A Caregiver’s Guide to Caring for a Narcissist

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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.

Strategies for coping with narcissistic family members

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".

  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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347 Comments

I have read that almost everyone has some narcissistic tendencies. I feel like I have been groomed to be a manager since childhood. It is my job to make sure everything runs smoothly. The other day she couldn't find her social security card and I just put my foot down and said ' it's your card and you are the last one who had it, so you will need to find it yourself.' (This did not go over well) When I was in my late teens a counselor told me that I seemed to have the weight of the world on my shoulders. I still do, only the load has gotten even larger. I know that I have some tendencies as well - I tend to want to control things ( maybe because when I was little, I never knew which mood my parents would be in that particular day or hour) and I have very little patience. My mother goes between feeling bad that she puts everything on me, to then expecting me to just automatically take charge of everything, and she has a very low frustration threshold. Anything that doesn't set well with her is my fault.
And I'm sure that everyone on here can relate to how no one believes this because when company comes, or the person is out is public, they seem so charming and sweet that people think that YOU are the problem!
When I was little and we were shopping, she would be just hissing at me about some trivial thing, and then someone would walk up to talk and she would go into the act. If they would complement me, she would say thank you and smile sweetly and then tear into me again as soon as they were gone.
The part that messes kids up is the Dr Jeckyl and Mr Hyde thing - they care, they don't care. You're great - you're terrible. I love you IF you do what I want. No one will love you like I do, so you better stick around and look after my needs. If I argue or complain then she wishes she was dead - so then I have THAT on my head as well....No wonder I'm so tired all the time. It is tiring trying to be a full time employee.
3pinkroses: I am sending three dozen pink roses to you! Thank you so much for your kind words. I really appreciate them and getting even a tiny amount of validation sure helps when your spirit has been so beaten down.
I loved your comment "I think they can bring out the worst in a person as they have already stripped away the best" -- that is for sure so true.
Thank you very much for giving me credit for the hardest job I have ever undertaken in the spirit of just trying to be a good daughter/person and do the right thing. More than once in the last three years have I wished that I could have my "old" life back.
Bless your heart for answering this post! Your understanding and remarks have really made my day today. I am grateful!
From the perspective of someone who has worked with seniors in long term care for many years, I want to say that I completely understand the very complicated and painful position of children who find themselves caring for narcissistic or otherwise abusive parents. Those of us who work in long term care do not judge you when you come to the end of your rope and have to find other care-options for your parents. We have the advantage of never having known your mothers or fathers until they day they step inside our facilities. We have no bad memories of how they've mistreated us, and we are trained in handling difficult behaviors from elders without allowing those behaviors to be injurious to us on an emotional level. The longer I have worked in this field the more I have come to understand the value of society as a whole taking responsibility for the care of our elders. Sometimes caring for a parent is just more than one caregiver can possibly bear, especially when there is a history of personality disorder or abuse.

I'm not fond of this author's suggestion that we determine "how much abuse we will accept." In my opinion, the answer to that is NONE. We should accept NO abuse from anyone, ever and I think that includes aging parents. Of course there are times when a non-personality disordered parent develops dementia and may display some behavior problems, but absent the past abuse and life-long dysfunctional relationship dynamics, those folks are much easier to tolerate and caregivers can find lots of support in caring for them. Unfortunately, there isn't much support out there for people who have to live with a personality disordered other in their lives at any age.