Psychiatry Fast Five Quiz: What Do You Know About Narcissistic Personality Disorder?

Stephen Soreff, MD


October 19, 2016

Over the long term, consistent outpatient care is the approach of choice in the treatment of NPD. This usually involves a combination of psychotherapy and medication management. The mainstay of treatment is individual psychotherapy—specifically, psychoanalytic psychotherapy. Psychotropic medications are not specifically used to treat NPD but are often used to treat concomitant anxiety, depression, impulsivity, or other mood disturbances or if the patient becomes significantly depressed, anxious, or suicidal during psychotherapy.

Besides individual psychoanalytic psychotherapy, group therapy and cognitive-behavioral therapy have also been used to treat NPD. Group therapy was initially thought to be unsuitable for patients with narcissism because clinicians assumed that these patients would be unable to handle the requisite give-and-take inherent in the group process. This initial assumption about the unsuitability of group therapy was reasonable, in that group processes usually require empathy, patience, and the ability to relate and connect to others—traits that are deficient in narcissistic individuals. Nevertheless, studies have suggested that long-term group therapy can benefit patients with narcissism by providing them with a safe haven in which they can explore boundaries, receive and accept feedback, develop trust, and increase self-awareness.

If the patient acutely decompensates or becomes a danger to self or others, inpatient treatment is warranted. As a rule, shorter hospital stays are best for patients with NPD; prolonged time in the hospital will do little to change the underlying severity of the illness. Hospitalization should only be used as a temporizing measure to allow stabilization of environmental stressors, adjustment of medication dosages, or both.

For more on the treatment of NPD, read here.

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