Top Treatments for Narcissistic Personality Disorder

Narcissistic personality disorder is a complex and challenging mental health condition characterized by an inflated sense of self-importance, a lack of empathy, and a pervasive pattern of grandiose behavior.

Individuals with narcissistic personality disorder often struggle with interpersonal relationships, emotional regulation, and distorted self-perceptions, leading to significant impairments in various aspects of their lives.

In the US, the general prevalence of narcissistic personality disorder is estimated at around 5%. Men are more frequently diagnosed with this condition, comprising approximately 75% of cases. Additionally, individuals with narcissistic personality disorder face a higher risk of suicide, highlighting the serious implications of the disorder.

Fortunately, there are several psychotherapeutic approaches available that have been developed and adapted to manage narcissistic personality disorder better. If you want to learn more about the different narcissistic personality disorder treatment options, continue reading below!

1. Psychotherapy

Source: Regis College

Psychotherapy is crucial for treating narcissistic personality disorder, given the disorder's complex challenges in psychological and physical healthcare settings. The traits of individuals with this disorder complicate the therapeutic process, making psychotherapy both difficult and essential for significant improvement.

Patients with narcissistic personality disorder often struggle to progress in therapy, frequently end treatment early, and typically have a poor therapeutic relationship. Their grandiosity and demand for admiration can hinder the typical therapeutic exchange, causing therapists sometimes to feel disengaged or critical.

Despite these difficulties, specific psychotherapeutic approaches have proven effective in managing narcissism. Here are some of the psychotherapy treatments for narcissism.

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) is recognized as an effective treatment for managing and treating various personality disorders, including narcissistic personality disorder. The core principle of CBT is to address maladaptive beliefs that individuals hold about themselves and others and the environmental factors that sustain problematic behaviors. This therapy enhances skills necessary for adaptive functioning, which are often deficient in individuals with personality disorders.

Tailoring CBT for Narcissistic Personality Disorder

In cases of narcissistic personality disorder, CBT is specifically adapted to modify distorted self-perceptions and unhealthy relational patterns typical of the disorder.

The treatment employs a combination of:

• Cognitive restructuring
• Behavior modification
• Exposure
• Psychoeducation
• Skills training

These techniques aim to alter the dysfunctional beliefs at the heart of narcissistic personality disorder and enhance the individual's social interaction skills, which are often fraught with conflicts and misunderstandings due to grandiose and entitlement-oriented thoughts.

Specialized CBT Model for Self-Esteem Issues in Narcissistic Personality Disorder

Further refining the use of CBT for personality disorders, recent research introduces a specific CBT model that addresses the self-esteem dysregulation commonly observed in narcissistic personality disorder. This model views symptoms of narcissistic personality disorder as a series of cognitive and behavioral patterns designed to manage emotional distress caused by maladaptive beliefs related to threats to self-esteem. A key component of this narcissistic personality disorder treatment model is cognitive restructuring, supported by behavioral experiments that encourage patients to confront feared situations, thereby learning healthier response mechanisms.

Research and Potential Applications

Preliminary findings from studies investigating this specialized CBT approach show promise in treating narcissistic personality disorder effectively. These results support the need for further research to confirm the effectiveness of CBT in this context and to explore its potential broader applications in psychopathology.

Specifically, research could focus on how this therapy can be used to manage self-esteem issues across various disorders, potentially offering a more widespread benefit in the treatment of psychopathological conditions.

Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT) stands out as a potentially effective treatment for narcissistic personality disorder, melding cognitive-behavioral strategies with acceptance-based techniques.

The core rationale for employing DBT in narcissistic personality disorder treatment centers on its structured approach to:

• Enhance emotional regulation
• Improve mindfulness
• Boost interpersonal effectiveness

These areas are typically challenging for individuals with narcissistic personality disorder, who may struggle with issues like grandiosity, entitlement, and fragile self-esteem that manifest in overt expressions of superiority.

Originally developed to address Borderline Personality Disorder, the framework of DBT has been adapted to meet the unique needs of those with narcissistic traits. This adaptation focuses on mitigating the specific manifestations of narcissism by enhancing emotional understanding and regulation, which are pivotal in reducing the problematic behaviors associated with narcissistic personality disorder.

A case study highlights DBT's potential in treating narcissistic personality disorder. This study reviews the key components of DBT, emphasizing the integration of cognitive-behavioral and acceptance-based skills tailored to address the complex dynamics of narcissism. The findings from this case study reveal clinically significant reductions in symptoms associated with narcissism over the course of treatment, suggesting DBT's effectiveness.

However, despite these encouraging results, the findings are considered preliminary. The case study underscores the necessity for further research to thoroughly assess the efficacy of DBT in treating narcissistic personality disorder. Future studies are needed to validate these preliminary outcomes and explore how DBT can be systematically applied to a broader spectrum of individuals with narcissistic personality disorder, potentially establishing it as a more definitive treatment option.

Schema-Focused Therapy

Schema-focused therapy (ST) emerged as an alternative treatment for narcissistic personality disorder, developed by Jeffrey Young. This therapeutic approach deviates from traditional cognitive therapies by integrating limited reparenting, prioritizing the patient's basic needs, and incorporating emotional activating techniques alongside cognitive and behavioral strategies.

Young's model of ST revolves around the concept of basic needs, early maladaptive schemas, and schema modes. It suggests that individuals with narcissistic personality disorder experience trauma related to attachment needs, leading to the development of maladaptive coping mechanisms and various schema modes. These modes, such as the Self-Aggrandizer mode and Detached Self-Soother mode, serve as self-regulatory functions, often manifesting in behaviors like superior self-presentation and addictive tendencies.

Despite the reluctance of individuals with narcissistic personality disorder to express vulnerable emotions directly, ST offers a promising approach to address the underlying issues driving narcissistic behaviors and coping mechanisms. The study illustrates how ST can be effectively applied in narcissistic personality disorder treatment, emphasizing its potential as a therapeutic intervention for facilitating meaningful change and addressing the core features of the disorder.

Transference-Focused Psychotherapy

Source: ACG

Transference-focused psychotherapy (TFP) has gained recognition as an empirically validated treatment primarily for borderline personality disorder (BPD), but its efficacy extends to individuals with narcissistic personality disorder as well. In adapting TFP for narcissistic personality disorder (TFP-N), specific modifications have been made to address the unique features of narcissistic pathology.

TFP-N retains essential treatment components, including a contracting phase and an interpretive process to identify and modify maladaptive mental representations of self and others. These representations are pivotal as they underlie affective and behavioral dysregulation in personality disorders like narcissistic personality disorder.

The primary objective of TFP-N is to target disturbed interpersonal patterns in the therapeutic interaction, focusing on here-and-now experiences to facilitate enduring changes in personality organization.

A case study showcases TFP as a viable treatment for narcissistic personality disorder, highlighting its adaptation from its evidence-based use in BPD. It emphasizes TFP's utilization of therapeutic strategies and techniques across modalities to effectively address pathological narcissism, despite the absence of a specific empirically validated treatment for narcissistic personality disorder.

The case study effectively demonstrates the patient's improvement by utilizing TFP interventions. These include:

• Establishing a therapeutic alliance
• Utilizing a treatment contract
• Addressing treatment-interfering behaviors
• Goal setting

Notably, the patient exhibited progress in self-reflection, formation of a healthier self and other perceptions, increased self-agency, tolerance of normative disillusionments, and enhanced empathy. This underscores the clinical utility of TFP in treating narcissistic personality disorder by targeting the core features of the disorder and fostering meaningful therapeutic change.

Metacognitive Interpersonal Therapy (MIT)

Addressing narcissistic personality disorder requires a strategic and structured approach that blends clinical insight with effective interventions. Metacognitive Interpersonal Therapy (MIT) emerges as a promising method for narcissistic personality disorder treatment, offering structured steps to unravel narcissistic tendencies systematically.

MIT begins by encouraging individuals with narcissistic personality disorder to reflect on their life stories, gradually guiding them toward understanding their inner thoughts and unhelpful patterns. Through this methodical process, MIT aims to cultivate healthier ways of thinking, feeling, and behaving while reducing the grip of perfectionism.

However, working with individuals diagnosed with narcissistic personality disorder poses significant challenges, including defining meaningful therapy goals and fostering active participation in the process. Narcissistic personality disorder patients often prioritize status pursuits, making it challenging to identify deeper goals. Moreover, bringing about change means tackling tough emotions like shame and guilt, which narcissistic personality disorder patients typically avoid.

In the case study of a patient in his thirties diagnosed with narcissistic personality disorder, struggling with depression, guilt, and envy, the therapist grapples with issues in the therapeutic relationship. Ultimately, the therapist forges a collaborative path through a structured narcissistic personality disorder supportive therapy plan, ensuring the patient understands and agrees with the outlined steps.

The case study underscores the importance of the therapy plan in navigating narcissistic personality disorder treatment, offering insights into fostering meaningful therapeutic engagement and progress. By addressing challenges in the therapeutic relationship and implementing a structured approach, MIT showcases its potential as a treatment option for narcissistic personality disorder.

2. Medication

There are no medications approved by the FDA for the direct treatment of Narcissistic Personality Disorder. However, medications may be prescribed to alleviate symptoms associated with related conditions such as anxiety or depression. Some medications that may help alleviate symptoms associated with Narcissistic Personality Disorder-related conditions include:

• Antidepressants
• Antianxiety medications (anxiolytics)
• Antipsychotic medications
• Anticonvulsant medications (primarily used to treat seizures, but some, such as lamotrigine, may assist in stabilizing mood)

Final Words

Narcissistic personality disorder treatment poses unique challenges due to the disorder's characteristics. Effective interventions include cognitive behavioral therapy, dialectical behavior therapy, schema-focused therapy, transference-focused psychotherapy, and metacognitive interpersonal therapy. Although no single therapy has proven conclusively superior, these approaches collectively provide promising options for addressing core issues such as distorted self-perceptions, emotional dysregulation, and interpersonal difficulties.

Individuals with this disorder are encouraged to seek early and committed engagement in these evidence-based treatments to achieve significant improvements in emotional regulation and interpersonal relationships.

For mental health professionals, it is imperative to stay informed about the latest developments in narcissistic personality disorder treatment and to tailor interventions to the unique needs of each individual. Continued research and clinical collaboration are vital to refine and validate these therapeutic approaches, ultimately improving the quality of care for those grappling with this complex disorder.

FAQs on Narcissistic Personality Disorder

How is narcissistic personality disorder treated in teens?

Treatments for teens often involve a combination of family therapy, a targeted parenting approach, and therapy to manage symptoms and improve social and emotional skills.​

What are the symptoms of narcissistic personality disorder?

Common symptoms include grandiosity, seeking constant attention and admiration, exaggerated achievements, and often a profound difficulty in understanding and relating to others' feelings.

What causes narcissistic personality disorder?

Narcissistic personality disorder is believed to result from a combination of genetic factors and environmental influences. This includes the genetic traits inherited from parents and the effects of one's upbringing, particularly how one was treated by parents during childhood.