- Symptoms may worsen over time,
with an increase in envy, disillusionment, and contempt; profound narcissism
can be found past middle age and in geriatric individuals.
Empirical studies indicate that there is a better prognosis and chance for improvement in NPD patients who have less severely disturbed object relations.
Improvements can be related
to the presence of corrective life events involving achievement, relationships,
and disillusionment. NPD patients who experience actual positive
life achievements have less need for grandiosity and fantasies of superiority
or exaggerated talent. Those with NPD who were able to be in long
term, close, committed relationships appear to have less need to behave
in ways that are maladaptively ego defensive: devaluing or exploiting
others, arrogance, and entitlement demands. If the person is in a
supportive relationship, self-esteem is improved. Finally, disappointments
that challenge the narcissist’s worldview—that reveal the incongruence
of the narcissist's self-opinion with the way the world actually is—serve
to reorient the narcissist’s world view to one that is more congruent with
and accepting of the way things actually are.
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