Diagnosis is by trained mental health professionals. To be diagnosed with the rather unflattering label of narcissistic personality disorder, one must possess at least five of the traits mentioned. A common and very important trait, which is not mentioned in this list, is that of little or no empathy. There are many who believe that as this is such a key aspect in people with NPD that it should have been included in the diagnostic criteria.
The cause is most likely complex with the possibility of more than one factor being at the root of this disorder.
For a narcissist to seek help, they need to see that the problems lie within themselves.
Unfortunately, narcissists rarely blame themselves when things go wrong. They do not hold themselves accountable and they will shift the blame onto others for the very things that they do themselves.
Many experts will say that a narcissist is most likely to seek help when they have hit rock bottom, perhaps when they have been abandoned by a long time partner or other family members.
This question appears to be open to debate. Pathological narcissism is a difficult disorder to treat. Recovery from NPD would be a lengthy process requiring the individual to remain in therapy for a considerable length of time.
Will a narcissist remain in therapy for as long as is required?
Will a narcissist acknowledge their therapist’s expertise?
I have known and read about narcissists in recovery over the short term. Some narcissists that I have spoken to will say that they have difficulty maintaining a change in their behaviour for considerable periods of time and tend to slip back into their old ways.
Some experts have gone out on a limb saying that they believe change is possible whilst others disagree believing long term change is extremely unlikely if not impossible.
Mayo Clinic Staff, (Nov 2014), Mayo Clinic: Narcissistic Personality Disorder, [Online], accessed Feb, 2016.