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, PhD, a psychologist who helps her elderly clients deal with a variety of mental health issues, claims that narcissistic tendencies often become less pronounced as a person ages. Yet many caregivers would say that they deal with self-important seniors daily.

Whether they come in the form of an uncompromising elderly care recipient, a selfish sibling or exploitative in-laws, narcissists can be a difficult burden for caregivers to bear. Although true NPD is deeply ingrained in one’s personality and it is notoriously difficult to treat, learning about this disorder can help caregivers better navigate relationships with their narcissistic care recipients.

What Is Narcissism?

Known as narcissistic personality disorder (NPD), narcissism is marked by feelings of extreme superiority, demanding endless praise and recognition, and constant manipulation of other people (including friends and family) with little or no regard for 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. In fact, their penchant and knack for manipulating those around them can make some narcissists difficult to detect.

Dr. Thomas suggests avoiding black and white thinking when it comes to spotting narcissism. Like many mental illnesses, NPD exists on a spectrum. “We all have a degree of narcissism in us,” she explains. After all, self-preservation is a basic evolutionary trait in many animals, especially humans.

Could the Person I’m Caring for Be a Narcissist?

If you think you may be caring for a senior with narcissistic tendencies, consider how pervasive your care recipient’s sense of self-importance is. Do their needs, no matter how trivial, always come before others’? Are they hypersensitive to criticism? Are feelings like fear, obligation and guilt a regular part of your caregiving routine? Does your care recipient encourage or provoke these emotions to use them to their advantage? If you answered yes to any of these questions, it doesn’t necessarily mean this person is a narcissist, but understanding their thought processes can help you learn how to navigate these more abrasive aspects of their personality.

It’s also important to consider whether a senior’s personality is much the same as it has been over the course of their life or whether new characteristics are emerging. 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.

However, 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, says Dr. Thomas. Grief and anxiety can manifest in unusual ways and it is important to rule out new or unusual changes in mood and behavior. In some cases, these symptoms can be easily treated, or they may point to a new underlying medical problem like the onset of dementia.

Are Narcissists a Product of Nature, Nurture 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 offer little to no thanks and refuse to reciprocate.

For true narcissists, their behavior patterns often extend far into their past, but they don’t emerge fully-formed from the womb. Dr. 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, their biology and their environment.

It makes sense. People are genetically programmed to be concerned for their individual health and wellbeing, even when it sometimes comes at the expense of others. Furthermore, NPD is thought to be hereditary. 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 person could develop narcissistic tendencies.

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Improving Interactions with a Narcissist

The dynamics that exist in a caregiving relationship are complex for even the most “healthy” and tight-knit families. When a care recipient exhibits narcissistic tendencies, it can be both frustrating and extremely painful for the person trying to provide care for them.

Meredith Resnick, LCSW, feels that taking care of a family member who is narcissistic can make interactions exceedingly difficult to navigate. “Because patterns between aging parents and adult children are typically long-standing, the emotions involved can be pretty intense,” she admits.

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 manner, Resnick says that the best option is to steer clear of outright confrontation at all costs. 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 care recipient, then 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 own interests. For example, if a senior refuses to take their medication because they think their prescribing doctor is a “quack,” simply remind them that if they don’t take the pills, they’re more likely to have to go back to the doctor and endure their uneducated ramblings. On the other hand, if they take the medication, they’ll be able to avoid further “unnecessary” trips to the doctor’s office.

Narcissists may be master manipulators and notoriously difficult to care for, but there are strategies that can help you get your way without wanting to pull your hair out. Most caregivers are uncomfortable with using these techniques at first but learning to detach and set boundaries will help. These things just take practice and a firm commitment.

Read: Detaching With Love: Setting Boundaries in Toxic Relationships

Strategies for Coping with Narcissistic Family Members

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

Dr. Thomas admits that caring for a narcissist isn’t easy and is likely to “challenge one to the core of their being.” She offers these three recommendations for caregivers who find themselves in this situation:

  1. Do as much as you can to get respite, maintain a social life of some sort and engage in activities that you enjoy and that rejuvenate you.
  2. Seek professional help from a counselor or psychologist to help you sort through your feelings and learn detachment.
  3. Set personal limits on how much abuse you are willing to take and stick to them no matter what.

It’s also important to remember that a relationship with a narcissist is, effectively, a one-way street. Those with NPD tendencies are so caught up in themselves that they have a limited ability to love other people, understand their perspectives or value their emotions. Truly accepting this reality will help you acknowledge your role as a protector and provider for someone who lacks the ability to reciprocate with feelings of love, appreciation, or even tolerance.

Know Your Limits

Resnick and Dr. Thomas both urge caregivers in this situation to take responsibility for their personal emotional state. Remember, you cannot control a narcissist. You can only control yourself.

If you are struggling to come to terms with your feelings and your mental and physical health are suffering, it may be time to set stricter boundaries with your care recipient or walk away altogether. In fact, professional health care workers may be more successful in providing quality care because they do not have a personal history with the senior and are therefore more immune to their emotional blackmail.

The last thing a narcissist wants is for their caregiver’s needs (or anyone’s needs, really) to supersede their own. Caregivers are usually selfless individuals, and those with NPD often use this to their advantage. BUT you must remember that you are important, too. Your health and happiness matter. Making meaningful changes to your situation will require you to act in your own self-interest for once. It will be difficult, but this is certainly not something to feel guilty about; it is a necessity.