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In the end do narcissists lose their mind and have to go into a mental hospital?

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The narcissist ages without mercy and without grace. His withered body and his overwrought mind betray him all at once. He stares with incredulity and rage at cruel mirrors. He refuses to accept his growing fallibility. He rebels against his decrepitude and mediocrity. Accustomed to being awe-inspiring and the recipient of adulation - the narcissist cannot countenance his social isolation and the pathetic figure that he cuts.
As a child prodigy, a sex symbol, a stud, a public intellectual, an actor, an idol - the narcissist was at the centre of attention, the eye of his personal twister, a black hole which sucked people's energy and resources dry and spat out with indifference their mutilated carcasses. No longer. With old age comes disillusionment. Old charms wear thin.
Having been exposed for what he is - a deceitful, treacherous, malignant egotist - the narcissist's old tricks now fail him. People are on their guard, their gullibility reduced. The narcissist - being the rigid, precariously balanced structure that he is - can't change. He reverts to old forms, re-adopts hoary habits, succumbs to erstwhile temptations. He is made a mockery by his accentuated denial of reality, by his obdurate refusal to grow up, an eternal, malformed child in the sagging body of a decaying man.
It is the fable of the grasshopper and the ant revisited.
The narcissist - the grasshopper - having relied on supercilious stratagems throughout his life - is singularly ill-adapted to life's rigors and tribulations. He feels entitled - but fails to elicit narcissistic supply. Wrinkled time makes child prodigies lose their magic, lovers exhaust their potency, philanderers waste their allure, and geniuses miss their touch. The longer the narcissist lives - the more average he becomes. The wider the gulf between his pretensions and his accomplishments - the more he is the object of derision and contempt.
Yet, few narcissists save for rainy days. Few bother to study a trade, or get a degree, pursue a career, maintain a business, keep their jobs, or raise functioning families, nurture their friendships, or broaden their horizons. Narcissists are perennially ill-prepared. Those who succeed in their vocation, end up bitterly alone having squandered the love of spouse, off-spring, and mates. The more gregarious and family-orientated - often flunk at work, leap from one job to another, relocate erratically, forever itinerant and peripatetic.
The contrast between his youth and prime and his dilapidated present constitutes a permanent narcissistic injury. The narcissist retreats deeper into himself to find solace. He withdraws into the penumbral universe of his grandiose fantasies. There - almost psychotic - he salves his wounds and comforts himself with trophies of his past.
A rare minority of narcissists accept their fate with fatalism or good humour. These precious few are healed mysteriously by the deepest offense to their megalomania - old age. They lose their narcissism and confront the outer world with the poise and composure that they lacked when they were captives of their own, distorted, narrative.
Such changed narcissists develop new, more realistic, expectations and hopes - commensurate with their talents, skills, accomplishments and education. Ironically, it is invariably too late. They are avoided and ignored, rendered transparent by their checkered past. They are passed over for promotion, never invited to professional or social gatherings, cold-shouldered by the media. They are snubbed and disregarded. They are never the recipients of perks, benefits, or awards. They are blamed when not blameworthy and rarely praised when deserving. They are being constantly and consistently punished for who they were. It is poetic justice in more than one way. They are being treated narcissistically by their erstwhile victims. They finally are tasting their own medicine, the bitter harvest of their wrath and arrogance.
Based on my book "Malignant Self Love - Narcissism Revisited"
� 2003 Lidija Rangelovska Narcissus Publications  
No they don't. They have enough self-control to not "break down", and even when they do go into mental hospital voluntarily, it's always within a narcissistic agenda.

However, some narcissist do get hospitalized for a co-morbidity psychiatric disorders, meaning they get hospitalized not for NPD. Cases shown that they make exceptionally difficult patients to deal with.
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