How to Care for a Narcissistic Family Member Without Losing Yourself

Deeply ingrained narcissistic traits rarely resolve later in life, says Dr. Kourtney Koslosky, chief of psychiatry at Greenwich Hospital and assistant professor at Yale School of Medicine in New Haven, Connecticut. “Adult children who grew up with narcissistic parents frequently bring lifelong patterns of shame, people-pleasing and feelings of never being good enough into caregiving. That history can make them especially vulnerable to emotional manipulation once care begins.”

If you choose to be a caregiver for a narcissistic person, do it with eyes open, says psychologist Julia L. Mayer, coauthor of The AARP Caregiver Answer Book. “Make sure you aren’t expecting that person to be a loving, attentive and appreciative family member. Remind yourself that you are doing this because it feels like the right thing to do.” She adds that it’s important to be mindful not to react to predictably negative behaviors from the care recipient, which can relive old, painful dynamics. “If you can do these things, you have a much better chance of successful caregiving with a narcissistic person without experiencing burnout.”​

Managing narcissism out of nowhere

​Distinguishing long-standing narcissistic traits from behaviors that develop later in life is a critical first step for caregivers, says Koslosky. When narcissistic traits have been present for decades, they often reflect enduring personality characteristics. However, similar behaviors can also emerge for the first time in older adulthood due to illness, cognitive decline or major life changes.

As people age, the loss of independence, physical illness or early dementia can amplify fear, anxiety and the need for control, Koslosky explains. “That can look like narcissism, even when it wasn’t there before.” New-onset paranoia, agitation or accusatory behavior may signal underlying medical conditions rather than a personality disorder. That distinction matters, she says, because it shapes both expectations for change and decisions about treatment and caregiving support.​

Bob Mastrogiovanni, 79, of Cherry Hill, New Jersey, describes how his wife, Kathy, was once a warm, generous and loving partner before multiple sclerosis (MS) slowly reshaped both her body and their relationship. As the MS progressed, her independence slowly vanished. By the early 1990s, she moved from a cane to a wheelchair and eventually became bedridden, losing the ability to walk, bathe, eat or care for herself.

With each loss, Mastrogiovanni, president of the Well Spouse Association, noticed a shift. Kathy, who had never been narcissistic, became increasingly focused on her own needs and fears. “She went from a giving person to someone whose world kept getting smaller,” he says. "The more function she lost, the more everything became about her. It was hard not to internalize her wants and demands.” 

Mastrogiovanni learned a crucial coping strategy from other spouses: Don’t get mad at the person; get mad at the disease. By mentally separating Kathy from the MS, he was able to compartmentalize her behavior as “the MS talking,” which helped him avoid anger and guilt.

Over time, he learned that caregivers must assert their own needs. “I would take a day off and she would say, 'You can’t leave me.'” With paid caregivers and the help of extended family, Bob carved out brief respites for himself, despite the guilt and emotional difficulty of leaving. “When the disease takes over, the needs multiply. That’s when caregivers have to bring in help — not because they are failing but because no one can carry it all by themselves.”​

Disarming the impact of narcissism

​When you’re caring for someone with narcissistic traits, trying to get them to understand your feelings or take responsibility often leads nowhere. What does help is shifting the focus back to yourself and how you manage the relationship. Caregivers can protect their well-being by setting clear boundaries around time and tasks, defining exactly what their role is — and isn’t — and sticking to simple routines that reduce conflict, limiting emotional engagement when conversations turn manipulative and making their own mental health a priority. The good news is there are concrete actions caregivers can take, including these five practical steps.​

1. Recognize triggers.

When someone grows up with a narcissistic family member, early trauma can shape how they respond to stress well into adulthood. Many caregivers default to people-pleasing by automatically anticipating needs, scanning for disapproval and rushing to fix problems before they’re named. For example, a caregiver may feel calm and competent until a family member criticizes or says, “I guess I’ll just handle this myself since you’re too busy” or goes silent after a request isn’t met immediately. Even if the comment is not malicious, it can trigger intense anxiety or guilt. “Notice the ping in your body, the tightness in your chest, the rush of shame or anger — that’s your nervous system warning you that something is wrong and that you need to avoid that situation,” says Anderson.​

2. Set boundaries.

Caring for a narcissist is one of the more difficult kinds of caregiving, admits Mayer, who emphasizes that boundary setting is not optional when caring for a narcissistic family member — it is an important lifeline. She advises caregivers to begin by setting boundaries with themselves before setting them with a family member: identifying what they can realistically handle, how much time and energy they can give, and where their limits are. Without this self-assessment, she warns, caregivers often take on more than they can sustain and slide quickly into burnout. Koslosky advises that boundaries should be concrete, time-based and non-negotiable. Rather than vague promises of availability, she recommends clearly defined limits, such as specific hours when a caregiver is reachable or scheduled times when professional help is present. These structures reduce opportunities for manipulation, which she explains is common in narcissistic dynamics.​

3. Define roles.

When narcissism is long-standing, Koslosky says role definition must be explicit and structured. She recommends that caregivers clearly outline which tasks they will handle and which will be delegated to others. For example, assigning care tasks to paid caregivers reduces opportunities for guilt trips or power struggles. She also notes that narcissistic individuals often attempt to test, bend or override roles, so consistency matters more than persuasion. “Understanding limits helps everybody know what people’s roles are, even if the narcissistic family member resents those limits.”​

4. Lean on other people.

Caregivers of narcissistic family members are often encouraged to cope quietly, but mental health experts say isolation only deepens the harm. “Leaning on others like trusted friends, family members, support groups or therapists can help caregivers reality-check the emotional distortions that frequently arise in narcissistic dynamics,” says Mayer. “Support groups are filled with people with narcissistic parents. Go find one where you feel like you fit in.”

Sharing stories with people who understand creates a protective buffer, making caregivers less vulnerable to criticism, guilt-tripping or emotional attacks. For those without a built-in support system, online and in-person support groups offer a vital sense of recognition and validation, while therapy can provide space to process long-standing family trauma that caregiving often reactivates. The message, clinicians emphasize, is simple but essential: Caregiving is not meant to be done alone, and protecting one’s own mental health is not selfish — it is necessary.​

5. Seek professional help.

When talking to family members or sharing feelings in support groups is not enough, therapy with a mental health professional can help re-anchor caregivers to their own perceptions, distinguish manipulation from legitimate need and rebuild confidence in their own judgment, says Kossmann. She underscores that effective therapy is less about “fixing” the narcissistic family member, because that is rarely possible, and more about helping the caregiver untangle lifelong feelings around people-pleasing, self-silencing, exaggerated guilt and the belief that love must be constantly earned. “Therapy becomes a safe space where caregivers can talk out loud without fear of being told they are ‘overreacting’ or ‘ungrateful,’’ says Kossmann.​ ​