NPD – prognosis not good

Patients with NPD are very resistive to treatment and commonly do not present for treatment unless they hit “rock bottom,” or are forced to accept treatment by a family member due to strained relations.

Similar to management of any personality disorder, treatment requires long-term therapy. The mainstay of treatment is psychotherapy; however, medications may be required to address any comorbid psychiatric conditions such as depression or anxiety. In-patient treatment may be required in cases of impending or threatened suicide.

Individual psychotherapy and cognitive behavioural therapy administered by an empathetic and patient psychologist allows the patient to identify unhelpful, negative behaviour patterns, mood and disruptive thoughts and replace them with positive ones.

It is important to educate patients with NPD about the signs and symptoms of the disorder and explain to them in a supportive way that their behaviour is a result of many different factors. Family and peer support, as difficult as they may be, is critical in keeping the patient compliant with following up with their psychotherapy appointments.

In the end, it is important to remember not to compete with a narcissist personality as they are usually driven by an unconscious sense of shame and inferiority. Also, resist attempts at stroking their ego as this can backfire in the long term.

Healthy boundary setting and learning not to expect any apologies are useful strategies that help to deal with a person having this disorder.

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