Diagnosis

Some features of narcissistic personality disorder are similar to 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 of narcissistic personality disorder more challenging.

Diagnosis of narcissistic personality disorder typically is based on:

  • Signs and symptoms
  • 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
  • Criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Treatment

Treatment for narcissistic personality disorder is talk therapy (psychotherapy). Medications may be included in your treatment if you have other mental health conditions.

Psychotherapy

Narcissistic personality disorder treatment is centered around talk therapy, also called psychotherapy. Psychotherapy can help you:

  • Learn to relate better with others so your relationships are more intimate, enjoyable and rewarding
  • Understand the causes of your emotions and what drives you to compete, to distrust others, and perhaps to despise yourself and others

Areas of change are directed at helping you accept responsibility and learning to:

  • Accept and maintain real personal relationships and collaboration with co-workers
  • Recognize and accept your actual competence and potential so you can tolerate criticisms or failures
  • Increase your ability to understand and regulate your feelings
  • Understand and tolerate the impact of issues related to your self-esteem
  • Release your desire for unattainable goals and ideal conditions and gain an acceptance of what's attainable and what you can accomplish

Therapy can be short term to help you manage during times of stress or crisis, or can be provided on an ongoing basis to help you achieve and maintain your goals. Often, including family members or significant others in therapy can be helpful.

Medications

There are no medications specifically used to treat narcissistic personality disorder. However, if you have symptoms of depression, anxiety or other conditions, medications such as antidepressants or anti-anxiety drugs may be helpful.

Lifestyle and home remedies

You may feel defensive about treatment or think it's unnecessary. The nature of narcissistic personality disorder can also 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.
  • Stick to your treatment plan. Attend scheduled therapy sessions and take any medications 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. Your addictions, depression, anxiety and stress can feed off each other, leading to a cycle of emotional pain and unhealthy behavior.
  • Stay focused on your goal. 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 doctor, or your doctor may refer 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're experiencing and for how long, 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 with which you've been diagnosed
  • Any medications, vitamins, herbs or other supplements you're taking, and the dosages
  • Questions to ask your mental health provider so that you can make the most of your appointment

Take a trusted family member or friend along, if possible, 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 type of disorder do you think I have?
  • Could I have other mental health conditions?
  • What is the goal of treatment?
  • What treatments are most likely to be effective for me?
  • How much do you expect my quality of life may 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 medications that can help my symptoms?
  • I have these 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?
  • When do these symptoms occur, and how long do they last?
  • 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 street drugs? How often?
  • Are you currently being treated for any other medical conditions?
Nov. 18, 2017
References
  1. Narcissistic personality disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://dsm.psychiatryonline.org. Accessed Sept. 25, 2017.
  2. Narcissistic personality disorder (NPD). Merck Manual Professional Version. http://www.merckmanuals.com/professional/psychiatric-disorders/personality-disorders/narcissistic-personality-disorder-npd. Accessed Sept. 25, 2017.
  3. Kacel EL, et al. Narcissistic personality disorder in clinical health psychology practice: Case studies of comorbid psychological distress and life-limiting illness. Behavioral Medicine. 2017;43:156.
  4. Caligor E, et al. Narcissistic personality disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis. https://www.uptodate.com/contents/search. Accessed Sept. 25, 2017.
  5. Caligor E, et al. Treatment of narcissistic personality disorder. https://www.uptodate.com/contents/search. Accessed Sept. 25, 2017.
  6. Hales RE, et al. Personality disorders. In: The American Psychiatric Publishing Textbook of Psychiatry. 6th ed. Washington, D.C.: American Psychiatric Publishing; 2014. http://psychiatryonline.org. Accessed Sept. 25, 2017.
  7. Caligor E, et al. Narcissistic personality disorder: Diagnostic and clinical challenges. American Journal of Psychiatry. 2015;172:415.
  8. Palmer BA (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 13, 2017.

Narcissistic personality disorder