- Seattle Anxiety Specialists, PLLC does not currently provide treatment for Narcissistic Personality Disorder. (For treatment, please refer to this list of DBT providers.)
Narcissistic Personality Disorder
Overview
Narcissistic Personality Disorder (NPD) is a mental health personality disorder, characterized by a pervasive pattern of grandiosity. Those with NPD will regularly overemphasize their own abilities, accomplishments, and traits, and expect that others will do the same. They believe that they deserve admiration, special treatment, and success, and will often become irate when they are not awarded the attention and reverence they believe that they deserve.[1] Despite heightened arrogance, their self-esteem is incredibly fragile,[2] and as such, are especially sensitive to humiliation or criticism and may react with rage or contempt that is disproportionate.[3] People with NPD also tend to have a lack of empathy; they don’t fully recognize the the needs and feelings of others, and will dismiss or overlook them in favor of their own wants and emotions.[4]
At the present, there is no clear, simple answer as to the cause of Narcissistic Personality Disorder. Some psychologists believe that the answer lies in genetics or neurobiology, and that there may be inherited characteristics or hitches in the connection between the brain and behavior that make an individual more likely to develop this disorder.[5] Others believe that the cause lies in an individual’s environment, suggesting that parent-child relationships may be to blame; according to the Mayo Clinic, overly adoring, permissive parents as well as excessively critical parents may lead to the development of NPD.[6]
According to the DSM-5, the prevalence estimates for Narcissistic Personality Disorder fall between 0% and 6.2% of the population, 50%-75% of whom are male.[7]
Signs and Symptoms
In order to be diagnosed with Narcissistic Personality Disorder, an individual must have begun to consistently show at least five of the following symptoms by early adulthood:[8]
Possesses a grandiose sense of self-importance
Preoccupied with fantasies of extreme power, success, importance and beauty
Believes that they are “special” in a way that most others aren’t, and thus can only be understood by a select few that are of the same “high status”
Demands excessive admiration
Has an unreasonable sense of entitlement
Is exploitative in their relationships (i.e., takes advantage of others)
Lacks empathy
Is either envious of others, believes others are envious of them, or both
Displays arrogant behaviors and attitudes
Complications
The largest and most prominent complication that can arise from Narcissistic Personality Disorder is the effect that it can have on the individual’s ability to make and maintain relationships. Because those with NPD often have significantly lower senses of empathy, it can be very difficult for them to genuinely connect with other people, since they are less likely to truly grasp (or be able to provide support for) the other person’s emotional experiences. Those with this disorder also tend to expect, consciously or otherwise, the relationship to be unbalanced in their favor; they’ll demand their companion’s full time, attention, and dedication, but won’t offer the same in return.[9]
Those with NPD are likely to face a multitude of comorbid conditions. It’s not uncommon for those with Narcissistic Personality Disorder to develop eating disorders and drug dependency, often in a misguided attempt to achieve the extreme physical and mental standards that they set for themselves.[10] Their extreme standards may also lead to the development of comorbid depression and/or anxiety.[11]
Treatment and Therapeutic Options
Currently, the best way to treat Narcissistic Personality Disorder is through therapy provided by a licensed mental health professional specializing in this disorder. Several forms of therapy could be helpful for those with NPD, each offering their own benefits. While these types of therapy differ in their process, they all generally share relatively similar goals when it comes to working with a patient with NPD. Among these goals would be helping the patient examine traits and behaviors that negatively impact their life, examining the experiences that may have led to the development of narcissistic defenses and developing new coping mechanisms to replace them, developing interpersonal skills, and learning to consider the needs of others.[12]
Some of the types of therapy that one might consider for Narcissistic Personality Disorder include:
Gestalt Therapy
This form of therapy focuses mainly on present experiences. While events from earlier in life may be discussed or explored, it will be with the purpose of learning how they affect present life. This focus on current life and experiences is based on the belief that understanding the how and why of an individual’s actions can help increase their self-awareness, and thus make them more cognizant of why certain behaviors may be unhealthy or unconstructive.[13] In turn, this helps the individual take steps towards accepting their feelings, taking responsibility for their actions, and strengthening their sense of self.[14]
Often, therapists performing Gestalt Therapy will incorporate various techniques, many of which involve role playing.[15] One such method is the “hot seat” technique, a process in which the therapist guides the patient through re-experiencing challenging situations and openly addresses their emotions in regards to those situations.[16] Similarly, they might employ the “empty chair” technique, in which the patient is instructed to have a dialogue with an imagined partner, which can be an actual individual or something symbolic.[17]
Schema Therapy
Schema therapy is, in many ways, a melting pot of several other forms of therapy. It combines characteristics from emotion-focused therapy, cognitive behavioral therapy, psychoanalysis, psychodynamic therapy, and attachment theory.[18] The goal of Schema Therapy is to identify the patterns of behavior developed in childhood (i.e., schemas) that can persist into an individual’s adult life and lead to the development of unhealthy coping mechanisms.[19] Some psychologists believe that is precisely what the root of Narcissistic Personality Disorder is: an unhealthy coping mechanism that has grown to an incredible magnitude.
Through Schema Therapy, the individual will be guided on how to experience and express emotions in a healthy manner, examine how their current schemas affect their interpersonal relationships, reframe the thought patterns that distress them, and practice communication.[20]
Mentalization-Based Therapy (MBT)
MBT is a psychodynamic approach to therapy, focused on helping the individual develop the ability to “mentalize.” This refers to an individual’s ability to understand their emotional experiences, recognize the differences between their emotions and those of others, understand how their thoughts and feelings affect their behavior, and to regulate their behavior using their newly-honed emotional insight.[21] In doing so, the individual would also gain a better understanding of how others feel, and enable them to respond with greater empathy and thoughtfulness.[22]
Dialectical Behavior Therapy (DBT)
Initially conceived as a means of treating Borderline Personality Disorder, DBT can also be helpful when it comes to treating Narcissistic Personality Disorder. This form of therapy focuses on helping the individual recognize and regulate their emotions, have a higher tolerance for distressing experiences, better navigate their relationships, and increase their mindfulness in order to better manage unwanted emotions.[23]
Metacognitive Interpersonal Therapy
Metacognitive Interpersonal Therapy is split into two separate steps: stage setting and change promoting. Stage setting is focused largely on addressing what’s already there. During this stage, the patient will explore their memories and already established schemas, be taught to identify their emotions and their triggers, and recognize unhelpful relationship patterns. Then, they move onto change promoting, during which stage they are taught to be aware of the differences between reality and their self-concept, realize that people and situations are nuanced rather than than simply being black-and-white, and work on developing interpersonal skills, such as empathy.[24]
Medication
At this time, there is no medication that can be prescribed with the express intent of treating Narcissistic Personality Disorder.[25] However, medication can still be helpful when it comes to treating related symptoms, even if they aren’t a direct result of NPD
, and can help make those more likely to stay in therapy for the duration of their treatment.[26] For example, if the individual experiences depression or anxiety (perhaps even directly relating to their treatment), they may be prescribed the appropriate medications to help alleviate those symptoms.
If you suspect that you might have this disorder, reach out to a licensed mental health provider specializing in NPD.
Contributed by: Jordan Rich
Editor: Jennifer (Ghahari) Smith, Ph.D.
REFERENCES
1 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
2 Ibid.
3 Mayo Clinic. (2022). Narcissistic Personality Disorder: Symptoms and Causes.
https://www.mayoclinic.org/diseases-conditions/narcissistic-personality-disorder/sympto
4 American Psychiatric Association (2013)
5 Mayo Clinic (2022) [1]
6 Ibid.
7 American Psychiatric Association (2013)
8 Ibid.
9 Mayo Clinic (2022) [1]
10 Ibid.
11 Ibid.
12 Raypole, C. (2021). Can Narcissistic Personality Disorder Be Treated? Psych Central.
https://psychcentral.com/disorders/narcissistic-personality-disorder/treatment
13 Ibid.
14 Ibid.
15 Ibid.
16 American Psychological Association. (2023). Hot-seat Technique.
https://dictionary.apa.org/hot-seat-technique
17 Pugh, M. (2017). Pull up a chair. British Psychological Society.
https://www.bps.org.uk/psychologist/pull-chair
18 Raypole (2021)
19 Ibid.
20 Ibid.
21 Ibid.
22 Ibid.
23 Ibid.
24 Ibid.
25 Mayo Clinic. (2022). Narcissistic Personality Disorder: Diagnosis and Treatment.
https://www.mayoclinic.org/diseases-conditions/narcissistic-personality-disorder/diagnosi
26 Raypole (2021)