Is (S)he Really a Narcissist?

“She/he is a total Narcissist.” This is a statement that I often hear from clients when they are describing an acquaintance or more often, an ex. Some add statements such as “he is always monopolizing conversations, has feelings of entitlement, and puts others down….she thinks she knows the “right” way and all other ways are wrong….he is cocky and lacks empathy…she thinks she is more important than everyone else.”

People generally tend to assume their ex-partner, co-worker, relative has serious mental health disorders and there seems to be a recent trend of calling someone a Narcissist or saying “they have Narcissitic Personality Disorder.” Though this term is thrown around casually, personality disorders are far less common than people think. The National Institute of Health (NIH) reports that only 1% of the population actually meets criteria for Narcissistic Personality Disorder (NPD). Of those about 62% are men and 38% are women.

NPD is characterized by a pervasive pattern of exaggerated feelings of self-importance, an excessive need for admiration and lack of empathy. It begins in early adulthood and is manifested in a variety of contexts (relationships, work, social life, school etc.). People likely believe that acquaintances have NPD because the diagnosis involves a distorted self-image with unstable and intense emotions and a major concern with vanity, prestige and power. While it is easy to believe that people clients once dated may have some of these traits, the chances that they actually have NPD are slim.

The Diagnostic and Statistical Manual 5 (DSM5) outlines criterion necessary for a person to be diagnosed with Narcissistic Personality Disorder. A person must meet 5 of the following 9 criteria:

1. A grandiose sense of self-importance

2. A fixation with fantasies of infinite success, control, brilliance, beauty or love

3. The belief that he or she is extraordinary and exceptional and can only be understood by or should connect with other extraordinary or important people and institutions

4. An extreme desire for unwarranted admiration

5. A sense of entitlement

6. Interpersonally oppressive behavior

7. A lack of empathy

8. Resentment towards others or the belief that others are resentful of them

9. A display of egotistical and conceited behaviors or attitudes

The American Psychological Association (APA) reports that those with NPD must have fair or superior impairment in at least two of the following areas:

1. Individuality

2. Self-direction

3. Empathy

4. Closeness

The DSM 5 also states “many highly successful individuals display personality traits that might be considered narcissistic. Only when these traits are inflexible, maladaptive, and persisting and cause significant functional impairment or subjective distress do they constitute narcissistic personality disorder.” In other words, while we can all think of someone who has some of the traits of NPD, it is only when criteria are met and there is marked impairment that they can be diagnosed as having NPD.

As is the case with many mental health disorders, there is a high prevalence of co-morbidity with NPD. The most common co-occurring disorder is Major Depressive Disorder (MPD) which occurs in 45-50% of cases. Bipolar Disorder is also common, occurring in about 5-11% of NPD clients. 24-64% of those with NPD also have Substance Use Disorders.

Treatment for NPD may consist of pharmacology as well as therapy. Cognitive Behavioral Therapy (CBT) is often used. There is some debate as to whether group or individual therapy is best for clients with this disorder. One school of thought is that those with NPD don’t do well in group therapy, yet others believe that learning to work in groups may actually be a beneficial treatment in itself. The best route may be determined on an individual basis between client and therapist. Clients typically come to therapy describing symptoms of anxiety, mania or depression prior to being diagnosed with NPD. If you or someone you know exhibits some of these symptoms or if you dated or married someone like this, and would benefit from discussing its impact on you with a trained therapist, please click here to meet with one of us.