My husband has narcissistic personality disorder, and I am becoming extremely depressed and frustrated living with him. His selfishness is very hard to accept over and over again. What can I do, and what help is there for him? I'm trying to avoid divorce, as at other times he is a good husband and father. --Lori

Narcissistic personality disorder (NPD) is characterized by "a pervasive pattern of grandiosity, need for admiration, and lack of empathy," according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, or DSM-IV. Such individuals overestimate their abilities and inflate their accomplishments, often appearing boastful. They often underestimate or devalue the abilities and accomplishments of others. Believing they are superior or unique, they may feel they can only be understood by other "special" or high-status people. They usually feel entitled to special treatment and are confused or furious when they're treated just like everybody else.

Because they consider their work and their needs to be so important and are usually insensitive to the needs of others, those with NPD often end up exploiting the people around them. They often come across as cold, haughty, arrogant, snobbish or patronizing, and they're often envious of others or believe others are envious of them.

Because narcissistic individuals usually require excessive admiration, you can probably guess that in reality their self-esteem is usually very fragile. The inflated ego can be seen as an attempt to overcome a fragile, wounded self -- one reason they may feel hollow or empty inside. The inflated ego is easily punctured by criticism or by not having needs met. The resulting exposure of the wounded self often brings pain, rage or disdain. Sometimes, though, the individual may react by socially withdrawing or expressing humility in an effort to cover up the grandiosity.
If your husband is exhibiting these patterns of behavior, it's no wonder you're having difficulty. You don't mention whether he's in psychotherapy (or where he got the diagnosis of NPD), but long-term psychotherapy with a qualified mental health professional experienced in personality disorders is the treatment of choice for NPD. Marital therapy can also help address the day-to-day problems affecting the relationship. The trouble, of course, is that narcissistic people usually don't see THEMSELVES as the problem ... or when they do, their fragile self-esteem is so threatened by the feared confrontation that they're afraid to open up to the potential pain. (They may fear therapy, for instance, because they assume the therapist will voice the self-criticisms they've been fleeing from for years.)

If your husband won't consider either individual or marital therapy, please consider entering therapy yourself if you haven't already. A good therapist can help you explore your options and possible coping strategies, including how best to take care of your own needs in the relationship. Good luck.