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A Caregiver’s Guide to Caring for a Narcissist

Narcissists—you can't leave them, it's nearly impossible to love them, and you feel like you want to pull your hair out whenever you're around them.

Laura Thomas, Ph.D., a psychologist who helps her elderly clients deal with a variety of mental health issues, says that narcissistic tendencies often become less pronounced as a person ages.

Yet many caregivers would say that they have to deal with self-important people on a daily basis.

Whether they come in the form of an uncompromising elderly care recipient, a selfish sibling, or an exploitative uncle, narcissists can be a difficult burden for caregivers to bear.

Formally known as Narcissistic Personality Disorder (NPD), narcissism is a mental disorder marked by feelings of extreme superiority, demanding endless praise and recognition, and constant manipulation of other people (including friends and loved ones) with little or no regard to their feelings or emotions.

Narcissists can come in a variety of flavors. They can be grandiose peacocks who strut about, shoving their imagined superiority in your face, or they can be magnetic and outwardly caring—until you get in their way.

Picking the overly-prideful out of a crowd

Their penchant for and ability to manipulate those around them can make a narcissist difficult to spot.

Thomas suggests avoiding viewing the issue as simply black and white—either a person is, or is not narcissistic. Caregivers should shift their focus to how pervasive of a senior's sense of self-importance is. "We all have a degree of narcissism in us," she says, explaining that the classic signs of the disorder "exist on a continuum."

The other trick is to examine a senior's personality over the course of their entire lives. If they have been noticeably ostentatious, manipulative, attention-seeking, and self-focused for years, chances are that they have always been (and will likely always be) a narcissist.

A senior who suddenly develops some narcissistic tendencies following a major life event, such as, the loss of a spouse, or the onset of a major health issue, may be suffering from a different mental ailment, like depression, according to Thomas.

Born, bred, or both?

For a caregiver, it can sometimes feel as though one is constantly surrounded by an army of self-important people who demand our time and attention, but refuse to reciprocate.

Where do they all come from?

Though their behavior patterns often extend far into their past, narcissists don't emerge, fully-formed, from the womb.

Thomas notes that pinning down specific causes of narcissism is tricky. She says that self-centered people are generally a product of the confluence of two greatly influential forces: biology, and environment.

It makes sense. People are genetically programmed to be concerned for their individual health and wellbeing, even when it is sometimes comes at the expense of others. If you combine those biological promptings with certain environmental factors, such as neglect, abuse, and over-parenting, it's not difficult to see how a narcissist could be developed.

Improving interactions

The complex relationship dynamics that exist in a caregiving relationship can make engaging a narcissistic care recipient both frustrating and hurtful for a caregiver.

Meredith Resnick, L.C.S.W., a health writer and social worker, feels that taking care of a family member who is narcissistic can make interactions difficult to navigate. "Because patterns between aging parents and adult children are typically, on some level, long-standing, emotion can feel intense," she says.

It's easy to become entrenched in an unproductive cycle of verbal blow-ups if caregivers are not careful when dealing with an egoistic elder.

When a senior is behaving in a selfish difficult manner, Resnick says that a caregiver should steer clear of outright confrontation. Before directly challenging an aging family member, the caregiver should first determine what they want to achieve by confronting the problem.

If the issue is a minor one, it might be best for the caregiver to cede the victory to the senior.

If, on the other hand, the issue impacts the health and wellbeing of the caregiver or their elderly family member—for example, the senior refuses to take their medication because they think their doctor is a "quack"—the caregiver should seek to address the problem in a productive way.

One way to do this is by aligning what you want the narcissist to do with their interests. In the case of the elder who won't take their meds, you may try reminding them that if they don't take the pills, they're more likely to have to go back to the "quack" doctor and endure their uneducated ramblings, whereas, if they take the medication, they might be able to avoid unnecessary trips.

Coping on your own

An elderly narcissist is unlikely to change their behavior. Psychologists agree that NPD is notoriously difficult to treat, even in young, physically healthy people.

Thomas admits that caring for a narcissist isn't easy and is likely to, "challenge one to the core of their being," and offers some strategies to help caregivers cope with narcissistic family members:

  1. Do as much as you can to maintain a social life of some sort.
  2. Seek professional help from a counselor or psychologist.
  3. Set personal limits on how much abuse you are willing to take, and stick to them.

It's also important to remember that a relationship with a narcissist is, effectively, a one-way street. Narcissists are so caught up in themselves that they have a limited ability to love other people.

Truly accepting this reality will help a caregiver to acknowledge their role as a protector and provider for someone who lacks the ability to reciprocate with feelings of love, appreciation, or even tolerance.

Resnick and Thomas both urge caregivers to take responsibility for choosing their personal emotional state. You can't control the narcissist—you can only control yourself.

Thomas' final piece of advice may be difficult for the caregiver, hunched in their foxhole, anxiously awaiting another barrage of narcissistic friendly fire, to accept. "Life never promised to be easy," she says, "In fact, we tend to grow the most around the difficult situations life throws at us—including the compassionate, gentle care of a narcissistic, aging parent."

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