Responding to Narcissistic Personality Disorder (NPD)
Recently, someone asked me for resources to help with a relationship in which the other person had been diagnosed with Narcissistic Personality Disorder. This diagnosis is a tough one because such a divergent sweep of resources is required and it is very hard work to establish and keep a safe connection. Some sort of a definition might be helpful, so I’ll paraphrase some of the main criteria of NPD as listed in the DSM-5:
- A sense of entitlement, self-aggrandizement and, at times, extremely low self-regard and self-esteem
- Intense and changeable emotions based upon current self-esteem
- A marked lack of empathy; therefore, no ownership of how one’s behaviours are causing harm to others or self
- Extremes in standards for self and others (can fluctuate between perfectionism and no standards at all)
- Superficiality in relationships; governed by what can be gained; little genuine interest in others
- More often diagnosed in younger adults and men
- Thought to be correlated with cultures who value individualism and to folks who may have deep roots in shame
Here are some ideas that I might explore in a counselling session with the non-NPD person:
- Diagnosis: What is NPD so that I understand what I am dealing with?
- Differentiation of Self: How do I stay with this relationship without losing myself and/or the relationship?
- Values and Beliefs: expectations of roles, expectations of self and other, and realistic goals for the relationship
- Possibilities: new and different ways of interaction based upon your beliefs and values
- Agency, self-esteem, boundaries, and the negotiation of power
- Managing emotions and interactions in the moment: awareness of triggers, maintaining the “objective reporter” role
- Creating ways of escape and psychological space
Typically, this type of relationship will not get better over time on its own and it is often very intense and sometimes even frightening to be with a person struggling with NPD symptoms. Navigating it will probably be confusing and disheartening at times. Learning about it, creating some distance from the relationship, and/or garnering some support for yourself can be of great value.
Shari van Spronsen, MA, RCC