Narcissistic personality disorder is rarely the primary reason for people seeking mental health treatment. When people with NPD enter treatment, it is typically prompted by life difficulties or to seek relief from another disorder, such as major depressive disorder, substance use disorders, bipolar disorder, or eating disorders, or at the insistence of relatives and friends. This is partly because individuals with NPD generally have poor insight and fail to recognize their perception and behavior as inappropriate and problematic due to their very positive self-image.

Treatment for NPD is centered around psychotherapy. In the 1960s, Heinz Kohut and Otto Kernberg challenged the conventional wisdom of the time by outlining clinical strategies for using psychoanalytic psychotherapy with clients with NPD that they claimed were effective in treating the disorder. Contemporary treatment modalities commonly involve transference-focused, metacognitive, and schema-focused therapies. Some improvement might be observed through the treatment of symptoms related to comorbid disorders with psychopharmaceuticals, but , according to Elsa Ronningstam, psychologist at Harvard Medical School, "Alliance building and engaging the patient's sense of agency and reflective ability are essential for change in pathological narcissism."

Pattern change strategies performed over a long period of time are used to increase the ability of those with NPD to become more empathic in everyday relationships. To help modify their sense of entitlement and self-centeredness schema, the strategy is to help them identify how to utilize their unique talents and to help others for reasons other than their own personal gain. This is not so much to change their self-perception of their "entitlement" feeling but more to help them empathize with others. Another type of treatment would be temperament change. Psychoanalytic psychotherapy may be effective in treating NPD, but therapists must recognize the patient's traits and use caution in tearing down narcissistic defenses too quickly. Anger, rage, impulsivity, and impatience can be worked on with skill training. Therapy may not be effective because patients may receive feedback poorly and defensively. Anxiety disorders and somatoform dysfunctions are prevalent but the most common would be depression.

Group treatment has its benefits as the effectiveness of receiving peer feedback rather than the clinician's may be more accepted, but group therapy can also contradict itself as the patient may show "demandingness, egocentrism, social isolation and withdrawal, and socially deviant behavior". Researchers originally thought group therapy among patients with NPD would fail because it was believed that group therapy required empathy that NPD patients lack. However, studies show group therapy does hold value for patients with NPD because it lets them explore boundaries, develop trust, increase self-awareness, and accept feedback. Relationship therapy stresses the importance of learning and applying four basic interpersonal skills: "...effective expression, empathy, discussion and problem solving/conflict resolution". Marital/relationship therapy is most beneficial when both partners participate.

No medications are indicated for treating NPD, but may be used to treat co-occurring mental conditions or symptoms that may be associated with it such as depression, anxiety, and impulsiveness if present.

The effectiveness of psychotherapeutic and pharmacological interventions in the treatment of narcissistic personality disorder has yet to be systematically and empirically investigated. Clinical practice guidelines for the disorder have not yet been created, and current treatment recommendations are largely based on theoretical psychodynamic models of NPD and the experiences of clinicians with afflicted individuals in clinical settings.

The presence of NPD in patients undergoing psychotherapy for the treatment of other mental disorders is associated with slower treatment progress and higher dropout rates.

Psychopathy has often been considered untreatable. Its unique characteristics makes it among the most of personality disorders, a class of mental illnesses that are already traditionally considered difficult to treat. People afflicted with psychopathy are generally unmotivated to seek treatment for their condition, and can be uncooperative in therapy. Attempts to treat psychopathy with the current tools available to psychiatry have been disappointing. Harris and Rice's "Handbook of Psychopathy" says that there is currently little evidence for a cure or effective treatment for psychopathy; as of yet, no pharmacological therapies are known to or have been trialed for alleviating the emotional, interpersonal and moral deficits of psychopathy, and patients with psychopathy who undergo psychotherapy might gain the skills to become more adept at the manipulation and deception of others and be more likely to commit crime. Some studies suggest that punishment and behavior modification techniques are ineffective at modifying the behavior of psychopathic individuals as they are insensitive to punishment or threat. These failures have led to a widely pessimistic view on its treatment prospects, a view that is exacerbated by the little research being done into this disorder compared to the efforts committed to other mental illnesses, which makes it more difficult to gain the understanding of this condition that is necessary to develop effective therapies.

Although the core character deficits of highly psychopathic individuals are likely to be highly incorrigible to the currently available treatment methods, the antisocial and criminal behavior associated with it may be more amenable to management, the management of which being the main aim of therapy programs in correctional settings. It has been suggested that the treatments that may be most likely to be effective at reducing overt antisocial and criminal behavior are those that focus on self-interest, emphasizing the tangible, material value of prosocial behavior, with interventions that develop skills to obtain what the patient wants out of life in prosocial rather than antisocial ways. To this end, various therapies have been tried with the aim of reducing the criminal activity of incarcerated offenders with psychopathy, with mixed success. As psychopathic individuals are insensitive to sanction, reward-based management, in which small privileges are granted in exchange for good behavior, has been suggested and used to manage their behavior in institutional settings.

Psychiatric medications may also alleviate co-occurring conditions sometimes associated with the disorder or with symptoms such as aggression or impulsivity, including antipsychotic, antidepressant or mood-stabilizing medications, although none have yet been approved by the FDA for this purpose. For example, a study found that the antipsychotic clozapine may be effective in reducing various behavioral dysfunctions in a sample of high-security hospital inpatients with antisocial personality disorder and psychopathic traits. However, research into the pharmacological treatment of psychopathy and the related condition antisocial personality disorder is minimal, with much of the knowledge in this area being extrapolations based on what is known about pharmacology in other mental disorders.

The prognosis for psychopathy in forensic and clinical settings is quite poor, with some studies reporting that treatment may worsen the antisocial aspects of psychopathy as measured by recidivism rates, though it is noted that one of the frequently cited studies finding increased criminal recidivism after treatment, a 2011 retrospective study of a treatment program in the 1960s, had several serious methodological problems and likely would not be approved of today. However, some relatively rigorous quasi-experimental studies using more modern treatment methods have found improvements regarding reducing future violent and other criminal behavior, regardless of PCL-R scores, although none were randomized controlled trials. Various other studies have found improvements in risk factors for crime such as substance abuse. No study has of yet in a 2013 review examined if the personality traits that form the core character disturbances of psychopathy could be changed by such treatments.

Malignant narcissism is a psychological syndrome comprising an extreme mix of narcissism, antisocial behavior, aggression, and sadism. Often grandiose, and always ready to raise hostility levels, the malignant narcissist undermines organizations in which they are involved, and dehumanizes the people with whom they associate.

Malignant narcissism is a hypothetical, experimental diagnostic category. Narcissistic personality disorder is found in the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-IV-TR), while malignant narcissism is not. As a hypothetical syndrome, malignant narcissism could include aspects of narcissistic personality disorder as well as paranoia. The importance of malignant narcissism and of projection as a defense mechanism has been confirmed in paranoia, as well as "the patient's vulnerability to malignant narcissistic regression".

Sadistic personality disorder is a personality disorder involving which appeared in an appendix of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-III-R). The later versions of the DSM (DSM-IV, DSM-IV-TR and DSM-5) do not include it.

The words "sadism" and "sadist" are derived from Marquis de Sade.

The social psychologist Erich Fromm first coined the term "malignant narcissism" in 1964, describing it as a "severe mental sickness" representing "the quintessence of evil". He characterized the condition as "the most severe pathology and the root of the most vicious destructiveness and inhumanity". Edith Weigert (1967) saw malignant narcissism as a "regressive escape from frustration by distortion and denial of reality", while Herbert Rosenfeld (1971) described it as "a disturbing form of narcissistic personality where grandiosity is built around aggression and the destructive aspects of the self become idealized".

Developing their ideas further, the psychoanalyst Otto Kernberg pointed out that the antisocial personality was fundamentally narcissistic and without morality. Malignant narcissism includes a sadistic element creating, in essence, a sadistic psychopath. In his article, "malignant narcissism" and psychopathy are employed interchangeably. Kernberg first proposed malignant narcissism as a psychiatric diagnosis in 1984, but so far it has not been accepted in any of the medical manuals, such as the ICD-10 or the DSM-5.

Kernberg described malignant narcissism as a syndrome characterized by a narcissistic personality disorder (NPD), antisocial features, paranoid traits, and egosyntonic aggression. Other symptoms may include an absence of conscience, a psychological need for power, and a sense of importance (grandiosity). Pollock wrote: "The malignant narcissist is presented as pathologically grandiose, lacking in conscience and behavioral regulation with characteristic demonstrations of joyful cruelty and sadism".

Kernberg believed that malignant narcissism should be considered part of a spectrum of pathological narcissism, which he saw as ranging from Hervey M. Cleckley's antisocial character (today's psychopath or antisocial personality) at the high end of severity, through malignant narcissism, and then to narcissistic personality disorder at the low end. The malignant narcissist thus represents a less extreme form of pathological narcissism than psychopathy. Malignant narcissism can be distinguished from psychopathy, according to Kernberg, because of the malignant narcissist's capacity to internalize "both aggressive and idealized superego precursors, leading to the idealization of the aggressive, sadistic features of the pathological grandiose self of these patients". According to Kernberg, the psychopath's paranoid stance against external influences makes him or her unwilling to internalize even the values of the "aggressor", while malignant narcissists "have the capacity to admire powerful people, and can depend on sadistic and powerful but reliable parental images". Malignant narcissists, in contrast to psychopaths, are also said to be capable of developing "some identification with other powerful idealized figures as part of a cohesive 'gang'...which permits at least some loyalty and good object relations to be internalized". "Some of them may present rationalized antisocial behavior – for example, as leaders of sadistic gangs or terrorist groups...with the capacity for loyalty to their own comrades".

Sadistic personality disorder has been found to occur frequently in unison with other personality disorders. Studies have also found that sadistic personality disorder is the personality disorder with the highest level of comorbidity to other types of psychopathological disorders. In contrast, sadism has also been found in patients who do not display any or other forms of psychopathic disorders. One personality disorder that is often found to occur alongside sadistic personality disorder is conduct disorder, not an adult disorder but one of childhood and adolescence. Studies have found other types of illnesses, such as alcoholism, to have a high rate of comorbidity with sadistic personality disorder.

Researchers have had some level of difficulty distinguishing sadistic personality disorder from other forms of personality disorders due to its high level of comorbidity with other disorders.

Grandiosity refers to an unrealistic sense of superiority—a sustained view of oneself as better than others that causes the narcissist to view others with disdain or as inferior—as well as to a sense of uniqueness: the belief that few others have anything in common with oneself and that one can only be understood by a few or very special people. It also occurs in reactive attachment disorder.

Grandiosity is chiefly associated with narcissistic personality disorder, but also commonly features in manic or hypomanic episodes of bipolar disorder.

Neurosis is a class of functional mental disorders involving chronic distress but neither delusions nor hallucinations. The term is no longer used by the professional psychiatric community in the United States, having been eliminated from the "Diagnostic and Statistical Manual of Mental Disorders" in 1980 with the publication of DSM III. It is still used in the .

Neurosis should not be mistaken for psychosis, which refers to a loss of touch with reality. Neither should it be mistaken for neuroticism, a fundamental personality trait proposed in the big Five personality traits theory.

There are many different neuroses: obsessive–compulsive disorder, obsessive–compulsive personality disorder, impulse control disorder, anxiety disorder, hysteria, and a great variety of phobias.

According to C. George Boeree, professor emeritus at Shippensburg University, the symptoms of neurosis may involve:

Neurosis may be defined simply as a "poor ability to adapt to one's environment, an inability to change one's life patterns, and the inability to develop a richer, more complex, more satisfying personality."

The Dorian Gray syndrome (DGS) denotes a cultural and societal phenomenon characterized by a man's extreme pride in his personal appearance and the fitness of his physique, which is accompanied by difficulties in coping with the requirements of psychological maturation and with the aging of his body.

The DGS is characterized by a triad of symptoms that overlap, and so combine diagnostic signs of dysmorphophobia, narcissistic character traits, and the immaturity of arrested development, which often are found in paraphilias.

To preserve ephemeral youth, the man afflicted with DGS tends to consume cosmetic products and services, hair-restoration procedures, anti-impotence drugs, and cosmetic surgery; hence, he might resist the psychosomatic and psychodynamic explanations of the syndrome. The term "Dorian Gray syndrome" refers to the protagonist of the novel "The Picture of Dorian Gray" (1891), an exceptionally handsome man whose hedonism and excessive self-love proved detrimental to the personal, social, and emotional aspects of his life, and who sought to escape the ravages of time and his own decadent lifestyle by having a supernatural portrait of himself age in his place.

Episodes of major depressive disorder and of suicidal crisis occur in the man afflicted with Dorian Gray syndrome when the defense mechanism activities, the pursuit of eternal youth, fail to indefinitely preserve his handsome face and sculpted physique; usually, anti-depressant drugs and psychotherapy are prescribed and applied to counter his feelings of failure.

Furthermore, if the man misunderstands the self-defensive character of "acting out" the DGS, and continues pursuing the timeless beauty of male youth, without being aware of the psychodynamics of narcissism, then he, as a psychiatric patient, establishes a cycle of chronic psychological depression. In extreme cases of DGS, the man seeks self-destruction, by means either of drugs or with plastic surgery, or both, in order to fill the narcissistic emptiness that is the Dorian Gray syndrome.

Multiple complex developmental disorder is likely to be caused by a number of different various genetic factors. Each individual with MCDD is unique from one another and displays different symptoms. Various neuropsychological disorders can also be found in family members of people with MCDD.

In mania grandiosity is typically more pro-active and aggressive than in narcissism. The manic character may boast of future achievements or exaggerate their personal qualities.

They may also begin unrealistically ambitious undertakings, before being cut down, or cutting themselves back down, to size.

Counterdependency is the state of refusal of attachment, the denial of personal need and dependency, and may extend to the omnipotence and refusal of dialogue found in destructive narcissism, for example.

Multiple complex developmental disorder (MCDD) is a research category, proposed to involve several neurological and psychological symptoms where at least some symptoms are first noticed during early childhood and persist throughout life. It was originally suggested to be a subtype of autistic spectrum disorders (PDD) with co-morbid schizophrenia or another psychotic disorder; however, there is some controversy that not everyone with MCDD meets criteria for both PDD and psychosis. The term "multiplex developmental disorder" was coined by Donald J. Cohen in 1986.

The roots of counterdependency can be found in the age-appropriate negativism of two-year-olds and teens, where it serves the temporary purpose of distancing one from the parental figure[s]. As Selma Fraiberg put it, the two-year-old "says 'no' with splendid authority to almost any question addressed to him...as if he establishes his independence, his separateness from his mother, by being opposite". Where the mother has difficulty accepting the child's need for active distancing, the child may remain stuck in the counterdependent phase of development because of developmental trauma.

In similar fashion, the teenager needs to be able to establish the fact of their separate mind to their parents, even if only through a sustained state of cold rejection; and again unresolved adolescent issues can lead to a mechanical counterdependence and unruly assertiveness in later life.

Katoptronophilia is a paraphilia for mirrors (the Greek word for "mirror" is "katoptron"). It may include activities such as having sex in front of mirrors, masturbating in front of mirrors, enacting other paraphilias in front of a mirror, having an orgy in front of a mirror, or enacting stripping fetishism in front of mirrors.

Enacting katoptronophiliac fantasies may involve constructing environments for erotic activity in which one is completely surrounded by mirrors, sometimes including even on the ceiling. A person who is a "katoptronophiliac" may put mirrors all over their house so they can have sex in any room in the house.

Many pornographic films show porn stars having sex in front of mirrors.

Many people enjoy having sex in front of mirrors and have mirrors in their bedrooms in which they can watch themselves have sex. They sometimes engage in this activity for their personal enjoyment. On a deeper level this could relate to the person's need to reflect and critique themselves, and also being on a mental state of narcissism. The person often is solely absorbed in themselves and likes to watch their actions so as to admire.

Primary treatment for this cancer, regardless of body site, is surgical removal with clean margins. This surgery can prove challenging in the head and neck region due to this tumour's tendency to spread along nerve tracts. Adjuvant or palliative radiotherapy is commonly given following surgery. For advanced major and minor salivary gland tumors that are inoperable, recurrent, or exhibit gross residual disease after surgery, fast neutron therapy is widely regarded as the most effective form of treatment.

Chemotherapy is used for metastatic disease. Chemotherapy is considered on a case by case basis, as there is limited trial data on the positive effects of chemotherapy. Clinical studies are ongoing, however.

Music

- RnB singer Ne-Yo included a song on his debut album "In My Own Words" entitled "Mirror", describing the fetish.

- In the film, "The Dreamers", from Bernardo Bertolucci, there is a scene in which one of the main characters practices the fetish.

- The film American Psycho (film) also contains a scene in which the protagonist, Patrick Bateman admires himself in the mirror whilst having intercourse with two escort girls, one of whom tries to get his attention shortly afterwards, apparently unsuccessfully, implying Bateman's fixation on his own image.

PTLD may spontaneously regress on reduction or cessation of immunosuppressant medication, and can also be treated with addition of anti-viral therapy. In some cases it will progress to non-Hodgkin's lymphoma and may be fatal. A phase 2 study of adoptively transferred EBV-specific T cells demonstrated high efficacy with minimal toxicity.

Treatment with chemotherapy has been used with some success, particularly using lomustine, prednisone, doxorubicin, and cyclophosphamide. Because of the rapid progression of this aggressive disease, the prognosis is very poor.

Intravacular lymphoma is an aggressive cancer that is rapidly fatal without treatment, but which can respond well to combination chemotherapy, usually some combination of Rituximab, Cyclophosphamide, Adriamycin, Oncovin, and prednisone (R-CHOP).

For malignant teratomas, usually, surgery is followed by chemotherapy.

Teratomas that are in surgically inaccessible locations, or are very complex, or are likely to be malignant (due to late discovery and/or treatment) sometimes are treated first with chemotherapy.