From the Research
Narcissistic Personality Disorder (NPD) is a complex mental health condition characterized by an inflated sense of self-importance, a deep need for excessive attention and admiration, troubled relationships, and a lack of empathy for others, as noted in a recent study 1. The scope of NPD is multifaceted, involving grandiosity, fantasies of unlimited power or importance, and the need for admiration or special treatment, as described in a study published in 2017 2. Some key features of NPD include:
- An inflated sense of self-importance
- A deep need for excessive attention and admiration
- Troubled relationships
- A lack of empathy for others
- Exploitative behavior towards others for personal gain
- Envy of others or a belief that others are envious of them
- Arrogant and haughty behavior
Individuals with NPD often have difficulty recognizing their problematic behaviors, which can lead to resistance to treatment, as noted in a study published in 2022 3. Treatment for NPD primarily involves psychotherapy, particularly cognitive-behavioral therapy, psychodynamic therapy, or schema therapy, as there are no specific medications approved for NPD itself, as discussed in a study published in 2011 4. However, medications may be prescribed to treat co-occurring conditions like depression or anxiety, including SSRIs, mood stabilizers, or anti-anxiety medications.
The development of NPD is believed to result from a combination of genetic predisposition and environmental factors, particularly childhood experiences involving either excessive adulation or criticism from caregivers, leading to maladaptive coping mechanisms, as noted in a study published in 2014 5. Recovery requires long-term commitment to therapy, as individuals with NPD often struggle with recognizing their problematic behaviors and may require a mentalizing approach to move from a "me-mode" to a "we-mode" in the therapeutic dyad, as described in a study published in 2022 3.
Key considerations for clinicians working with NPD patients include:
- Recognizing the challenges of treating NPD, including difficulty with engagement and power struggles
- Understanding the attachment functions, mentalizing imbalances, and problems of epistemic disregard among patients with NPD
- Taking a "not-knowing" stance with interest and curiosity in clarifying and expanding a shared awareness of the patient's emotional experiences
- Using a mentalizing approach to break through the self-centered "me-mode" of the therapeutic dyad and move towards a "we-mode" of interaction.