Some features of narcissistic personality disorder are like those of other personality disorders. Also, it's possible to be diagnosed with more than one personality disorder at the same time. This can make diagnosis more challenging.
Diagnosis of narcissistic personality disorder usually is based on:
- Your symptoms and how they impact your life.
- A physical exam to make sure you don't have a physical problem causing your symptoms.
- A thorough psychological evaluation that may include filling out questionnaires.
- Guidelines in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.
Treatment for narcissistic personality disorder is talk therapy, also called psychotherapy. Medicines may be included in your treatment if you have other mental health conditions, such as depression.
Narcissistic personality disorder treatment is centered around psychotherapy. Psychotherapy can help you:
- Learn to relate better with others so your relationships are closer, more enjoyable and more rewarding.
- Understand the causes of your emotions and what drives you to compete, to distrust others, and to dislike others and possibly yourself.
The focus is to help you accept responsibility and learn to
- Accept and maintain real personal relationships and work together with co-workers.
- Recognize and accept your actual abilities, skills and potential so you can tolerate criticism or failures.
- Increase your ability to understand and manage your feelings.
- Understand and learn how to handle issues related to your self-esteem.
- Learn to set and accept goals that you can reach instead of wanting goals that are not realistic.
Therapy can be short term to help you manage during times of stress or crisis. Therapy also can be provided on an ongoing basis to help you achieve and maintain your goals. Often, including family members or others in therapy can be helpful.
There are no medicines specifically used to treat narcissistic personality disorder. But if you have symptoms of depression, anxiety or other conditions, medicines such as antidepressants or anti-anxiety medicines may be helpful.
Lifestyle and home remedies
You may feel defensive about treatment or think it's unnecessary. The nature of narcissistic personality disorder also can 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.
- Follow your treatment plan. Attend scheduled therapy sessions and take any medicines 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. Addiction, depression, anxiety and stress can lead to a cycle of emotional pain and unhealthy behavior.
- Stay focused on your goals. 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 health care provider, or you may be referred 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 have and how long you've had them, 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 you have.
- Any medicines, vitamins, herbs or other supplements you're taking, and the doses.
- Questions to ask your mental health provider so that you can make the most of your appointment.
Consider taking a trusted family member or friend along 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 do you think may be causing my symptoms?
- What are the goals of treatment?
- What treatments are most likely to be effective for me?
- In what ways do you think my quality of life could 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 medicines that can help my symptoms?
- I have 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?
- 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 recreational drugs? If so, what do you use and how often?
- Are you currently being treated for any other medical conditions?