Have you ever known someone who constantly talks about themselves, exaggerates their achievements, and has unreasonable expectations of praise and admiration? Chances are you may know someone with narcissistic personality disorder.

NPD is a mental health condition characterized by an inflated sense of self-importance, a lack of empathy for others, and a constant need for attention and praise.

If you recognize these traits in someone close to you, it can be frustrating and hurtful. But don’t worry, there are ways to handle the challenges of a relationship with a narcissist and support effective treatment.

Diagnostic Criteria for NPD according to DSM-5

To be diagnosed with NPD, you must meet at least five of the following criteria according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5):

1. An exaggerated sense of self-importance and entitlement. You believe you’re special and deserve special treatment, admiration, and favors from others.
2. Preoccupation with fantasies about success, power, or attractiveness. You dwell on dreams of achievement, success, or ideal love.
3. Believes he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people. You think very highly of yourself and look down on most others.
4. Requires excessive admiration. You need constant praise and admiration from those around you.
5. Has a sense of entitlement and unreasonable expectations of especially favorable treatment. You expect people to do what you want without consideration for their needs or feelings.
6. Is often envious of others or believes that others are envious of him or her. You feel jealous of other’s successes and believe they must be jealous of you.
7. Is often preoccupied with feelings of envy. You feel envious and bitter towards those who have what you want.
8. Shows arrogant, haughty behaviors or attitudes. You come across as conceited, boastful, and pretentious.

Core Symptoms of NPD: Grandiosity, Lack of Empathy, Admiration-Seeking Behavior and Self-Importance

If someone in your life exhibits an exaggerated sense of self-importance, requires constant admiration, and lacks empathy for others, they may have narcissistic personality disorder (NPD).

“Even though friends say they are interested in your life, they never really want to talk about you as much as you want them to.”
― Charise Mericle Harper

Core Symptoms of NPD:

Grandiosity. They believe they are special or unique and should only associate with high-status people or institutions. They often exaggerate their achievements and talents.

Admiration-seeking behavior. They have an excessive need for admiration and praise to support their overinflated ego. They may fish for compliments or brag frequently.

If someone close to you displays these tendencies regularly, especially in more than one context, they could be dealing with NPD. The good news is talk therapy, especially psychodynamic therapy, can be effective at managing symptoms and building self-awareness. 

With time and effort, living with or loving someone with NPD is possible. The first step is acknowledging the signs.

Exploitative Behavior in NPD Relationships

With NPD, relationships become one-sided. Your needs and feelings don’t matter to the narcissist. They see people as objects to exploit for their own gain.

You may feel used, manipulated, and taken advantage of to meet their constant need for admiration, praise, and ego stroking. They lack empathy, so your pain, hurt or distress means little to them. Their actions are always justified in their minds.

“Narcissistic personality disorder is named for Narcissus, from Greek mythology, who fell in love with his own reflection. Freud used the term to describe persons who were self-absorbed, and psychoanalysts have focused on the narcissist’s need to bolster his or her self-esteem through grandiose fantasy, exaggerated ambition, exhibitionism, and feelings of entitlement.”
― Donald W. Black

They may make empty promises to get what they want from you, then fail to follow through. Your time, money, skills, and talents are fair game to exploit. They believe they deserve special treatment and that normal rules of reciprocation don’t apply to them.

If you confront their selfish behavior, they will likely become angry and defensive, and blame you for their actions. They refuse to take responsibility for the damage they cause. The relationship revolves around them, leaving little room for your needs or desires.

Getting out of an exploitative relationship with someone who has NPD can be challenging, but ultimately freeing. Seeking counseling or joining a support group can help give you the strength and skills to establish boundaries, stop the manipulation, and move on to healthier relationships where you are appreciated and respected.

Covert vs. Overt Narcissism: Variations in NPD Presentation

Covert narcissists express their narcissism in more subtle, passive ways. Rather than aggressively seeking attention, covert narcissists feel entitled to privileges and praise but believe they shouldn’t have to work for them. They tend to be self-pitying, sensitive to perceived slights, and hold grudges.

Overt narcissists openly demand attention and admiration. They feel superior to others and believe they deserve special treatment. Overt narcissists tend to be arrogant, boastful, and domineering. They aren’t afraid to step on others to get what they want and feel little empathy for the people they hurt.

“Being a control freak is a weakness, not a strength. If you can’t allow others to shine, you’re exhibiting signs of narcissism and showing a lack of self-confidence. It is isolation through ego.”
― Stewart Stafford

While the expressions differ, covert and overt narcissism stem from the same underlying lack of empathy and an inflated sense of self-importance. 

The variations mainly come down to differences in temperament and life experiences that shape how narcissism manifests. Both types can be damaging in relationships, but covert narcissism may be harder to recognize at first.

Treatment needs to address the specific symptoms and behaviors of each individual. Recovering from NPD is a challenging, lifelong process, but with a commitment to change, both covert and overt narcissists can learn to build better connections.

The Role of Childhood Factors in NPD Development

Childhood experiences play a significant role in the development of NPD. As a child, someone with NPD likely dealt with neglect, lack of affection, or excessive pampering. They may have had parents who were self-absorbed, cruel, or highly critical.

These unstable or traumatic early experiences can damage a child’s self-esteem and sense of security. To cope, the child may develop an exaggerated sense of self-importance as a defense mechanism. They learn that the only person they can truly rely on is themselves.

As a result, people with NPD tend to be excessively preoccupied with themselves and lack empathy for others. They have an unrealistic sense of superiority and entitlement, and they expect constant admiration and praise. They believe they are special and unique, and they can only associate with other high-status people.

“In a narcissist’s world you are not their one and only. You are an extension of that person and last place in their mind, while they secure back up narcissistic supply.”
― Shannon L. Alder

Underneath this grandiose exterior, however, the person with NPD often feels insecure and inadequate. The over-the-top self-confidence is a façade to mask their inner vulnerability. Their self-worth depends entirely on the admiration of others, and they lack a stable sense of identity or self-acceptance.

This mix of grandiosity and fragility makes the person with NPD difficult to deal with. They demand excellence from those around them but struggle to acknowledge their own imperfections and vulnerabilities.

Providing treatment during childhood, such as psychotherapy, can help prevent the development of full-blown NPD. Treatment focuses on building self-esteem, learning empathy, and developing healthier relationships.

NPD and Comorbid Mental Health Conditions

NPD often co-occurs with other mental health conditions, such as:

• Depression and anxiety: Feeling inadequate or worthless and worrying excessively about perceived flaws are common in NPD. Treatment of comorbid depression and anxiety can help improve self-esteem and quality of life.
• Bipolar disorder: The dramatic, erratic mood swings of bipolar disorder may intensify narcissistic traits and behaviors. Stabilizing mood is critical before addressing NPD.
• Substance use disorders: Using drugs or alcohol to numb feelings of insecurity, enhance confidence, or escape emotional distress is frequent in NPD. Overcoming addiction is necessary to effectively treat the underlying personality disorder.
• Other personality disorders: NPD shares traits with histrionic, borderline, and antisocial personality disorders. A diagnosis of NPD does not rule out other personality disorders, and integrated treatment plans may be required to address this “personality disorder not otherwise specified”.

Getting the right diagnosis and tailored treatment plan is key. A combination of psychotherapy, medication, lifestyle changes, and learning coping strategies can help manage symptoms, improve relationships, and cultivate a healthier sense of self. 

“But both the narcissist and his partner do not really consider each other. Trapped in the moves of an all-consuming dance macabre, they follow the motions morbidly — semiconscious, desensitized, exhausted, and concerned only with survival.”
― Sam Vaknin

But accepting you need help and committing to the difficult process of change are the first steps towards overcoming NPD.

Impact of NPD on Interpersonal Relationships

NPD can have a devastating effect on relationships. When a narcissist enters into a relationship, they are really entering into a one-sided partnership where their needs come first. 

Their sense of entitlement and lack of empathy means they expect constant praise, admiration, and accommodation from their partner.

• They demand excessive admiration and praise from their partner to feed their ego and fragile self-esteem. Failure to provide this admiration may result in rage or withdrawal.
• They lack empathy and are unwilling to recognize their partner’s needs, wants, and feelings. Everything revolves around them and their desires.
• They frequently devalue, criticize, and undermine their partner to make themselves feel superior and in control. This emotional abuse slowly breaks down the partner’s self-esteem.
• They are prone to jealousy and believe that their partner should devote themselves fully to meeting the narcissist’s needs. Any perceived slight can provoke rage and paranoia.
• They frequently manipulate, exploit, and control their partner through threats, emotional outbursts, and violence. This coercive control is meant to force the partner into submission.
• Ultimately, relationships with narcissists end up hollow and unfulfilling. Their partners become depleted from the constant demands for affection and approval while receiving little empathy or support in return. The only way to escape this cycle is to leave the relationship.

Narcissistic Rage and Its Triggers

Narcissistic rage can be triggered in several ways. As someone with NPD, you may fly into a rage when:

• Your ego or self-image is threatened or criticized in any way. Any perceived insult, no matter how small, can set off an angry outburst.
• You feel rejected or abandoned. Fear of being alone or not getting enough attention from those around you may spur feelings of rage.
• You experience a loss of control or power. Not getting your way or having your needs met immediately can trigger a rage reaction.

The rage you experience is a defense mechanism to regain control and power. However, these angry outbursts usually only serve to damage relationships and cause hurt for both you and others. 

“For some, life may be a playground to undermine the brainwaves of others or simply a vainglorious game with an armory of theatrics, illustrating only bleak self-deception, haughty narcissism and dim deficiency in empathy. (“Another empty room”)”
― Erik Pevernagie

The rage may subside quickly, but the emotional aftermath can last much longer.

Some steps you can take to better manage narcissistic rage include:

• Recognize the underlying triggers that cause your angry reactions. Look for the root causes of feelings of vulnerability, lack of control, and ego threat.

• Develop empathy for how your rage affects others. Make an effort to understand the emotional impact on people around you.

• Find healthy outlets for your anger and frustration. Engage in regular exercise, art or music therapy, journaling, or talking to a therapist.

• Learn coping strategies to stay calm in triggering situations. Take a timeout to relax and reflect before reacting. Stay focused on the current issue, not past grievances.

• Make a sincere apology to anyone hurt by your rage. Rebuild trust and strengthen your relationships. Anger management is a lifelong process, but by gaining awareness and coping skills, you can better control narcissistic rage.

The Psychological Mechanisms Behind NPD

The underlying psychological mechanisms of NPD involve an unhealthy sense of self and impaired empathy. People with NPD have an exaggerated sense of self-importance. 

They believe they are special or unique and should only associate with high-status people or institutions.

They expect admiration and preferential treatment. This is due to an underlying fragile self-esteem and lack of a stable sense of identity or self.

Hypersensitivity to criticism

People with NPD are hypersensitive to criticism, perceived slights or insults. They have trouble handling anything they interpret as negative feedback. 

This hypersensitivity is due to an underlying lack of self-esteem and feelings of inadequacy. They lash out or become angry and argumentative in response to protect their inflated self-image.

Exploitation of others

Individuals with NPD lack empathy and a sense of reciprocity in relationships. They tend to exploit people and manipulate them to get their needs met. Once others are no longer useful, they are discarded. This pattern of behavior is due to selfishness, entitlement and viewing people as objects to serve their needs.

“Playing the victim role: Manipulator portrays him- or herself as a victim of circumstance or of someone else’s behavior in order to gain pity, sympathy or evoke compassion and thereby get something from another. Caring and conscientious people cannot stand to see anyone suffering and the manipulator often finds it easy to play on sympathy to get cooperation.”
― George K. Simon Jr.

The psychological drivers of narcissistic personality disorder create significant problems in relationships and daily functioning. Treatment aims to improve self-esteem, empathy, emotional regulation, and relational patterns.

Neurobiological Factors and Brain Imaging in NPD

Studies show there are neurological components involved with NPD. Brain scans of those with NPD often show differences in areas involved with:

• Self-reflection. Areas of the brain involved in self-reflection and self-awareness also appear to function differently. This could impact their ability to have insight into themselves, their own flaws and the impact of their behavior.
• Emotional regulation. There seem to be differences in the areas of the brain involved in controlling emotions and impulses. This may relate to difficulties managing anger, frustration and disappointment in a constructive way.
• Reward processing. Parts of the brain involved in feeling rewarded and reinforced tend to be highly active in those with NPD. This could perpetuate their constant need for admiration, status and special treatment.

While biology is not destiny, and environment also plays a role, these neurological differences likely interact with life experiences to shape the development of NPD. 

The more we understand the biological components, the better equipped we will be to develop targeted treatment options. 

Treatment may involve psychotherapy, medication, or a combination of approaches to help improve empathy, self-awareness, and emotional regulation in those living with NPD.

Cognitive-Behavioral Patterns in NPD Individuals

Cognitive-behavioral patterns are deeply ingrained in those with NPD. Their core beliefs and automatic thoughts revolve around their perceived superiority and entitlement.

Some common thought distortions include:

• Magnification: Exaggerating your own achievements and talents. Minimizing your flaws and mistakes.
• Need for admiration: Constantly seeking compliments and praise from those around you to boost your self-esteem.
• Perfectionism: Holding unrealistically high expectations for yourself and others that are nearly impossible to meet. This often leads to frustration, anxiety, and anger.
• Blaming others: Rarely taking responsibility for your actions and mistakes. It’s always someone else’s fault.

These harmful thought patterns are deeply ingrained from an early age but the good news is they can be challenged and restructured with effort and awareness. 

“Narcissists are consumed with maintaining a shallow false self to others. They’re emotionally crippled souls that are addicted to attention. Because of this they use a multitude of games, in order to receive adoration. Sadly, they are the most ungodly of God’s creations because they don’t show remorse for their actions, take steps to make amends or have empathy for others. They are morally bankrupt.”
― Shannon L. Alder

Cognitive-behavioral therapy, or CBT, is one of the most effective treatments for NPD. CBT helps identify unhealthy core beliefs and teaches new ways of thinking that are more balanced, rational and helpful.

Over time, these alternative perspectives can reshape old habits and help reduce narcissistic tendencies. It’s a difficult process, but for those willing to commit to change, CBT offers hope.

Effective Therapeutic Approaches for NPD

Psychodynamic Therapy

This approach focuses on identifying unconscious motivations and gaining insight into how past events influence current behaviors. 

The goal is to help the person develop empathy and adapt maladaptive behaviors. This is a long process that can take years, but for some, it leads to improved relationships and coping skills.

Cognitive-Behavioral Therapy (CBT)

CBT challenges negative and irrational thought patterns related to grandiosity and entitlement. It teaches social skills and strategies for coping with criticism or perceived slights. 

CBT may also incorporate role-playing to help the person learn empathy. While CBT alone may not drastically change a narcissist’s personality, it can be helpful for specific issues.

Medication

There are no medications specifically approved for NPD. However, medications may be used to treat co-occurring conditions like depression or anxiety. 

Antidepressants have had limited success in reducing narcissistic behaviors and may cause undesirable side effects. Medication should only be used under the guidance of a psychiatrist experienced with NPD and narcissistic behaviors.

“Stay away from lazy parasites, who perch on you just to satisfy their needs, they do not come to alleviate your burdens, hence, their mission is to distract, detract and extract, and make you live in abject poverty.”
― Michael Bassey Johnson

In the end, the most effective approach is often a combination of therapy and education. But the person must be willing to acknowledge their challenges and commit to the difficult process of change.

For narcissists, this first step is the hardest part. With insight, hard work, and the support of professionals and loved ones, improvement and healthier relationships are possible. But complete “cures” of NPD are rare. Ongoing effort and management of behaviors are typically needed to sustain progress.

Psychotherapy as a Primary Treatment for NPD

Psychotherapy, or talk therapy, is typically the primary treatment for narcissistic personality disorder. The goal of psychotherapy for NPD is to help the individual develop self-awareness and empathy towards others.

Therapy Options

There are several types of therapy that can be effective for NPD:

• Psychodynamic psychotherapy aims to uncover the underlying causes of narcissistic behaviors and help the person gain insight into how their early experiences influenced their self-image and relationships.
• Schema therapy combines CBT with psychodynamic psychotherapy. It helps identify and modify unhealthy life patterns and core beliefs that contribute to narcissistic traits. Schema therapy has shown promising results for long-term improvement of NPD.
• Group therapy allows individuals with NPD to interact with others in a therapeutic setting. This can help them practice empathy and social skills, gain feedback, and hold each other accountable. However, group therapy may be challenging for people high in narcissism and works best once some progress has been made in individual therapy.

The effectiveness of psychotherapy depends on the person’s level of insight and motivation to change. Multiple approaches are often integrated for the best outcome. 

While narcissistic traits may always remain to some degree, psychotherapy can help people with NPD lead happier, healthier, and more fulfilling lives.

Dialectical Behavior Therapy (DBT) for Emotion Regulation

DBT focuses on learning skills to help regulate emotions and reduce unhealthy behaviors. A key part of DBT for NPD is mindfulness — learning to be fully present and aware of your thoughts and feelings without judgment. This can help increase self-awareness and control impulses.

Some DBT skills for emotion regulation include:

• Mindfulness of current emotions. Take a pause and notice what you’re feeling right now. Name the emotions and accept them without criticism. This can help reduce rumination and reactivity.
• Opposite action. Do the opposite of what your emotional urge is telling you to do. If you feel angry and want to yell, take a few deep breaths and speak in a calm, gentle tone instead. This can help change the trajectory of your emotions.
• Problem-solving. Identify the problem, brainstorm solutions, evaluate the pros and cons, and pick one to try. Looking at the situation rationally can help shift your emotional state to a more balanced one. Start with small issues and build up to more complex ones.
• Self-soothing. Do something nice for yourself to relax and calm down, like taking a warm bath, listening to soothing music, journaling, or light exercise. Pick things you enjoy and find comforting. Self-soothing helps regulate emotions and avoid unhealthy impulses

DBT teaches that emotions are understandable and human. The goal is not to eliminate emotions but to build skills so you can experience them in a healthier way.

With regular practice of these skills, emotions become less overwhelming and easier to navigate. DBT can be very helpful for those with NPD to gain awareness and control over their emotions and behaviors.

Cognitive-Behavioral Therapy (CBT) for Challenging Core Beliefs

Cognitive-behavioral therapy (CBT) is one of the most effective treatments for narcissistic personality disorder. CBT helps you challenge the negative and unrealistic core beliefs that fuel your self-centered views and entitlement.

“The sadistic narcissist perceives himself as Godlike, ruthless and devoid of scruples, capricious and unfathomable, emotion-less and non-sexual, omniscient, omnipotent and omni-present, a plague, a devastation, an inescapable verdict.”
― Sam Vaknin

Through CBT, a therapist will help you examine your beliefs about yourself and how you interact with others. You’ll explore how these beliefs developed and how they negatively impact your relationships. Then, you’ll work to challenge those beliefs by looking at alternative ways of thinking that are more realistic and flexible.

Some common beliefs that are targeted in CBT for NPD include:

• I am superior to others.
• I deserve special treatment and admiration.
• If others don’t admire me, there is something wrong with them.
• My needs and desires should always come before others.

CBT uses techniques like cognitive restructuring, role-playing, and empathy training to help change these unhealthy beliefs and the behaviors they drive. Over time, you can adopt alternative beliefs that promote healthier relationships, such as:

• All people have equal worth and value.
• My needs and desires are no more important than others.
• Not everyone has to admire me for me to feel good about myself.
• Compromising and meeting others halfway will lead to better relationships.

Through consistent practice of CBT techniques with a skilled therapist, you can overcome narcissistic beliefs and build self-esteem independent of the admiration and praise of others. CBT gives you the power to transform your thought patterns and create fulfilling relationships.

Group Therapy for Developing Social Skills in NPD

Group therapy for NPD can be very beneficial for developing better social skills and learning how to build healthy relationships.

In a group setting, you’re able to observe how others interact and communicate in a supportive environment. You can learn new behaviors by modeling what others say and do. Group members and therapists provide feedback in real-time, helping you gain insight into how your words and actions affect others.

“I don’t care what you think unless it is about me.”
― Kurt Cobain

Over multiple sessions, you have the opportunity to apply new skills, get constructive criticism, and make corrections. You can start to form connections with other group members, building trust and supportive relationships — something that is challenging for those with NPD.

The group dynamic also helps reduce feelings of isolation. Hearing from others struggling with similar issues can help you feel less alone and normalize your condition. Group members can even become part of your support system.

Of course, group therapy isn’t for everyone. It requires a willingness to be open, vulnerable, and accept feedback. But with the right mindset and approach, group therapy can be one of the most effective treatments for learning empathy, improving relationships, and overcoming narcissistic tendencies. 

The benefits of connecting with others and seeing your impact on them in real-time can lead to meaningful changes in behavior and thinking over the long run.

Pharmacological Approaches for NPD Symptoms

When it comes to treating the symptoms of NPD, medications and therapy can be helpful. Several medications may help reduce certain symptoms, though there are currently no drugs approved specifically for NPD.

Antidepressants

Antidepressants, like selective serotonin reuptake inhibitors (SSRIs), may be used to treat symptoms of depression and anxiety that often accompany NPD. Common SSRIs prescribed include escitalopram (Lexapro), sertraline (Zoloft), and fluoxetine (Prozac). These medications work by adjusting serotonin levels in the brain to improve mood and reduce negative thoughts.

Anti-Psychotics

Low doses of antipsychotic medications, such as risperidone (Risperdal) or quetiapine (Seroquel), are sometimes used to help decrease anger, aggression, and irritability. They work by blocking the effects of dopamine in the brain.

Mood Stabilizers

Mood stabilizers, such as lithium, valproate (Depakote), or carbamazepine (Tegretol), are occasionally prescribed to help regulate mood swings and outbursts of anger common in people with NPD. They work by controlling fluctuations in brain chemicals that regulate mood and emotions.

Anxiolytics

Anti-anxiety medications, known as anxiolytics, may also be used to reduce anxiety, tension, and irritability. Common medications include buspirone (Buspar), clonazepam (Klonopin), and lorazepam (Ativan). They work by slowing activity in the brain to produce a calming effect.

While medications may provide some benefits in managing symptoms, psychotherapy, and counseling remain the primary treatments for NPD. 

Medications are often used to supplement therapy rather than as a sole treatment approach. Close monitoring is also needed to determine the most effective medications and dosages for each individual.

Help for Narcissistic Personality Disorder: Treatment Options and Coping Strategies

To help manage your narcissistic personality disorder symptoms and improve your relationships, several treatment options and coping strategies can be effective.

Therapy

Talk therapy, like psychodynamic psychotherapy, can help you gain insight into your condition. A therapist can help challenge unhealthy thoughts and behaviors, build self-esteem independent of others’ approval, and teach empathy. Cognitive behavioral therapy focuses on changing negative thought patterns and the behaviors that stem from them.

Set Boundaries

Establish clear boundaries to limit manipulation and unhealthy demands on your time. Learn to say “no” when you need to. Put some distance between yourself and people who drain you emotionally.

Challenge negative thoughts

Notice negative thoughts about yourself and others, and try to adopt a more balanced perspective. Ask yourself questions to challenge unfair assumptions and develop empathy. With practice, this can help reduce feelings of entitlement, lack of empathy and hypersensitivity to criticism.

Connect with others

Make an effort to connect with people in your life in a genuine way. Do small things to show you care, like sending a quick text to say hello or asking follow up questions. Appreciate the good in your relationships and express that appreciation. Building real intimacy and closeness can help address the root causes of narcissistic traits.

Treatment for NPD typically involves long-term effort and commitment. But by developing insight into your condition, strengthening your relationships, and making healthy lifestyle changes, you can learn to lead a happier, more fulfilling life.

Conclusion

So there you have it, the key signs and symptoms of NPD, and some treatment options to help manage it. The road to recovery is long, but with the right treatment plan and support system in place, progress is possible.

Remember that having some narcissistic traits doesn’t necessarily mean you have NPD. We all have moments of self-centeredness and lack of empathy. But if you see several of these symptoms in yourself or someone you know and they’re causing significant problems, it’s worth speaking to a mental health professional.

They can properly assess what’s going on and recommend next steps. The most important thing is not to go through this alone. Reach out for help right away. With work and commitment, you can build healthier relationships and a better-balanced sense of self. There is hope and healing ahead!