From the Research
Narcissistic personality disorder (NPD) is a mental health condition that requires a comprehensive treatment approach, prioritizing psychotherapy, particularly cognitive-behavioral therapy or psychodynamic therapy, to improve morbidity, mortality, and quality of life outcomes. Treatment of NPD typically involves long-term therapy, often for several years, focusing on helping patients develop a more realistic self-image, improve interpersonal relationships, and increase empathy 1.
Key Considerations in Treatment
- Psychotherapy is the primary treatment modality, with cognitive-behavioral therapy and psychodynamic therapy being the most effective approaches 2, 3.
- Medications may be prescribed to treat co-occurring conditions like depression or anxiety, such as SSRIs (e.g., fluoxetine 20-80mg daily) or anti-anxiety medications (e.g., lorazepam 0.5-2mg as needed) 4.
- Family involvement in treatment can be beneficial, as the disorder significantly impacts relationships with loved ones 5.
- Recovery is possible but requires commitment to the therapeutic process and willingness to examine deep-seated patterns of thinking and behavior 1.
Principles of Effective Therapy
- Helping patients identify goals and direction of their therapies
- Promoting a sense of agency
- Promoting a shift of focus to sense of vulnerability
- Anticipating difficulty in developing and maintaining the treatment alliance 3
- Avoiding common mistakes, such as engaging in a power struggle with the patient, overindulging the grandiosity of the patient, directly challenging the grandiosity of the patient, and ignoring treatment-interfering behaviors 3
Diagnostic Considerations
- NPD presents specific diagnostic challenges, and its presentation may conceal significant narcissistic pathology 5.
- Internal emotional distress, interpersonal vulnerability, fear, pain, anxiety, a sense of inadequacy, and depressivity can co-occur with narcissistic personality functioning 5.
- It is essential to give attention to the two sides of character functioning, which include both self-serving and self-enhancing manifestations as well as hypersensitivity, fluctuations in self-esteem, and internal pain and fragility 5.