Narcissism and Narcissistic Abuse in Relationships (Part XIV)

Treatment

Narcissistic personality disorder is rarely the primary reason for which people seek mental health treatment. When people with NPD enter treatment (psychologic or psychiatric), they usually are prompted by difficulties in their lives, or are seeking relief from some other disorder of their mental health, such as a major depressive disorder, a substance use disorder (drug addiction), a bipolar disorder (manic depression), or an eating disorder (anorexia nervosa, rumination disorder, bulimia nervosa).  The reason for such an indirect path to psychotherapeutic treatment is partly because narcissists generally possess poor insight, and are unaware that their actions produced their mentally unhealthy circumstance, and so fail to recognize that their perceptions and behaviors are socially inappropriate and problematic, because of their very positive self-image (inflated self-concept).

In general, psychotherapy is the basis for treating narcissistic personality disorder.  In the 1960s, Heinz Kohut and Otto Kernberg challenged the conventional wisdom of the time with clinical strategies that applied psychoanalytic therapy to NPD clients, which, they claimed, effectively treated that personality disorder. Contemporary psychotherapy treatments include transference-focused therapy; metacognitive therapy; and schema therapy, to treat the client's particular subtype of NPD. Improvements to the mental health of patients with NPD are possible with psychopharmaceutical treatment of the symptoms of the comorbid disorders; despite such drug therapy, the psychologist Elsa Ronningstam said that "alliance-building and engaging the patient's sense of agency and reflective ability are essential for [achieving] change in pathological narcissism."  Psychiatric medications usually are not indicated for treating NPD, but can be used to treat the co-occurring symptoms of psychological depression, anxiety, and impulsiveness, when present in the NPD client.  In the field of relationship counseling mental health therapy is most beneficial when both partners participate in the treatments.

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 psychodynamic models 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

The lifetime rates of narcissistic personality disorder are estimated at 1% in the general population; and between 2% to 16% in the clinical population.  A 2010 review found rates of NPD of up to 6% in community samples, and that the yearly number of new cases of NPD in men is slightly greater than in women.  A 2015 review found that the rates of NPD have been relatively stable for men and women throughout the thirty-year period in which data were collected.

History

The historical use of the term narcissism, to describe a person's excessive vanity and self-centeredness, predates the modern medical classification of NPD (narcissistic personality disorder). The mental condition of narcissism is named after the Greek, mythological character Narcissus, a beautiful boy, born of a nymph, who became infatuated with his own reflection in a pool of water. At first, Narcissus did not understand that the image he saw in the pool of water was a reflection of him; when he did understand that fact, he pined for the unattainable image and died of grief, for having fallen in love with someone who did not exist outside of himself.

Further conceptual developments and refinements of the mental condition of Narcissism produced the term narcissistic personality structure, which was introduced by Otto Friedmann Kernberg, in 1967; and the term narcissistic personality disorder, which was proposed by Heinz Kohut, in 1968.