Pathological Narcissism: How To Identify The Signs
The word narcissism comes from the story of a mythical Greek youth, Narcissus, who was cursed by the gods and fell in love with his own reflection. He fell in love with his own reflection in the waters of a spring and died staring at that reflection. A person who is narcissistic does not necessarily have to be beautiful to believe that they are. A person with narcissistic tendencies may be confident that they are superior to others regardless of who they are.
What is narcissistic personality disorder?
The American Psychological Association defines personality as “the enduring configuration of characteristics and behavior that comprises an individual’s unique adjustment to life, including major traits, interests, drives, values, self-concept, abilities, and emotional patterns.” It can be influenced by life experiences and situations, environment, and inherited characteristics.
Personality disorders are a group of mental health conditions characterized by unhealthy patterns of feeling, thinking, and behaving. These behaviors and experiences are often different from the expectations of the culture in which the affected individual lives. People who have a personality disorder sometimes have a difficult time coping with everyday problems and getting along with other people. They may believe that their way of thinking and acting is normal behavior. Because they may have a different view of people and the world, they may find it difficult to participate in some educational, family, and/or social activities.
People with narcissistic personality disorder may find their relationships unfulfilling, and others may avoid being around them. They may become disappointed or frustrated if they are not given admiration or favors that they feel they deserve.
Characteristics of someone with narcissistic personality disorder may include:
- Having a grandiose feeling of self-importance, such as exaggerating talents or achievements or overestimating abilities
- Demanding excessive admiration focused on fantasies of power, success, and beauty
- Paying close attention to self-image (how they are viewed by others)
- Belittling other people’s concerns or problems and/or acting as if others’ problems were unimportant
- Showing patronizing attitudes and/or overconfident behaviors
- Having a sense of entitlement
- Monopolizing conversations and looking down upon or belittling people whom they perceive as inferior
- Insisting on having the best of everything, such as the nicest home, car, or office
Additionally, people with pathological narcissism may find it difficult to handle anything they perceive as criticism. They may become angry or impatient, feel slighted easily, have difficulty controlling behavior and emotions, and experience major problems handling stress and adapting to change. They may feel depressed if they do not achieve what they perceive as perfection. Many people with pathological narcissism secretly experience feelings of shame, vulnerability, and fear of humiliation.
What is pathological narcissism?
A certain amount of self-love may be healthy and normal. However, when an over-inflated sense of self-worth is present and a person begins to believe that they are better than others, this can have a negative impact on several areas of the person’s life.
Characteristics of pathological narcissism may lead a person to have a chronic need for personal gratification and attention. Additionally, they may be socially dominant and ambitious. A tendency to brag, a lack of empathy toward others, and a dependence on others to fulfill responsibilities can also be common.
What causes this type of narcissism?
Researchers have not identified an exact cause of pathological narcissism. Some believe that the disorder forms when infants and young children fail to experience normal bonding with caregivers, especially maternal figures. According to the Cleveland Clinic, it may be a combination of genetics, upbringing, childhood experience, and culture.
A person with pathological narcissism may not recognize their own behavior and be unable to admit that they might have a problem. They may experience difficulty developing meaningful relationships that last. This may be because their personality is sometimes abusive and belittling toward others.
Effects of pathological narcissism
People who live or work with someone who experiences pathological narcissism may feel overwhelmed. The physical and emotional impacts of living with or working with a person who has pathological narcissism can be quite severe.
A person with NPD may be prone to blame others for their mistakes and attempt to make them feel guilty for their problems. This can cause tension at work and, if left unresolved, can lead to violence in the workplace.
When a person with narcissistic personality disorder does not get their way, they may become angry or aggressive. Some people with narcissistic personality disorder physically or sexually abuse others as a means of controlling them.
At the beginning of a romantic relationship, people with narcissistic traits may be charming. However, over time, they can become cold and manipulative. This can result in anxiety and/or depression for their partner.
Complications associated with pathological narcissism may include an increased risk of alcohol and/or substance use, relationship difficulties, work or school difficulties, depression, and suicidal* thoughts or behaviors.
If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.
* If you or a loved one is experiencing suicidal thoughts, reach out for help immediately. The 988 Suicide and Crisis Lifeline can be reached at 988 and is available 24/7. The Lifeline also offers assistance via live chat on its website.
Diagnosing pathological narcissism
Narcissistic personality disorder is diagnosed through clinical evaluation. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it is defined in terms of personality traits of attention-seeking and grandiosity and in impairments in relationships.
The DSM-5 states that at least five of the following criteria must be present for a diagnosis of narcissistic personality disorder to be made:
- Fantasies about beauty, success, and power dominate the individual’s thoughts.
- The individual needs to be admired all the time.
- The individual lacks empathy (the ability to recognize the feelings and needs of others).
- Their behavior appears arrogant or haughty.
- The individual is envious of other’s successes or believes others envy them.
- The individual has an exaggerated sense of self-importance.
- The individual feels that they are “special” and can only relate to other “special” people.
- The individual shows exploitative behavior and takes advantage of others.
- The person feels an entitlement to most things.
Treating pathological narcissism
While there is no known cure for pathological narcissism, with psychotherapy, some people may begin to understand what causes their disorder and learn how to relate with others more effectively. Learning to effectively communicate with others may result in improved behavior and a change in overall attitude. Further, it may help the individual set and achieve realistic goals and expectations.
Many people with NPD don’t attend therapy to treat narcissism, but rather to address an uncomfortable symptom and avoid future discomfort. According to the Cleveland Clinic, a therapist may use cognitive behavioral therapy, dialectical behavior therapy, group therapy, metacognitive therapy, or couples or family therapy to treat people with narcissistic personality disorder. They may at least stay long enough to identify some of their triggers and learn coping mechanisms.
During therapy, they may also learn to relate better with others and to identify the causes of their emotions. In some cases, therapy for narcissistic personality disorder may help people learn to work harder to maintain relationships, manage their feelings, and accept criticism.
For some, medications may be ordered to help manage some symptoms, such as aggression, depression, and anxiety.
When it’s time to see a doctor
People with pathological narcissism may not believe that anything is wrong. Therefore, they may be unlikely to seek treatment. Initially, some people with narcissistic personality disorder who seek treatment do so for symptoms such as depression, anxiety, or alcohol or drug use.
If you or someone you love is experiencing symptoms of pathological narcissism, it may help to seek support to begin to understand the dynamics of the disorder. A counselor may be able to help you develop the tools you need to achieve mental wellness and relate to others more effectively. If you recognize the symptoms of narcissistic personality in yourself or if you are feeling overwhelmed by sadness or depression, consider reaching out to a mental healthcare provider.
If you don’t feel comfortable with traditional in-person therapy, you might consider online therapy, which research has demonstrated to be just as effective as in-person therapy. An online counselor can provide a safe outlet to discuss your concerns and help you create a plan of action to address whatever challenges you’re facing.
With online therapy, you can sign up for therapy from the comfort and safety of your own home. You can communicate with a therapist via phone, live chat, videoconferencing, or a combination of these modalities.
Takeaway
What are the traits of a pathological narcissist?
Narcissistic personality traits may include having a grandiose sense of importance, a need for admiration, and a lack of empathy. Per the DSM criteria, someone with NPD must have at least five of the following:
- Grandiose sense of self-importance
- Preoccupation with fantasies of power, beauty, brilliance, success, or perfect love
- Need for excessive admiration
- Belief that they are “special” and should only associate with or can only be understood by other special people or institutions
- Sense of entitlement, like an unreasonable expectation that people will comply with their expectations or that they will receive favorable treatment
- Takes advantage of or exploits others to achieve their own ends
- Lacks empathy and is unwilling to identify the needs of others
- Envious of others or believes that others are envious of them
- Arrogant, haughty attitudes and behaviors
What is the difference between pathological narcissism and narcissism?
The difference between pathological narcissism and narcissism is that pathological narcissism is a diagnosable condition that involves abnormal psychology, while narcissism is a term commonly used to describe someone selfish or conceited.
Pathological narcissism or narcissistic personality disorder (NPD) is a diagnosable mental health condition. It can be challenging to diagnose, which makes it difficult to estimate prevalence. Generally, NPD is considered pretty rare, affecting only 0.5% to 5% of the general US population. There are multiple types of narcissism, too, including vulnerable narcissism and grandiose narcissism, established by the narcissism spectrum model.
The terms “narcissist” and “narcissism” may also be used to call out someone who has an inflated ego or insists on always getting their way. But if someone does something you don’t like or that you find selfish or inconsiderate, that doesn’t necessarily mean they’re a narcissist.
Do I have pathological narcissism?
The only way to determine if you have pathological narcissism is to talk to your doctor or a mental health professional. Narcissism can be challenging to diagnose, so it may not be something you can figure out on your own. If you think that you are experiencing symptoms of NPD, a mental health professional can do a pathological narcissism inventory and help you get a definite diagnosis and then learn coping skills for how to move forward in your life.
Is pathological narcissism NPD?
Yes, pathological narcissism is the same as NPD or narcissistic personality disorder. Mental health professionals can use a narcissistic personality inventory or five factor narcissism inventory to get a diagnosis.
What are narcissist red flags?
There are many pathological traits and narcissistic red flags to look for, but they may depend on the nature of the relationship. It may be challenging to spot red flags in someone you are just getting to know, as many narcissistic behaviors take time to appear, but there are some warning signs to look for.
Someone with NPD may have little to no empathy. They may ignore other people’s feelings, opinions, or ideas and lack patience when dealing with people. They generally do not like to rely on others, and their self sacrificing self enhancement may cause them to avoid asking for help.
People with NPD may use narcissistic grandiosity or self-important behavior to cover up low self-esteem, which can cause them to try to make others feel unsure of themselves or talk down about themselves with the goal of getting validation or compliments from others.
Whether you’re dating someone with NPD or have a close friend or family member with the condition, you may notice other red flags over time. Gaslighting can be a common tactic used by people with NPD to make people feel uncertain about reality. You may feel the need to keep records of things like texts or a detailed journal so that you have proof of what actually happened.
Someone with NPD may also insult you or point out your insecurities. When you respond to these criticisms, they may accuse you of overreacting or claim they were only joking.
How do you deal with a pathological narcissist?
Dealing with someone with NPD can be challenging. Instead of trying to change them, it can help to focus on your own self-care instead. People with NPD can resist change, and if you confront them about their behavior, they may do whatever it takes to maintain the upper hand. Instead, it may be better to focus on setting boundaries and caring for yourself.
Take some time to work on your own self-esteem. If you have healthy self-esteem, it can be easier for you to set and maintain boundaries. You may also be better equipped to cope with the behaviors of someone with NPD.
Set clear boundaries and enforce them. Instead of trying to change the person with NPD, focus on maintaining your boundaries and communicating what you find unacceptable to the other person.
Practice self-care. Try activities like meditation, yoga, or deep breathing that can help you remain calm when dealing with someone with NPD. Ensure you have a reliable support system outside of your relationship, as coping with someone with grandiose and vulnerable narcissism can be emotionally draining.
How common is pathological narcissism?
Pathological narcissism is relatively rare. In the general US population, the prevalence of NPD is believed to be between 0.5% and 1%. Prevalence can be as high as 15% in clinical settings.
What personality disorder is mistaken for narcissism?
The symptoms of NPD can overlap with those of other personality disorders. The differential diagnosis for NPD can include other cluster B personality disorders, like antisocial personality disorder, borderline personality disorder, and histrionic personality disorder.
Can a pathological narcissist change?
There is no treatment for the interpersonal and affective processes of pathological narcissism, but some forms of treatment can be helpful. Long-term psychotherapy can be helpful for people with NPD but is often challenging. Many people with NPD don’t attend therapy to treat NPD; they go to address a specific symptom and learn how to avoid discomfort in the future. Therapy can help people with NPD understand their condition and learn how to interact and communicate with others more effectively. Some doctors may prescribe medications to treat other disorders that occur along with NPD, but there are no medications to treat NPD specifically unless future research proves otherwise.
How do you live with a pathological narcissist?
If you decide to stay in a relationship with someone with NPD, there are some things you can do to make living with a narcissist more manageable.
Despite their grandiosity and vulnerability, people with NPD may be very controlling and struggle to accept when something is their fault. They may blame you for things happening due to their insecurity or manipulate you into believing that challenges in your life are the results of your actions. In time, it can be difficult to think that everything isn’t your fault.
To combat this, you can stop apologizing for things that are not your fault. You can set healthy boundaries by telling them that you’re uncomfortable with them blaming you and walking away.
Those in relationships with people with NPD may need to change their expectations about what they want from their relationships. It can be hard to accept, but people with NPD are unlikely to apologize for their mistakes, and they may be unable to see their faults or go through extreme measures to hide any imperfections and insecurities from others.
Learn about their common behaviors so you know what to expect. Predicting how someone with NPD will behave can be challenging, but you may be able to pick up on things that make them lash out. If you know what to expect, you can step away or remove yourself from the situation entirely.
Establish boundaries to let them know what you will and will not accept. Be transparent and stay firm. When someone with NPD pushes your boundaries, sometimes you can leave the room and wait until they compose themselves before continuing the conversation.
People with NPD often have poor interpersonal functioning and low self-esteem. If you can find a genuine reason to complement them, it can help them build more confidence and overcome their narcissistic vulnerability. Don’t lie or flatter them; instead, look for genuine traits or things that they’ve done that you genuinely like.
Learn to deal with any unkind words someone with NPD may say to you. When they say something insulting, let them know that what they said is unkind and you’re not willing to tolerate that treatment. Then, take some time to remind yourself of your self-worth and try to gain high self esteem.
If you are in a relationship with someone with NPD, attending counseling can help. Whether you attend therapy on your own or go together, therapy can help you learn why the person with NPD behaves as they do and how you can cope with the challenges of your relationship.
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