psychodynamic Therapy explores unconscious motivations and unresolved childhood conflicts contributing to narcissistic traits, aiming for deep emotional insight and lasting personal growth through understanding these formative experiences. Schema-Focused Therapy targets ingrained cognitive schemas—such as “I must always be admired” or “I can’t show weakness”—with the goal of replacing them with balanced, compassionate self-concepts and improved relational patterns.
Metacognitive Interpersonal Therapy (MIT) enhances the patient’s capacity to reflect on their own and others’ thoughts and feelings, improving emotional insight and reducing interpersonal conflicts. Family Therapy supports both the individual with NPD and their loved ones in navigating relational challenges together, fostering healthier communication and boundary-setting.
Most support groups for NPD focus on the family members and loved ones of those with the condition rather than the people themselves. Some options include the Narcissistic Peer Support Group, Out of the Fog, and Stop Walking on Eggshells.
If a person or a family member recognizes the symptoms and believes they may have NPD, they should make an appointment with a doctor, especially if they have ongoing symptoms of a co-occurring mental health condition like depression. Treatment for NPD is generally long-term and multifaceted, emphasizing personal growth rather than simply symptom reduction.
[1] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. [2] American Psychological Association. (2017). What Is Narcissistic Personality Disorder? Retrieved from https://www.apa.org/topics/narcissism [3] International Society for the Study of Trauma and Dissociation. (2017). Schema Therapy. Retrieved from https://isst-d.org/treatment/schema-therapy/ [4] Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press. [5] Yeomans, F., & Kroenke, K. (2012). Narcissistic personality disorder: An overview. Dialogues in Clinical Neuroscience, 14(3), 281–290. doi: 10.31887/DCNS.2012.14.3/fyeomans
- Cognitive Behavioral Therapy (CBT), a common therapy for NPD, focuses on identifying and restructuring distorted thought patterns to foster empathy and develop adaptive coping strategies.
- Science-backed medical-conditions treatments often involve using psychotherapies and therapies-and-treatments like Psychodynamic Therapy, Schema-Focused Therapy, and Metacognitive Interpersonal Therapy (MIT) for managing complex conditions such as Narcissistic Personality Disorder (NPD).
- Nutrition and health-and-wellness strategies may not directly address NPD, but maintaining overall well-being can support mental health and could potentially be beneficial as a part of a comprehensive treatment plan.
- Alternatively, neurological disorders might share some common underlying causes or manifest similar symptoms with NPD, making it essential to consider a thorough medical evaluation when diagnosing NPD, especially when associated mental health conditions are present.
- Although there are no FDA-approved medications for NPD, people with NPD may be diagnosed with co-occurring medical-conditions like anxiety, depression, or other mental health issues that might require pharmacological treatments.
