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 licensed psychologist based in California who helps clients of all ages deal with a variety of mental health issues, claims that narcissistic tendencies often become less pronounced as a person ages. Yet many family caregivers—especially adult children—would say that they deal with self-important seniors daily.

Whether they come in the form of an uncompromising parent, a selfish sibling or exploitative in-laws, narcissists can be a difficult burden for caregivers to bear. Although true narcissistic personality disorder (NPD) is deeply ingrained and notoriously difficult to treat, learning about this disorder can help family caregivers better navigate relationships with aging narcissists.

What Is Narcissism?

Known as narcissistic personality disorder, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) describes narcissism as a specific set of impairments in one’s identity and self-direction, impairments in interpersonal functioning and pathological personality traits. Narcissistic behavior is marked by antagonism, which involves a lack of empathy for others, attention-seeking (grandiosity), manipulativeness, deceitfulness and callousness.

While most people tend to have a rigid concept of what a classic narcissist acts like, there are a few different types of narcissism. A narcissist can be a grandiose peacock who struts about, flaunting their imagined sense of superiority in your face, or they can be charming and outwardly caring—until you get in their way. Covert narcissists may come across as shy, self-deprecating, introverted and/or sensitive. In fact, their penchant and knack for manipulating those around them can make some narcissists difficult to identify.

Dr. Thomas suggests avoiding black and white thinking when it comes to spotting narcissism. Like many mental disorders, 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. To complicate matters further, individuals with narcissistic personality disorder often have additional mental health issues, such as depressive disorder, substance use disorders, or other personality disorders.

Read: Understanding Mental Health Issues in Seniors

Could You Be Caring for a Narcissistic Parent?

If you think you may be caring for an elderly narcissist, consider how pervasive your care recipient’s sense of self-importance is. Do their needs, no matter how trivial, always come before those of 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 (a tactic known as emotional blackmail or FOG)? If you answered yes to any of these questions, it doesn’t necessarily mean your parent is a narcissist. However, understanding their thought processes can help you learn how to navigate these more abrasive aspects of their personality.

It is 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-absorbed 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 disorder like depression Dr. Thomas notes. Grief and anxiety can manifest in strange ways and it is important to rule out new or unusual changes in mood and behavior. In some cases, these symptoms can be more easily treated, or they may point to an underlying medical problem like the onset of dementia.

What Causes a Person to Become a Narcissist?

For a family caregiver, it can sometimes feel as though one is constantly surrounded by 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 do not 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 well-being, even when it sometimes comes at the expense of others. Furthermore, NPD is thought to be hereditary. If you combine those biological features with certain environmental factors, such as neglect, abuse and/or over-parenting, it’s not difficult to see how a person could develop narcissistic tendencies.


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How to Deal With a Narcissistic Parent

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, author of When Your Parent Is a Narcissist, 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 is easy to become entrenched in an unproductive cycle of emotional blackmail and verbal blow-ups if caregivers are not careful when dealing with a narcissistic mother or father. If a senior is behaving in a selfish manner, Resnick says that the best option is to avoid being baited into outright confrontation at all costs. Before directly challenging an aging narcissist, 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 adult child to cede the “victory” to their parent.

If, on the other hand, the issue affects the health and well-being 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 your parent refuses to take their medication because they think the prescribing physician is a “quack,” simply remind them that they’re more likely to have to attend another appointment and endure the doctor’s uneducated ramblings if they don’t take their pills. Conversely, 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 family 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.

3 Rules for Defending Yourself Against the Aging Narcissist

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

Dr. Thomas admits that caregiving for a narcissist 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 care, maintain a social life of some sort and engage in activities that you enjoy and that rejuvenate you. This will prevent caregiver burnout.
  2. Work with a mental health professional, such as a counselor or psychologist, to help you sort through your feelings and hone the tools you need to recognize and cope with emotional blackmail.
  3. Set personal limits on how much contact you are willing to make and stick to your boundaries no matter what.

It is also important to remember that a relationship with a narcissist is essentially 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.

Respect Your Limits While Caregiving

Resnick and Dr. Thomas both urge family caregivers in this situation to take responsibility for their personal emotional state. Remember, you cannot control a narcissist; you can only control yourself. Your number one goal should be finding out how to help a narcissistic parent without losing yourself in the process.

If you are struggling to come to terms with your feelings and your mental and physical health are suffering, it is likely time to set stricter boundaries with your care recipient or walk away altogether. In fact, professional health care workers from in-home care companies or in senior living facilities 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 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 care plan will require you to act in your own self-interest for once. Many family caregivers must make the difficult decision to go low-contact or even no-contact with their narcissistic parents. It will be tough, but this is certainly not something to feel guilty about; it is a necessity.

Read: Detaching With Love: Setting Boundaries in Toxic Relationships

Sources: StatPearls: Narcissistic Personality Disorder (https://www.ncbi.nlm.nih.gov/books/NBK556001/); Connecting DSM-5 Personality Traits and Pathological Beliefs: Toward a Unifying Model (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3833658/); DSM-IV and DSM-5 Criteria for the Personality Disorders (https://www.psi.uba.ar/academica/carrerasdegrado/psicologia/sitios_catedras/practicas_profesionales/820_clinica_tr_personalidad_psicosis/material/dsm.pdf); Merck Manuals Professional Edition: Narcissistic Personality Disorder (NPD) (https://www.merckmanuals.com/professional/psychiatric-disorders/personality-disorders/narcissistic-personality-disorder-npd)