Narcissistic personality: beneath the confidence
Narcissistic personality is often caricatured. In the consulting room it looks different: a fragile sense of self-esteem coexisting with real ambitiousness, and the inner pain of disappointments — a person who can appear confident or cold and yet is extremely vulnerable to criticism, envy, shame and emptiness. Relationships, work and family life suffer — and so does the person.
How it presents
Some people come because of depression after a professional or romantic loss. Some come because a partner or employer insisted. Some come because success has stopped feeling like anything. Narcissistic difficulties also hide behind other diagnoses — recurrent depression, substance use, anxiety — and treatment that ignores them tends to stall.
How we treat it
Treatment draws on Transference-Focused Psychotherapy as adapted for narcissistic pathology by Otto Kernberg and colleagues. It is a direct, structured psychotherapy: it addresses how the patient experiences the therapist and others — admiration, devaluation, envy, the fear of depending on anyone — because that is where change happens. Co-occurring depression, anxiety or sleep problems are treated in parallel, with medication only where it has a clear target.
A note on distinguishing conditions
Some presentations that look narcissistic are better explained by other conditions, including Asperger-type traits in adults. Careful diagnosis comes first. Dr. Bernardi's earlier research at Mount Sinai studied the brain's attentional networks in autism, and the overlap between Asperger-type traits and narcissistic traits in adults is an active research interest of the practice. See ADHD, narcissistic traits or Asperger's?
Questions
Can narcissistic personality disorder be treated?
Yes. Psychodynamic treatments, including Transference-Focused Psychotherapy adapted for narcissistic pathology, can lead to meaningful change, particularly when the person is motivated by suffering such as depression, loss or repeated relationship failure.
Do people with narcissistic personality seek therapy?
Often they come for something else — depression after a loss, conflict at work, a partner's ultimatum. Recognizing the narcissistic organization underneath allows treatment to address the real problem.
Is narcissism the same as Asperger's?
No, but some adult presentations overlap, and careful evaluation is needed to distinguish them because treatment differs.
Related reading
- ADHD, narcissistic traits or Asperger's? Telling them apart in adults
- Borderline personality disorder and Transference-Focused Psychotherapy
- Executive and leadership coaching
MIND FIRST sees patients in Midtown Manhattan (Grand Central) and the Financial District, and by telehealth for patients located in New York, Florida or Milan. Dr. Bernardi is licensed to practice medicine in New York, Florida and Italy.
You can reach our office by email or by text.
Email: admin@neuroscienceforthemind.com
Text: 917-993-3292