How is narcissistic personality disorder treated?

Narcissistic personality disorder (NPD) is a condition that causes many symptoms, including emotion dysregulation, grandiosity, and a lack of empathy. NPD can cause impairments in daily functioning and can contribute to significant difficulties within interpersonal relationships. Narcissistic personality disorder is typically treated with therapy, which may involve various approaches.

Which types of therapy are used to treat narcissistic personality disorder?

There is limited research into the treatment of narcissistic personality disorder (NPD). Currently, the most widely researched personality disorder is borderline personality disorder (BPD) ^[1].

BPD and NPD are listed in the DSM-5 ^[2] within Cluster B, along with antisocial and histrionic personality disorders. Cluster B personality disorders share symptoms such as emotion dysregulation, difficulties with interpersonal relationships, and a distorted self-image. It is common to have traits of several personality disorders as well as comorbid conditions such as depression or anxiety ^[3][4].

Recent research is developing a better understanding of how to treat the various types of personality disorders, including NPD. Many studies suggest that treatments for BPD may also be effective for NPD or may help to inform therapeutic approaches for this condition ^[3][5][6].

The effectiveness of different types of therapy may vary from person to person, depending on their symptoms and past experiences. For example, research suggests that there are two types of NPD: vulnerable NPD and grandiose NPD. Research suggests these two types present with varying symptoms and may have different underlying causes, thus requiring different treatment approaches ^[1][3].

Due to the nature of NPD, therapists may find it challenging to treat individuals with the condition, so developing trusting therapeutic relationships is paramount ^[1][7].

Commonly used types of therapy to treat NPD include:

Psychodynamic therapy

Personality disorders are often formed in response to childhood experiences or trauma. As such, psychodynamic therapy can be a valuable approach to treating NPD, helping the individual to examine and validate these experiences.

By focusing on past experiences, psychodynamic therapy can explore how the individual’s past has influenced their current thoughts and behaviors. This can increase self-awareness and help the individual to recognize and change harmful patterns of behavior ^[8][9].

Transference-focused psychotherapy

Transference-focused therapy (TFP) is a type of psychodynamic therapy that also uses childhood or past experiences to inform current treatment. It has been shown to be effective at treating BPD and can be adapted to treat NPD ^[5].

With TFP, the therapist encourages the individual to express emotions relating to their view of self and others within therapy. The therapist can then explore these dynamics and their underlying causes to help the individual recognize how they influence their current thought and behavior patterns. Thus, they can begin to alter these patterns and reduce the impact of harmful beliefs ^[3][5].

Schema-focused therapy

Schema-focused therapy is based on the idea that individuals, particularly those with a personality disorder, have developed maladaptive thoughts and behaviors through early experiences. These thought and behavior patterns are called schemas, which continue to develop and impact individuals throughout their lives.

Schema-focused therapy helps individuals identify their schemas, so they can examine and reflect on the experiences that led to their formation. The therapist will help to provide the individual with the skills to challenge and regulate the harmful impacts of these schemas ^[1][10].

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) has been found to be effective in treating several conditions, including borderline personality disorder. As such, it is believed that CBT can be an effective treatment for many individuals with NPD ^[4][11].

CBT can help individuals identify and challenge negative thoughts and beliefs while developing an understanding of how their emotions impact their behaviors. With CBT, individuals can learn how to manage their emotions and behaviors and develop positive coping skills ^[11].

Dialectical behavior therapy

Dialectical behavior therapy (DBT) is a type of CBT specifically developed for treating borderline personality disorder. Due to the similarities between BPD and NPD, it may be effective to use DBT to treat NPD ^[6][12].

DBT involves individual or group therapy to teach skills that help improve emotion regulation, distress tolerance, self-awareness and mindfulness, and interpersonal skills ^[6].

Mentalization-based therapy

Mentalization-based therapy (MBT) works by encouraging the individual to recognize and reflect on their thoughts. This helps them to identify patterns of negative thoughts and emotions, examining and challenging the validity of these beliefs ^[1][13].

Gestalt therapy

Gestalt therapy is an approach that is similar to mindfulness. It focuses on the individual’s current thoughts and feelings, helping them to become more aware of the present. It can help individuals with NPD develop a better understanding of their identity and how to express themselves ^[14].

This approach can allow the individual to recognize the difference between healthy forms of expression and their expressions of narcissistic traits, such as grandiosity and defensiveness ^[15].

Is medication used to treat narcissistic personality disorder?

Although there are no FDA-approved medications for NPD, doctors may prescribe a medication to help manage certain NPD symptoms or comorbid conditions ^[3].

For example, antidepressants might be prescribed to help manage co-occurring symptoms of depression and anxiety and can help to improve impulse and emotion dysregulation. Additionally, a doctor might prescribe an antipsychotic medication or mood stabilizer to help reduce symptoms of psychosis or manage symptoms such as impulsivity and emotion dysregulation ^[3][13].

Other ways to treat narcissistic personality disorder

It may be possible to improve the management of some NPD symptoms with the use of various self-care techniques, such as ^[7][16]:

• Setting goals: It can be helpful to set targets or goals to help motivate and encourage treatment adherence. Having a goal to work toward can remind you why you want to improve your mental health and provide a sense of achievement when reaching goals.
• Learning triggers: Some people find keeping a record or diary of their mood and behavior changes useful. It may be helpful to write down what happened when you experienced negative or harmful thoughts and feelings. This can help you recognize what leads to these emotions so you can avoid or manage these situations.
• Talking to others: Sharing your concerns or emotions with others can help you to manage emotional distress and receive support and advice.
• Looking after physical health: Taking care of your general well-being can help to improve mental health symptoms. This includes eating a healthy diet, having a sleep schedule, and exercising regularly.
• Utilizing mindfulness and relaxation exercises: Techniques such as breathing exercises, yoga, meditation, and relaxation activities can help to reduce feelings of stress, anxiety, and depression that may occur within NPD and can help you to feel more in control of your emotions.