From Illness to Adaptation

Ray of Hope.

Source: Zac Durant/Unsplash

Narcissistic personality disorder is among the most puzzling disorders in the field of psychotherapy, notoriously elusive to spot and even more challenging to treat. It has the infamous distinction of likely impacting more people than those who suffer it, affecting the multitude of victims entangled in the web of their abusive relationships. But there may be a missing piece to this puzzle. Recent research suggests our current understanding may be wrong.

Removing the Roadblock

NPD is described by an inflated sense of self-importance, a lack of empathy, and a tendency toward aggressive and exploitative behavior toward others. But here's the rub: treating NPD can backfire because critical feedback fuels narcissistic injury and rage. Sufferers often have grave difficulty acknowledging their condition, mostly because it carries a label that is highly stigmatizing. This stigma is a key roadblock to seeking, engaging, and complying with treatment.

But what if we applied a completely different perspective to the problem? Some psychologists are suggesting that narcissism may not be a pathology at all but rather an adaptation. This shift in thinking might potentially revolutionize the way we view and treat NPD. Destigmatizing NPD can shed light on the distinctions between healthy and maladaptive narcissism. By doing so, we might open a window for reflection among sufferers while unlocking a path for more effective treatment interventions.

Better Treatment Needed

This is especially important because there is an alarming lack of evidence for effective treatment for NPD. The prevailing theories suggest that NPD is rooted in negative early childhood experiences, which makes it difficult to understand the causal pathways and identify the best treatment options. Longitudinal studies to measure these individuals from early childhood to later adulthood are much-needed but highly time-consuming.

In addition, psychopharmacological interventions also encounter hurdles with narcissistic clients, who tend to be wary of dependency and sensitive to medication side effects. Their controlling tendencies and inclinations toward independence may stand in the way of establishing therapeutic alliances, the key component for effective treatment.

Understanding Adaptive Traits

However, there is a ray of hope in acknowledging that narcissism might also have some positive benefits. For example, research has found that the presence of narcissistic traits in individuals who otherwise appear normal (otherwise known as subclinical narcissism) can facilitate prosocial benefits such as likability, popularity, and gregariousness. These traits can improve well-being and provide societal benefits. There is also compelling evidence that narcissism may be associated with a reduction in psychiatric symptomology in subclinical narcissists. Researchers found that subclinical narcissism predicted decreased psychiatric symptoms, and this was associated with positive well-being outcomes across various domains (Papageorgiou et al., 2019). These researchers also identified specific narcissistic traits related to positive life outcomes citing mental toughness and openness to experiences as predictors of decreases in depression.

Not only may narcissism be a psychosocial adaptation, but some researchers are now conceptualizing it as an evolutionary adaptation that confers advantages by empowering narcissistic individuals to attain and maintain status through increased access to resources (Holtzman & Donnellan, 2015).

Reframing the Picture

Cognitive reframing has been shown to play a significant role in helping treatment-resistant narcissists remain in therapy. When therapists help people with NPD reframe their perceptions and beliefs, they can begin to alter their rigid maladaptive patterns of thinking and acting. This cognitive reframing approach has been shown to help narcissists replace maladaptive beliefs with adaptive ones, suggesting that if we can change the way individuals with NPD see themselves and others, we can develop more effective treatment outcomes. Better accepting the “diagnosis” is key to establishing a therapeutic alliance and sticking to treatment goals.

In Summary

Narcissistic personality disorder has a profound impact on sufferers, victims, and society as a whole. It's a ripple effect that touches families, communities, governments, and businesses worldwide. The adaptation model offers a fresh new take on potentially promising new treatment approaches yet to be discovered.

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Changing our label, frame, and model for understanding NPD opens a new path to reflection and empathy. By destigmatizing NPD and seeing it as an adaptation rather than an illness, we can reduce distress and impairment not only for those who suffer from it but also for everyone affected by narcissistic relationships. Research continues to uncover promising possibilities, and if we can embrace these new views, we may learn how to provide better support for all of those impacted by NPD.

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