Narcissistic Personality Disorder Impact on Relationships & Mental Health Support Options
Because of these patterns, NPD typically has wide-reaching effects on daily life. For example, it can strain interpersonal relationships, create tension within families, disrupt functioning in the workplace, and complicate friendships and broader social interactions.
These challenges in relationships usually arise from difficulties with empathy, increased sensitivity to criticism, and patterns of manipulation or dominance.
If you’re concerned about the impact of NPD on your relationship, a mental health professional can offer much-needed support and guidance. This page can also help you better understand the NPD impact on relationships by exploring:
The impact of NPD on different types of relationships- Mental health impacts of NPD on partners
- Support options for people with NPD
- Where to find professional support for narcissistic personality disorder
The Impact of NPD on Relationships
People with NPD, unfortunately, often struggle to maintain relationships. What’s more, this difficulty isn’t limited to intimate, romantic relationships. It may also include general challenges in other social settings with family, friends, and workplace colleagues.
The following sections detail how NPD can impact different types of relationships.
Important note: The findings discussed in the following sections may involve extreme or pathological examples of narcissistic traits. NPD is a spectrum, so people’s symptoms can vary in severity. Therefore, if you or a loved one has narcissistic traits, this is not confirmation that you will struggle in such ways.
NPD Impact on Romantic Relationships
NPD can distort the dynamics of intimacy, trust, and mutual respect in romantic relationships.
In fact, research consistently highlights the detrimental effects of narcissistic traits on relationship satisfaction. For instance, a 2024 study revealed that narcissism is linked to various obstacles within couple relationships, including emotional coercion and a lack of empathy.2
These issues often boil down to how people with NPD often engage in manipulative behaviors to maintain control, which include:
- Gaslighting
- Making subtle demeaning comments
- Shifting blame to the partner for every misunderstanding
Narcissists also may seek dominance in romantic partnerships. Evidence for this statement comes from studies that observed how narcissism can manifest as controlling behaviors that undermine a partner’s autonomy and create persistent power imbalances.3 Such dynamics often hinder healthy communication and mutual decision-making between partners.
In addition, a core feature of NPD is impaired empathy. People with NPD typically struggle to understand their partner’s emotions, which can result in feelings of isolation and neglect. Over time, this lack of emotional attunement can erode the foundations of relationships.
Finally, emotionally dependent partners may be particularly vulnerable to the impact of narcissism. According to research, narcissistic partners tend to exploit this dependency, which could result in repeated cycles of psychological abuse.4
Impact of NPD on Parent-Child Dynamics
Parents or caregivers with clinically significant narcissistic traits can have a huge impact on the attachment, selfhood, and interpersonal expectations of their children.
One reason for this effect comes down to how narcissistic parents often expect admiration from children. Naturally, the child may learn to manage their parents’ image and avoid triggering their anger. Unfortunately, this pattern can create hypervigilance to others’ needs and a tendency toward people-pleasing in a child.
A contrasting reason for this impact is how some narcissistic parents over-praise their child, but to meet their own need for reflected glory, not the child’s intrinsic worth. Research on this parenting trait shows how it can actually lead to higher narcissistic traits in children.
Finally, narcissistic parents may designate one child as the “golden child” and another as the “scapegoat.” In this dynamic, the golden child is idealized as an extension of the parent, while the scapegoat bears disproportionate blame for family tensions. This split can foster sibling rivalry.
Collectively, these patterns may lead to the following outcomes in children:
- Attachment insecurity: Children of narcissistic parents may be more likely to develop anxious or avoidant attachment patterns5
- Internalizing symptoms: Parental narcissism strongly correlates with higher levels of depression and anxiety in children6
- Identity diffusion: Without consistent validation, children often struggle to form a stable sense of self. Many report feeling that they do not know who they are outside of achievements or external approval
- Intergenerational transmission: Overvalued children are at risk of developing narcissistic traits themselves. In contrast, neglected children may struggle with self-doubt and difficulties in later relationships5
NPD Impact on Friendships
Narcissistic grandiosity usually leads to being liked and accepted quickly in new social settings. But, in the long run, this effect tends to fade pretty quickly. In its place, traits of envy and dominance may produce friction in friendships. In fact, friends of people with narcissism often report lower levels of closeness (intimacy) and feeling valued (appreciation).Conflict is also more common in friendships with those scoring high on narcissistic traits. Friendship is supposed to be a two-way effort with elements of equality. However, when one friend pushes to be in control, resentment can grow.
Interestingly, a study followed 831 people over one year to examine how narcissistic admiration and rivalry can shape the quality of close friendships.7 It assessed four major outcomes: intimacy, appreciation, conflict, and dominance, and found that:
-
Narcissistic rivalry was linked to lower levels of appreciation and intimacy- Both narcissistic admiration and rivalry were associated with higher levels of conflict in friendships
- People high in rivalry were more dominant within their friendships
- Not feeling appreciated predicted later increases in rivalry
- Higher rivalry, in turn, led to feeling less appreciated, creating a negative cycle
Impact of NPD on Workplace Relationships
In workplaces, narcissistic people are often seen as high-energy and ambitious at first. But as their interactions accumulate, their actions may lead to harmful effects on work culture.
For example, research tells us that narcissistic traits are a predictor of hostile, aggressive behavior among coworkers. In fact, results from a sample of 236 nurses showed that pathological narcissism (very high levels of narcissistic traits) predicted workplace bullying.8
Leaders with narcissism could also affect subordinates’ career outcomes. A study in China with 291 employees explored how leader narcissism could lead to supervisor-subordinate conflict, which in turn might negatively influence career success. It found that employees with dominant personality traits particularly experienced conflict when their leader scored high on narcissism.9 This effect might suggest that narcissistic leaders disliked any form of pushback from employees.
Narcissistic leaders may also focus on short-term visibility or personal credit while neglecting sustainable practices. This links with lower job performance and emotional exhaustion among employees, potentially leading to lower productivity, increased likelihood of committing errors, and higher absenteeism.
NPD Impact on Social and Community Relationships
People with NPD typically attach themselves to others who make them look good or raise their social status, which can appear as social climbing. Additionally, studies show that narcissism is also linked to aggressive behavior, gambling problems, overspending, and substance use.
Symptoms of NPD have also been connected with arson, vandalism, threats of violence, and physical assault in community settings.
In fact, research on crime shows that people diagnosed with NPD were 5.64 times more likely to be sexual offenders compared to non-sexual offenders.10 This startling data indicates how a lack of empathy, a core feature of NPD, could lead to harmful or abusive actions.
Again, as an important reminder, the people included in the studies discussed may have had more severe or pathological NPD traits. These findings are not confirmation that you or a loved one will behave in such challenging ways.
The Mental Health Impact of NPD on Partners
Depression in this context often stems from persistent invalidation, loss of autonomy, and repeated cycles of devaluation. Living with a narcissistic partner could also mean living with unpredictability due to sudden outbursts of rage and withdrawal. Therefore, constant uncertainty may create a state of hypervigilance, where a partner is always on edge.
Another study looked at more than 1,200 people and demonstrated that narcissistic traits in partners predicted post-traumatic stress disorder (PTSD) symptoms.12 In these cases, psychological manipulation and coercive control could have left trauma imprints similar to those caused by overt violence.
Finally, research also documents heightened somatic complaints, such as headaches, fatigue, and recurrent illness, in partners exposed to pathological narcissism.13
Mental Health Support Options for People With NPD
Unfortunately, there’s no magic pill that “fixes” NPD overnight. Instead, long-term psychotherapy has shown the most benefits in helping people with NPD.
We take a look at some of the most effective mental health support options for people with NPD in the following sections.
Psychotherapy
As mentioned, psychotherapy remains the backbone of treatment in NPD. In fact, schema-focused therapy (schema therapy) is one of the most studied approaches for narcissism.14
Schema therapy is effective for a range of personality disorders, including NPD, and works by targeting deeply ingrained maladaptive patterns. This can help people replace rigid and defensive ways of coping with healthier strategies and has been linked to improved day-to-day functioning.
Additionally, psychodynamic therapies, such as transference-focused psychotherapy (TFP), are also well supported for treating NPD. TFP uses the therapeutic relationship to highlight how patients split others into “all good” or “all bad” categories, before helping them integrate these extremes into a more stable self-view.
Finally, mentalization-based treatment (MBT) can address empathy deficits, and recent reviews have found it beneficial for improving social functioning in people with borderline and narcissistic traits.
Group Therapy and Social Skills Training
Group settings give the opportunity for immediate interpersonal feedback. Group schema therapy, in particular, has been studied for personality disorders and was shown to reduce maladaptive behaviors.
Further, skills-based groups, drawing on dialectical behavior therapy (DBT) principles, can offer structured practice in emotion regulation, managing criticism, and reciprocal communication.
However, group therapy may not be easy for people with narcissistic traits. Many might initially struggle with feedback and attempt to dominate discussions. Yet, with skilled facilitation, group therapy can provide “corrective emotional experiences.” Therefore, it could give people a chance to see how their behaviors impact others and to test alternative ways of relating.15
Medication for Managing Comorbid Conditions
Many people with NPD who seek help do so because of comorbid conditions such as depression, anxiety, or impulsive aggression.
Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for co-occurring depression and anxiety. Alternatively, in cases where mood instability or aggression is severe, mood stabilizers (such as lamotrigine) or atypical antipsychotics may be considered.
However, medication is best viewed as supportive. It may alleviate distressing symptoms that make psychotherapy possible, but it cannot replace the long-term, reflective work needed to address the core features of NPD.
Get Help for Narcissistic Personality Disorder at Mission Connection
Living with NPD can be difficult both for the person with it and those around them. While there is no quick cure, meaningful progress is possible with the right support. You can reduce the negative effects of NPD on your relationships and begin building healthier connections with a strong support system.
At Mission Connection, our licensed mental health professionals are here to walk alongside you on this journey. We provide comprehensive assessments and can help you understand the full picture of your mental health.
From there, we guide you through evidence-based treatment options, so you can make informed decisions about what is best for you. Plus, if co-occurring conditions such as depression or anxiety are present, we also offer medication management to ensure your needs are fully addressed.
Our services are designed with flexibility in mind; we can work with you either online, in outpatient, or in-person settings, depending on what feels most comfortable for you. Reach out to our team today to learn more.
References
- Weinberg, I., & Ronningstam, E. (2022). Narcissistic personality disorder: Progress in understanding and treatment. FOCUS, 20(4), 368–377. https://doi.org/10.1176/appi.focus.20220052
- Lim, A. Y. (2024). Narcissism and couple relationship satisfaction: The mediating roles of accepting differences and conflict resolution strategies. Personality and Individual Differences, 225, 112656. https://doi.org/10.1016/j.paid.2023.112656
- Wright, A. G. C., Stepp, S. D., Scott, L. N., Hallquist, M. N., Beeney, J. E., Lazarus, S. A., et al. (2017). The effect of pathological narcissism on interpersonal and affective processes in social interactions. Journal of Abnormal Psychology, 126(7), 898–910. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5679127/
- de M., & Mena-Baumann, A. (2024). Emotional dependence and narcissism in couple relationships: Echo and Narcissus syndrome. Behavioral Sciences, 14(12), 1190. https://www.mdpi.com/2076-328X/14/12/1190
- Cramer, P. (2019). Narcissism and attachment. The Journal of Nervous and Mental Disease, 207(2), 69–75. https://doi.org/10.1097/NMD.0000000000000928
- Vignando, M., & Bizumic, B. (2023). Parental narcissism leads to anxiety and depression in children via scapegoating. The Journal of Psychology, 157(2), 1–21. https://doi.org/10.1080/00223980.2022.2153746
- Wehner, C., & Ziegler, M. (2022). Narcissism and friendship quality: A longitudinal approach to long-term friendships. Journal of Social and Personal Relationships, 40(2), 026540752211220. https://doi.org/10.1177/02654075221122006
- Jang, S. J., & Lee, H. (2022). Pathological narcissism, interpersonal cognitive distortions, and workplace bullying among nurses: A cross-sectional study. Journal of Nursing Management, 30(8), 4250–4258. https://doi.org/10.1111/jonm.13771
- Wang, H., Li, D., Wu, L., & Ding, Z. (2021). Effects of leader narcissism on career success of employees: An interpersonal relationship perspective. Frontiers in Psychology, 12, 799802. https://doi.org/10.3389/fpsyg.2021.799802
- Jay, J., & Sigler, A. (2017). Risk and prevalence of personality disorders in sexual offenders (Master’s thesis, City University of New York). CUNY Academic Works. https://academicworks.cuny.edu/cgi/viewcontent.cgi?article=1007&context=jj_etds
- Day, N. J. S., Bourke, M. E., Townsend, M. L., & Grenyer, B. F. S. (2019). Pathological narcissism: A study of burden on partners and family. Journal of Personality Disorders, 34(6), 1–15. https://doi.org/10.1521/pedi_2019_33_413
- Arabi, S. (2023). Narcissistic and psychopathic traits in romantic partners predict post-traumatic stress disorder symptomology: Evidence for unique impact in a large sample. Personality and Individual Differences, 201, 111942. https://doi.org/10.1016/j.paid.2022.111942
- Kealy, D., Rice, S. M., Ogrodniczuk, J. S., & Cox, D. W. (2018). Investigating the link between pathological narcissism and somatization. Journal of Nervous & Mental Disease, 206(12), 964–967. https://doi.org/10.1097/NMD.0000000000000903
- Behary, W. T., & Dieckmann, E. (2012). Schema therapy for narcissism. In W. K. Campbell & J. D. Miller (Eds.), The handbook of narcissism and narcissistic personality disorder (pp. 445–456). Wiley. https://doi.org/10.1002/9781118093108.ch29
- Nook, E. C., Jaroszewski, A. C., Finch, E. F., & Choi-Kain, L. W. (2022). A cognitive-behavioral formulation of narcissistic self-esteem dysregulation. FOCUS, 20(4), 378–388. https://doi.org/10.1176/appi.focus.20220055
