Dr. Joseph Burgo, author of The Narcissist You Know, states that to heal narcissism the task is to help the narcissist bear their feelings of shame and worthlessness, which is a very slow process. In a talk on narcissism, he shared that narcissists actually believe that their false alien self is their real self -- they have constructed a web of lies for themselves so strong that it is real to them. As someone who has recovered from psychotic episodes, I can relate to this experience - but the delusions of someone with psychosis are less convincing to others and wax and wane (with episode and recovery and relapse) vs. the character issue of personality disorder. At 25, during an episode of psychotic depression, I believed that I was the most evil person in the world (despite having never committed any actual evil) -- so evil that I made God so angry that God himself turned evil because he was so filled with rage at having created me and he decided to send everyone in the entire world to hell for eternity because of me. Compare the believability of this delusion, or perhaps, of a delusion that one is Jesus, to that of a narcissist -- i.e., an apparently very kind man is secretly an emotional abuser who believes he is the perfect husband. Wrongly declaring oneself an awesome catch for the opposite sex is never criteria for involuntary hospitalization, yet such a delusion is actually dangerous for potential victims of what is called narcissistic abuse.
Burgo's view is a rather pessimistic one that many narcissists may not be able to recover due to the equivalent of brain damage. This has long been believed to be true about schizophrenia, however, even though several studies have shown rates of complete recovery to be around 2/3 (references available). Not everyone can heal from everything, and many people go to their grave with disorders of various kinds. With recovery, the serenity prayer applies:
Although I do not have narcissistic personality disorder, it is a disorder I have looked into because of a love relationship I once had with a peer who emotionally abused me, seemingly due to this disorder. I spoke to my professor, who is an expert on personality disorders and a contributing editor for Psychotherapy Networker magazine, and he recommended Diana Diamond's psychodynamic take on narcissism as helpful in understanding the process of recovery from this disorder:
Also optimistic is a book entitled Understanding and treating pathological narcissism (Ogrodniczuk, 2012).
Below is an extremely simplified comparison I've made between depression and narcissistic personality disorder. My understanding of depression is based on personal recovery experience and work experience and graduate counseling coursework; my understanding of NPD is more nascent personally and professionally.
The narcissist is always seeking new sources of narcissistic supply. New people easily become infatuated with the false alien self and the idealization that the narcissist is dishing onto them, thus supporting the narcissist in hiding from his feelings of worthlessness. Family members, partners, and other people closest to the narcissist pose a threat, however, because they are aware of his imperfections, and the narcissist cannot bear to hear about such imperfections because he is too afraid to look at and work through the feelings of worthlessness associated with them. The narcissist is so afraid of his core self-loathing that to question his perfection feels like a trauma to him, an experienced defined as narcissistic injury. Such an injury easily leads them to respond with narcissistic rage. People in relationships with narcissists are thus at risk of emotional and possibly physical abuse as well as emotional and possibly physical affairs. In such situations of abuse, the abuser may harm the abused and then be so unable to cope with the shame of recognizing his imperfections that he projects his crimes onto the victim rather than face them, thus raising the impact of the trauma he has perpetrated exponentially.
Less peer support exists for those who have NPD, even though the trauma and neglect suspected to be at the bottom of this disorder is very real and even though, whatever the source of their brokenness, their inability to navigate human relationships is extremely painful for them. For those with narcissistic traits who perpetrate verbal and emotional abuse as a result of their disorder, at least one support group exists at http://mevac.proboards.com. Mental health counseling for domestic violence offenders is also available in many places locally.