What Is… Narcissism & Narcissistic Personality Disorder

In this series, I dig a little deeper into the meaning of psychological terms. This week’s term is narcissism, along with narcissistic personality disorder.

You can find narcissism everywhere on the internet these days, although it’s not always used accurately. The term derives from Greek mythology and the story of Narcissus, who fell in love with his own reflection in a pool of water and became so obsessed he did nothing but stare at it. He eventually died out of grief that he was in love with someone who didn’t exist outside of himself.

Wikipedia explains that the field of psychology has two main ways of looking at narcissism: as a personality trait and as a disorder. Key elements of narcissism as a trait are:

• a belief of being better than others
• greatly exaggerated views of the self
• an inflated belief in their ability to create change
• a belief of being unique/special
• an orientation towards success

Subclinical narcissism, which doesn’t meet the full personality disorder criteria, is one part of the so-called dark triad or dark tetrad of personality, along with Machiavellianism and psychopathy (and sadism for the tetrad). This combination puts people at particularly high risk for antisocial behaviour.

Narcissistic personality disorder

Narcissistic personality disorder (NPD) is a diagnosis in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). It’s classified as being in cluster B, the dramatic/emotional erratic personality disorders, which also includes borderline, histrionic, and antisocial personality disorders.

NPD aymptoms

Narcissistic personality disorder symptoms include:

• Greatly overestimate their own importance and talents
• Preoccupied with fantasies of fantastic achievements, power, or characteristics
• Belief that they’re special/unique and should only spend time with similarly special/unique people to boost self-esteem
• A need for admiration to stand in for self-esteem
• A sense of entitlement
• Exploit others to achieve their own goals
• Lack empathy
• Envious of others and believe others envy them
• Arrogance and haughtiness

As with any other personality disorder, it’s not unusual for people to have some of these symptoms some of the time. To be diagnosed with NPD, the symptoms must cause significant distress or impairment in functioning (more likely the latter). They must begin prior to adulthood, and they’re pervasive, inflexible, and generally consistent across time and across contexts.

Typically, self-esteem is very fragile, so external sources of esteem are sought. Unlike in bipolar mania, where there is episodic grandiosity, grandiosity in NPD is an ongoing pattern.

Other characteristics

Prevalence rates can vary significantly depending on who you’re asking. Estimates can range from 1-6% in the general population, but up to 15% in mental health care settings.

NPD occurs in up to 6% of the population, and it’s more common in males than females. People with NPD often have a co-occurring disorder, such as a depressive disorder, substance use disorder, or another personality disorder.

There appears to be a strong heritable component to NPD, but various environmental and psychosocial factors also play a role. Parents who are either overly critical or overly indulgent may be a factor.

Treatment

People with NPD often don’t seek out treatment, or if they do, it’s for a co-occurring disorder rather than the NPD. Lack of insight may pose a barrier to treatment, and there are high drop-out rates from therapy.

The treatment of choice is psychodynamic psychotherapy, which explores underlying conflicts. Transference-focused therapy is a particular form of psychodynamic therapy that focuses on the expression of emotions. Mentalization-based therapy or schema therapy may also be helpful.

Medication may have some role to play in managing mood lability and impulse control issues. Antidepressants, mood stabilizers, or the antipsychotic risperidone may offer some benefit.

Measuring narcissism

The Narcissistic Personality Inventory is one test to measure levels of narcissism as a personality trait (not disorder). There’s a version of the NPI here. This test is designed to be used in the general population, so high scores don’t automatically indicate that someone meets the criteria for an NPD diagnosis.

My score on that test was 5/40 (meaning low levels of narcissism), but what was interesting about the test was the black-and-white nature of it. Each question had two possible responses to choose from; one response suggested narcissism and the other response seemed more suggestive of a lack of confidence. There seemed to be little room for a person who is confident yet modest.

All kinds of people online are armchair diagnosing people, usually their exes, with NPD. While that may be appealing to do, it’s no more accurate or useful than diagnosing any other form of mental disorder.

Related concepts

There are several terms related to narcissism that often turn up online. In psychoanalytic theory, narcissistic supply refers to those individuals who are drawn upon, using techniques like flattery, to boost self-esteem. In narcissistic individuals, self-esteem is often based on external appraisals rather than positive self-appraisals. Narcissistic injury refers to feelings of humiliation or defeat that result from criticism by others. This can lead to a counterattack or attempts to save face.

The DSM-5 doesn’t break down NPD into subtypes, but various subtypes have been suggested, including grandiose/overt and vulnerable/covert.

The term narcissistic abuse originally referred to emotional abuse in parent-child relationships, but it’s since expanded to the point that it seems to encompass almost any instance of “my ex was a jerk.”

Is the term “narcissist” overused?

I wonder sometimes about the appropriateness of ideas from the field of psychology gaining a life of their own as pop psychology on the internet. After a messy breakup, a former friend of mine quickly fell down the narcissistic abuse rabbit hole online. While buddy was a jerk, none of the behaviour she described was consistent with narcissism. She’d also brought her own considerable emotional baggage to the table that she seemed completely unaware of.

Latching onto this idea of narcissistic abuse wasn’t helpful to her; if anything, it made it harder for her to move on. This isn’t at all meant to detract from the very real and significant harm that emotional abusers cause. It’s just that once something gets popular on the internet, there’s a tendency for people to run with it, even if it means they’re running in the wrong direction.

Your thoughts?

References

• Merck Manual Professional Version: Narcissistic personality disorder
• StatPearls: Narcissistic personality disorder
• Wikipedia: Narcissism | Narcissistic personality disorder | Narcissistic abuse and supply | Narcissistic rage and narcissistic injury