It is very difficult to have a relationship with someone who is narcissistic. In its pure and most severe form, the person is diagnosed with Narcissistic Personality Disorder.

 
DSM-IV Criteria for Narcissistic Personality Disorder

In order to be diagnosed with Narcissistic Personality Disorder (NPD), the person has to meet the criteria in the Diagnostic and Statistics Manual.

Personality disorders are inflexible and pervasive and appear in multiple areas of life, not just one relationship. They are apparent in either adolescence or early adulthood  and they can’t be due to the physiological effects of a drug addiction.

There have to be at least five of the following characteristics for someone to be diagnosed with Narcissistic Personality Disorder:

• A grandiose sense of self-importance where one exaggerates achievements and abilities and expects to be recognized as superior to others.
• Fantasies of unlimited success, power, brilliance, beauty, or ideal love.
• A belief that one is special or unique and should only associate with special people.
• Requires excessive admiration.
• A sense of entitlement that involves favorable treatment or automatic compliance with expectations.
• Exploitation of others to achieve one’s own ends and an expectation to be given whatever is wanted or needed.
• Lacks empathy and is unwilling to recognize others’ needs or feelings and views others’ needs and feelings as weakness.
• Envious of others and believes others are envious of oneself.
• Arrogant and haughty behaviors and attitudes.

It should be noted that a person can have narcissistic-like behaviors due to addictions or other problems that are not serious enough to be diagnosed with the personality disorder but that still cause many relationship problems.

One of the causes of NPD is the state of being psychologically empty and anxious with a shaky sense of self and low self-esteem which is the opposite of the image that the person projects. In addition, narcissists often have deep childhood wounds.

 
Relationship Problems with Narcissists

Relationships with narcissists aren’t easy. Here are some of the problems you may have:
 

• They are very charming and charismatic to draw you into the relationship.
• You lose your sense of “self” and your needs, wants, and desires.
• The relationship operates on the narcissist’s terms and your feelings, needs, and concerns don’t matter.
• You have to spend energy making sure the narcissist feels important, admired, and special.
• You feel controlled and have difficulty saying no.
• The relationship takes lots of energy.
• They are moody and difficult to deal with.
• They are sensitive to criticism and react to it with rage or shame.
• They are perfectionistic and intolerant of others’ mistakes and overreact to them.
• They have unrealistic demands and expectations of others.
• You will experience emotional pain.
• They are unable to look at themselves and see personal problems or weaknesses.
• They will need to feel “one up” on you at all times.
• They will not be empathic toward you or the children.
• They will be unconcerned with how they affect you and treat you.
• They will not be able to give unconditional love and approval or acknowledge other people’s individuality.

 
 
Coping Skills for Dealing with a Narcissist

You cannot make narcissists change. Personality disorders are the most difficult psychological problems to treat because the person lacks insight into who they are and has no awareness of the need to change. Your efforts to force change will most likely cause more backlash toward you.

You need to focus your efforts on changing yourself.  Face the truth about who they are, adjust your expectations, refocus your efforts, and learn to take care of yourself. Here are some of the things you can do:
 

• Work on developing a strong sense of “self.”
• Learn to validate your “self.”
• Give up trying to make the narcissist validate your feelings, thoughts and needs.
• Attend to your own needs.
• Identify the things in you that make you vulnerable to the narcissist’s behaviors.
• Identify the narcissistic behaviors so you can defend yourself against them and not    be surprised when they happen.
• Stop trying to explain yourself and instead make short statements about what you will and won’t do.
• Set clear boundaries and refuse to back down.
• Develop assertiveness skills.
• Sever the relationship if necessary or limit interactions if it is too toxic.

 
If the narcissist refuses to respect your boundaries or becomes abusive when you begin to take care of yourself, you may need to put some distance between you.