Chapter One: What is Narcissism?
Chapter One: What is Narcissism?
“How starved you must have been that my heart became a meal for your ego.” —Amanda Torroni
Before we get into the technical explanations and definitions, it’s helpful to hear a few of the real-life experiences people have had with this mental condition.
Real-Life Experiences with Narcissism
Bill, a self-identified narcissist, describes what it feels like as he interacts with other people. He says he’s aware that he’s acting like an “asshole,” but he truly believes that it’s the fault of those around him that he must act that way. They deserve it in his mind. He also knows that deep down, he experiences a sense of self-loathing, but he dares not face that issue head-on. He prefers his delusions over reality. For him, it’s a form of escapism, whereby he can just say, “fuck reality, fuck facts!” He says, “I have to get my needs met. I deserve to get my needs met.”
Carol, who’s lived with a narcissist for many years, describes him as being delusional in his belief that he’s perfect and always in the right. She says he feels justified in his need to control everything and everyone because he knows he is right, and he is pervasive in his sense of entitlement. He truly believes that the world owes him. He devalues everyone else and overvalues himself. Nothing, she notes, compares to his ego.
Jay describes his experience with his narcissistic wife as one where she simply goes off into “la-la land” at a moment’s notice. He says they’ll be talking about some subject, and suddenly, she’ll start ranting about something offensive he had done that has little relation to the subject at hand. He finds himself on the defensive with no understanding of how the conversation transitioned to this topic. It leaves him feeling confused, attacked, and shamed. Moreover, it takes him hours to get her back to the original topic, which is usually something important they need to resolve.
What is this Confusing Condition?
As you can see from the real-life descriptions above, narcissism is a confusing and frustrating mental condition. But before we can really understand the narcissist, we have to know what narcissism is, and perhaps equally as importantly, what it is not. Is someone who is vain a narcissist? Is someone who thinks they are better than other people a narcissist? As we see in the testimonials above, those are narcissistic traits, but that doesn’t mean those people are narcissists. It’s become fashionable to refer to anyone who seems like a bad person as a narcissist, but are they really? So, just what constitutes narcissism?
If you have healthy self-esteem, you will have some narcissistic traits. Narcissism, like other mental conditions, exists on a continuum. There are degrees of narcissistic traits, and to be diagnosed with narcissistic personality disorder (NPD), you have to have several traits that are a predominant part of your personality. Having a few of those traits isn’t enough, but before we go any further, let’s examine the official definition of narcissism and the toxic traits associated with the condition.
Formal Definition and Traits of Narcissism
The fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines NPD as “comprising a pervasive pattern of grandiosity (in fantasy or behavior), a constant need for admiration, and a lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by the presence of at least 5 of the following 9 criteria” (Ambardar, 2019):
A grandiose sense of self-importance;
A preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love;
A belief that he or she is special and unique and can only be understood by, or should associate with, other special or high-status people or institutions;
A need for excessive admiration;
A sense of entitlement;
Interpersonally exploitive behavior;
A lack of empathy;
Envy of others or a belief that others are envious of him or her;
A demonstration of arrogant and haughty behaviors or attitudes.
To be diagnosed with NPD, a person must demonstrate several characteristics over an extended period of time. These traits point to how the narcissist has an inflated sense of their own importance, which thus manifests as a deep need for admiration and adoration. This is combined with a lack of empathy for other people, and as you already know, that can result in troubled relationships.
The thing is that, although they have this inflated sense of importance, underneath that lies a very fragile self-esteem that makes the narcissist vulnerable to any kind of criticism. This combination of an exaggerated sense of importance combined with a fragile ego manifests in the following symptoms.
They have a sense of entitlement—they believe themselves to be deserving of special treatment because of their inflated sense of importance;
They require excessive admiration, validation, and adoration—if you’re not focused on their every need, they feel slighted;
They believe themselves to be superior, regardless of their achievements or lack thereof, and they expect to be recognized as such;
Because they believe themselves to be superior, they will often exaggerate their talents and achievements;
They believe they can only associate with people who are also special, but they will never recognize them as being as special as they are. They will also try to “take down” people they believe are better, as that will show just how special they are;
They will usually monopolize conversations, and if they believe you to be inferior to them (which they do for almost everyone), they will belittle or look down on you;
They expect to be given special favors;
They demand unquestioned compliance with their wishes;
They will not hesitate to take advantage of other people to achieve their goals;
They won’t recognize the needs or feelings of other people because they can’t;
They are arrogant and often behave in a haughty manner, which manifests as being boastful, pretentious, and conceited;
They insist on only the best, whether it’s their car, office, or home, because they believe they deserve nothing less.
When they are confronted with even the slightest criticism, they feel extremely threatened and will frequently react in one of the following ways:
If they believe they are not being treated in a special enough way, they may become very impatient and even angry. For example, they might snap at a waiter who doesn’t seem to be giving them the devoted attention they believe they should receive. Jennifer described the nightmare of going out to eat with her toxic husband, “Once he had decided the waiter was no good, he loudly criticized his every move. It was mortifying”;
They are easily offended and may respond with rage or contempt to even the gentlest suggestion. Jim, a narcissist, reveals that he feels the same kind of threat when criticized—no matter how gentle the critique—as if his very life is being threatened. He feels an immediate need to respond and an almost uncontrollable urge to “crush” the person criticizing him;
They often belittle other people to make themselves feel and appear superior. Jonathan notes that his narcissistic wife frequently tells their friends how inept he is at handyman tasks. She often tells stories about how she has to fix an appliance or redo a home improvement project after he did it. He describes feeling emasculated by her demeaning treatment of him;
They are unable to appropriately regulate their emotions and behavior. Another narcissist, Trevor, describes that he simply can’t control his rage. When he is triggered, it’s as if a bomb explodes inside him, and he can’t stop himself from yelling and belittling the person responsible. The context does little to quell his rage. He will yell at a coworker in front of others as readily as he will his wife in the privacy of their home;
They have great difficulty dealing with any stress, and they struggle with adapting to change. Carol describes her narcissistic husband Mark as a virtual slave to his routine. He experiences great stress if anything causes a change to his normal pattern, and he often blames her if that happens;
They may become depressed if they feel they are falling short of perfection. Jon expresses a great sense of failure over even the smallest problem that he can’t resolve quickly. He notes, “I feel like I’m a loser if something I’m doing—even if it’s the first time I’ve tried it—doesn’t work out”;
They harbor secret feelings of shame, vulnerability, insecurity, and humiliation. Steven describes his almost constant fear of being exposed as a fraud. He has worked hard to get where he is in his job, but he still believes that someday, someone will come along and expose him as a fake.
These descriptions give you some insight into what the narcissist is thinking and how their symptoms cause problems in their life. It’s no wonder that narcissists typically have problems with forming and maintaining relationships, be they romantic, professional, familial, or even just friendships. This usually means they end up unhappy and disappointed with their lives, particularly since it seems like they are not getting the admiration, special treatment, or favors they believe they deserve.
Many people think of narcissism as being excessively vain, but according to psychologist Dr. Ramani Durvasula, although taking and posting selfies and checking your look in the mirror every chance you get are narcissistic tendencies, the fact that you have those tendencies doesn’t necessarily mean you’re a narcissist.
In fact, she believes that narcissism has been badly misunderstood. It’s become a bit of a buzz word in our modern society. Dr. Durvasula identifies four main pillars of narcissism. These are a lack of empathy, a chronic sense of entitlement, grandiosity, and a desperate need to seek out validation and admiration. These pillars are the core of the personality disorder.
Personality Disorders
Narcissism is what is characterized as a Cluster B personality disorder, but what does it mean to have a personality disorder, and what is Cluster B? Let’s start with what characterizes a personality disorder.
A personality disorder is a mental condition whereby you think in a very rigid, unhealthy pattern that also results in unhealthy behaviors. People who have personality disorders typically have problems relating to other people and situations. This results in social problems that can affect both their personal and professional lives.
Because someone like a narcissist has likely been that way most—if not all—of their life, they often don’t even know they have a problem. It just seems natural to them. When they face challenges, they don’t realize that part of the problem lies with their own behavior, and so they tend to blame other people around them.
Most personality disorders begin when you’re young, during your teenage years, or in early adulthood. There are different kinds of personality disorders which are categorized in clusters. Disorders in each cluster show similar signs and symptoms. It is also true that many people who have one personality disorder may also have a second one as well.
Cluster A Personality Disorders
These disorders all are characterized by eccentric, odd thinking and/or behavior. They include conditions such as paranoid personality disorder and schizoid personality disorder.
Cluster B Personality Disorders
This is the category that includes narcissistic personality disorder, and all of the disorders in this cluster are characterized by dramatic, unpredictable, or overly emotional behaviors and thinking. Aside from NPD, this cluster also includes borderline personality disorder, antisocial personality disorder, and histrionic personality disorder.
Cluster C Personality Disorders
The disorders in this cluster are characterized by anxious, fearful thinking and behaviors. Examples include avoidant personality disorder and obsessive-compulsive personality disorder.
Diagnosing and Treating Personality Disorders
Personality disorders aren’t new, but they were first really described around the beginning of the 20th century as part of Freudian analysis. During that time, psychologists and psychiatrists were first describing a variety of personality differences that they were seeing in patients.
Although certain symptoms of mental disorders were readily identifiable, others were less clear. Personality disorders fall into that category because they are, in a sense, intrinsic to the individual. They are woven into the fabric of their personality. It makes it hard to know you have a problem because it just seems normal, and it makes it just as hard for a therapist to spot.
That doesn’t mean that people are always blind to what’s going on. Even the most defended narcissist can sometimes see their own blind spots and weaknesses. But usually, they have to want to understand why they have certain challenges in their life, and for many people with NPD, they often have trouble seeing themselves as the source of any problem.
As for the professionals who are trying to study and treat these kinds of disorders, it can also be hard to identify the specific problem. As the science reporter for the New York Times, Benedict Carey, notes, professionals need training beyond the usual education they get to spot these problems as well.
Another reason this is so problematic to identify is that people who suffer from something like narcissistic personality disorder can also have other symptoms like depression and anxiety. Those are easier to spot and tend to get treated, whereas the underlying condition ends up going undiagnosed. What’s more, even experts disagree on the specifics of each disorder.
Another problem that was pointed out by Dr. Pat Webster, clinical psychologist and author of the book Winning at Love: The Alpha Male’s Guide to Relationship Success, is that certain disorders like NPD are endemic. She argues that the US has become a “culture of narcissists.” Because of that, the traits associated with NPD often get rewarded in that context.
Moreover, there are a lot of people running around with personality disorders. Dr. Mark Lenzenweger, a psychology professor at Binghamton University, notes that approximately one in every ten Americans suffers from some kind of diagnosable personality disorder (NPR Talk of the Nation, 2012). Now, that’s not all NPD. The prevalence of NPD is estimated at approximately 0.5 percent of the general population of the United States. Interestingly, it was found in 20 percent of the military population and 17 percent of the population of first-year medical students (Sheenie Ambardar & Bienenfeld, 2019). That might reflect the success accorded certain symptoms in people who have NPD.
According to Lenzenweger, diagnosing a patient with a personality disorder involves a complicated process of sifting through their life history in order to ensure the symptoms are long-standing—i.e., have gone on for at least five years—and then separating out transitory symptoms like anxiety and depression, which can complicate the diagnosis. Only after this due diligence can the professional be certain they’re dealing with a personality disorder. Oftentimes, clinicians and patients alike don’t have that kind of time, and that’s certainly true for the loved ones who are trying to deal with the narcissist at home. Finally, to be diagnosed, the person suffering from NPD has to actually seek out treatment, and because they aren’t really aware or admit that they have a problem, this rarely happens.
Treatment
If a narcissist does seek out help, the treatment they receive will vary in accordance with a number of factors. The main treatment is talk therapy, also known as psychotherapy, but the patient might also be given certain medications, particularly if they have other mental health conditions like depression.
With psychotherapy, the goal is to help the narcissist relate better to other people, so they can form and maintain more intimate and rewarding relationships. It is also designed to help them understand the causes of their emotions, why they feel the need to compete with other people, why they can’t trust others, and ultimately to get at the self-loathing that’s driving the behavior.
With time, a narcissist can learn to accept responsibility for their actions and maintain good personal relationships, successfully collaborate with coworkers, recognize their own abilities, tolerate criticism, learn from failure, regulate their emotions, build self-esteem, and let go of what they cannot control. They can also learn better coping strategies for times of stress. The support of their family and friends is a necessary element of successful treatment.
There exist no medications approved specifically for treating NPD, but clinicians will often prescribe medication for symptoms that accompany the disorder, like anxiety. There are, however, some lifestyle changes that can be implemented to help alleviate the worst of the symptoms. These include things like keeping an open mind and remembering what the goal of treatment is, sticking to the plan by attending your scheduled therapy sessions, and taking any prescribed medications as directed. They should also treat other problems like alcohol or drug abuse, as well as mental health problems, and engage in family therapy to learn new strategies for interacting with loved ones.
Conclusion
In sum, you can see how complex narcissistic personality disorder is, and it’s no wonder that so many people continue to suffer without any real treatment. Most of the time, they don’t even realize, or won’t admit, that they have a problem. Even if they do, getting a correct diagnosis can be a challenge, and then there’s the problem of sticking to a treatment regimen, something many narcissists simply won’t do.
That paints a rather bleak picture for the loved ones of the narcissist, but all is not lost. There are ways that you can take control over the kind of treatment you will permit, and this can help you shape the behavior of your narcissistic loved one. We’ll discuss this more in the second book in this set, but for now, let’s talk about whether narcissism is actually endemic in the United States or any culture.
