If you think you might be a narcissist, we’ve got some good news.
You’re probably not—or, at least, you’re not on the extreme end of the spectrum. Extreme narcissists typically wouldn’t assume that they’re narcissists; by definition, they don’t want to entertain the idea that they’re somehow imperfect.
“Narcissistic personality disorder is a pretty severe diagnosis,” Heather Stevenson, PsyD, tells Urbo. “I think that the word gets thrown around a lot. A person can have narcissistic traits and not have the personality disorder.”
Stevenson spent the last several years working in a maximum-security prison with several men who have the actual disorder, and she asked us to make one point clear: There’s a world of difference between people with the narcissistic personality disorder (frequently referred to as NPD) and people with slightly narcissistic tendencies.
“You want to think of it as a spectrum,” she says. “A personality disorder is a very long-standing pattern. I want to really make sure that that’s emphasized.”
Sanam Hafeez, PsyD, agrees with that assessment—people should exercise some caution before using words like “narcissist.”
“The tricky thing with NPD is that [those with the disorder] rarely believe anything is wrong with them,” Hafeez tells Urbo via email. “Remember, a narcissist places blame on everything outside of themselves for their current state. Less than three percent of the population are actually diagnosed with NPD, yet it seems that … more people are exhibiting the characteristics of narcissism, and many [are doing so] in an extreme way.”
By one estimate, NPD affects up to 6.2 percent of adults, with rates higher for men (7.7 percent) than for women (4.8 percent). If you believe that someone in your life has narcissistic tendencies, here are a few crucial things to keep in mind.
Narcissistic behaviors aren’t always obvious.
Narcissism doesn’t always manifest the same way, but the disorder is associated with a poor ability to regulate self-esteem. By definition, narcissists are obsessed with themselves—which doesn’t leave much room for close personal relationships.
“Someone with these narcissistic tendencies, they’re going to be so focused on themselves that any relationship isn’t a reciprocal type of relationship,” Stevenson says. “Someone on the narcissistic side is going to say, ‘How can this person benefit me?'”
That can lead to exploitative behaviors; narcissists are more likely to feel entitled to certain parts of a relationship and less likely to see others as equal. Those signs might not show up at the outset of a relationship, partially because some narcissistic people can be quite charming at first.
“They are incredibly charming and likable, and they are able to turn the conversation back to themselves,” Hafeez says. “This is why they are exceptionally good at job interviews. They know how to adapt to become the character of who they need to become to achieve their goal.”
People with NPD are more likely to be extroverted, but they aren’t always tremendous charmers. A paper published in The American Journal of Psychiatry noted that people with NPD “may be grandiose or self-loathing, extraverted or socially isolated, captains of industry or unable to maintain steady employment, model citizens or prone to antisocial activities.”
Needless to say, the spectrum is pretty wide, but psychiatrists look for telltale signs when making diagnoses.
“If you see someone who constantly thinks highly of themselves—they can do no wrong, they’re perfect, they’re impervious to any wrongdoing—in the sense that it feels extreme, and it’s a constant pattern, that’s one of the key signs of narcissism,” Stevenson says.
“But perfectionism isn’t the same thing,” emphasizes Stevenson. “These disorders are often intertwined, so I wouldn’t recommend jumping to conclusions if you notice narcissistic behaviors in someone.”
Over time, a non-narcissistic person will start to notice something.
The person with narcissistic tendencies won’t be able to communicate his emotions effectively, which will likely put stress on the relationship.
“You’ll feel, I’m constantly giving to this person and not getting anything back, because it is so much more of a one-sided relationship most of the time,” Stevenson says. “That’s not to say that they’re never giving—but everything has this undertone of, ‘What can I get?’ The relationships that they tend to have are very surface-level. They don’t get very deep, and they don’t show a lot of their emotion.”
Extreme narcissists often place a strong value on appearances, and they’re less likely to feel empathy for others (although they’re not necessarily unable to feel empathy).
“They are often impeccably dressed and groomed, and if they are not, they will have something they use as a reflection of prestige or status,” Hafeez says. “For example, the guy who wears jeans and a t-shirt and drives a $150,000 car, or the woman who brags about her $6,000 handbag. When they speak, they never accept any responsibility or speak of the lessons they learned from a challenge.”
Being in a relationship with a narcissist can be an emotionally taxing experience. However, if you’re convinced you know someone with NPD, don’t confront them just yet.
Narcissists rarely seek treatment until they’re facing consequences.
Here’s the thing about narcissists: They rarely admit that they have flaws, and as a result, they rarely seek help from psychiatric professionals.
“People don’t necessarily come in to get treatment for [NPD],” Stevenson says. “After all, they don’t think anything’s wrong with themselves. They might feel the pressure from other people—they don’t necessarily feel it’s because of something they’re doing wrong.”
“Typically, something has to happen to the narcissist where they spiral downward,” Hafeez says. “Perhaps they get into trouble legally by someone who they’ve wronged and are ordered to have a psychological evaluation. Through there, it’s diagnosed.”
Both Stevenson and Hafeez say that narcissism isn’t curable, per se, but it is changeable. Regular treatment can provide a patient with the tools needed to manage the disorder.
“First, there’s a full evaluation to see if there are other personality disorders present, which is possible,” Hafeez says. “Psychotherapy or talk therapy is usually the approach. Medication isn’t necessary unless there’s another issue prevalent. …Through psychotherapy, narcissists can learn how to cultivate healthy relationships and set more realistic goals for themselves based on their actual strengths and talents.”
“They can gain more awareness of their feelings so that they can manage them by assuming more responsibility for outcomes in their lives.”
Stevenson says that diagnosed narcissists need ongoing therapy to address the negative aspects of the disorder.
“It’s a lot of work trying to help them get more aware of and in touch with their own emotions and emotional states,” she notes. “A lot of times, the people who have these types of personalities are shutting off a lot their emotions and only living in a small spectrum of emotion.”
“One way to treat some of that is to open up their emotional world—to be bigger, to have more language for it, to identify and see different things going on, not only within themselves, but with emotional expressions of other people. We’re really just trying to build that kind of language and awareness. That’s one of the core things.”
To build those emotional experiments, therapists will often ask questions.
“If they’ve got a partner who’s upset, we’ll ask, ‘How do we work on that? What made them upset? Is there anything you did that contributed to that?'” Stevenson says. “We want to have a dialogue [with] more open communication and less defensiveness. There’s a lot of skill building around those areas to help manage NPD.”
It’s a long, difficult process, and narcissistic people rarely take the first step unless they’re facing serious consequences as a result of their behavior.
If you believe you’re in a relationship with a narcissist, here’s what you can do.
First, don’t use the word “narcissist.” Stevenson says that she doesn’t bring up that term when working with patients since the label isn’t exactly useful from a therapeutic standpoint.
I don’t agree with her choices, actions, or politics; but having been in a horrendous relationship w a malignant narcassist, sometimes it’s about self preservation. So I’ll give her a pass. The psychological war fare of a MN is mind bending… I barely survived.
— OneBrokeMom (@Kristen_2017) May 28, 2018
“Calling someone a narcissist is a great way to get them angry with you,” she says. “It’s not a great way to get them into therapy.”
Remember, narcissism is a spectrum, and a person displaying some narcissistic behaviors—for instance, wearing ostentatious clothing or disregarding the feelings of others—isn’t necessarily diagnosable with NPD.
“If you see some [narcissistic behaviors], don’t assume that it’s the worst-case scenario,” Stevenson says. “I’d encourage people, if they feel like they’re in that type of relationship or situation, to seek help for themselves. That’s the best way to address the issue; ask, ‘What is it that drew me to this type of relationship? Why do I want to stay in this type of relationship?'”
Of course, if you don’t want to maintain the relationship, you can always end it. Through therapy, you can gain the emotional tools you need to either end the relationship or guide the other person toward help. Just remember that you can only guide another person; you certainly can’t force them into a therapist’s office.
“You can’t control anyone other than yourself,” Stevenson says. “You can’t push someone else to help or therapy, but you can work on yourself.”