Friday, August 03, 2018

Narcissistic Personality Disorder

Narcissistic personality disorder (NPD) is a personality disorder with a long-term pattern of abnormal behavior characterized by exaggerated feelings of self-importance, an excessive need for admiration, and a lack of empathy. Those affected often spend a lot of time thinking about achieving power or success, or on their appearance. They often take advantage of the people around them.The behavior typically begins by early adulthood, and occurs across a variety of social situations.

This article is about the psychiatric condition. For information about the trait, see Narcissism.

"Megalomania" redirects here. For other uses, see Megalomania (disambiguation).

Quick facts: Synonyms, Specialty …

The cause of narcissistic personality disorder is unknown. It is a personality disorder classified within cluster B by the Diagnostic and Statistical Manual of Mental Disorders.Diagnosis is made by a healthcare professional interviewing the person in question. The condition needs to be differentiated from mania and substance use disorder.

Treatments have not been well studied.Therapy is often difficult as people with the disorder frequently do not consider themselves to have a problem. About one percent of people are believed to be affected at some point in their life. It appears to occur more often in males than females and affects young people more than older people. The personality was first described in 1925 by Robert Waelder, and the term NPD came into use in 1968.

Signs and symptoms

People with narcissistic personality disorder (NPD) are characterized by their persistent grandiosity, excessive need for admiration, and a personal disdain and lack of empathyfor other people. As such, the person with NPD usually displays arrogance and a distorted sense of superiority, and they seek to establish abusive power and control over others. Self-confidence (a strong sense of self) is different from narcissistic personality disorder; people with NPD typically value themselves over others to the extent that they openly disregard the feelings and wishes of others, and expect to be treated as superior, regardless of their actual status or achievements. Moreover, the person with narcissistic personality disorder usually exhibits a fragile ego (self-concept), intolerance of criticism, and a tendency to belittle others in order to validate their own superiority.

The DSM-5 indicates that persons with NPD usually display some or all of the following symptoms, typically without the commensurate qualities or accomplishments:

Grandiosity with expectations of superior treatment from other peopleFixated on fantasies of power, success, intelligence, attractiveness, etc.Self-perception of being unique, superior, and associated with high-status people and institutionsNeeding continual admiration from othersSense of entitlement to special treatment and to obedience from othersExploitative of others to achieve personal gainUnwilling to empathize with the feelings, wishes, and needs of other peopleIntensely envious of others, and the belief that others are equally envious of themPompous and arrogant demeanor

Narcissistic personality disorder usually develops in adolescence or during early adulthood. It is not uncommon for children and adolescents to display some traits similar to those of NPD, but such occurrences usually are transient, and do not meet the criteria for a diagnosis of NPD. True symptoms of NPD are pervasive, apparent in varied situations, and rigid, remaining consistent over time. The NPD symptoms must be sufficiently severe to the degree that significantly impairs the person's capabilities to develop meaningful human relationships. Generally, the symptoms of NPD also impair the person's psychological abilities to function, either at work, or school, or important social settings. The DSM-5 indicates that the traits manifested by the person must substantially differ from cultural norms, in order to qualify as symptoms of NPD.

Associated features

People with NPD tend to exaggerate their skills and accomplishments as well as their level of intimacy with people they consider to be high-status. Their sense of superiority may cause them to monopolize conversationsand to become impatient or disdainful when others talk about themselves. In the course of a conversation, they may purposefully or unknowingly disparage or devalue the other person by overemphasizing their own success. When they are aware that their statements have hurt someone else, they tend to react with contempt and to view it as a sign of weakness. When their own ego is wounded by a real or perceived criticism, their anger can be disproportionate to the situation, but typically, their actions and responses are deliberate and calculated. Despite occasional flare-ups of insecurity, their self-image is primarily stable (i.e., overinflated).

To the extent that people are pathologically narcissistic, they can be controlling, blaming, self-absorbed, intolerant of others' views, unaware of others' needs and the effects of their behavior on others, and insist that others see them as they wish to be seen.Narcissistic individuals use various strategies to protect the self at the expense of others. They tend to devalue, derogate, insult and blame others, and they often respond to threatening feedback with anger and hostility. Since the fragile ego of individuals with NPD is hypersensitive to perceived criticism or defeat, they are prone to feelings of shame, humiliation and worthlessness over minor or even imagined incidents. They usually mask these feelings from others with feigned humility or by isolating themselves socially, or they may react with outbursts of rage, defiance, or by seeking revenge. The merging of the "inflated self-concept" and the "actual self" is seen in the inherent grandiosity of narcissistic personality disorder. Also inherent in this process are the defense mechanisms of denial, idealization and devaluation.

According to the DSM-5, "Many highly successful individuals display personality traits that might be considered narcissistic. Only when these traits are inflexible, maladaptive, and persisting and cause significant functional impairment or subjective distress do they constitute narcissistic personality disorder." Due to the high-functionality associated with narcissism, some people may not view it as an impairment in their lives. Although overconfidence tends to make individuals with NPD ambitious, it does not necessarily lead to success and high achievement professionally. These individuals may be unwilling to compete or may refuse to take any risks in order to avoid appearing like a failure. In addition, their inability to tolerate setbacks, disagreements or criticism, along with lack of empathy, make it difficult for such individuals to work cooperatively with others or to maintain long-term professional relationships with superiors and colleagues.

Causes

The causes of narcissistic personality disorder are unknown. Experts tend to apply a biopsychosocial model of causation, meaning that a combination of environmental, social, genetic and neurobiological factors are likely to play a role in formulating a narcissistic personality.

Genetic

There is evidence that narcissistic personality disorder is heritable, and individuals are much more likely to develop NPD if they have a family history of the disorder. Studies on the occurrence of personality disorders in twins determined that there is a moderate to high heritability for narcissistic personality disorder.

However the specific genes and gene interactions that contribute to its cause, and how they may influence the developmental and physiological processes underlying this condition, have yet to be determined.

Environment

Environmental and social factors are also thought to have a significant influence on the onset of NPD. In some people, pathological narcissism may develop from an impaired attachment to their primary caregivers, usually their parents. This can result in the child's perception of himself/herself as unimportant and unconnected to others. The child typically comes to believe they have some personality defect that makes them unvalued and unwanted. Overindulgent, permissive parenting as well as insensitive, over-controlling parenting, are believed to be contributing factors.

According to Leonard Groopman and Arnold Cooper, the following have been identified by various researchers as possible factors that promote the development of NPD:

An oversensitive temperament (personality traits) at birth.Excessive admiration that is never balanced with realistic feedback.Excessive praise for good behaviors or excessive criticism for bad behaviors in childhood.Overindulgence and overvaluation by parents, other family members, or peers.Being praised for perceived exceptional looks or abilities by adults.Severe emotional abuse in childhood.Unpredictable or unreliable caregiving from parents.Learning manipulative behaviors from parents or peers.Valued by parents as a means to regulate their own self-esteem.

Cultural elements are believed to influence the prevalence of NPD as well since NPD traits have been found to be more common in modern societies than in traditional ones.

Pathophysiology

There is little research into the neurological underpinnings of narcissistic personality disorder. However, recent research has identified a structural abnormality in the brains of those with narcissistic personality disorder, specifically noting less volume of gray matter in the left anterior insula.Another study has associated the condition with reduced gray matter in the prefrontal cortex.

The brain regions identified in the above studies are associated with empathy, compassion, emotional regulation, and cognitive functioning. These findings suggest that narcissistic personality disorder is related to a compromised capacity for emotional empathy and emotional regulation.

Diagnosis

DSM-5

The formulation of narcissistic personality disorder in the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) was criticised for failing to describe the range and complexity of the disorder. Critics said it focuses overly on "the narcissistic individual's external, symptomatic, or social interpersonal patterns—at the expense of ... internal complexity and individual suffering," which they argued reduced its clinical utility.

The Personality and Personality Disorders Work Group originally proposed the elimination of NPD as a distinct disorder in DSM-5 as part of a major revamping of the diagnostic criteria for personality disorders, replacing a categorical with a dimensional approach based on the severity of dysfunctional personality trait domains. Some clinicians objected to this, characterizing the new diagnostic system as an "unwieldy conglomeration of disparate models that cannot happily coexist" and may have limited usefulness in clinical practice.The general move towards a dimensional (personality trait-based) view of the Personality Disorders has been maintained despite the reintroduction of NPD.

ICD-10

The World Health Organization's (WHO) International Statistical Classification of Diseases and Related Health Problems, 10th Edition (ICD-10) lists narcissistic personality disorder under Other specific personality disorders. It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

Subtypes

While the DSM-5 regards narcissistic personality disorder as a homogeneous syndrome, there is evidence for variations in its expression. In a 2015 paper, two major presentations of narcissism are typically suggested, an "overt" or "grandiose" subtype, characterized by grandiosity, arrogance, and boldness, and a "covert" or "vulnerable" subtype characterized by defensiveness and hypersensitivity. Those with "narcissistic grandiosity" express behavior "through interpersonally exploitative acts, lack of empathy, intense envy, aggression, and exhibitionism." Psychiatrist Glen Gabbarddescribed the subtype, which he referred to as the "oblivious" subtype as being grandiose, arrogant, and thick-skinned. The subtype of "narcissistic vulnerability" entails (on a conscious level) "helplessness, emptiness, low self-esteem, and shame, which can be expressed in the behavior as being socially avoidant in situations where their self-presentation is not possible so they withdraw, or the approval they need/expect is not being met." Gabbard described this subtype, which he referred to as the "hypervigilant" subtype as being easily hurt, oversensitive, and ashamed. In addition, a "high-functioning" presentation, where there is less impairment in the areas of life where those with a more severe expression of the disorder typically have difficulties in, is suggested.

Theodore Millon suggested five subtypes of narcissism. However, there are few pure variants of any subtype, and the subtypes are not recognized in the DSM or ICD.

More information: Subtype, Description …

Possible additional categories not cited by the current theory of Millon might include:

More information: Subtype, Description …

Will Titshaw also suggested three subtypes of narcissistic personality disorder which are not officially recognized in any editions of the DSM or the ICD.[citation needed]

More information: Subtype, Description …

Comorbidity

NPD has a high rate of comorbidity with other mental disorders. Individuals with NPD are prone to bouts of depression, often meeting criteria for co-occurring depressive disorders. In addition, NPD is associated with bipolar disorder, anorexia, and substance use disorders, especially cocaine. As far as other personality disorders, NPD may be associated with histrionic, borderline, antisocial, and paranoid personality disorders.

Treatment

Narcissistic personality disorder is rarely the primary reason for people seeking mental health treatment. When people with NPD enter treatment, it is typically prompted by life difficulties or to seek relief from another disorder, such as major depressive disorder, substance use disorders, bipolar disorder, or eating disorders, or at the insistence of relatives and friends.[citation needed] This is partly because individuals with NPD generally have poor insight and fail to recognize their perception and behavior as inappropriate and problematic due to their very positive self-image.

Treatment for NPD is centered around psychotherapy. In the 1960s, Heinz Kohutand Otto Kernberg challenged the conventional wisdom of the time by outlining clinical strategies for using psychoanalytic psychotherapy with clients with NPD that they claimed were effective in treating the disorder. Contemporary treatment modalities commonly involve transference-focused, metacognitive, and schema-focusedtherapies. Some improvement might be observed through the treatment of symptoms related to comorbid disorders with psychopharmaceuticals, but as of 2016, according to Elsa Ronningstam, psychologist at Harvard Medical School, "Alliance building and engaging the patient's sense of agency and reflective ability are essential for change in pathological narcissism."

Pattern change strategies performed over a long period of time are used to increase the ability of those with NPD to become more empathic in everyday relationships. To help modify their sense of entitlement and self-centeredness schema, the strategy is to help them identify how to utilize their unique talents and to help others for reasons other than their own personal gain. This is not so much to change their self-perception of their "entitlement" feeling but more to help them empathize with others. Another type of treatment would be temperament change.Psychoanalytic psychotherapy may be effective in treating NPD, but therapists must recognize the patient's traits and use caution in tearing down narcissistic defenses too quickly.[citation needed] Anger, rage, impulsivity, and impatience can be worked on with skill training. Therapy may not be effective because patients may receive feedback poorly and defensively. Anxiety disorders and somatoform dysfunctions are prevalent but the most common would be depression.[citation needed]

Group treatment has its benefits as the effectiveness of receiving peer feedback rather than the clinician's may be more accepted, but group therapy can also contradict itself as the patient may show "demandingness, egocentrism, social isolation and withdrawal, and socially deviant behavior". Researchers originally thought group therapy among patients with NPD would fail because it was believed that group therapy required empathy that NPD patients lack. However, studies show group therapy does hold value for patients with NPD because it lets them explore boundaries, develop trust, increase self-awareness, and accept feedback. Relationship therapy stresses the importance of learning and applying four basic interpersonal skills: "...effective expression, empathy, discussion and problem solving/conflict resolution".[citation needed] Marital/relationship therapy is most beneficial when both partners participate.

No medications are indicated for treating NPD, but may be used to treat co-occurring mental conditions or symptoms that may be associated with it such as depression, anxiety, and impulsiveness if present.

Prognosis

The effectiveness of psychotherapeutic and pharmacological interventions in the treatment of narcissistic personality disorder has yet to be systematically and empirically investigated. Clinical practice guidelines for the disorder have not yet been created, and current treatment recommendations are largely based on theoretical psychodynamicmodels of NPD and the experiences of clinicians with afflicted individuals in clinical settings.

The presence of NPD in patients undergoing psychotherapy for the treatment of other mental disorders is associated with slower treatment progress and higher dropout rates.

Epidemiology

Lifetime prevalence of NPD is estimated at 1% in the general population and 2% to 16% in clinical populations. A 2010 systematic review found the prevalence of NPD to be between 0% to 6% in community samples.There is a small gender difference, with men having a slightly higher incidence than in women.

According to a 2015 meta-analysis that looked at gender differences in NPD, there has recently been a debate about a perceived increase in the prevalence of NPD among younger generations and among women. However, the authors found that this was not reflected in the data and that the prevalence has remained relatively stable for both genders over the last 30 years (when data on the disorder were first collected).

History

The use of the term "narcissism" to describe excessive vanity and self-centeredness predates by many years the modern medical classification of narcissistic personality disorder. The condition was named after Narcissus, a mythological Greek youth who became infatuated with his own reflection in a lake. He did not realize at first that it was his own reflection, but when he did, he died out of grief for having fallen in love with someone that did not exist outside himself.

The term "narcissistic personality structure" was introduced by Kernberg in 1967 and "narcissistic personality disorder" first proposed by Heinz Kohut in 1968.

Early Freudianism

Sigmund Freud commented, regarding the adult neurotic's sense of omnipotence, that "this belief is a frank acknowledgement of a relic of the old megalomania of infancy".He similarly concluded that "we can detect an element of megalomania in most other forms of paranoic disorder. We are justified in assuming that this megalomania is essentially of an infantile nature and that, as development proceeds, it is sacrificed to social considerations".

Edmund Bergler also considered megalomania to be normal in the child, and for it to be reactivated in later life in gambling. Otto Fenichel states that, for those who react in later life to narcissistic hurt with denial, a similar regression to the megalomania of childhood is taking place.

Object relations

Whereas Freud saw megalomania as an obstacle to psychoanalysis, in the second half of the 20th century object relations theory, both in the United States and among British Kleinians, set about revaluing megalomania as a defence mechanism that offered potential access for therapy. Such an approach built on Heinz Kohut's view of narcissistic megalomania as an aspect of normal development, by contrast with Kernberg's consideration of such grandiosity as a pathological development distortion.

Society and culture

In popular culture, narcissistic personality disorder has been called megalomania.

Fiction

An article on the Victorian Web argues that Rosamond Vincy, in George Eliot's Middlemarch (1871–72), is a full-blown narcissist as defined by the DSM.

In the film To Die For, Nicole Kidman's character wants to appear on television at all costs, even if this involves murdering her husband. A psychiatric assessment of her character noted that she "was seen as a prototypical narcissistic person by the raters: on average, she satisfied 8 of 9 criteria for narcissistic personality disorder... had she been evaluated for personality disorders, she would receive a diagnosis of narcissistic personality disorder".

Other examples in popular fiction include television characters Adam Demamp(portrayed by Adam DeVine in Workaholics) and Dennis Reynolds (portrayed by Glenn Howerton in It's Always Sunny in Philadelphia).

Criticism

A Norwegian study concluded that narcissism should be conceived as personality dimensions pertinent to the whole range of PDs rather than as a distinct diagnostic category. Alarcón and Sarabia in examining past literature on the disorder concluded that narcissistic personality disorder "shows nosological inconsistency and that its consideration as a trait domain with needed further research would be strongly beneficial to the field"

Theodore Millon (August 18, 1928 – January 29, 2014) was an American psychologistknown for his work on personality disorders.

Biography

Millon was born in 1928, the only child of immigrant Jewish parents from Lithuania and Poland. His 19th-century ancestors came from the town of Valozhyn, then a part of the Russian Empire.:309 Receiving degrees from both American and European universities, he was a member of the board of trustees of Allentown State Hospital, a large Pennsylvaniapsychiatric hospital for 15 years. Shortly thereafter he became the founding editor of the Journal of Personality Disorders and the inaugural president of the International Society for the Study of Personality Disorders. He was Professor Emeritus at Harvard Medical School and the University of Miami.

In 2008, Millon was awarded the Gold Medal Award For Life Achievement in the Application of Psychology by the American Psychological Association.

The American Psychological Foundation presents an award named after Millon, known as the "Theodore Millon Award in Personality Psychology," to honor outstanding psychologists engaged in "advancing the science of personality psychology including the areas of personology, personality theory, personality disorders, and personality measurement."

Theoretical work

Millon has written numerous popular works on personality, developed diagnostic questionnaire tools such as the Millon Clinical Multiaxial Inventory, and contributed to the development of earlier versions of the Diagnostic and Statistical Manual of Mental Disorders.

Among other diagnoses, Millon advocated for an expanded version of passive aggressive personality disorder, which he termed 'negativistic' personality disorder and argued could be diagnosed by criteria such as "expresses envy and resentment toward those apparently more fortunate" and "claims to be luckless, ill-starred, and jinxed in life; personal content is more a matter of whining and grumbling than of feeling forlorn and despairing" (APA, 1991, R17). Passive-Aggressive Personality Disorder was expanded somewhat as an official diagnosis in the DSM-III-R but then relegated to the appendix of DSM-IV, tentatively renamed 'Passive-Aggressive (Negativistic) Personality Disorder'.

Millon's personality disorder subtypes

Millon devised a set of widely acknowledged subtypes for each of the DSM personality disorders:

Books

  • 1969: Modern Psychopathology: A Biosocial Approach to Maladaptive Learning and Functioning, Saunders
  • 1996: (with Roger D. Davis) Disorders of Personality: DSM IV and Beyond 2nd edition, John Wiley & Sons ISBN 0-471-01186-X
  • 2004: Personality Disorders in Modern Life, John Wiley and Sons. ISBN 0-471-23734-5
  • 2004: Masters of the Mind: exploring the story of mental illness. John Wiley & Sons. ISBN 9780471469858
  • 2007: (with Seth Grossman) Moderating Severe Personality Disorders: A Personalized Psychotherapy Approach, John Wiley & Sons.
  • 2007: (with Seth Grossman) Resolving Difficult Clinical Syndromes: A Personalized Psychotherapy Approach, John Wiley & Sons.
  • 2007: (with Seth Grossman) Overcoming Resistant Personality Disorders: A Personalized Psychotherapy Approach, John Wiley & Sons.
  • 2008: (editor with Paul H. Blaney) Oxford Textbook of Psychopathology, 2nd Ed., Oxford University Press.
  • 2008: (editor with Robert Krueger and Erik Simonsen) Contemporary Directions in Psychopathology: Toward the DSM-V and ICD-11, Guilford Press
  • 2008: The Millon inventories: a practitioner's guide to personalized clinical assessment, Guilford Press ISBN 978-1-59385-674-8
  • 2011: Disorders of Personality: Introducing a DSM/ICD Spectrum from Normal to Abnormal, 3rd edition John Wiley & Sons ISBN 0470040939

See also

References

More information: Tap to expand …

Sources

Brian Blackwell (case study)EgomaniaEgotismHubrisNarcissistic abuseNarcissistic leadershipNarcissistic parentNarcissistic Personality InventoryNarcissistic rage and narcissistic injuryNarcissistic supplySelfishnessSuperiority complexTrue self and false self

References

More information: Tap to expand …

Further reading

Masterson, James F (1 June 1981). The Narcissistic and Borderline Disorders: An Integrated Developmental Approach (First ed.). London: Routledge. ISBN 978-0876302927.Brown, Nina W (1 April 2008). Children of the Self-Absorbed (Second ed.). Oakland: New Harbinger Publications. ISBN 978-0743214285.Behary, Wendy (1 July 2013). Disarming the Narcissist (Second ed.). Oakland: New Harbinger Publications. ISBN 978-1608827602.Hotchkiss, Sandy (7 August 2003). Why Is It Always About You? (Reprint ed.). Florence: Free Press. ISBN 978-1572245617.Jean M. Twenge, Ph.D. and W. Keith Campbell, Ph.D., The Narcissism Epidemic, New York, Free Press 2009 ISBN 978-1-4165-7625-9

External links

Quick facts: Classification, External resources …

Narcissistic personality disorder PubMedNarcissistic personality disorder Mayo ClinicNarcissistic Personality DisorderCleveland ClinicNarcissistic personality disorder: research summarized PubMed


Symptoms

Signs and symptoms of narcissistic personality disorder and the severity of symptoms vary. People with the disorder can:

  • Have an exaggerated sense of self-importance
  • Have a sense of entitlement and require constant, excessive admiration
  • Expect to be recognized as superior even without achievements that warrant it
  • Exaggerate achievements and talents
  • Be preoccupied with fantasies about success, power, brilliance, beauty or the perfect mate
  • Believe they are superior and can only associate with equally special people
  • Monopolize conversations and belittle or look down on people they perceive as inferior
  • Expect special favors and unquestioning compliance with their expectations
  • Take advantage of others to get what they want
  • Have an inability or unwillingness to recognize the needs and feelings of others
  • Be envious of others and believe others envy them
  • Behave in an arrogant or haughty manner, coming across as conceited, boastful and pretentious
  • Insist on having the best of everything — for instance, the best car or office

At the same time, people with narcissistic personality disorder have trouble handling anything they perceive as criticism, and they can:

  • Become impatient or angry when they don't receive special treatment
  • Have significant interpersonal problems and easily feel slighted
  • React with rage or contempt and try to belittle the other person to make themselves appear superior
  • Have difficulty regulating emotions and behavior
  • Experience major problems dealing with stress and adapting to change
  • Feel depressed and moody because they fall short of perfection
  • Have secret feelings of insecurity, shame, vulnerability and humiliation

When to see a doctor

People with narcissistic personality disorder may not want to think that anything could be wrong, so they may be unlikely to seek treatment. If they do seek treatment, it's more likely to be for symptoms of depression, drug or alcohol use, or another mental health problem. But perceived insults to self-esteem may make it difficult to accept and follow through with treatment.

If you recognize aspects of your personality that are common to narcissistic personality disorder or you're feeling overwhelmed by sadness, consider reaching out to a trusted doctor or mental health provider. Getting the right treatment can help make your life more rewarding and enjoyable.

Causes

It's not known what causes narcissistic personality disorder. As with personality development and with other mental health disorders, the cause of narcissistic personality disorder is likely complex. Narcissistic personality disorder may be linked to:

  • Environment ― mismatches in parent-child relationships with either excessive adoration or excessive criticism that is poorly attuned to the child's experience
  • Genetics ― inherited characteristics
  • Neurobiology — the connection between the brain and behavior and thinking

Risk factors

Narcissistic personality disorder affects more males than females, and it often begins in the teens or early adulthood. Keep in mind that, although some children may show traits of narcissism, this may simply be typical of their age and doesn't mean they'll go on to develop narcissistic personality disorder.

Although the cause of narcissistic personality disorder isn't known, some researchers think that in biologically vulnerable children, parenting styles that are overprotective or neglectful may have an impact. Genetics and neurobiology also may play a role in development of narcissistic personality disorder.

Complications

Complications of narcissistic personality disorder, and other conditions that can occur along with it, can include:

  • Relationship difficulties
  • Problems at work or school
  • Depression and anxiety
  • Physical health problems
  • Drug or alcohol misuse
  • Suicidal thoughts or behavior

Prevention

Because the cause of narcissistic personality disorder is unknown, there's no known way to prevent the condition. However, it may help to:

  • Get treatment as soon as possible for childhood mental health problems
  • Participate in family therapy to learn healthy ways to communicate or to cope with conflicts or emotional distress
  • Attend parenting classes and seek guidance from therapists or social workers if needed

Lifestyle and home remedies

You may feel defensive about treatment or think it's unnecessary. The nature of narcissistic personality disorder can also leave you feeling that therapy is not worth your time and attention, and you may be tempted to quit. But it's important to:

  • Keep an open mind. Focus on the rewards of treatment.
  • Stick to your treatment plan. Attend scheduled therapy sessions and take any medications as directed. Remember, it can be hard work and you may have occasional setbacks.
  • Get treatment for alcohol or drug misuse or other mental health problems. Your addictions, depression, anxiety and stress can feed off each other, leading to a cycle of emotional pain and unhealthy behavior.
  • Stay focused on your goal. Stay motivated by keeping your goals in mind and reminding yourself that you can work to repair damaged relationships and become more content with your life.

Preparing for your appointment

You may start by seeing your doctor, or your doctor may refer you to a mental health provider, such as a psychiatrist or psychologist.

What you can do

Before your appointment, make a list of:

  • Any symptoms you're experiencing and for how long, to help determine what kinds of events are likely to make you feel angry or upset
  • Key personal information, including traumatic events in your past and any current major stressors
  • Your medical information, including other physical or mental health conditions with which you've been diagnosed
  • Any medications, vitamins, herbs or other supplements you're taking, and the dosages
  • Questions to ask your mental health provider so that you can make the most of your appointment

Take a trusted family member or friend along, if possible, to help remember the details. In addition, someone who has known you for a long time may be able to ask helpful questions or share important information.

Some basic questions to ask your mental health provider include:

  • What type of disorder do you think I have?
  • Could I have other mental health conditions?
  • What is the goal of treatment?
  • What treatments are most likely to be effective for me?
  • How much do you expect my quality of life may improve with treatment?
  • How often will I need therapy sessions, and for how long?
  • Would family or group therapy be helpful in my case?
  • Are there medications that can help my symptoms?
  • I have these other health conditions. How can I best manage them together?
  • Are there any brochures or other printed materials that I can have? What websites do you recommend?

Don't hesitate to ask any other questions during your appointment.

What to expect from your mental health provider

To better understand your symptoms and how they're affecting your life, your mental health provider may ask:

  • What are your symptoms?
  • When do these symptoms occur, and how long do they last?
  • How do your symptoms affect your life, including school, work and personal relationships?
  • How do you feel — and act — when others seem to criticize or reject you?
  • Do you have any close personal relationships? If not, why do you think that is?
  • What are your major accomplishments?
  • What are your major goals for the future?
  • How do you feel when someone needs your help?
  • How do you feel when someone expresses difficult feelings, such as fear or sadness, to you?
  • How would you describe your childhood, including your relationship with your parents?
  • Have any of your close relatives been diagnosed with a mental health disorder, such as a personality disorder?
  • Have you been treated for any other mental health problems? If yes, what treatments were most effective?
  • Do you use alcohol or street drugs? How often?
  • Are you currently being treated for any other medical conditions?.



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