02 Aug Treatment Interventions for Narcissistic Personality Disorder: A Comprehensive Review
Narcissism is central to our self-esteem and emotions. Healthy narcissism is a balanced and functional expression of self-love and self-esteem considered normal and adaptive in everyday life. It involves having a positive and realistic self-image without crossing into the extremes of grandiosity and entitlement in pathological narcissism. This healthy narcissism supports our sense of self-worth, confidence, ability to set boundaries in relationships, and resilience in the face of challenges.
Pathological narcissism differs from normal, healthy narcissism foremost because of fluctuating or dysregulated self-esteem and emotions. This results in the individual attempting to protect a grandiose yet vulnerable sense of self and to avoid threats and inferiority caused by negative feelings and experiences. As outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Narcissistic Personality Disorder (NPD) is classified by symptoms of a pervasive pattern of grandiosity, need for admiration, and lack of empathy, often leading to difficulties in interpersonal relationships and other psychosocial impairments. These traits may result in difficulty in work and personal relationships, prompting individuals to seek treatment.
The treatment of NPD remains a challenging task, necessitating a multi-dimensional and tailored approach to address the complex nature of this disorder. Psychotherapeutic interventions are the first line of treatment for NPD. Treating NPD can be more challenging than other psychiatric conditions. An added layer of complexity in treating individuals with NPD involves how they link with a therapist. Most narcissists do not seek treatment independently due to the nature of the symptoms of this disorder. They externalize and blame others for their problems, lack insight into their behavior, and tend to feel justified in their behavior, resulting in resistance to examine their behavior. People with NPD are commonly confronted by others, such as family members or colleagues, to seek treatment. Researchers in a 2020 study in Behavioral Medicine identified dropout rates, poor treatment compliance, resistance, and defensiveness as the most common barriers to treatment for NPD.
Dialectical Behavior Therapy (DBT) has shown promise in addressing some aspects of NPD. Incorporating mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness to help individuals with NPD manage their intense emotions and improve interpersonal functioning. Research published in 2011 identified that incorporating DBT skills into traditional therapeutic approaches might be a promising avenue for treating NPD. Objective measures of symptom change in a case study reported clinically significant decreases in narcissism symptoms throughout treatment. There is, however, currently limited empirical research into the efficacy of DBT and NPD. Psychotherapeutic approaches similar to DBT, such as Cognitive-Behavioral Therapy (CBT), can be adapted to address NPD. Specifically, CBT can target coping strategies for dealing with criticism, failure, and the need for excessive admiration. Researchers, however, identify limited empirical evidence investigating CBT’s efficacy in treating NPD.
Integrative Approaches such as Schema Therapy also show promising results in treating NPD. Schema therapy identifies and modifies deep-seated core beliefs that underlie NPD traits. This integrative approach combines cognitive, behavioral, and experiential techniques to promote lasting change. Although empirical research on emerging treatments for NPD, such as Schema Therapy and Mindfulness-Based Interventions, is still developing, preliminary studies have shown promising results. A 2014 large-scale study reported in the American Journal of Psychiatry examined the efficacy of Schema Therapy compared to other clinical approaches in treating Personality Disorders, including NPD. The study concluded that Schema Therapy resulted in a higher rate of recovery, more significant declines in depression, and better general and social functioning improvement than other approaches.
Psychologists must take careful consideration in the treatment of individuals with NPD. The personality features are self-preserving in nature, and tearing down narcissistic defenses too quickly, without having developed other resources, may increase the patient’s risk. Symptoms of narcissistic collapse include depression, angry outbursts, anxiety, and even self-harm or suicide.
The treatment of NPD requires a multi-dimensional and individualized approach. Emerging trends in treatment emphasize the importance of empathy-building and mindfulness-based techniques. Continued research and clinical innovations are crucial for improving the effectiveness of interventions and enhancing the lives of individuals with NPD and those around them.