What makes a narcissist tick?
If a person has been diagnosed with the Narcissistic Personality Disorder,therapy, in most cases, can only mitigate and ameliorate his condition, but not cure it.
Only narcissists, who go through a severe life crisis, tend to consider the possibility of therapy at all. When they attend the therapeutic sessions, they, usually, bring all their rigid defence mechanisms to the fore. The therapy quickly becomes a tedious - and useless - affair for both therapist and patient.
Most cerebral narcissists are very intelligent. They base their grandiose fantasies on these natural advantages. When faced with a reasoned analysis, which shows that they suffer from NPD - most of them accept and acknowledge the new information. But first they have to face it - and this is the difficult part:they all are deniers of reality.
Moreover, cognitively assimilating the information is a mere process of labelling. It has no psychodynamic effect. It does not affect the narcissist's behaviour patterns and interactions with his human environment. These are the products of veteran and rigid mental mechanisms.
Narcissists are PATHOLOGICAL liars. This means that they are either unaware of their lies - or feel completely justified and at ease in lying to others. Often, they believe their own lies and attain "retroactive veracity". Their very essence is a huge, contrived, lie: the FALSE Self, the grandiose FANTASIES, and the IDEALISED objects.
Personality disorders are ADAPTATIVE. This means that they help to resolve mental conflicts and the anxiety, which, normally, accompanies them.
Narcissists sometimes contemplate suicide (suicidal ideation) when they go through a crisis - but they are not very likely to go beyond the contemplation phase.
Narcissists are, in a way, sadists. They are likely to use verbal and psychological abuse and violence against those closest to them. Some of them move from abstract aggression (the emotion leading to violence and permeating it) to the physically concrete sphere of violence. However, I have seen no research which proves that they are more prone to do so than any other group in the general population.
The NPD is a newcomer to the zoo of mental disorders. It was not fully defined until the late 80s. The discussion, analysis and study of narcissism are as old as psychology - but there is a great difference between being a "mere" narcissist and having a NPD. So, no one has a clue as to how widespread this particular personality disorder is - or, even, how widespread personality disorders are (estimates range between 3 and 15% of the population. I think 5-7% would be a fair estimate).