Can a Narcissist Change? An Honest, Science-Backed Guide for Anyone Who Recognises Themselves in the Pattern
This article is written for a specific reader.
Not for the person who has been hurt by a narcissist, though we have written for them too. This is for the person who has been reading, or listening, or sitting silently with a growing and uncomfortable recognition of all the things they are talking about on social media and articles actually describing themself. The person who has started to see themselves in descriptions they never expected to relate to. Who has noticed a pattern in their relationships, the way people eventually pull away, the intensity that burns bright then collapses, the gap between how they present and how they feel inside, and is asking, with some courage and some dread: is this me?
If that is you, recognising narcissistic patterns in yourself and wondering whether change is possible, then this is one of the most important things you will read. Because the fact that you are asking the question at all places you in a very small category. And that category matters more than almost anything else when it comes to what is possible.
First: What Does It Actually Mean to Have Narcissistic Traits or NPD?
Narcissism exists on a spectrum. At one end are people with elevated narcissistic traits, a strong need for admiration, difficulty with criticism, a tendency to centre themselves in relationships, that cause friction but do not define every interaction. At the other end is Narcissistic Personality Disorder (NPD), a formally diagnosed clinical condition characterised by the DSM-5 as a pervasive pattern of grandiosity, an excessive need for admiration, and a significant lack of empathy that begins in early adulthood and affects multiple areas of life.
Research published in Frontiers in Behavioral Neuroscience estimates that between 0.5% and 5% of the population meets the clinical threshold for NPD, with higher prevalence among men, though narcissistic traits exist across all genders and backgrounds (Elleuch, 2024).
Importantly: most people reading this will sit somewhere in the middle of that spectrum. They will not necessarily meet full diagnostic criteria for NPD. But they will recognise patterns, in how they respond to perceived slights, in how they relate to partners, in the way shame moves through them, that they want to understand and address. That recognition is not a weakness. It is the beginning of something.
Can a Narcissist Actually Change? What the Research Says
The clinical consensus has, historically, been cautious. People with NPD are among the least likely to seek therapy, partly because the disorder’s defensive architecture makes vulnerability deeply threatening, and partly because a person who genuinely believes they are exceptional rarely feels motivated to change. Dropout rates in therapy are significantly higher among people with narcissistic traits than other client groups.
But the picture is more hopeful than it is often portrayed.
A landmark 2024 study published in The Journal of Nervous and Mental Disease examined eight patients with diagnosed NPD who underwent sustained psychotherapy over 2.5 to 5 years. The results were significant: average DSM-5 NPD criteria scores dropped from 7.75 to 2.31. Diagnostic Interview for Narcissism scores fell from 11.0 to 0.75. By the end of treatment, none of the patients met the diagnostic criteria for NPD, and all showed improvements in work, relationships, and financial independence (Weinberg, Ronningstam et al., 2024).
This is a small study. But it is peer-reviewed, it is recent, and it is meaningful, because it demonstrates that with sustained, skilled therapeutic intervention, significant change is not just theoretically possible. It has been documented.
A separate body of research from Medical News Today confirms that narcissistic traits also tend to naturally decline with age, a 2024 longitudinal study found that narcissism decreases across multiple dimensions as people move through adulthood (Medical News Today, 2025). Change, in other words, happens, but it happens far faster and more meaningfully when it is deliberate.
The honest caveat: change for someone with deeply entrenched narcissistic patterns is slow, non-linear, and requires sustained commitment. There is no shortcut, no insight that immediately transforms behaviour, no relationship that will do the work therapy has to do. But for those who genuinely engage, the evidence says it is possible.
What Makes Change So Difficult, and Why That Is Not Your Fault
Understanding the architecture of narcissism is not an excuse. But it is essential context for anyone attempting to change it.
Neuroimaging research has identified dysfunction in the anterior insular cortex and prefrontal circuits in people with NPD, the regions responsible for empathy, emotional regulation, and self-referential processing (Springer Nature, 2024). This means that the difficulty with empathy and emotional regulation that characterises narcissism is not purely a choice. There is a neurological dimension to it.
Additionally, the roots of narcissism are almost always developmental. Research consistently links narcissistic personality structures to early childhood experiences, including both excessive idealisation (being told you are special without limits) and emotional neglect or abuse (learning that vulnerability is dangerous and that only strength and performance earn love). The grandiose self that narcissism constructs is, in many cases, a protective structure built around a deeply wounded inner child who never learned that they were enough simply as themselves.
This does not excuse harmful behaviour. But it does reframe where change has to begin, not at the surface of behaviour, but at the level of the beliefs and wounds that drive it.
The Signs That Change Is Genuinely Possible for You
The most significant predictor of whether a person with narcissistic traits can change is not the severity of those traits. It is motivation, specifically, internal motivation. Not the desire to change in order to keep a partner, or to avoid consequences, or to be seen as the kind of person who can change. But a genuine, self-directed recognition that the current pattern is causing harm and that a different way of being is worth working toward.
Other indicators that change is more likely:
You feel shame, not just guilt. Guilt says “I did something wrong.” Shame says “there is something wrong with me.” While chronic shame is painful and requires therapeutic work, its presence indicates a capacity for moral self-reflection that is essential for growth.
You can hold another person’s perspective, even briefly. The ability to momentarily step outside your own experience and recognise how your behaviour lands on someone else, even if that recognition is uncomfortable, is a foundational skill that therapy can build on.
You are willing to be uncomfortable. Therapeutic change for narcissistic patterns requires tolerating significant discomfort, the exposure of vulnerability, the acknowledgement of harm caused, the dismantling of defences that have felt essential to survival. Willingness to sit in that discomfort, rather than flee from it, is what separates people who change from those who don’t.
You have sought this information yourself. You are reading this. That matters.
The Therapeutic Approaches That Work
If you recognise these patterns and want to change them, therapy is not optional, it is the only evidence-based route. Self-awareness alone, without professional support, is rarely sufficient for the kind of deep structural change that narcissism requires. Here are the modalities with the strongest evidence base for NPD and narcissistic traits:
Schema Therapy
Schema therapy works by identifying the core beliefs, or “schemas”, formed in childhood that drive current behaviour. For people with narcissistic traits, common schemas include entitlement (“I deserve special treatment”), emotional deprivation (“my needs will never be genuinely met”), and defectiveness (“if people see the real me, they will reject me”).
A randomised controlled trial published in the American Journal of Psychiatry found schema therapy to be superior to both treatment as usual and clarification-oriented psychotherapy for personality disorders including NPD, with a significantly lower dropout rate than transference-focused therapy (Giesen-Bloo et al., AJP, 2014). A 2023 study also found schema therapy specifically effective in improving self-esteem and reducing impulsivity in individuals with NPD (Health Nexus, 2023).
Schema therapy is widely considered one of the most promising approaches for narcissistic personality structures because it addresses root causes rather than surface behaviours.
Transference-Focused Psychotherapy (TFP)
TFP uses the therapeutic relationship itself as the vehicle for change, examining how the client relates to the therapist as a window into their broader relational patterns. It is intensive (typically twice weekly) and psychoanalytically grounded, helping clients integrate fragmented self-concepts and develop a more stable, realistic sense of self.
Research from the APA and Psychodynamic Psychiatry supports TFP’s effectiveness specifically for narcissistic pathology (Diamond, Yeomans & Keefe, 2021). The 2024 Weinberg and Ronningstam case series that showed full remission in NPD patients drew on patients who had undergone variants of this approach.
Mentalization-Based Therapy (MBT)
Mentalization is the capacity to understand your own and others’ mental states, thoughts, feelings, intentions, and how they drive behaviour. For people with narcissistic traits, this capacity is often underdeveloped: they may understand others’ behaviour intellectually without grasping the emotional reality behind it.
MBT builds this capacity systematically, and research indicates it can improve both empathic functioning and relationship quality in people with personality disorder presentations (Study Finds, 2025).
What to Look for in a Therapist
Not every therapist is equipped to work with narcissistic personality structures. You need someone who:
-
Has specific experience with personality disorders
-
Can hold firm, clear therapeutic boundaries without being punitive
-
Offers warmth alongside honesty, the therapeutic relationship is the medium through which change happens
-
Will not collude with your defences, but will also not shame you for having them
In the UK, the BACP therapist directory allows you to filter by speciality. The British Psychological Society also lists accredited clinical psychologists with personality disorder experience.
What the Process of Change Actually Looks Like
This is the part most articles skip. Knowing that change is possible is one thing. Understanding what the journey looks like is what prepares you for it.
It begins with sitting with discomfort you have been avoiding your whole life. The grandiose self-image that narcissism constructs exists precisely to protect against feelings of shame, inadequacy, and worthlessness. Dismantling it means encountering those feelings, not once, but repeatedly, in the contained safety of a therapeutic relationship. This is painful. It is also unavoidable.
It requires accountability without self-destruction. One of the most difficult tasks for people with narcissistic traits is learning to acknowledge harm caused without collapsing into either denial or catastrophic shame. Therapy helps you develop the capacity to say “I hurt someone, and I take responsibility for that” without that acknowledgement feeling like it annihilates your sense of self.
It is not linear. There will be sessions where genuine insight breaks through. There will be weeks where the old patterns reassert themselves with full force. Progress in this kind of therapy is measured across years, not months. The 2024 study showing full NPD remission involved patients who had worked for between 2.5 and 5 years. Set your timeline accordingly.
Your relationships will change, and not always comfortably. As you develop greater empathy and self-awareness, you will begin to see how your patterns have affected the people around you. Some relationships will strengthen. Others may not survive the honesty that growth requires. Grief is a normal part of this process.
Books Worth Reading
These are clinically grounded, honestly written resources for anyone seeking to understand narcissistic patterns, including in themselves:
Why Is It Always About You? by Sandy Hotchkiss, A foundational text that maps what Hotchkiss calls the “seven deadly sins of narcissism” with clarity and without cruelty. Valuable both for self-recognition and for understanding the developmental roots of narcissistic behaviour.
Disarming the Narcissist by Wendy T. Behary, Written primarily for those in relationship with narcissists, but deeply useful for anyone with narcissistic traits who wants to understand how their behaviour lands on others. Behary’s schema therapy framework is compassionate and practical.
Identifying and Understanding the Narcissistic Personality by Elsa F. Ronningstam, The most clinically rigorous of the recommendations. Ronningstam is one of the foremost researchers in NPD globally and co-authored the 2024 study cited in this article. Dense reading, but invaluable for deep understanding.
The New Science of Narcissism by W. Keith Campbell, An accessible, research-grounded overview of what narcissism actually is (and isn’t), written by one of the leading academic psychologists in the field. Excellent as a starting point.
Adult Children of Emotionally Immature Parents by Lindsay C. Gibson, Not about narcissism directly, but essential reading for anyone whose narcissistic traits developed in response to emotionally immature or neglectful parenting. Understanding where the patterns came from is part of changing them.
The Bottom Line
Can a narcissist change? Yes, but not easily, not quickly, and not without deliberate, sustained work in a skilled therapeutic relationship.
The research is clear that the single biggest factor determining whether change happens is not the severity of the traits. It is the willingness to seek help and stay in the process even when it is deeply uncomfortable.
The fact that you have read this far, that you recognised yourself in something and chose curiosity over defensiveness, is not a small thing. Most people with narcissistic traits never get here. The wound that creates narcissism is, at its core, the belief that the real self is unacceptable and must be hidden. The first act of genuine change is deciding to look at the real self anyway.
That takes more courage than most people will ever be asked for. And it is worth it, not just for the people in your life, but for you.
For more on relationships, self-awareness, and mental health, explore The Confidence Magazine’s Relationships and Empowerment sections. If you found this article via our piece on toxic friendships or narcissistic relationships, this piece is its companion, written for the other side of the dynamic.
References & Citations
-
Elleuch, D. (2024). Narcissistic Personality Disorder through psycholinguistic analysis and neuroscientific correlates. Frontiers in Behavioral Neuroscience, 18, 1354258. https://www.frontiersin.org/journals/behavioral-neuroscience/articles/10.3389/fnbeh.2024.1354258/full
-
Weinberg, I., Ronningstam, E., Ravichandran, C., & Gunderson, J. (2024). Can Patients With Narcissistic Personality Disorder Change? The Journal of Nervous and Mental Disease, 212(7), 392–397. https://journals.lww.com/jonmd/fulltext/2024/07000/can_patients_with_narcissistic_personality.6.aspx
-
Springer Nature. (2024). Narcissistic Personality Disorder [Encyclopedia Entry]. https://link.springer.com/rwe/10.1007/978-3-031-40858-8_555-1
-
Giesen-Bloo, J. et al. (2013/2014). Results of a Multicenter Randomized Controlled Trial of the Clinical Effectiveness of Schema Therapy for Personality Disorders. American Journal of Psychiatry. https://psychiatryonline.org/doi/10.1176/appi.ajp.2013.12040518
-
Diamond, D., Yeomans, F., & Keefe, J. R. (2021). Transference-Focused Psychotherapy for Pathological Narcissism and Narcissistic Personality Disorder. Psychodynamic Psychiatry, 49(2), 244–272. https://www.apa.org/pubs/journals/features/pap-pap0000145.pdf
-
Health Nexus. (2023). The Effectiveness of Schema Therapy Focused on Mindset on Self-Esteem and Impulsivity in Individuals with Narcissistic Personality Disorder. https://journals.kmanpub.com/index.php/Health-Nexus/article/view/2474
-
Medical News Today / Villines, Z. (Updated 2025). Can a narcissist change? Impact of therapy, love, or age.Medically reviewed by Bethany Juby, PsyD. https://www.medicalnewstoday.com/articles/can-a-narcissist-change
-
Study Finds. (2025). Can Narcissists Actually Change? https://studyfinds.org/can-narcissists-actually-change/
-
ResearchGate / Rohde. (2015). Schema Therapy: An Approach for Treating Narcissistic Personality Disorder.https://www.researchgate.net/publication/281519389
Please Note: This article is for informational and educational purposes only and does not constitute professional psychological, psychiatric, or therapeutic advice. If you believe you may have narcissistic personality traits or NPD and want to address them, we strongly encourage you to seek support from a qualified mental health professional. In the UK, you can find a specialist via the BACP therapist directoryor the British Psychological Society. Self-recognition and help-seeking are acts of courage, and the right support makes all the difference.