Narcissistic Disorder Treatments

The Diagnostic and Statistical Manual of Mental Disorders Text Revision (DSM-IV-TR), the diagnostic handbook used by psychiatrists, psychologists and mental health workers describes narcissistic personality disorder (NPD) as a personality disorder. Individuals with NPD feel an overpowering need to create a self-image of perfection and invincibility. They attempt to project that impression to others and engage in behaviors that impair inter-personal relationships, job performance, financial security or physical health.

Diagnosis and Symptoms

• A diagnosis of NPD requires evidence of symptoms in at least five of the following areas:
  NPD patients may exaggerate achievements and skills, expecting to be recognized for abilities without having actually done anything to demonstrate such abilities.
  NPD patients may be obsessed with fantasies about being successful, powerful, brilliant, beautiful and adored.
  NPD patients may believe they are unique, special individuals that can't be understood by ordinary people. They may demand access to "important" people who are supposedly the only ones who can understand them.
  NPD patients may need people to admire and look up to them.
  NPD patients may believe they deserve special treatment and obedience to their demands from others.
  NPD patients may exploit others to accomplish their own purposes.
  NPD patients may lack empathy toward others and may not be able to recognize the needs of anyone other than themselves
  NPD patients may envy others and believe that others are envious of them.
  NPD patients may exhibit arrogant attitudes, behaviors and beliefs.
  Subtypes of NPD include needy, clinging or craving narcissists, paranoid narcissists, manipulative narcissists, and the so-called phallic narcissists who tend to be male, aggressive, athletic and exhibitionist.

Treatment

• The difficulty faced by individuals with narcissistic personality disorder stems from a massive lack of self confidence and self-esteem compensated for by creating an artificial sense of self-importance and distorted perception of reality. Successful treatment of this disorder is difficult and strategies require the willing engagement of the NPD patient. Therapists may actually use narcissistic traits to help accomplish this by nurturing the patients underlying weak self-esteem. A variety of interventions are necessary to accomplish this.

Medication

• No medications have been shown effective in treating NPD as of 2009. If the NPD patient is depressed as well, anti-depressant medications may actually reinforce the narcissistic behaviors.

Hospitalization-Short Term

• NPD patients are frequently hospitalized, especially those with severely impulsive or self-destructive behaviors or who do not have the ability to discern fantasy from reality. Short hospital stays are usually brief and treat just the symptoms that led to the hospitalization.

Hospitalization-Long Term

• Narcissistic personality disorder patients may enter long-term residential treatment if they are a danger to themselves or others, resist outpatient treatment and have chronic destructive behaviors and chaotic lives. A residential program offers intense individual and/or group psychotherapy, family work and a therapeutic environment that reinforces therapy goals, provides safety and support for the patients fragile ego. The ultimate goal of hospitalization is to help the patient resolve his conflicted internal world and help him create a more cohesive less vulnerable self-image and self-concept.

Psychotherapy

• NPD patient therapy ranges from psychoanalysis and Adlerian therapy to rational emotive, group and Gestalt therapies. Discouragingly poor results with NPD have led therapists to advocate setting smaller, more achievable goals for patients. NPD patients have difficulty forming personal bonds, criticize and devalue the therapist and downplay their own symptoms, which severely undermines the therapeutic process. Psychologists, psychiatrists, counselors and therapists disagree about symptomology and treatment so broadly that extensive studies remain to be done to identify what, if anything, works consistently and effectively in the treatment of NPD.