I have occasionally seen claims that a certain presidential candidate has Narcissistic personality disorder. Assuming such a thing exists, and he really has it, or somebody has it, how is this normally identified and treated?
Narcissistic and Borderline personality disorders are notoriously hard to treat and almost impossible to ‘cure’. For the first, it is difficult to get people to even go to treatment in the first place because they think everything is awesome with themselves at least. Borderlines usually know something isn’t right because they tend to destroy relationships and live a high of high drama but they don’t usually believe they are the ones that need treatment.
If you can get them to follow through on treatment at all, it usually focuses on damage mitigation and learning to recognize and emulate how normal people would behave in given situations. That doesn’t actually cure the personality disorder (it is a fundamental trait after all) but they may be able to learn some skills that allows them to behave more normally if they monitor their behavior and modify it so that it more closely models a more normal range of behavior.
There are standard psychological tests for many different personality disorders but it takes a trained psychologist or psychiatrist to diagnose someone with one definitively because it also requires multiple sessions and a detailed life history to do it correctly.
I’m not sure about Narcissistic, but Borderline often comes with other mental health comorbidities. 96% of BPD have an axis I mood disorder as well, typically Anxiety, Depression and/or substance abuse. My absolute “favorite” as a nurse is Boderline and Bipolar. That’s a shit cocktail, lemme tell ya. In that kind of situation, you do your best to treat the mood disorder pharmaceutically, and teach lots and lots of coping strategies for when the Borderline causes drama and trauma.
Below is a link to a report that ranks past presidents according to their tendency toward Grandiose Narcissism which is characterized by exhibitionism, attention-seeking, inflated demands of entitlement, and denial of weaknesses:
If you get a Borderline person in the office for depression of anxiety, and treat that with drugs, plus get them into therapy, it’s often not that big a leap to suggest that they might also have this other thing-- here, read about it. Borderlines crave attention, and treatment for it often involves lots of attention from therapists and doctors. A psychiatrist of my acquaintance told me it really isn’t all that difficult to get a Borderline to agree to in-patient treatment, or intensive outpatient programs, because they are getting lots of attention.
A bigger problem is getting them really, truly stable before withdrawing some of the attention. They often go immediately back into old behavior patterns when the attention goes away.
But some of the same medications that can legitimately be prescribed for anxiety and depression help with Borderline Personality Disorder as well-- that is, a doctor doesn’t need to say, “Here, this is good for depression,” while prescribing something that in ONLY for the patient’s BPD.
Narcissistic Personality Disorder is harder. It doesn’t usually come with co-morbidities. If a patient ever sets foot in a therapist’s office, it’ll usually be for couples therapy (and the person will be sure all the problems are the partner’s fault, but he or she will go to humor the partner), or because of some legal entanglement. Those rarely lead to the person accepting a diagnosis.
I heard of some people who lay-diagnosed a family member with this, and staged an intervention. It didn’t work. Aside from the fact that lay-diagnoses can be wrong, Narcissistic “I’m right, the rest of the world is wrong,” is going to come into play here." Narcissists essentially are deluded, but not in the same way that psychotics are, because psychotics can’t function around their delusions most of the times. Narcissists can and do-- usually at other people’s expense, but they don’t care.
I don’t know how they treat it, but I think a good first step is getting the person to admit that they have a personality problem, and that the person truly wants help. The problem with narcissists is that they believe there is nothing wrong with them, as they tend to blame everyone else for their wrongdoings. It’s ironic that narcissists initially give a much better impression than perhaps a quiet person; for example, at a party, and it’s very hard to pinpoint every on, let’s say in a dating situation, that the person may have narcissism.
Narcissism and other personality disorders, unfortunately, are very hard to diagnose, as many of the symptoms “overlap”.