Narcissism is probably the most ill-represented of the large psychological characteristics you hear so much about nowadays. So correlated with manipulativeness, low empathy, and grandiose self-importance, not surprisingly, narcissism is so frequently held in the public imagination to be an untreatable personality disorder. But is narcissism really untreatable, or are we propagating a label that is frustrating recovery and improvement?
Here, we will explore the nature of narcissism, what the literature has to say about treatment, the challenges involved, and whether or not significant change is even possible. If you’ve ever asked yourself, “Is narcissism treatable?” then this in-depth examination is for you.
What is Narcissism?
Before we deal with the issue of treatability, we must define narcissism appropriately. The term “narcissism” is used in colloquial usage to describe a self-centered or arrogant individual. But in clinical psychology, narcissism is a continuum, spanning the range from the healthily self-assured to the narcissistic personality disorder (NPD).
Clinical Narcissism
Narcissistic Personality Disorder, as defined in DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), is a pervasive pattern of grandiosity, excessive need for admiration, and absence of empathy that originates in early adulthood and is exhibited in various situations.
Common symptoms are:
- A sense of entitlement.
- Exploitative relationships.
- Preoccupation with fantasies of being successful, powerful, or beautiful.
- Inability to accept blame or criticism.
- Begrudging other individuals or supposing that other individuals begrudge them.
The Origin of Narcissism: Nature or Nurture
Among the strong claims of the psychologists is whether narcissism is inherited or environmental. Most of them agree that it is a combination of both.
Abuse, abandonment, or excessive praise that lacks punishment could give rise to narcissistic tendencies.
Others cite attachment problems, in that the young person fails to form a cohesive sense of self and compensates for this through grandiosity.
Others highlight temperamental vulnerabilities—biological tendencies toward sensitivity or difficulties in emotional control.
Understanding the etiology of narcissism is necessary, though, since that will determine if the tendencies are even possible to unlearn or change—and that brings us right back to the problem of treatment.
Can Narcissism Be Treated? The Short Answer
Yes—but with grave difficulties.
Notwithstanding the common misconception, narcissism is not necessarily untreatable. But, successful treatment thereof hinges, inter alia, on the following factors:
- The degree of narcissism;
- The individual’s desire to modify;
- The presence of co-occurring conditions, such as depression or substance abuse;
- The skills of the therapist and the mode of therapy used.
Why Narcissism is Thought to Be Untreatable
The misconception that narcissistic personality disorder is untreatable comes from several places:
1. Lack of Insight
Narcissists are not very self-aware. They might see themselves as being wrongly victimized or they are superior to everyone, so they are going to have difficulty hearing feedback or accepting blame.
2. Fear of Vulnerability
Therapy demands vulnerability, and that is what narcissists most fear. Emotional disclosure tests their inner defenses, commonly erected for the sake of the fragile self-image.
3. Manipulative Tendencies
Others employ therapy in an attempt to control others or to rationalize their actions. This perpetuates the attitude that “it won’t work” for them.
4. Personal Negative Experiences
Narcissistic abuse victims commonly bring reports of unsuccessful intervention, adding fuel to the sense of hopelessness surrounding transformation.
How Narcissism Is Treated
1. Psychotherapy (Talk Therapy)
The most effective treatment for narcissism—particularly NPD—is long-term psychotherapy. Methods may involve:
- Cognitive Behavioral Therapy (CBT): Help narcissists recognize distorted cognitions and challenge grandiose assumptions.
- Schema Therapy: Aims to address primary childhood maladaptive beliefs and develop improved adaptation coping strategies.
- Transference-Focused Psychotherapy: Useful for patients with personality disorders, the method explores emotional reactions within the client-therapist relationship.
- Dialectical Behavior Therapy (DBT): While more commonly used in borderline personality disorder, DBT also allows narcissists to handle extremes of emotion and relational difficulties.
2. Group Therapy
Group settings are also effective in reflecting back narcissistic traits back to the client so that they become conscious of how others see them. While effective only with those open to change, the group setting is not for every individual.
3. Medication
Narcissism does not have a special medication, but antidepressants, mood stabilizers, or an anti-anxiety medication may be prescribed when there are co-occurring conditions.
Can Narcissists Actually Change?
Here’s the fine print answer: some are capable, others aren’t. Changing relies heavily on the individual’s:
- Level of motivation;
- Capacity for self-reflection;
- Support system;
- Duration of treatment.
Studies have also suggested that those with narcissistic tendencies (as differentiated from pure NPD) have the chances of improving themselves in the long run. They might be able to become more empathetic, improve their relations, and regulate their emotions better through proper interventions.
However, people with extreme NPD and minimal awareness of the problem are far less likely to recover—especially if they’re in therapy simply to please a lover or court.
The Importance of Treatment with Compassion
Ironically, shaming narcissists in the hopes of fixing them does not work. Recovery comes in helping them build a stronger, more unified self—one that need not encompass grandiosity or manipulation of others.
Effective therapists in working with narcissistic patients are able to strike a balance in empathy and responsibility, slowly assisting them in confronting their actions while establishing their potential for change.
Is It Worth Trying?
If you’re working with a narcissist—a parent, spouse, or coworker, say—a part of you may ask if it’s even worth trying to get them to see a pro.
The following should be remembered:
Mild to moderate narcissism is treatable, in part, if the person is suffering in some manner (e.g., depressed or losing relationships). Willingly availing themselves of therapy, narcissists are more likely to succeed.
Although the article is regarding whether or not narcissism is treatable, we do also need to discuss the aftereffects of narcissistic abuse. Victims will commonly have PTSD, anxiety, low self-esteem, and continued problems trusting others. If you’ve been narcissistically abused, you’re not responsible for the recovery of your abuser. It’s okay for you to leave them even if they start treatment. Recovery of narcissism is not overnight, and you are more important than their potential.
Conclusion: Ending the Stigma
Is narcissistic personality disorder treatable? Yes. But not always, and not necessarily. The narcissistic inclinations are tempered, even reframed—when the person is receptive to self-exploration, receptive to input, and engaged in the intense emotional processing required. But expecting instantaneous change or remaining hopeful for someone in denial is likely to occasion more misery. Grasping the subtleties of narcissism, the symptoms, and when to engage—or extricate—one’s self can empower clinicians and those being influenced to make informed, compassionate choices.
