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Doctor Blake
Doctor Blake, Psychologist
Category: Mental Health
Satisfied Customers: 146
Experience:  Ph.D., Ed.S., NCSP Clinical Psychologist; 15+ years of experience; dual licensure
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Hi There After doing some research today on my boyfriends

Resolved Question:

Hi There

After doing some research today on my boyfriends Narcisstic tendecies, I've come to the conclusion he may suffer from NPD. He has massive difficulty with apologies, goes AWOL and gives the silent treatment for weeks on end when he feels thats he has done something wrong. When he comes back, he does not want to discuss any issues but just to carry on as if nothing has happened. I wanted some advice with the best way of dealing with this please, and possible support and advice that may be on offer to him, and myself.
Submitted: 6 years ago.
Category: Mental Health
Expert:  Doctor Blake replied 6 years ago.

Good morning!


Thanks for writing to JA.


To begin, you should know that Narcissistic Personality Disorder (NPD) is somewhat controversial. You should know several things about the field of psychology/psychiatry:

1. The "big book" used for diagnosing mental disorders is the Diagnostic and Statistical Manual of Mental Disorders... and has undergone a number of revisions and changes over the years.

2. While there are still discussions and arguments about the material contained in the DSM, none is more controversial than those disorders located on Axis II (so-called "Personality Disorders").

3. You should understand that there are licensed mental health professionals who do not believe in the concept of "personality" and do not, therefore, believe that a personality can be disordered.

4. Even for those who find sufficient evident for "personality," the disorders listed on Axis II can be controversial. Besides difficulties with diagnostics, if personality is an immutable trait of an individual - how can one treat it? If one were to diagnose an individual's entire personality as "disordered," what could one do to "re-order" it?


The reason you are probably finding difficulty locating help dealing with narcissism (NPD) per se is because of the controversy surrounding the concept of the disorder. Simply put, most licensed mental health professionals would like find other diagnostic categories to describe your BF's behavior. Certainly an Axis I disorder would be "more treatable" with a better prognosis than an Axis II disorder. Axis I disorders also tend to be better researched and have better developed treatment protocols (either medication or therapy).


Research has consistently demonstrated that treatment plus medication is more effective than medication alone or treatment alone for a majority of Axis I disorders. Further research has shown that Cognitive Behavioral Therapy (CBT) is the most effective form of psychological treatment/intervention.


A licensed psychologist/psychotherapist with specific training in CBT modalities would be able to address your concerns. I would encourage you to find a licensed mental health professional with whom to work, employing CBT. Referring to a psychiatrist for medical treatment is appropriate if you are interested in pursuing this approach.


Again, the mantra of years of research says: medication or treatment alone is not as effective as both working in tandem. Some research has also indicated that insight-oriented talk therapy is counter-productive with some forms of Axis I disorders... it actually exacerbates the condition(s). So, seek out a CBT therapist who will provide targeted, efficient, and effective therapy - not someone who signs you as a "lifer." If you're going to a therapist for years, something about the therapy isn't working.


SO: I will return to an adage I learned during my residency... "If you hear hoof beats bearing down upon you, it's far more likely to be a horse than a zebra that's coming..." The same is true with mental health disorders. NPD is highly controversial, very rare (if it exists at all), and some would argue, untreatable. A host of other disorders (that *are* treatable with good prognoses) could explain the very same behaviors used to describe NPD.


Knowing that you care for your BF, and want the best for him - I would encourage you to work with licensed mental health professionals who specialize in horses, rather than zebras. You deserve (and he deserves) solutions to his problems... and I believe the first step you might take is getting an objective, scientifically-based evaluation from a licensed mental health professional - preferably someone with a CBT background.


Thanks. I hope you're well and that this was helpful.


* FEEDBACK ENCOURAGED. Please contact me prior to leaving negative feedback so that we can resolve the matter. I am eager to work with all JA clients to provide them with useful/helpful answers. Thanks again.

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