The path to change for someone with narcissistic personality disorder is more narrow than previously perceived, according to a new report published in Psychological Bulletin.

Researchers analyzed 51 studies of more than 37,000 participants to see how narcissistic tendencies shifted during a lifespan. They found that over a course of decades, narcissism did decrease, but only a little. At most, researchers saw a moderate decline.

Narcissistic personality traits include a sense of entitlement, lack of empathy, need for admiration, and a grandiose sense of self-importance.

Dr. Ramani Durvasula, a clinical psychologist in Los Angeles who focuses on narcissistic and antagonistic personality types, has treated about 50 narcissist and says these findings reflect her own experiences.

"For the longest time it always felt defeatist to take the stance that people with narcissistic personality disorder don't change," she says. "But I know this doesn't change. It's not going to change."

Durvasula has a new show, Reality Check, on the interactive streaming platform Fireside where she discusses different mental health issues.

Oftentimes, she says, people take solace in the idea that anyone could improve at anytime. But, in reality, this is an idealistic and potentially harmful perspective.

"We have to get out of our Hallmark movie ways," she says. "It doesn't feel fair, and it's hard, but it's a fundamental truth that they don't change."

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'Narcissism is characterized by a lack of self-reflectiveness'

Someone with NPD, by definition, doesn't believe anything is wrong with them.

"The more maladaptive a personality, the less likely they are to change," Durvasula says. "On top of that, narcissism is characterized by a lack of self-reflectiveness."

Most narcissists come from two types of upbringings: one where their parents were neglectful and possibly abusive and one where they were spoiled.

If a person was raised with the former type of childhood, they might be more amenable to change, she says: "You might be able to get in a little more purchase, get your feet in there with a client who is then starting to recognize why they are so 'me against the world,' why they feel so combative." 

With those who grew up spoiled, Durvasula hasn't seen any success. 

"With the spoiled child narcissist, forget it," she says. "That is indoctrinated. People telling their kids they are the most special and you deserve everything. No you don't. I've never seen luck with those clients." 

'A narcissist can come off like an empathic person'

Narcissists can present as well-adjusted and thoughtful, which is why many people can unknowingly be in relationships with one for years.

"They can keep it together when their needs are well-supplied," Durvasula says. "When they are getting all the praise they want, all the adulation they want, their partner is anticipating their needs, everything is going well like psychological clockwork, a narcissist can come off like an empathic person."

However, it's unrealistic to expect that you can meet the needs of someone at all times.

"It's almost like somebody on a diet," she says. "If you can structure your life just so and get the right amount of activity and genetically be lucky enough, you can get that weight off and keep it off, but that's not usually how it goes because that's not how life goes."

Instead of expecting a narcissist to change, Durvasula advises those in relationships with them to seek professional help.

"We need to help people work through the grief of a relationship that is not unfolding in a way they feel psychologically safe," she says.

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