Family and Caregiver Schizophrenia Discussion Forum

Nephew diagnosed paranoid schizophrenic with narcissitic personality

My 22 year old nephew was diagnosed with paranoid schizophrenia with a narcissitic personality about a year ago and refuses to take medication. He lives by himself …doesn’t have a job and no longer attends college. My brother financially supports him and my nephew repeatedly brings up negative things that occurred years ago during his parents divorce to try and get what he wants. Is is my imagination or does he have the ability even with a brain disorder to manipulate?

1 Like

Schizophrenia does not make you too stupid to manipulate people… we can be smart or not so smart like everyone else. So yes, it is very likely he has that ability.


Even creatures with no brain at all do what they can to survive.
Humans are experts at the blame game.

Thanks for your response. I never thought that sz means that someone is stupid, I guess I just am having a hard time understanding how the disease works. For example, I can have a conversation with my nephew over the phone about very simple subjects pertaining to my children and how they are doing in elementary school and how my husband is doing with work, and all of the sudden he is telling me that I am no longer part of the family. I guess there are things that I say that all of the sudden “triggers” something in his head. That being said, my brother tells me that repeatedly if my nephew is in “a mood” he will start telling my brother that he is a louse excuse for a father and dirty, all the while this is on the way home from dinner and a movie and grocery shopping where he got whatever he wanted. Could this be deep hatred he has for the divorce and now he is voicing it? He never spoke of it before

I don’t know, it could be. What you described now sounds like his narcissistic side. Schizophrenia can give you a short fuse but this sounds like narcissism, which often makes people abusive and manipulative.

1 Like

Absolutely - manipulation is entirely separate from sz. Put boundaries on what you will and won’t accept in terms of what you’ll do for your nephew.

You might also find this helpful - First Aid for Psychosis:

If I may…

Do you know if your nephew is currently suffering a psychotic episode? If he’s refusing to take his medication, he very well may be in the middle of one, in which case he might be responding to hallucinations and delusions instead of what you and his father are actually doing or saying.

I’m on the diagnosed side of things, and I can tell you from experience it’s hard to tell the difference between what is said and what is hallucinated, especially over the phone where you can’t read lips. And with paranoia, we tend to believe everyone is against us.

I’ve very rarely blown up at people during those times, and I don’t think I ever did post-diagnosis, but I’ve definitely had the urge on countless occasions over the years…usually, I end up holding my breath and trying to get away (off the phone, out of the car, etc) asap. But then, I was never very secure about my support system

1 Like

yikes! i’m a bit embarrassed to post, but feel the information may be helpful. I’m dz sz (with a self dz of narcissism) and your situation with your nephew sounds all too familiar. I constantly bring up the past with my immediate family to get things sided in my direction. being a decade and a half older than your nephew, the issue does still come up constantly for me, the manipulation and madness that ensues. one thing to point out: the manipulation was at its worst when unmedicated/ using recreational drugs.


I don’t know if he is suffering an episode, but will say that he only wants to be seen/visited by his father (my brother.) He believes he is 2nd to God and that makes me believe he is suffering from some type of psychosis. His last “episode” was July 4 of this past year where he was arrested for DUI and fleeing police. I am so terribly confused as to how to help. He refuses to seek medical attention/medication and I’m afraid all of his manipulating has guilted my brother in not forcing him to seek help. My understanding is that we can’t “make” him do anything. I think my brother isn’t ready to give him an “ultimatum” … This is so heartbreaking for all of us

The best thing you can do is get some books, check online about this disease. It is a very complicated illness, and very hard to force someone to stay on meds. These days, its hard to even get someone into the hospital for treatment. Do set some boundaries for yourself. No need to get angry( hard to do sometimes ) just tell your nephew that you need to get off the phone, you cant deal with that kind of talk, behavior, etc…
Your brother and nephew will need a lot of support, you will too if you`re on board with this.
Wish you luck!

From my experience, I would GUESS that he is currently having an episode. It’s very common for people with Schizophrenia to have delusions of grandeur. I certainly have. Delusions are a positive symptom and–if I’m not mistaken–a sign of a psychotic episode. An “episode” is any time the positive symptoms (hallucinations and delusions) are present. They can come and go, but each of my episodes lasted around six months. Some of the delusions can remain, but they’re a lot easier to believe when you’re actively hallucinating (e.g. I would take the hallucinations as evidence that my delusions were real).

Most of the time, you won’t be able to see anything as obvious as him running from the police. He probably just “lost his cool” that day (said oh-so flippantly smh). I’ve had days like that, though I’ve never done anything that dangerous. They would happen DURING an episode, but only when the paranoia got too much for me to handle. In my worst of those days (pre-diagnosis), I admitted myself to the hospital for suicidal thoughts. I was convinced someone was going to kill me and that I could save myself a long, painful experience if I did it myself. I didn’t trust the doctors, but considering the combination of patients, staff, security, and nature of the Behavioral Health ward it felt like the safest place I could be. Another time, I insisted my ex husband open all the air conditioning ducts to look for cameras. Even after he did, I still wasn’t convinced they weren’t there–I thought they could have been small enough to blend in and not be visible. Psychotic thought doesn’t make much sense, and it’s usually extremely self-centered.

I can’t imagine being on the outside of that trying to figure out how to cope with it. I don’t know you or your nephew, but I’m grateful to you and your brother on his behalf for the attempts you’re making at help and understanding.

Personally, I always wished people would “shoot straight” with me. I longed to have someone I could turn to and say, “did you hear that,” or, “I’m thinking this. Is that even possible?” I desperately wanted that person to be able to calmly answer my questions, like Finnick did for Annie in the Hunger Games books. The problem, unfortunately, is that I seriously doubt I would have trusted anyone enough to play that role for me. Psychosis is a very frightening and lonely experience.

I agree that you should set behavioral limits to what you’re willing to put up with. I think even I could have understood it if someone had said, “Okay. I get that things suck for you, but I really don’t like you talking to me like that and I’m going to hang up if you keep it up.”

Even in the depths of my worst psychotic episodes I could understand codes of conduct and how to treat people. For a long time, I was a stay-at-home mother and if things got too bad I would make sure my children were in a safe place (no one in a high chair/bath/etc, inside where I could hear them) and excuse myself to go “take a shower” or something so I could have a mini-breakdown without them seeing but making sure they knew where to find me.

I think your nephew would be able to understand a set of boundaries if you set and enforced them. If he gets too nasty with you, let him know he’s crossed that boundary and hang up. Having problems doesn’t give him license to lash out at you or his dad.

But that’s just my personal opinion, and it’s from my own experience on your nephew’s end of things. It never hurts to find out what the professionals have to say…

1 Like

Find out for yourself. Observe to notice to recognize to acknowledge to accept to own to appreciate to understand what he does and its effects on others, including yourself.

And while you’re doing that, you might want to read THE masterwork on the whole sz deal at…

Your can turn your brother onto that if you like, as well as the following:

Sz pts tend to get “better” when they work with board-certified psychopharmacologist to develop a medication formula that stabilizes their symptoms sufficiently so that they can tackle the psychotherapy that will disentangle their thinking.

The best of the therapies for that currently include…

10 StEP –

the even newer somatic psychotherapies like…


or standard CBTs, like…

Schematherapy –
Learned Optimism –
Standard CBT –

I am living with a family member who has sza and narcissistic personality disorder.
Completely self-centred, no empathy, highly aggressive in manipulations (demands, gas lighting, identification projection, physical posturing, insults, threats).

What I find the most frustrating is the interplay. On the one hand family member completely misinterprets things (you always pick on me) but on the other hand turn then turns those misinterpretations into fuel for his hatred towards me.

It,s very hard to deal with because the aggression and hostility and also indifference to my well-being are hurtful.

Personally I,m at the point where I,m completely hands off, communication broke down after a big fight. Since then family member is showing symptoms that precursor to a major episode (sleeplessness, going out in the middle of the night).

I,m worried, don,t know what to do, and at the same time seriously need to back off because the situation is grinding me down to point where I,m adding to the problem.

1 Like

it’s hard to be manipulative with schizphrenia, especially when the symptoms are flaring. you’re too distracted by the unreal. perhaps the diagnosis is wrong.

May help (just change “parent” to “family member” as you read them):

10 StEP –


1 Like

I believe my girlfriend is paranoid schizophrenic narcissistic i would appreciate any ones support

What about her makes you think this?


An ultimatum may be necessary in order for your nephew to move toward recovery. Please encourage your brother to get involved with NAMI or other support network and possibly consult with a Psychiatrist to develop a plan for getting help for your nephew. People can get better.