The label is everywhere – from reality TV to relationship advice and even the US president. But psychologists say true narcissistic personality disorder is rare, complex and often misunderstood.
The term narcissist has become the defining insult of our age. It can seem like a convenient catch-all for various kinds of crappy human behaviour as everyday selfishness, arrogance and even abuse is labelled narcissistic. It’s become pop psychology, something to call your ex, (or the US president). Suddenly, everyone is a narcissist.
But the word is thrown around, and “grossly misused” argues Debbie Mirza, author of The Covert Passive Aggressive Narcissist: Recognising the Traits and Finding Healing.
“People often use this word to describe someone who is selfish and arrogant,” but anyone who has experienced a true narcissist would never use the label so lightly, she says.
Dr Catriona Davis-McCabe, a counselling psychologist and president of the Australian Psychological Society, worries that the term has become normalised.
“We often see it on the TV in reality programs where people will call a partner narcissistic, but they are not referring to Narcissistic Personality Disorder.”
Yet a formal diagnosis of narcissism remains “extremely rare” says Dr Kelly Gough, a clinical psychologist and president of The Australian Psychologist Association. It is one of the more complex and contested mental health diagnoses, he says.
Identifying the narcissists among us
Narcissists walk among us but are poorly understood by the average person.
“People with Narcissistic Personality Disorder see life as a vertical hierarchy,” leading American expert Elinor Greenburg says, “where the goal is to get as close to the top as possible. Everything is about status.”
There is nothing wrong with a bit of healthy confidence and self-love, says Sydney psychologist Dr Amanda Ferguson.
“A really good, strong self-esteem and being proud of your success, a healthy ego, is a wonderful thing that you need to succeed in the world,” she says.
The problem, she argues, is “people now have social media access to everything, including AI, many think they can diagnose it.”
The diagnostic leap from being a bit selfish and chuffed with yourself to full blown narcissism can be found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) – a book of mental health conditions and their diagnostic criteria used by psychologists and psychiatrists around the world.
Narcissistic Personality Disorder (NPD) has a lifetime prevalence of about 7.7 per cent of men and 4.8 per cent of women. At any point in time around 1 or 2 per cent of us may meet the diagnostic criteria for NPD, a specific web of nine traits outlined in the DSM’s most recent edition.
“It’s important to remember” says Ferguson, “that any of us can exhibit some personality disorder traits occasionally, but to meet the criteria of a personality disorder, the traits must be repeatedly observed over different times, places, and circumstances.”
An exaggerated sense of self-importance, preoccupation with fantasies of success, power and brilliance, a belief they are special, excessive need for admiration, sense of entitlement, pattern of taking advantage of others, a lack of empathy along with envy and arrogance are the criteria to look out for.
A person with five or more of these red flags can be diagnosed with NPD.
“If you’ve got nine of the traits you’ve got full blown narcissism, maybe progressing to antisocial personality disorder,” Ferguson says. Someone with fewer than five could still exhibit narcissistic behaviours but not enough for a diagnosis.
Narcissism can present as vulnerable or grandiose, colloquially known as covert or overt.
We all know about the balls-out, boasting, shiny, charismatic braggadocio of the overt or grandiose narcissist who creates stories and causes chaos and confusion. But vulnerable narcissists are a sub-species that can appear fragile and charming. This is a mask.
They are insidious and pernicious, says US psychologist Dr Ramani Durvasula. “Quietly hostile, passive aggressive, sullen, brooding, victimised. A covert narcissist’s tactics only show up when there are no witnesses, apart from the victims.”
They can appear needy, brittle and dependent. “It draws us in” says Ferguson, “it makes us want to help and protect them.”
But this is weaponised weakness. By getting people to feel sorry for them covert narcissists are gathering the sympathy and support to isolate their victim.
Says Durvasula: “Covert narcissism is essentially a manipulation through victimhood”.
Vulnerable narcissism was first acknowledged by the DSM in 2013 and discussion about its diagnosis is ongoing.
“There’s a lot of debate and ongoing research about how to define and diagnose these people,” Ferguson says. Is NPD a spectrum? Are traits influenced by culture or social expectations? How reliable is clinical diagnosis?
Emotional ground zero
However you define it, anyone who has been the victim of a covert narcissist is in no doubt of the emotional devastation they can leave behind.
There is a global industry of psychologists and online forums helping victims recover when their lives are reduced to ground zero by someone with this personality disorder.
“I was a shell,” says Louise, a professional woman who asked to use a pseudonym and says she was nearly destroyed by an 11-year marriage to a covert narcissist. “I came close to suicide.”
Another victim, Robert, says when you first start a relationship with a narcissist it can feel magical: “You’ll think you have met someone kind and generous, a sweet person who seems to share many of your ideals and vision of the future”.
“What many victims don’t realise – until years or even decades later when the truth finally comes out – is that the person you met never truly existed”.
Instead, they were studying you, learning how to become your perfect companion by mirroring your traits, mimicking your behaviours and flooding you with praise and admiration, says Robert, who also asked to use a pseudonym.
When the real person emerges it looks like this: “The gaslighting is constant. Mood swings and outbursts of anger are frequent. It is a cycle of highs and lows. The narcissist lives in chaos and confusion, and they need you to live in confusion as well,” Robert says.
Louise and Robert wanted to hide their identities because, like many victims, they feel shame about being taken in by a narcissist and frightened of the consequences of speaking out.
A new version of reality
None of this surprises Elizabeth Shaw, a psychologist with Relationships Australia.
The covet narcissist will use “rat cunning” she says, and go to any lengths to be in a dominant position, even if another person’s self-esteem is eroded to make them feel better.
“They create a new version of reality where they’re always the victim, the hero, or the innocent party,” she says.
The narcissist’s true nature can remain seductively, pleasantly, hidden behind the magic, as Robert described, until a simple trigger – casual criticism, someone else being praised – sets off a cascade of insecurity.
“They remove the context, erase the lead-up and cut out the things they did or said to push you over the edge,” Shaw says.
Suddenly you are presented as an unstable abuser.
“It is a clever, cruel trick” says author Debbie Mirza. “They have effectively vanished from the crime scene they created, leaving you standing there holding the evidence of your own emotions.”
But if you expose a vulnerable narcissist and leave the relationship, the smear campaign can begin.
Robert’s narcissist unleashed scorched earth retribution.
Separation from his partner led to “about six months of sustained harassment. My business was targeted. I was falsely reported and audited. I was accused of criminal behaviour and investigated. None of it was true – the goal was to overwhelm me with chaos and pressure,” he says.
“Many others joined in, including my friends and even my own brother, spreading rumours, attacking my credibility. It was a coordinated effort to destroy my reputation.”
Inside the mind of a ‘narc’
Diagnosed narcissist Jacob Skidmore has made full use of social media to build his profile as The Nameless Narcissist. The author and YouTuber maintains his goal is to destigmatise the condition.
Skidmore, fast-talking and charismatic, live streams weekly to his followers and is regularly interviewed for insights into life as a narcissist and what drives the behaviour.
“I can’t feel good about myself unless people are giving me admiration,” he reveals on his YouTube channel.
In one of his videos Skidmore says hiding true emotions and “trying to charm people through a facade” is not about self-love but “about thinking we are better than other people so we can feel good about ourselves, even though we still kind of hate ourselves.”
The lack of empathy, he explains is because “we’re so fixated on what other people think of us”.
“I always say ‘I’m not thinking about you’,” he says. “I’m thinking of what you think of me. We’re so worried about managing our self-esteem that we can’t really even consider the needs and wants of other people.”
Skidmore says he is so ruled by this need to be liked he is “willing to compromise things that feel somewhat genuine”.
Skidmore is strikingly self-aware. He is aware, for example, that his videos on YouTube are the ultimate way to seek and receive attention and validation.
He is also aware that being a narcissist in the first place has been quite handy in building his social media profile as the grandiosity has given him the courage to approach people and put his videos out there.
“It has made me famous” he admits.
He believes remission from NPD is possible.
“When I say recovery I don’t mean that I am not a narcissist anymore. I will be for the rest of my life. That is the nature of the thing,” he says. “What I mean is that I am not being harmful to others. I’m not lying. I’m not being exploitative. I’m not being disrespectfully grandiose and letting that affect my life. I’m adapting to the world around me in order to be functioning and not hurt other people.”
And although it can be hard to find empathy for a narcissist, you can see Skidmore’s suffering.
“This is hell. There is something disgusting inside me that I need to keep to myself,” he says in one video.
“I hate myself. But I am better than anyone else. I need to better than everyone around me. My life feels like an act. I feel like shell, a patchwork of traits that I stole from other people over the years. It feels like being dead, emotion is deeply uncomfortable and distressing. Emptiness is safe.”
Where does Skidmore believe his narcissistic personality came from? Once again he is reflective. And there is tragedy in his theory: “I was abused to the point where I got a personality disorder and now I am unable to love.”
Is change possible?
The term narcissism was coined in 1899 by German psychiatrist Paul Nacke. He named the condition after Narcissus, the devastatingly handsome boy from Greek mythology who rejected the affections of others, became enamoured with his own reflection, and spent his life staring at himself in a river.
Sigmund Freud brought the label into the mainstream with his 1914 paper On Narcissism: An Introduction, that argued narcissism was a normal stage of development. He claimed all children are narcissists.
In the 1970s American psychoanalyst Heinz Kohut argued, similarly to Freud, that narcissism was a stage we all pass through.
But unlike Freud, who had his doubts about whether narcissism could be treated, Kohut believed if we became stuck in the narcissistic phase psychoanalysis could help develop a healthy sense of self.
Psychologists do not diagnose NPD until at least age 30, Ferguson says. “Personality is bedrock by 30. You’re not going to become someone different.”
However, there is good news too. Just as Freud and Kohut saw narcissism as a condition of youth there is evidence that people become less narcissistic as they age. The disorder shows up differently in men and women. But even so, as researchers from the University of Bern and University of Munster found, someone who was more narcissistic than their peers as a child will remain so as an adult.
Many believe the more important question is whether the narcissist can even recognise that they need to change. Ferguson suggests that the reason NPD is rare is because so few make it to therapy in the first place.
Inherent in the problem of diagnosing and being able to calculate the statistical prevalence, she says, “is the fact that the narcissist either won’t go to therapy or very rarely will stay in therapy. So you’re not diagnosing that many of them because you’re not seeing them.”
Born or made?
Why would a person grow up with “self-esteem so brittle or insecurities so dominant that the narcissism plays out in ways that are destructive to others,” psychologist Ferguson asks.
It is rooted, she argues, in “an unstable sense of self. They are constantly having to fill up that void. It is like a bottomless pit.”
In her research Ferguson found that this unstable sense of self can develop in early childhood and is often the result of insecure or severed attachment that leaves a person never feeling safe.
“Our research showed that typically, by the age of three, the child either didn’t bond sufficiently with the carer or was held too close and didn’t develop a sense of self because of an attachment disorder,” she says. “That may be why they can seem to regress to the age of a two or three year old when their temper tantrums come on.”
Personality disorders are created by a range of factors, Ferguson explains.
A person’s genetics or inherited characteristics combine with the influence of nurture, how and where they were raised. These influences are further affected by our neurobiology, how our brains and nervous systems connect to form our personalities.
“Some research shows NPD occurs when parents are either overly protective or neglectful or when they give excessive adoration or excessive criticism that doesn’t match the child’s experience,” Ferguson says.
She says she often finds evidence of personality disorder in older members of a family that may “have contributed genetically to the person we are trying to understand.”
Then there is the golden child syndrome.
Studies show that when parents overvalue, overestimate and overpraise their child’s qualities they can become more narcissistic over time.
We can never, Ferguson says, “overestimate the importance of the early years of life”.
Adverse childhood experiences profoundly affect the brain, disrupting normal stress responses.
“All these changes to bodies and brains from childhood trauma persist into adulthood and are lifelong,” Ferguson says.
A path to healing: Reclaim yourself
For a narcissist’s victim, maybe the path to healing is not to seek a cure for the narcissist but to reclaim yourself.
Psychologist Katie Feder works with people recovering from narcissist abuse. A narcissist wouldn’t bother with a person who patrolled healthy boundaries, she says, there is no sport in that.
“I believe that there is a dynamic within us that allows this to take hold,” she explains.
Narcissists are attracted to people with a high level of empathy, givers, open hearted and kind with porous boundaries, preferably with status that can make the narcissist look good – but definitely not outshine them.
Feder wants people to understand that it is very rare to get validation or agreement from a narcissist.
“There is no empathy, no accountability,” she says. “This is one of the hardest things for people to accept. There is nothing you can say or do.”
“Don’t”, she says, “carry it until your last breath”.
The recovery, Feder says, “lies in the reclamation of self. The energy, time and attention comes away from the narcissist and back onto yourself.”
Ferguson agrees.
“Once we understand the personality disorder, accept it and detach emotionally,” she says, “We are free.”
Credits
Words: Susan Chenery
Illustrations: Lindsay Dunbar
Editor: Catherine Taylor
