You might know someone who frequently shifts blame onto you, smirks when caught in a lie, or twists your words until you’re apologizing for their mistakes. Over time, you may wonder if someone like this can truly change. Such behavior is often seen in individuals with narcissistic traits.
When people high in narcissism feel criticized or slighted, their fragile or inflated self-esteem feels threatened. This often triggers aggressive reactions aimed at protecting their self-image. As a result, those around them often demand change. However, the impact isn’t only on others; narcissists themselves frequently experience feelings of rejection, largely because their own behavior pushes people away.
Psychology distinguishes two main types of narcissism: grandiose and vulnerable. Grandiose narcissists see themselves as superior, while vulnerable narcissists are hypersensitive to criticism. Both types can be arrogant and self-centered, and when extreme, may be diagnosed with narcissistic personality disorder (NPD), also known as pathological narcissism.
Narcissists may use passive-aggressive tactics like social exclusion or withholding affection as punishment. Sometimes, they may also act with overt aggression, even without provocation.
While narcissists can change, it requires significant effort and professional intervention. NPD is a lifelong mental health condition without a cure, but symptoms can be managed through therapy. The most common treatment is talking therapies, especially cognitive behavioral therapy (CBT), which helps individuals recognize and change unhelpful thoughts and behaviors.
Many therapists prefer introspective relational techniques for narcissism treatment. This approach encourages clients to explore their feelings and motivations in a nonjudgmental environment, helping them overcome their fear of vulnerability. Building trust and rapport is critical since narcissists often strive to maintain an image of confidence, masking feelings of shame, guilt, aggression, or victimization. These barriers make therapy challenging and lead to higher dropout rates among narcissistic patients compared to general therapy populations.
People with NPD rarely seek therapy voluntarily because they often don’t perceive their behavior as problematic. They typically enter treatment for external issues like job loss, divorce, or depression. When patients do engage, they often present in a vulnerable state rather than a grandiose one, which requires therapists to adapt their approach.
Alternative therapies inspired by treatments for borderline personality disorder—such as dialectical behavior therapy, mentalization-based therapy, and schema therapy—have been tested with some success, but evidence for their effectiveness in NPD remains limited. These treatments also face challenges like long durations and difficulties building therapeutic rapport.
In 2025, researchers proposed using psychedelic-assisted therapies, such as MDMA, to create emotional openness in therapy for narcissistic individuals. While MDMA can enhance empathy and prosocial behavior, its mental health risks, legal restrictions, and the necessity of strong therapist-patient trust complicate its use. Clinical trials are ongoing but not yet complete.
For now, success in treating narcissism depends mostly on the therapist’s skill in building trust and addressing defensive behaviors. Narcissists can change, but it demands patience and expert care.
If you or someone you know struggles with narcissistic behaviors and their impact, consider reaching out to a licensed mental health professional for guidance and support.