From the Research
Narcissistic personality disorder (NPD) is most effectively treated with clarification-oriented psychotherapy (COP), as evidenced by a 2022 study showing significant improvements in symptoms with medium to high effect sizes 1. NPD is characterized by a pattern of grandiosity, need for admiration, and lack of empathy, with key symptoms including:
- Inflated sense of self-importance
- Preoccupation with fantasies of unlimited success or power
- Belief in being "special" and only understood by high-status people
- Requiring excessive admiration
- Sense of entitlement
- Interpersonal exploitation
- Lack of empathy
- Envy of others or belief others envy them
- Arrogant behaviors or attitudes People with NPD often have difficulty handling criticism, maintain unstable relationships, react with rage when challenged, and hide feelings of insecurity behind a façade of confidence. The disorder stems from a combination of genetic factors, childhood experiences, and neurobiological factors affecting emotional regulation and empathy, as discussed in a 2021 study on the Alternative DSM-5 Model for Personality Disorders 2. NPD is diagnosed by mental health professionals through clinical interviews and psychological assessments, not self-diagnosis. While other forms of psychotherapy, such as psychodynamic therapy and cognitive-behavioral therapy, may also be effective, as shown in a 2003 meta-analysis 3 and a 2020 study on psychodynamic treatment principles 4, the most recent and highest quality evidence supports the use of COP. Key aspects of treatment include:
- Long-term psychotherapy
- Tailored approach to the individual patient's characteristics
- Emphasis on empathic validation and direct advice
- Addressing comorbidity with other personality disorders and traits
- Managing resistances and transference-countertransference developments.