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Narcissists think their always right in the grand, broad scheme of things. Even if they make mistakes, however the size or scope, it's never their fault in the truest sense. I disagree somewhat about it being the most difficult or worst of psychiatric illnesses to diagnose or treat effectively. That probably goes to paranoid schizophrenics who suffer strong, persistent delusions, auditory or visual hallucinations, or schizoid/schizotypal disorders, those who's delusions have them entertaining magical, fantasy-like thinking. People like Elliot Alderson, hero hacker protagonist of Mr. Robot TV series, has dissociative identity disorder and we as the audience don't find out he and a evil, radical version of his dead father are two separate composite personalities combating one another until late in Season 1.
You’re right. Paranoia is a bear. But I’ve had much more success with them than NPD. I have had at least some success reasoning with them, and not to mention that we have treatments (not great ones...but at least we have things that help). NPD on the other hand has no good treatment and you almost have to feed into their narcissism to gain rapport. It’s a mess. I can think of my worst five patients while doing inpatient and just about all of them I suspect had a personality disorder....and of them NPD was the worst.