The nature of narcissists' personality disorder is so profound and so primitive that narcissists damage virtually everyone who comes into contact with them. They hurt their children in ways that are hardly imaginable to anyone who hasn't been there. Narcissists elicit profound and primitive wrath and hostility from sane and stable people. This damages the social fabric by alienating the very people who might possibly be able to counterbalance the narcissists' malign influences.
The children and other victims of narcissists often seek psychotherapy to come to terms with the damage suffered at the hands of narcissists. Melissa's Therapy FAQ may be of interest to people considering entering psychotherapy. I have links to some online discussion and support groups on another page.
Narcissists are generally not candidates for conventional analytical treatment, since psychological analysis is a dialogue and narcissism is a soliloquy. Because of narcissists' incapacity for genuine relationship, their treatment tends to be of the "Band-Aid" variety that deals with specific acute difficulties, such as depression, which can be treated with drugs. Part of Narcissistic Personality Disorder is the conviction is that "I'm okay, it's everybody else who's not okay," so narcissists rarely seek treatment voluntarily. Some wait until they are in such bad shape that they require hospitalization. Because narcissists' self-image is so scanty and fragile, they depend on the reflection of themselves in others' perception to be aware of themselves; sometimes it is really as if these people do not have bodies, have no real material existence. Therefore, social isolation, such as comes following the loss of a job, the failure of a marriage, or the alienation of friends and family, has swift and terrible effects on narcissists. Their thinking quickly deteriorates into chaotic incoherency and disorganization. For this reason, when they do receive treatment, the therapists' first order of business is to restore and fortify the narcissists' ego defenses -- i.e., the therapist must help the narcissist recover the habitual grandiose and self-obsessed self-image. When reasonably recovered, the narcissist usually leaves therapy before any work can be done on the underlying personality disorder.
"Narcissistic Personality Disorder Treatment" by Phillip W. Long, M.D.
Bibliography on diagnosing and treating personality disorders.
About treatment of NPD.
"Dual Diagnosis and the Narcissistic Personality Disorder" by Sharon C. Ekleberry. Treatment of NPDs with addictions. Bibliography.
"On Narcissism: Psychological Theories and Therapeutic Interventions in the Narcissistic Disorders". An anonymous piece, widely available on the Web, has been around for at least five years Its title describes it efficiently and, as far as I can judge, it is okay. Bibliography.
"Self-Management for People with Narcissistic Personality Disorder" from New York - Presbyterian Hospital. (This seems pathetically naive and inadequate to me, though others apparently disagree.)
"The Use of Countertransference in Response to Narcissistic Defenses of Group Members" by Desy Safàn-Gerard. This is a short professional paper reviewing other articles addressing problems encountered by psychotherapists when patients in therapy groups stimulate the therapist's narcissistic reactions. Psychoanalytically oriented. Bibliography.
"You Owe Me! Children of Entitlement" by Lynne Namaka. For teachers and therapists of self-involved children.
"Narcissism: A Genetic Trait -- NPA Theory of Personality Types Based on Mendelian Genetics" by A.M. Benis, Sc.D., M.D. Sort of interesting.
"Let's Strike Out: Self-Esteem Rhetoric In Special Education" by Yong G. Hwang, Louisiana State University.
"Narcissism Goes to Church: Encountering Evangelical Worship" by Monte Wilson.
"Modern American Christianity is filled with the spirit of narcissism. We are in love with ourselves and evaluate churches, ministers and truth-claims based upon how they make us feel about ourselves. If the church makes me feel wanted, it is a good church. If the minister makes me feel good about myself, he is a terrific guy. If the proffered truth supports my self-esteem, it is, thereby, verified."
The following links, while perhaps exhausting, are not exhaustive, but most of the stuff on the Web about personality disorders is about Borderline and most of the stuff on NPD is no more than repetitions of the DSM-IV criteria.
abstracts of research articles on NPD
Narcissistic Personality Disorder
"Narcissistic Personality: A Stable Disorder or a State of Mind?" by Elsa Ronningstam, Ph.D. and John Gunderson, M.D., discusses recent research findings that some people diagnosed with NPD improve significantly in relatively short periods of time (within three years). "Our findings suggested that what appeared to be a narcissistic personality disorder at baseline actually included two types of pathology: one being a context or state-dependent type of pathology, and the other being a more long-term and stable trait pathology. The unimproved group proved to have had a higher level of pathological narcissism in the area of interpersonal relations at baseline, especially in their capacity to become involved in committed long-term relationships. This implies that severely narcissistically disturbed interpersonal relations may be the essential feature that defines patients with narcissistic personality disorder."
"People to Avoid" Short descriptions of personality disorders.
"Aggression and Transference in Severe Personality Disorders" by Otto F. Kernberg, M.D. --> Rage, hatred, envy.
"The serial bully" --> characteristics of workplace bullies.
"The Impact of Narcissism on Leadership and Sustainability" by Bruce Gregory, Ph.D. "When the narcissistic defense is operating in an interpersonal or group setting, the grandiose part does not show its face in public. In public it presents a front of patience, congeniality, and confident reasonableness."
I have written a separate page of links related to attachment and the particular moral and social issues raised by attachment problems.
A rabbit is in a forest typing his life story. A fox comes along and says, "What are you doing, rabbit?" The rabbit says that he's typing his life story. The fox doesn't believe it, so the rabbit says, "Come in here to the cave, and I'll show you the beginning of it." So the fox goes in, and a few minutes later the rabbit comes out brushing his whiskers.
Then a wolf comes along and asks what the rabbit is doing. He doesn't believe the rabbit either. So the rabbit says again, "Come on in my cave, and I'll show you the beginning of it." So the wolf goes in, and the rabbit comes out ten minutes later, brushing his whiskers.
Then a bear comes along and asks what the rabbit is doing. He doesn't believe the rabbit either, so the rabbit takes him into the cave. Ten minutes later out come a lion and a rabbit.
The moral is this: It doesn't matter so much what life story you think you're writing, it's who your collaborators are.
[From "Forces in Human Development", a speech by Dr. Jerome Kagan.]
A sweet story -- I don't know if I even think it's true:
There is a tribe in East Africa in which the art of true intimacy (I would call it bonding) is fostered even before birth. In this tribe, the birth date of a child is not counted from the day of its physical birth nor even the day of conception, as in other village cultures. For this tribe the birth date comes the first time the child is a thought in its mother's mind. Aware of her intention to conceive a child with a particular father, the mother then goes off to sit alone under a tree. There she sits and listens until she can hear the song of the child that she hopes to conceive. Once she has heard it, she returns to her village and teaches it to the father so that they can sing it together as they make love, inviting the child to join them. After the child is conceived, she sings it to the baby in her womb. Then she teaches it to the old women and midwives of the village, so that throughout the labor and at the miraculous moment of birth itself, the child is greeted with its song. After the birth, all the villagers learn the song of their new member and sing it to the child when it falls or hurts itself. It is sung in times of triumph, or in rituals and initiations. The song becomes a part of the marriage ceremony when the child is grown, and at the end of life, his or her loved ones will gather around the deathbed and sing this song for the last time.
[From "Birth and Violence" by Thomas R. Verny.]