Can NPD Be Treated? What the Evidence Shows

Two headlines circulate about narcissistic personality disorder. One says it cannot be treated. The other says a new trial has proven that it can. Both are more certain than the evidence.

The honest answer is that the evidence is thin, not empty. Fewer people with NPD have ever been enrolled in a treatment trial than with borderline personality disorder, by a wide margin. That gap tells you how little has been tested. It does not tell you that treatment fails. A span nobody has weighed is not a broken span.

Key takeaways

• NPD is not proved untreatable. Its direct trial base is far thinner than BPD’s, and the one recent randomized trial is seriously contested.
• Twelve independent experts published eleven objections to the 2026 trial and concluded it should not be considered a benchmark. Concerns were raised; misconduct was not proven. No effect sizes from that trial are reported here because they cannot be independently verified.
• Meaningful change shows up in behavior and function: accountability, reciprocity, steadier self-esteem, and staying in treatment. Those are clinical goals, not proven trial outcomes.

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Two presentations, not two disorders

Clinicians describe grandiose and vulnerable narcissism: the outwardly entitled, dismissive pattern, and the inwardly ashamed, easily wounded one. These are presentations or dimensions of the same pathology. They are not official subtypes in the diagnostic manual, and one person can show both at different times or shift between them.12 Internet summaries that sort people into two fixed types are simplifying past what the field actually holds.

What the one direct trial found, and why it is contested

In 2026, a randomized trial reported on 114 adults diagnosed with NPD, assigned to schema-focused therapy or the Unified Protocol, a transdiagnostic cognitive-behavioral treatment. Both groups improved over 12 months of follow-up, according to the authors.3

Three design facts sit beside that result. There were two active arms and no untreated or usual-care comparison, so the trial cannot show that either treatment beats no treatment. No public registration record for the trial could be located. And the full text is behind a paywall and not in an open repository, so its effect sizes cannot be independently checked. That is why no numbers from the trial are reported here.34

Then twelve independent experts, including several who write the field’s major guidance on personality disorders, published a commentary with eleven numbered objections. They concluded that the trial should not be considered a benchmark for NPD treatment. Five of their objections are concrete enough for any reader to weigh.4

1. There was no untreated group, only two active arms.
2. None of the commentary’s authors could find a public record of the trial’s registration.
3. Almost every outcome, including the primary one, relied on self-report.
4. The trial reported zero dropout in both arms, in a field where personality-disorder trials typically lose 40 to 60 percent of participants.
5. The two arms received very different doses: roughly 28 to 36 sessions of the Unified Protocol over seven to nine months, against roughly 48 to 53 sessions of schema-focused therapy over fourteen months.

The commentary also questioned recruitment through social media advertisements and the unusually even split between grandiose and vulnerable presentations and between men and women.4

Two boundaries on all of this. A commentary raises concerns; it does not prove misconduct or invalidate every finding. And as of September 7, 2026, the published record held no correction, erratum, expression of concern, or retraction of the trial, and no reply from its authors.34 The dispute is unresolved. That is exactly why the trial cannot be a benchmark yet.

What the older evidence says

Natural course. A 2014 study followed people with NPD for two years. Of 96 at the start, 40 were still in the study at the end. Among those 40, 53 percent no longer met the full categorical diagnosis, while dimensional measures of narcissistic pathology were more stable.5 That is a natural-history observation with heavy loss to follow-up. It is not a treatment success rate, and it cannot be used as one.

Named therapies, described more than tested. Transference-focused psychotherapy has a published adaptation for pathological narcissism and NPD, but its major randomized trials enrolled people with BPD, not NPD.6 Mentalization-based treatment has a published NPD adaptation, and the article describing it reports no controlled NPD outcome trial.7 These are serious clinical models. Their evidence in NPD is theory, case description, and indirect transfer from other diagnoses.67

The mixed-sample schema-therapy trial. A 2014 multicenter trial randomized 323 people with several personality disorders to schema therapy, clarification-oriented psychotherapy, or usual care. Only 16 of the 323 had NPD, spread across all three arms, six of them in schema therapy. The trial excluded borderline and antisocial personality disorder. The authors reported that results did not vary with diagnosis, but sixteen people cannot supply an NPD-specific answer.8

What meaningful change looks like

Because the trials measure little of what families and patients actually want, it helps to be clear about what change would look like if it happened. Specialists describe goals like these.1

• Accountability: acknowledging a specific harm without a counterattack.
• Reciprocity: relationships in which the other person’s needs get real airtime.
• Steadier self-esteem: fewer collapses into shame or rage after ordinary criticism.
• Sustained engagement: staying in treatment past the first narcissistic injury it causes.

These are clinical goals that a person and a clinician can track in observable behavior. They are not proven trial outcomes, and no research promises a personality replacement.1 Better trials are the repair for that gap. Until they exist, the fair expectation is change in how someone acts and functions, measured over months, not a new person.

A note for families and partners

You cannot diagnose someone from the outside, and you cannot make another adult engage in treatment. Nothing in this evidence changes that.1

Safety decisions do not depend on a diagnosis at all. They depend on observable acts. Threats, intimidation, physical harm, financial control, and isolation are dangerous whatever label a person does or does not carry, and NPD is not an explanation that excuses them. If any of that is happening, the National Domestic Violence Hotline is 1-800-799-7233, text START to 88788, with online chat at thehotline.org, and it is listed with the other crisis routes at the end of this page.9 This article does not tell anyone to stay or to leave. It says that the question of danger is separate from the question of treatment.

When to get help sooner

Get urgent help for suicidal intent, a plan with access, or an inability to stay safe. Vulnerable narcissistic states can involve intense shame and despair. Get urgent help if anyone in the home is being threatened or hurt. Call or text 988 in the United States for suicide or emotional crisis. Call 911 or go to the nearest emergency department for immediate danger.

What to do next

If you are the person with the diagnosis, ask a clinician which model they use for narcissistic pathology, and agree on two observable behaviors to track over the next three months. If you are a family member, write down the acts that worry you, sort them into safety and everything else, and take the safety list to the hotline or a clinician first.

Frequently asked questions

Can narcissistic personality disorder be treated?

It is not proved untreatable. The direct evidence is thin: one contested 2026 trial, one natural-history study with heavy dropout, treatment models described more than tested, and a mixed trial with 16 NPD patients.

Did a 2026 trial prove that therapy works for NPD?

It reported improvement in both of two active treatments. Twelve independent experts published eleven objections, including no untreated group, no locatable registration, self-report primary outcomes, zero dropout, and unequal dose, and concluded it should not be treated as a benchmark.

Are grandiose and vulnerable narcissism two types of NPD?

They are presentations or dimensions, not official subtypes. One person can show both.

What does successful treatment look like?

Change in behavior and function: taking accountability, reciprocity in relationships, steadier self-esteem after criticism, and staying in treatment. Those are clinical goals, not proven trial outcomes.

My partner has NPD and I am afraid. What matters most?

Safety, decided by what they do, not by their diagnosis. Threats, harm, and control are dangerous regardless of label. The National Domestic Violence Hotline is 1-800-799-7233 or text START to 88788.

This article is for education, not personal medical advice. Do not start, stop, restart, or change a medication without the clinician who manages it. Every numeric and citation claim was verified against primary journal sources on September 7, 2026, including a search for corrections or retractions of the 2026 trial. Publication records and hotline details change; confirm current status before acting on anything here.

Related reading on NP FADY

• Narcissistic Personality Disorder: Beyond Ego and Internet Labels
• Your Partner Is Not a TikTok Diagnosis
• Supporting Someone With a Personality Disorder
• What Personality-Disorder Recovery Really Looks Like
• When Full DBT Is Out of Reach

References

1. Weinberg I, Ronningstam E. “Narcissistic Personality Disorder: Progress in Understanding and Treatment.” Focus (American Psychiatric Publishing). 2022;20(4):368–377. DOI: 10.1176/appi.focus.20220052. PMID: 37200887. Open full text.

2. Pincus AL, Cain NM, Wright AGC. “Narcissistic grandiosity and narcissistic vulnerability in psychotherapy.” Personality Disorders: Theory, Research, and Treatment. 2014;5(4):439–443. DOI: 10.1037/per0000031. PMID: 24446581. PubMed.

3. Mohajerin B, et al. “A Randomized Controlled Trial Comparing Two Treatments for Vulnerable and Grandiose Narcissism: Unified Protocol vs. Schema-Focused Therapy.” Clinical Psychology & Psychotherapy. 2026;33(2):e70247. DOI: 10.1002/cpp.70247. PMID: 41792983. N = 114; two active arms; no public registration record located; effect sizes not independently verifiable. PubMed.

4. Dimaggio G, Inchausti F, Bateman A, et al. “Can All Oxygen Molecules Accumulate in One Corner of the Room? Treating Pathological Narcissism Requires High Standard Randomized Clinical Trials. A Commentary on the Trial by Mohajerin et al.” Clinical Psychology & Psychotherapy. 2026;33(4):e70319. DOI: 10.1002/cpp.70319. PMID: 42590888. Twelve authors; eleven numbered objections. Open full text.

5. Vater A, Ritter K, Strunz S, et al. “Stability of narcissistic personality disorder: tracking categorical and dimensional rating systems over a two-year period.” Personality Disorders: Theory, Research, and Treatment. 2014;5(3):305–313. DOI: 10.1037/per0000058. PMID: 24512458. Baseline N = 96; 40 retained at two years. PubMed.

6. Diamond D, Yeomans FE, Stern B, et al. “Transference-Focused Psychotherapy for Pathological Narcissism and Narcissistic Personality Disorder (TFP-N).” Psychodynamic Psychiatry. 2021;49(2):244–272. DOI: 10.1521/pdps.2021.49.2.244. PMID: 34061655. PubMed.

7. Choi-Kain LW, Simonsen S, Euler S. “A Mentalizing Approach for Narcissistic Personality Disorder: Moving From ‘Me-Mode’ to ‘We-Mode.’” American Journal of Psychotherapy. 2022;75(1):38–43. DOI: 10.1176/appi.psychotherapy.20210017. PMID: 35016552. Psychiatry Online.

8. Bamelis LLM, Evers SMAA, Spinhoven P, Arntz A. “Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders.” American Journal of Psychiatry. 2014;171(3):305–322. DOI: 10.1176/appi.ajp.2013.12040518. PMID: 24322378. N = 323; 16 with narcissistic personality disorder, 6 of them in schema therapy; borderline and antisocial personality disorder excluded. PubMed.

9. National Domestic Violence Hotline. “Get help.” Accessed September 7, 2026. Call 1-800-799-7233, text START to 88788, or chat online. The Hotline.

If you or someone you know is in crisis

• Call 911 or go to your nearest emergency room for any life-threatening emergency.
• 988 Suicide & Crisis Lifeline — call or text 988, available 24/7. En español: marque 988 y oprima 2. Veterans: 988 and press 1, or text 838255.
• Crisis Text Line — text HOME to 741741.
• The Trevor Project (crisis support for LGBTQ+ young people) — call 1-866-488-7386, or text START to 678-678.
• National Sexual Assault Hotline (RAINN) — call 1-800-656-HOPE (4673) or text HOPE to 64673; free, confidential, 24/7. Online chat at RAINN.org/hotline.
• National Domestic Violence Hotline — call 1-800-799-SAFE (7233) or text START to 88788; 24/7, help in 200+ languages. Online chat at TheHotline.org. If your phone or computer may be monitored, calling from a safer device is an option.
• Riverside County — Inland SoCal Crisis Helpline 951-686-HELP (4357), 24/7 (Inland SoCal United Way / 211+, in partnership with RUHS-BH); Community Access, Referral, Evaluation and Support (CARES) Line 800-499-3008, 24/7.
• San Bernardino County — Access Unit (Behavioral Health Helpline) 888-743-1478, 24/7; Mobile Crisis/CCRT 800-398-0018 (24/7, all ages) or text 909-420-0560. Arrowhead Regional Medical Center (ARMC) has a dedicated walk-in adolescent psychiatric ER (ages 13–17).
• Children under 13 — call 911 for immediate danger, contact your county's mobile crisis team (they respond to all ages), or go to the nearest pediatric emergency room.
• California Peer-Run Warm Line (non-crisis — someone to talk to) — call or text 1-855-600-WARM (9276); daytime and evening hours, not a 24/7 line.
• NP Fady (non-emergency) — for routine scheduling or questions, call (909) 707-6261. This line is not monitored for emergencies.