ABSTRACT
This chapter provides the DSM-IV criteria for narcissistic personality. Some of the dysfunctional features of narcissistic personality disorder can possibly be improved on mood stabilizers such as lithium, valproate, carbamazepine, gabapentin, or lamotrigine. Given the possibility that some narcissistic personalities have mild paranoid tendencies and hostility, a trial of a low dose of risperidone, olanzapine, or sertindole is potentially beneficial to the patient. Mood stabilizers alone may be sufficient to give some therapeutic benefits to individuals with narcissistic personality disorder, in which case they are the preferred and primary medications. Narcissistic personality disorders typically present to clinical attention due to Axis I symptoms such as depression or anxiety, as is true of all personality disorders. Among personality disorders, narcissistic, antisocial, schizoid, and paranoid personality disorders are, in the author’s experience, the most difficult to engage in treatment. Patients with narcissistic personality disorder typically come to clinical attention either due to external pressure or due to distressing Axis I symptoms.
