Narcissistic Personality Disorder: Understanding the Struggle Behind the Mask

When people hear the term narcissist, they often picture someone arrogant, selfish, and unwilling to change. The reality is much more complicated—and far more human. Narcissistic Personality Disorder (NPD) is a mental health condition that affects how someone sees themselves, relates to others, and copes with emotional pain. It can cause serious strain in relationships, leaving friends and family members feeling hurt, confused, or shut out. At the same time, people with NPD are often wrestling with their own hidden battles, even when they work hard to keep those struggles out of sight [1].

This psychological condition is part of what are known professionally as the Cluster B personality disorders, alongside borderline personality disorder, antisocial personality disorder, and histrionic personality disorder—each characterized by emotional dysregulation, impulsivity, and interpersonal difficulties.

Narcissistic Personality Disorder Symptoms

Common narcissistic personality traits and tendencies may include:

• An exaggerated sense of self-importance or grandiosity
• A strong need for admiration and validation
• A lack of empathy or concern for others’ feelings
• Difficulty handling criticism or feedback
• Manipulative or exploitative behaviors in relationships
• Narcissistic rage when challenged or rejected
• Viewing oneself as superior, special, or unique

NPD can show up as a strong need for admiration, difficulty handling criticism, and a tendency to put one’s own needs first [2]. This can lead to situations where loved ones feel unseen, dismissed, or even manipulated. It’s important to acknowledge these realities—because they hurt, and because ignoring them doesn’t help anyone. But it’s equally important to remember that what may look like an inflated ego is often a shield against deep shame, fear of failure, and a painful sense of not being good enough [3]. When we look past the surface, we often find a person who is just as in need of compassion and understanding as anyone else.

How Narcissistic Personality Disorder Can Be Treated

Treatment for NPD is not a quick or easy process, and there’s still debate about the best way to approach it [4]. Research is limited, but many therapists use practical, goal-oriented approaches like Cognitive Behavioral Therapy (CBT) or Dialectical Behavior Therapy (DBT). These therapies target maladaptive narcissism, emotional regulation, and narcissistic defenses.

Common psychotherapy options for treating NPD may include:

• CBT (Cognitive Behavioral Therapy): Restructures distorted beliefs and thought patterns
• DBT (Dialectical Behavior Therapy): Helps regulate mood and impulsivity
• Schema Therapy: Targets early maladaptive schemas and core identity issues
• Psychodynamic Therapy: Explores unconscious motivations and relational patterns
• Group Therapy: Builds empathy and interpersonal awareness in a safe setting
• EMDR (Eye Movement Desensitization and Reprocessing): Sometimes used to process trauma underlying narcissistic traits

Success often comes from creating a non-judgmental, honest relationship where the therapist supports the person with NPD in reaching their goals—not just the goals others have for them. When that alliance is built, deeper trauma work can begin, sometimes leading to remarkable breakthroughs.

In my own experience, I’ve seen people with NPD make impressive improvements in their relationships, self-awareness, accountability, and emotional resilience.

It’s also important to note that NPD rarely exists in isolation. Many people with NPD also live with depression, anxiety, or substance use disorders [5]. If these co-occurring issues are left untreated, progress is much harder to sustain. Addressing all aspects of a person’s mental health—rather than just focusing on one diagnosis—gives them the best chance for long-term growth and stability.

For loved ones, the journey can be challenging [6]. Setting healthy boundaries is essential—not as punishment, but as a way to protect your own well-being.

Support strategies for dealing with a narcissistic person may include:

• Identifying and asserting clear behavioral boundaries
• Seeking therapy for yourself to manage emotional exhaustion
• Educating yourself about narcissistic relationship patterns
• Avoiding codependency and enabling cycles
• Encouraging them to seek professional help from a narcissistic personality disorder specialist

Remember that you can care about someone without sacrificing your safety or mental health. In many cases, the best way to support a person with NPD is to encourage treatment, model respectful communication, and refuse to engage in hurtful patterns.

While change takes time, it’s possible. People with NPD can—and do—learn to manage their defenses, connect more genuinely with others, and live fuller, more satisfying lives. It’s not about erasing personality traits or forcing conformity. It’s about finding healthier ways to relate, building trust, and replacing shame-driven reactions with more authentic self-expression. Beneath the mask, there’s a real person who can grow, heal, and thrive—just like anyone else.

How We Use This Information to Help People

At Windmill Wellness Ranch, we see our clients at human beings, not pathologies. Where some professionals may shy away from doing the more difficult work, we embrace it. This means that we work with clients who experience the pain of NPD and help them find their true selves underneath. This includes creating hope, using evidence-based practices, and helping them find better relationships with both themselves and those who love them.

Since people with NPD often struggle with substance use as well and have more complicated recoveries as a result, our residential treatment setting provides safety and support to untangle and address both issues. We understand that integrated care including support for underlying personality disorder traits is key to healing.

We are also proud of the support we offer families. Our weekly family workshops and SMART Recovery Family & Friends meetings create a forum for our clients and their families to learn and practice new tools and ways of understanding each other. These resources are available indefinitely, because our alumni and families are welcome to keep coming to these meetings for as long as they like after treatment has concluded.

There Is Hope: NPD Recovery Is Possible

If you love someone with NPD—or if you’re living with it yourself—there is hope. People with NPD aren’t destined to stay stuck in behaviors destructive to themselves and others. With the right support, they can build lives filled with meaningful relationships, emotional resilience, and a stronger sense of self.

Recovery for those with narcissistic personality disorder is not about erasing all narcissistic traits, it’s about understanding why these traits formed and how they can be transformed. This includes healing vulnerable narcissism, rebuilding personality functioning, and embracing change from within.

If you or someone you love is struggling, don’t hesitate to reach out and get help. Our admissions team can walk you through what to expect and answer any questions. Call 830-251-5606 or contact us online.

References:

1. Weinberg, I., & Ronningstam, E. (2022). Narcissistic personality disorder: Progress in understanding and treatment. Focus, 20(4), 368-377.

2. Weinberg, I., & Ronningstam, E. (2020). Dos and don'ts in treatments of patients with narcissistic personality disorder. Journal of personality disorders, 34(Supplement), 122-142.

3. Fjermestad-Noll, J., Ronningstam, E., Bach, B. S., Rosenbaum, B., & Simonsen, E. (2020). Perfectionism, shame, and aggression in depressive patients with narcissistic personality disorder. Journal of personality disorders, 34(Supplement), 25-41.

4. Dimaggio, G. (2022). Treatment principles for pathological narcissism and narcissistic personality disorder. Journal of Psychotherapy Integration, 32(4), 408.

5. Coleman, S. R., Oliver, A. C., Klemperer, E. M., DeSarno, M. J., Atwood, G. S., & Higgins, S. T. (2022). Delay discounting and narcissism: A meta-analysis with implications for narcissistic personality disorder. Personality disorders: theory, research, and treatment, 13(3), 210.

6. Day, N. J., Bourke, M. E., Townsend, M. L., & Grenyer, B. F. (2020). Pathological narcissism: A study of burden on partners and family. Journal of personality disorders, 34(6), 799-813.

Hope and Steps Forward for People with Narcissistic Personality Disorder

• Know that change is possible — Many people with NPD have built stronger relationships and greater self-confidence through therapy and support.
• Be honest with yourself — Acknowledge when your defenses are up and ask yourself what feelings might be underneath.
• Set your own goals — Focus on changes that matter to you, not just what others expect.
• Consider professional support — Therapies like CBT and DBT, as well as trauma-focused approaches, can help you build emotional resilience.
• Address other challenges too — If you struggle with depression, anxiety, or substance use, treating these together increases your chances of success.
• Celebrate progress, not perfection — Even small changes in communication, empathy, or self-control are steps toward a healthier, more fulfilling life.

💡 Practical Tips for Supporting Someone with Narcissistic Personality Disorder (and Protecting Yourself)

• Set clear boundaries — Decide ahead of time what behaviors you will and won’t accept, and communicate these calmly but firmly.
• Don’t take everything personally — Remember, defensiveness or criticism may be more about their shame and fear than about you.
• Model healthy communication — Speak respectfully, listen actively, and avoid escalating conflicts when possible.
• Encourage professional help — Suggest therapy or support groups, and offer to help find resources if they’re open to it.
• Take care of yourself — Maintain your own friendships, hobbies, and self-care routines so your well-being doesn’t depend entirely on the relationship.
• Seek your own support — Consider therapy or a support group for loved ones of people with personality disorders.