Narcissistic Personality Disorder Treatment

Narcissistic personality disorder treatment is very difficult. Even with therapy, the prognosis is negative. Read more about treatment for NPD.

Narcissistic personality disorder treatment presents a challenge to mental health professionals because many people with narcissistic personality disorder (NPD) don't believe they need treatment. Consequently, they typically only seek help after they've hit rock bottom. Treatment for narcissistic personality disorder often includes a combination of psychotherapy and medication. These approaches seek to help the individual learn to relate to others in a more compassionate way, but none of the treatment combinations stand out as particularly effective.

Narcissistic Personality Disorder Treatment

Narcissistic personality disorder treatment depends on the severity of functional impairment caused by the condition. Thus, severity levels for NPD are based on the impact narcissistic personality disorder symptoms have on the individual:

Mild impairment. Self-centered, ego-driven behavior causes occasional, minor problems, but, for the most part, the person functions well in everyday life.

Moderate impairment. Self-centered, ego-driven behavior causes an individual to miss excessive time at work or school and neglect household chores. The individual also exhibits considerable performance issues at work, school, or home and frequently avoids or alienates friends and family. Finally, the person poses a considerable risk to self or others (suicidal ideation, neglect of children, abusing children or committing crimes).

Severe impairment. Self-centered, ego-driven behavior causes a person to remain in bed or in total isolation all day as well as night, completely alienates friends and family, poses a severe risk to self or others (persistent suicidal, abusive, or criminal behavior; fails to maintain minimal personal hygiene).

People whose NPD results in severe impairment may require hospitalization. The in-patient setting allows treatment for narcissistic personality disorder to focus on the immediate crisis (i.e. suicidal behavior or complete lack of impulse control). Once alleviated, the patient can continue with therapy designed to address the underlying, long-term problems caused by NPD.

Those with moderate impairment usually do not require hospitalization before they begin long-term therapy for the disorder. People with only mild impairment are high-functioning and generally do not seek professional help; although, it could prove beneficial.

Narcissistic Personality Disorder Therapy

Narcissistic personality disorder therapy usually includes some type of psychotherapy, such as cognitive behavioral therapy (CBT), family therapy, or group therapy. Types of therapy include:

Cognitive-behavioral therapy (CBT) – With CBT, the therapist helps the client identify negative and distorted thoughts and replace them with positive ones based in reality. This vidual l frequently incorporates talk therapy to bring awareness to harmful inner dialogues and repeated maladaptive behaviors. Once identified, the therapist guides the client in replacing these with healthy ones.

Psychodynamic therapy – The psychodynamic therapy vidual l focuses on unconscious thinking processes that influence an individual's behavior. The goal is to enhance the client's self-awareness of these unconscious ideations and help him make the connection between these and distorted conscious thought processes and behaviors. When used in narcissistic personality disorder therapy sessions, the doctor guides the client in examining unresolved conflicts from involvement in past dysfunctional relationships, usually beginning with the individual's parents or another primary caregiver.

Family and other group therapy – both of these therapies involve encouraging a dialogue between the therapist, NPD patient, and other participants in hopes that this will serve to resolve past conflicts and further develop the client's level of self-awareness. Therapists usually do not include family or group therapy in the NPD treatment plan until the client has made some visible improvements.

Narcissistic Personality Disorder Medications

The FDA has not approved any specific narcissistic personality disorder medications. Consequently, doctors and therapists don't use medication as a treatment for narcissistic personality disorder directly. Instead, they prescribe medication to address any co-occurring mental disorders, such as depression or obsessive-compulsive disorder.

Some evidence suggests that using newer antidepressant medications like Prozac® and others can exacerbate NPD behaviors and agitate symptoms. Because of this risk, therapists typically prescribe MAO inhibitors or mood stabilizers, such as lithium, for depression. These drugs do not appear to cause any noticeable exacerbation of the NPD symptoms and behaviors.

Narcissistic Personality Disorder Prognosis

As with the other personality disorders, the narcissistic personality disorder prognosis depends on the severity of the condition and the client's level of commitment to treatment. For younger people with the disorder, the outlook is marginally hopeful. But for longstanding NPD, the outlook is negative.

article references

APA Reference
Gluck, S. (2021, December 17). Narcissistic Personality Disorder Treatment, HealthyPlace. Retrieved on 2024, July 20 from

Last Updated: January 28, 2022

Medically reviewed by Harry Croft, MD

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