Can Narcissists Change? What Research Says About NPD & Personal Growth

Yes — narcissists can change, but the question is more complicated than a simple yes or no. Clinically diagnosed narcissistic personality disorder (NPD) is a treatable condition, and several specialized therapies have demonstrated meaningful reductions in narcissistic symptoms and improvements in relational functioning. What rarely changes is the underlying personality structure itself — the core temperament and pattern of relating that was set in early life. What can change, and often does when treatment is sustained, is how those traits are expressed, the severity of the impairment they cause, and the person's capacity for empathy, accountability, and intimacy.

This guide explains the difference between everyday "narcissism" and the clinical disorder, what research actually shows about change, why change is so difficult, the therapy approaches that work, and what realistic growth looks like for both narcissists and the people around them.

What Is Narcissistic Personality Disorder?

Before we can ask whether a narcissist can change, we have to be clear about what we mean by "narcissist." The word is used in two very different ways, and conflating them leads to misleading conclusions about what change is possible.

In everyday conversation, calling someone a narcissist usually describes behavior — vanity, self-absorption, an inflated sense of importance, a lack of consideration for others. Almost everyone has some narcissistic traits at times. A meaningful proportion of the population has enough of these traits to be considered high in narcissism on personality measures without ever meeting criteria for a disorder.

Narcissistic personality disorder (NPD), by contrast, is a specific clinical diagnosis in the DSM-5-TR. To meet criteria, a person must show a pervasive pattern of grandiosity, a deep need for admiration, and a lack of empathy that:

• Begins by early adulthood
• Shows up across multiple areas of life (work, relationships, identity)
• Causes significant distress or impairment in functioning
• Is not better explained by another mental health condition

Lifetime prevalence estimates for NPD in the U.S. general population fall in the range of roughly 1–6%, depending on the survey methodology. Researchers also distinguish between grandiose narcissism (overtly entitled, attention-seeking, dominant) and vulnerable (or covert) narcissism (hypersensitive to slight, shame-prone, withdrawn but still entitled). Both involve fragile self-esteem underneath the surface, and both can — but do not always — escalate to a diagnosable disorder.

This distinction matters for the change question. The looser the use of "narcissist," the more variable the change picture; the closer to true NPD, the more specific and demanding the treatment.

Can Narcissists Change? What Research Shows

The honest answer the research supports is: change is possible, slower than for most other conditions, and uneven across different parts of the disorder. The picture looks something like this.

• Narcissistic traits in the general population shift naturally with age. Longitudinal studies of personality across adulthood consistently show modest declines in grandiose narcissism from the 20s into middle age, particularly as people take on caregiving roles, encounter career and relationship setbacks, and develop more nuanced self-concepts.
• Symptom-level change in NPD — reductions in entitlement, devaluation, interpersonal exploitation, and reactive rage — has been documented in trials of specialized therapies, particularly schema therapy, mentalization-based therapy (MBT), transference-focused psychotherapy (TFP), and longer-term psychodynamic therapy. Reductions in self-harm, depression, and relational crises commonly appear earlier than reductions in grandiosity itself.
• Trait-level personality change — a fundamental reorganization of the way someone perceives themselves and others — is rarer and slower. The most rigorous research on personality disorder treatment generally shows that people retain a recognizable temperament, but the severity, rigidity, and impairment of their patterns can soften considerably.
• Spontaneous, untreated change is uncommon. Without sustained therapy, real life pressure, or a major loss that disrupts the usual defenses, people with NPD tend to maintain their patterns into late adulthood.

Two findings recur across the clinical literature. First, dropout from treatment is high — narcissistic defenses often turn on the therapy itself, leading people to leave once the work touches their shame. Second, when people stay in specialized treatment for two or more years, the outcomes are meaningfully better than the public narrative suggests.

The Reddit-level claim that "narcissists never change" is mostly a description of what happens without treatment, or with the wrong kind of treatment, in people whose external life has not yet challenged their self-image enough.

Why Change Is Hard for Narcissists

If specialized therapy works, why is change still so difficult? Several features of NPD push directly against the therapy process.

The disorder is ego-syntonic for long stretches. People with NPD often experience their grandiosity, entitlement, and contempt for others as accurate perceptions of reality rather than as symptoms. A person with depression usually wants the depression gone; a person with NPD frequently wants the world, the partner, or the boss to change instead.

Shame is intolerable. Underneath the grandiose surface is a self-image that cannot survive being ordinary, criticized, or wrong. Therapy inevitably requires sitting with shame, accepting feedback, and acknowledging harm done — exactly the experiences the narcissistic defenses exist to prevent. Many people leave treatment at the moment the work becomes effective, because it is also the moment it becomes painful.

Empathy is impaired but not absent. Research on NPD distinguishes between cognitive empathy (knowing what another person feels) and affective empathy (feeling something in response). People with NPD often have relatively intact cognitive empathy, which is part of how they can be socially skilled, charming, or manipulative. Affective empathy is more impaired. Therapy can strengthen affective empathy slowly, but it does not arrive at therapist-pace.

The therapeutic relationship gets pulled into the pattern. Therapists working with NPD repeatedly see the same dynamics that appear in personal relationships: idealization, then devaluation; demands for special treatment; contempt when the therapist disappoints; flight when shame surfaces. Modalities that explicitly work with this — TFP, MBT, schema therapy — were developed precisely because standard supportive therapy often gets devoured by these defenses.

External motivation runs out. Many people with NPD enter therapy under pressure — a divorce, a custody dispute, a workplace warning, a probation requirement, a partner's ultimatum. Once the external threat eases, motivation collapses. Sustained change tends to require the external pressure lasting long enough for some internal motivation to develop.

Time scales are long. Specialized treatments for personality disorders are measured in years, not weeks. The cultural expectation of a brief, symptom-focused therapy that produces visible change in twelve sessions does not map onto NPD.

The Stages of Change model is useful here. Many people with NPD enter therapy at pre-contemplation or contemplation, where the problem is still located outside themselves. Movement into the preparation, action, and maintenance stages takes time, and external pressure is often what keeps the person in the room until that movement happens.

Therapy Approaches for NPD

There is no FDA-approved medication for NPD itself, and no single therapy is yet considered a fully established gold standard the way DBT is for borderline personality disorder. What exists is a small group of specialized, evidence-supported approaches that share several features: they are long-term, structured, relational, and explicit about working with the personality patterns themselves rather than only with surface symptoms.

• Schema therapy. Developed by Jeffrey Young, schema therapy treats NPD as the product of unmet childhood emotional needs that solidified into early maladaptive schemas (such as defectiveness, entitlement, and emotional deprivation) and rigid coping modes (a "self-aggrandizer" mode that hides a "lonely child" mode underneath). It uses cognitive, experiential, and relational techniques — including limited reparenting from the therapist — to soften the schemas. Trials in personality disorders, including NPD, have shown reductions in symptoms and improvements in functioning maintained at follow-up.
• Mentalization-based therapy (MBT). Originally developed for borderline personality disorder, MBT targets the capacity to hold one's own and others' minds in mind. People with NPD frequently lose this capacity under stress, collapsing into either grandiose certainty or wounded victimhood. MBT-NPD adaptations exist and show promise, particularly for vulnerable narcissistic presentations and for people whose primary difficulty is relational rather than overt grandiosity.
• Transference-focused psychotherapy (TFP). A psychodynamic treatment developed by Otto Kernberg and colleagues, TFP works directly with the split self- and other-representations that drive narcissistic and borderline functioning, using the therapy relationship as the primary lab. It is highly structured, twice weekly, and typically runs for two or more years. Outcomes include reductions in identity diffusion and improvements in reflective functioning.
• Long-term psychodynamic therapy. Open-ended psychodynamic work, not manualized but conducted by an experienced clinician with personality-disorder training, remains one of the most widely used real-world treatments for NPD and has a substantial naturalistic evidence base.
• Cognitive behavioral therapy (CBT) and CBT-derived approaches. Standard CBT is not a first-line treatment for the personality structure itself, but it is useful for the conditions that bring many people with NPD into the room — depression, anxiety, substance use, anger problems — and for specific behavioral targets like rage outbursts or workplace conflict.
• Dialectical behavior therapy (DBT) adaptations. DBT was not designed for NPD, but DBT skills (emotion regulation, distress tolerance, interpersonal effectiveness) are often integrated into broader treatment, particularly when there are co-occurring mood, self-harm, or impulse-control problems.
• Couples and family therapy. When the presenting problem is relational, structured couples or family work can be added to individual therapy. It is rarely sufficient on its own for diagnosable NPD, but it can address the system that is sustaining or exacerbating the pattern.

A practical point: the therapist's training matters more than the brand of the therapy. Personality disorder work is a sub-specialty; many otherwise excellent therapists do not have the training to handle the transference and dropout patterns NPD produces.

For a closer comparison of the major NPD modalities and what the trials show, see best therapy for narcissistic personality disorder.

What 'Change' Actually Means

A lot of the confusion in the "can narcissists change" debate comes from people using the word "change" to mean very different things. It helps to separate three levels.

Behavioral change. This is change in what someone does — fewer rage episodes, less stonewalling, less overt put-downs, more follow-through on commitments, more apologies that include real responsibility rather than blame-shifting. Behavioral change is the fastest and most common form of change in treatment. It is also the form most vulnerable to relapse when external pressure eases. A narcissist whose partner threatens divorce may show real behavioral change for months and then slide back when the threat passes.

Symptom change. This is reduction in the diagnostic features themselves — entitlement, exploitation, lack of empathy, devaluation, grandiosity. Symptom change is slower than behavioral change and tends to follow it. Specialized treatments target symptom change explicitly and the evidence for it is real.

Trait-level (characterological) change. This is change in the underlying personality structure — the way the person experiences themselves, the way they relate to others' minds, the way shame and pride are organized. Trait-level change is the deepest, slowest, and rarest form of change. It is also the only form that gives reliable durability. Trait-level change is what makes a person not only behave better but feel different from the inside.

To make this concrete, three real-life examples:

• Behavioral change only. A man in his fifties enters couples therapy after his wife threatens to leave. He stops the rage outbursts and learns to take time-outs. Six months later the marriage is calmer. He has not done individual work, and his contempt for colleagues, ex-partners, and his adult children is unchanged. If his wife dies or leaves, the pattern will likely reassert itself in the next relationship.
• Symptom change. A woman in her forties with vulnerable NPD enters schema therapy after a depressive episode. Over two years, her entitled withdrawal, her devaluation of friends, and her self-pity decrease substantially. She is meaningfully easier to be in relationship with. The underlying sensitivity to shame is still there but is now something she notices rather than something that runs her.
• Trait-level change. A man in his thirties enters long-term psychodynamic therapy after a custody fight. Over four years, his self-experience shifts; he can hold the reality of having harmed his children without collapsing into grandiose denial or suicidal shame. He stays in treatment because the work has become his own, not his ex-wife's. Friends who knew him a decade earlier describe him as a different person.

Most of the people who change in treatment land somewhere in the first two categories. The third is possible but uncommon, and it usually requires both years of skilled therapy and life circumstances that make the old defenses untenable.

For people in relationship with a narcissist, the practical implication is this: early behavioral change is not yet evidence of durable change. Look for whether the change persists when the external pressure is removed, whether it generalizes across relationships, and whether the person can talk about their pattern with insight and ownership rather than blame.

How to Support (or Protect) Yourself Around a Narcissist

A large share of people searching whether narcissists can change are not narcissists themselves — they are partners, adult children, parents, siblings, friends, or coworkers trying to decide whether to stay, leave, hope, or harden. The honest answer is that you have less power over their change than over your own response to them.

A few principles tend to hold across situations.

• Do not stake your wellbeing on their change. Whatever change is possible for them is on their timeline, not yours. Build a life that is livable even if they never change. This is the difference between hope and a plan.
• Stop trying to explain. Long, well-reasoned attempts to make a narcissist see your perspective usually feed the dynamic rather than resolve it. Brief, clear, repeated statements of what you will and will not do are more useful than another explanation of why.
• Set behavioral, not emotional, conditions. "I need you to feel different about me" is not enforceable. "I will leave the room when you call me names" is.
• Use external structure. Custody arrangements, written agreements, finance separation, third-party communication, mediated meetings — these reduce the surface area for manipulation and give you something to hold to when the dynamic intensifies.
• Look for sustained patterns, not promises. Apologies, gestures, and stretches of good behavior after a rupture are part of the cycle, not yet evidence of change. Look for whether the pattern holds across months, contexts, and the absence of any consequence.
• Get your own support. Therapy with someone trained in narcissistic abuse recovery, peer support groups, and trusted friends who can mirror reality back to you are not luxuries — they are how you keep your perception of yourself intact when someone close to you is systematically distorting it. For a deeper modality guide, see best therapy for narcissistic abuse recovery.
• Recognize that leaving is a legitimate response. Some narcissistic relationships are not safely repairable, particularly where there is contempt, control, financial abuse, or any physical violence. Choosing to leave is not a failure of patience or compassion.

If you are trying to read the relationship more carefully — the cycle, the gaslighting, the bargaining, the costs of staying — our companion piece on narcissism in relationships goes deeper into the relational pattern itself.

The Bottom Line

Narcissists — including people with diagnosed NPD — can change. The change is usually partial, slower than the change seen in mood or anxiety disorders, and concentrated in behavior and symptoms first, with characterological change emerging only over years of skilled treatment. The therapies that work are specialized: schema therapy, MBT, TFP, and long-term psychodynamic work, with CBT and DBT skills useful for co-occurring problems. Sustained change almost always requires both an external situation that makes the old patterns untenable and a therapist trained in personality disorder work.

For people on the other side of a narcissistic relationship, the practical takeaway is to base your decisions on what is actually happening over time, not on what is being promised, and to protect your own wellbeing as a non-negotiable starting point. Hope is not the same as a plan, and waiting is not the same as healing.

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