It’s a cliché within a cliché to point out our collective infatuation with using psychiatric terminology to diagnose our friends and enemies. “I’m a little OCD,” we say after vacuuming the living room rug for the third time in one week. “The weather,” we grouse, “has been so schizophrenic lately.”
We often label people as narcissistic who seem to care only for themselves and disregard norms that govern social life.
But what does the diagnosis of narcissism really entail?
Beyond this superficial — in the literal sense — reading of narcissistic people, the contemporary medical understanding of someone with narcissistic personality disorder is a multidimensional appreciation of the narcissist’s indiscriminate social aggression. The current psychiatric framework defines Narcissistic Personality Disorder — so it is a "personality" disorder, as opposed to what are called “affective” disorders.
This difference is key for beginning to understand the severity and treatment-resistance of NPD.
Major Depression is an affective disorder, along with other bold-faced names like Bipolar I and Obsessive-Compulsive Disorder. Having a monstrous, malicious, and cannily unpredictable disease like depression is like wearing Spiderman’s brutalist black-and-white costume: it is an alien and destructive thing, but it’s only a parasite that is purged from his body eventually.
But a personality disorder is like being a version of Superman with an unwarranted idea of his own greatness. Superman is Krypton’s prodigal son, but he can never truly be an earthling, and everything about his material existence is potentially hazardous to his loved ones on his adopted home planet.
Spiderman’s struggle with an unwanted wardrobe change and Superman’s suspect heritage, show us the critical difference between personality disorders and other mental illnesses.
The term narcissism comes to us from ancient Greek mythology.
Narcissus one day happened to notice his reflection in a pond. No classic of Greek mythology would be complete without a soap opera fight between the Greek’s too-human gods: Nemesis had cursed Narcissus to suffer for his vanity. Narcissus was entranced by his reflection in a pond.
As he was so enraptured with the shimmering surface of the water he realized no one would ever be able to love him as he loved himself. After this realization that he would be forever under appreciated, he took his own life rather than let it succumb to a cold, disinterested world.
Psychiatrists and psychotherapists (of which I am neither) use the term Narcissistic Personality Disorder to refer to people who have both immensely inflated egos and crippling insecurity that causes severe interpersonal turbulence.
Diagnosing someone is not a precondition for finding them odious. At the same time, understanding the way personality disorders manifest themselves inside and out can give you a new appreciation for the intense struggle that your asshole coworker is fighting day and night.
If we — laypeople, that is — use the Diagnostic and Statistical Manual of the American Psychological Association as a piece of literature, then thinking of someone as being clinically narcissistic can be a way of enhancing our own humanity. If we can identify a narcissist by their behavior, then we might also get closer to understanding what would compel them to act so abrasively in the first place.
Think about someone you know who always has to be the best, who refuses to share credit for group efforts, and who is constantly buying things to enhance their self-image. Maybe they come into work with a new shoulder bag every week, or they buy a new BMW every 18 months, even though they make less than you do.
This combination of ceaseless demand for fealty from people around the narcissist, and a tendency to consume the latest and greatest is part of a pattern of disordered desire for attention and respect.
Let’s start to understand narcissism by examining these persistent behaviors that wreak havoc on everyone in the narcissist’s life.
1. “I’m the only one keeping this company afloat; without me we would fold tomorrow!”
No matter how much a narcissistic person does for their job or for another person, they have always done far more in their own mind. Moreover, they’ve worked slavishly and selflessly to zero recognition. Narcissists are often workaholics because they invest so much of their tightly limited self-esteem in their work. People with NPD have to be the best, but they don’t let sub-par performance keep them from feeling like the biggest fish in the tank.
While it may be obvious to everyone around them that they constantly need to be the center of attention, a truly narcissistic person feels chronically ignored and under appreciated. Most of us are happy to receive occasional praise at work, and we try to be fulfilled by our relationships. The narcissist is unable to store the emotional satisfaction of praise and a job well done, they are always looking for ways to remind their cohort how indispensable and omnipotent they are. The narcissist’s self-loathing prevents them from absorbing the accolades and adoration they seek.
2. “You’re worthless!”
With a hyperbolic assessment of one’s own worth comes a very low assessment of everyone else. Narcissistic people frequently speak bluntly and act in a rude, thoughtless manner toward those around them. This disdain brings with it a swaggering attitude; thinking that you are the best means believing others should treat you as such.
Narcissistic personality disorder can make a person totally ignorant of their own aggressive power grabs; what they see as necessary, proactive behavior on their part tends to be viewed by others as an inappropriate tantrum designed to alienate as many people as possible while somehow convincing those people to do the narcissist’s bidding. And yet the narcissist is often successful in this.
Managers and higher-ups can rule by fear, and their verbal abuse can sometimes generate a kind of Stockholm Syndrome where the narcissist’s underlings work tirelessly to please their superior. Making demands of everyone you encounter can often be successful, especially if you’ve trained those around you that refusing your demands means more trouble than simply doing your bidding.
3. “Why don’t I have any friends?”
A narcissist’s personality is like a circus tent held up by their the special treatment and compliments they pry out of those around them. Again we see that this inability to make friends stems from the idiopathic, all-encompassing nature of personality disorders that can totally derail even the simplest human interactions.
What to do when you think you’ve spotted a narcissist?
1. “There’s no medication for selfish.”
Unlike disorders such as clinical depression or bipolar, "[t]here are no medications specifically approved by the Food and Drug Administration (FDA) to treat personality disorders," according to the Mayo Clinic. "However, several types of psychiatric medications may help with various personality disorder symptoms."
Narcissists are not psychopaths, whose disregard for the feelings of others comes from their monomaniacal shark-like ids, but their personalities and habits of interacting with others are so ingrained and integral to their existence that treating their antisocial tendencies requires intensive specialized psychotherapy. However, it requires a great deal of patience to treat someone with a personality disorder, and their outbursts are explosive and disruptive to the therapist’s practice.
2. “Do you still love me?”
If the potential narcissist in your life feels the social consequences of their behavior and is motivated to change, then getting treatment can be a straightforward thing. The first stop should be an appointment with a psychiatrist or nurse practitioner who can evaluate the potential NPD. A profoundly narcissistic person can feel totally unloved and resist treatment as another attempt by the world to keep him down.
The daily ritual of building up one’s outer walls by demeaning other people only to end up as miserable as you began is an exhausting one. But getting treatment for someone with a psychiatric disorder like NPD can be practically impossible if that person is a functional adult who does not want treatment.
3. “I hate you!”
You may have to live with a narcissist for a long time to come. Learning to handle their tissue-paper psyches and endless demands can make your interior life a lot easier, even if their’s is still a mess. Like a zeppelin filled with hydrogen, the smallest spark can consume a narcissist’s colossal ego. Sticking to the basics of non-violent communication is a good first step.
Use the old standbys: speak in “I” phrases, talk to the person as if they’re a person and not a problem you have to face. When you bring up a person’s mental illness, bring it up first by expressing your love and concern. It’s not the job of a narcissist’s partner to diagnose or treat them, a partner must be that exactly: someone to be by their partner’s side and to give everything they have to lead them both toward a better life.
If you have to engage with a person with NPD — at work, for example — make the exchange as straightforward as possible without delving into their personal orbit. Flattery can be a powerful tool in your conversations with narcissists. You don’t need to shower them with toadying affection, but the right observation about a narcissist’s latest acquisition or overplayed bon mot can grease the rails a little.
Living with a narcissist might better be described as coping with one. Every day might be different, and unfortunately dealing with a narcissist means being prepared to field their unpredictable, arbitrary demands and gauge their wildly labile moods.
Hope for treatment?
First, you stop and consider the situation: how might this person fit our definition of narcissism? Are you forced to interact with them (work, school, etc.)? If you are interacting with a narcissist, perhaps the only thing you can do is wait for any pause in the narcissist’s exegesis on their own superiority to raise anything that might relate to your job and your professional relationship to the narcissist.
If you suspect your romantic partner or spouse suffers form NPD, the easiest way to approach it is not by handing out blanket diagnoses, but by trying to address the symptoms. Recognizing narcissism is fine, but in order to address it you may get farther by pointing out parts of the narcissist’s behavior that make it hard to be around them. If you can gradually open up about the parts of their demeanor that upset you, then professional help might be achievable
NPD won’t go into easy remission like depression when treated quickly with a serotonin and norepinephrine reuptake inhibitor. NPD is a disorder that necessitates a long-term commitment to treatment. But there is hope; treatments like Dialectical Behavioral Therapy can truly help people with personality disorders to overcome their demanding, abusive mental illness. The tough part is that it is almost impossible to compel a narcissist to seek and maintain treatment.