Fast Five Quiz: Narcissistic Personality Disorder

Stephen Soreff, MD


January 10, 2020

The mainstay of treatment is individual psychotherapy—specifically, psychoanalytic psychotherapy. Other therapeutic modalities used to treat the disorder include group, family, and couples therapy, as well as cognitive-behavioral therapy (CBT) and short-term objective-focused psychotherapy. Many individuals with narcissistic personality disorder do not enter therapy, believing that they know more than the healthcare provider.

The general preference is for a flexible and moderate approach that combines an empathic understanding of the patient's need for narcissistic defenses with a thorough exploration of those defenses. In line with such an approach, the therapist should recognize the self-preserving role that narcissism plays in the patient's daily life and should be cautious about tearing down narcissistic defenses too quickly. At the same time, the therapist should strive to help the patient gain a realistic understanding of his or her own behavioral deficiencies.

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 narcissistic personality disorder; prolonged time in the hospital typically does little to change the underlying severity of the illness. Hospitalization should only be used as a temporizing measure to allow stabilization.

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.

A specific form of CBT, known as schema-focused therapy, centers on repairing narcissistic schemas and the defective moods and coping styles associated with them. This highly active and work-intensive form of treatment encourages patients to confront narcissistic cognitive distortions (eg, black-and-white thinking and perfectionism).

Read more about the treatment of narcissistic personality disorder.


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