Narcissistic Personality Disorder
I specialize in helping men who either want help working on narcissist traits or struggle to live in relationship with a narcissist.
People often ask, “How can I identify a narcissist?” The DSM IV & V provide helpful criteria* (both listed at the bottom of this article) which I have reviewed with many clients and are helpful in identifying narcissistic traits. However, I typically point out two important things.
First, and what I suggest is most important; the label ‘narcissist’ is in and of itself not helpful and often creates defensiveness and fear. Try to avoid using the word or label, because doing so doesn’t get you much. If possible, attempt to start discussing the underlying traits that are having an impact on your relationship. Whether you are right or wrong about whether someone is a narcissist gets you very little. Beginning a discussion about narcissistic traits and how they impact you can have a dramatic impact on your life and relationship with the person you love.
Second, there are three main traits I suggest that encapsulate the narcissistic personality:
- lack of empathy,
- grandiose sense of self,
- and consistent gaslighting (the ability to get another to deny factual reality or truthful historical accounts/experiences).
More on each of these in a little bit, let’s start with some helpful tips in understanding the word ‘narcissist’ and narcissistic traits.
A couple things I want to mention about narcissistic personality disorder, and personality disorders in general, is I have found it helpful to conceptualize the person’s presentation on a spectrum. Also, I like to remind people there are some awesome advantages to possessing narcissistic traits, narcissism isn’t wholly bad.
If we start with considering narcissism on a spectrum, it is just helpful to know narcissism and narcissistic traits don’t live on a binary, either or grid. As an example (and I am not political and not commenting on anything politically) our current US President is a clear and public example of someone who presents with very clear and present narcissistic traits and I would suggest is most likely on the far side of the spectrum. Another person might only have a grandiose sense of self, or lack empathy in certain interpersonal relationships, and therefore could be considered lower on the spectrum. Using the DSM IV & V diagnostic criteria is a helpful guide in gauging where someone might fall on a narcissistic spectrum. 2-4 traits might signify mild or moderate narcissism, where as someone with 7-9 traits could be considered to have severe or extreme narcissism.
Again, many narcissistic traits prove very helpful in life and are often the very traits that you may have originally found attractive in your significant other. A lack of empathy often helps professional leaders make hard decisions that are best for the organization or self-preservation in times of difficulty or when a quick decision is required. A grandiose sense of self allows individuals to create and maintain healthy boundaries in relationship with others. Presenting with confidence, having a heightened sense of self-worth, and greatly valuing self are necessary traits in leadership positions at both work and home in the family. I work with many of my clients in helping them identify that applying these traits at work and home often have different consequences, and it is an art and takes time to recognize and learn the difference.
The narcissistic traits I focus on when working with a narcissistic client are lack of empathy in important interpersonal relationships, and grandiose sense of self in regards to family and attachment relationships. Lack of empathy is simply the unwillingness to ‘walk in another’s shoes’ or disregard for how one’s actions and words impact another. Lacking empathy can have serious and deleterious impact on romantic and long term relationships if not addressed. Developing empathy is a very difficult task to work on in the therapeutic relationship, and I would suggest takes significant amounts of training and lifetime experience on behalf of the counselor. As you select a counselor, make sure the professional you decide to work with has a track record of successfully working with narcissistic traits.
Clearly a grandiose sense of self and lacking empathy are traits that can be highly correlated. I would suggest having an over-stated opinion of oneself is beneficial to the more common alternative, which is a deflated or less than view of the self. In both circumstances, the therapeutic work is to begin to help a client focus on and understand the feeling of shame. The therapeutic endeavor of working on or with shame is too expansive to address here, but suffice it to say it is typically requires a significant investment of time and financial resources.
Gaslighting, or the ability of a narcissist to distort reality for another, is what I consider on of the most harmful types of manipulation and psychological damage an individual can perpetrate on someone else. I believe the therapeutic work actually rests in assisting the victim or individually being psychologically manipulated. In most instances, someone who is being ‘gaslit’ lacks self-confidence, has an inaccurate and depleted view of self, and has codependent traits. I work with such clients to grow appreciation and belief in themselves, and to understand codependent tendencies and how the application of such tendencies is often not helpful.
Narcissistic Personality Disorder Diagnostic Criteria
Narcissistic Personality Disorder DSM-IV Criteria
- A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
- Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
- Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
- Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high- status people (or institutions).
- Requires excessive admiration.
- Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations.
- Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends.
- Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
- Is often envious of others or believes that others are envious of him or her. self-centeredness; firmly holding to the belief that one is better than others; condescending toward others.
- Shows arrogant, haughty behaviors or attitudes
DSM-5 Criteria - Revised June 2011
The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose narcissistic personality disorder, the following criteria must be met:
A. Significant impairments in personality functioning manifest by:
- Impairments in self functioning (a or b):
- Identity: Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal may be inflated or deflated, or vacillate between extremes; emotional regulation mirrors fluctuations in self-esteem.
- Self-direction: Goal-setting is based on gaining approval from others; personal standards are unreasonably high in order to see oneself as exceptional, or too low based on a sense of entitlement; often unaware of own motivations.AND
- Impairments in interpersonal functioning (a or b):
- Empathy: Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimate of own effect on others.
- Intimacy: Relationships largely superficial and exist to serve self-esteem regulation; mutuality constrained by little genuine interest in others‟ experiences and predominance of a need for personal gain.
B. Pathological personality traits in the following domain: 1. Antagonism, characterized by:
C. Grandiosity: Feelings of entitlement, either overt or covert;
D. Attention seeking: Excessive attempts to attract and be the focus of the attention of others; admiration seeking.
E. The impairments in personality functioning and the individual‟s personality trait expression are relatively stable across time and consistent across situations.
F. The impairments in personality functioning and the individual‟s personality trait expression are not better understood as normative for the individual‟s developmental stage or socio-cultural environment.
F. The impairments in personality functioning and the individual‟s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).