Significant change in individuals with narcissistic personality disorder often requires extreme external motivators coupled with high motivation for change.

“So someone who will no longer have access to family members they want to see or to financial resources that they need to keep themselves afloat, it's things that often are that dramatic. It's not always that. But we can see, though, in those kind of extenuating situations where the problem is so big, the envy is so high. But the motivation for change is very, very high, because since on the carrot and stick model, the stick here is very, very strong, that if a person then goes and does that, you can see change inside of them.”