Narcissism had become a massive buzzword. It’s almost fashionable. I was in a coffee shop the other day and overheard a woman say to her friend, “My boyfriend turned out to be a narcissist” and her friend sighed and countered, “Mine too.” They didn’t even need to talk about what that meant.
I do feel we need to speak more about narcissism though, where it comes from, how it operates, and how to handle it – because as that café chat suggests, there seems to be a narcissist hiding around every corner these days. Under every rock. On every dating app. And hiding is the particular issue we need to be aware of, because narcissism as described in the DSM does not cover this very real aspect of the disorder.
Narcissistic Personality Disorder or NPD was first recognised as an illness in 1980 in the DSM, where your classic or stereotypical narcissist is described in 9 criteria encompassing a pervasive pattern of grandiosity (in fantasy or behaviour), a need for admiration, entitlement, and a lack of empathy. In addition features such as interpersonal exploitation, envy, and arrogant, haughty behaviours and attitudes are listed. “Preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love”; “Believes is special and unique”.
This turns out to be a rather narrow and homogeneous definition of NPD however. It does match the “oblivious narcissist” or extroverted subtype noted by Gabbard in 1989. But in 1993 Masterson made us aware of the existence of “closet narcissists” who differ from “exhibitionistic narcissists”. Much more scary and baffling is the covert narcissist, the wolf in sheep’s clothing whom you can’t see coming from afar.
We get caught out in collegial, romantic, filial and therapeutic relationships by only realising later, sometimes much too late, that we have been hoodwinked by a cunning narcissist who was all charm and intelligence until challenged or criticised. At which point the individual flipped, and became focused on rage, resentment and revenge. Our jaws drop at the atomic level of hostility we suddenly witness, and are often targets of.
This affective reactivity, and the antagonism and distress underlying it are, I feel, insufficiently covered by the 9 criteria in the current DSM. As are an inherent emptiness and boredom which may find expression in substance abuse; plus paranoid thinking, charisma, and a disregard for common morality (including honesty and accountability) and the law.
In popular discourse concepts like gaslighting, love bombing, false self, smear campaign and flying monkeys have become useful but they are not present (yet) in the DSM. Although interpersonal exploitation is mentioned, terms such as supply, hoovering, triangulation and other kinds of emotional manipulation, are not.
Perhaps most importantly, the issue of assailable self-esteem and feelings of inferiority is not covered. In 1989 Gabbard also wrote about the introverted or “hypervigilant narcissist” who contrasts the stereotype and in 2024 a study by Littrell asserted that there are essentially two types of narcissist: grandiose and vulnerable. A grandiose narcissist is the person we all think of when we hear the word narcissist. They feel superior to others, have more entitlement, and have a strong, usually inflated, level of self-esteem. But this is just the tip of the iceberg.
It’s important to become aware, in both our private and professional lives, that there are in fact many shades of narcissism. On the net as many 16 different kinds of narcissist (and counting) are described! I will try to summarise these variable presentations in my talks, so that we can become more discerning.
In addition, some researchers agree that rather than fitting neatly into separate categories, narcissists shift in and out of overt states, depending on the stress they’re under. Hence the flip I touched on, the two sides, the changeability. Once a narcissist’s mask has dropped, it can be hard to believe what you are seeing. It’s as if the person you knew is dead. In truth, they never existed. They say marrying a narcissist, for example, is like building a beautiful house on a frozen pond in winter.
We wouldn’t have to listen to “How to Know if your Partner is a Narcissist” on YouTube if the phenomenon of narcissism were that obvious or simplistic! Even as trained practitioners, we have to face that narcissists are hard to spot, and we can get beguiled. There is no need for self-recrimination, only continuing education.
We also need to consider the interplay between our own vulnerable, sensitive psyches as mental health professionals, and that of the unempathic, duplicitous narcissist. There is a huge attraction between narcissists who seek power, attention and supply, and individuals who are geared towards attunement, sympathy, and conflict reduction. People drawn to the helping professions can exhibit codependent behaviours. All too often we are prone to smoothing and giving our power away, and we may be self-critical, preferring to tend to the needs of others.
If we consider narcissism as an Empathy Deficit Disorder and codependency as a Self-love Deficit Disorder, it becomes apparent that the dance between these two can be extremely destructive. Survivors of narcissistic abuse really struggle to break free and regain their equilibrium and trust. Their sense of their own reality has been questioned and they are second-guessers of themselves of note, filled with self-doubt, some to the point of psychosis. The disavowed self-loathing of the narcissist has been projected onto the other in an unconscious process, and readily received. One can feel mad, and suicidal.
On the upside, the narcissistic encounter in which idealisation switches to devaluation, is a golden opportunity to meet our deepest childhood hurts. If you have been abandoned, misunderstood, misrepresented, humiliated or punished unfairly in the past, these triggers will rise up in technicolour before you. It makes us consider whether our connections were genuine, or just an instance of trauma bonding. Certainly, narcissists also carry profound wounds. But these are linked with such shame that they have gone underground, leaving most narcissists unable to own their pain and therefore impervious to recovery, with a tendency to blame.
In the Greek myth, Narcissus unknowingly fell in love with his own image, mistaking self-love for love of another. By experiencing self-love as projection rather than as connection, he self-isolated to the point of dying of unrequited love. In his place grew a beautiful Narcissus flower. We must not get confused.
Therefore we must recognise that people with NPD may be the life and soul of the party or socially isolated, captains of industry or unable to maintain steady employment, model citizens or prone to antisocial activities. Given this heterogeneity, it is actually far from self-evident what such individuals could have in common to justify a shared diagnosis. Section III of the DSM-5-TR does offer an alternative, dimensional or trait model which can be used in a hybrid way with the categorical one, and there is great scope here when thinking about personality disorder.
Narcissism like any mental health issue requires our compassion but more than that, it asks clear boundaries of us, for us to look it in the eye and not excuse it. It is vital for practitioners to learn about optimal, practical ways to manage NPD so we can teach them to the loved ones of narcissists, where the fallout is huge. Responding in ways that preserve your sanity and self-regard when dealing with a narcissist often feels counter-intuitive and unkind. Our clients will need a great deal of support in embracing acceptance and letting go of the hope that narcissism will heal itself.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text revision). Washington: American Psychiatric Association.
Gabbard, G. O. (1989). Two subtypes of narcissistic personality disorder. Bulletin of the Menninger Clinic, 53(6), 527–532.
Littrell, S. (2024). The metacognitive abilities of narcissists: Individual differences between grandiose and vulnerable subtypes. Personality and Individual Differences, 221, 112570.
Masterson, J. (1993). The emerging self: A developmental, self, and object relations approach to the treatment of the closet narcissistic disorder of the self. New York: Brunner/Mazel.
Rosenberg, R. (2013). The human magnet syndrome: Why we love people who hurt us. Emotional manipulators, codependents & dysfunctional relationships. Illinois: Premier Publishing & Media.
Vaknin, S. (2013). Malignant self-love: Narcissism revisited. Skopje: Narcissus Publications.
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