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Mirror, mirror on the wall, who’s really a narcissist after all?

September 13, 2019 by Kimberly Drake

The term “narcissist” is splashed across social media, is a trending search on Google and used in casual conversations as often as the weather. It seems as though Narcissistic Personality Disorder (NPD) is used to explain the problematic or self-centered behavior of loved ones, friends and colleagues, but is this label warranted? Are these people indeed narcissists, or is it possible this psychological term is overused and has become the pop culture disorder of the decade?

What is true narcissism?

NPD became a part of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-3) in 1980. Debate on the validity of this and other personality disorders almost removed it from the updated DSM-5, but opposition resulted in NPD to remain in the new edition.

According to the Mayo Clinic, NPD is one of several types of personality disorders and is a mental condition in which “people have an inflated sense of their importance, a deep need for excessive attention and admiration, troubled relationships, and a lack of empathy for others. But behind this mask of extreme confidence lies a fragile self-esteem that’s vulnerable to the slightest criticism.”

The DSM-5 has several criteria that must be met for a person to be diagnosed with NPD, and they include:

• Grandiosity with expectations of superior treatment from other people.

• Fixation on fantasies of power, success, intelligence, attractiveness.

• Self-perception of being unique, superior and associated with high-status people and institutions.

• Sense of entitlement to special treatment, admiration and obedience from others.

• Exploitation of others to achieve personal gain.

• Unwillingness to empathize with the feelings, wishes and needs of other people.

• Intense envy of others, and the belief that others are equally envious of them.

• Constantly demeans, bullies and belittles others.

Making sense of these criteria is the challenge, and in her book “Why Is it Always About You? The Seven Deadly Sins of Narcissism,” clinical social worker and psychotherapist Sandy Hotchkiss attempted to explain in layman’s terms what constitutes a true narcissist. The book garnered acclaim as a tool in helping to clarify NPD from James F. Masterson MD, an internationally recognized psychiatrist who was a leader in the study and treatment of personality disorders.

According to Hotchkiss, those “sins” are as follows:

Shamelessness — Narcissists are often openly shameless and are not bound emotionally by the needs and wishes of others.

Magical thinking — Narcissists see themselves as perfect and use projection to offload shame onto others.

Arrogance — A narcissist who is feeling deflated may re-inflate their sense of self-importance by diminishing or degrading somebody else.

Envy — A narcissist attempts to secure a sense of superiority over another person’s ability by using contempt to minimize the other person or their achievements.

Entitlement — Narcissists hold unreasonable expectations of how they should be treated and demand compliance. Failure to comply is considered an attack on their superiority and can trigger narcissistic rage.

Exploitation — This trait involves the exploitation of others without regard for their feelings or interests.

Bad boundaries — Narcissists often look at others as an extension of themselves, and people either exist to meet their needs or may as well not exist at all. Those who feed the narcissist’s needs are treated as if they are part of the narcissist and are expected to live up to those expectations. Also, narcissistic parents demand specific behavior from their children because they see the children as extensions of themselves, “representing” them in the public eye.

The ‘house of mirrors’ known as NPD

Theoretical subtypes not listed in the DSM-5 are muddled with confusion and navigating them is like finding your way out of a roomful of mirrors at a carnival attraction. In general, a person with NPD can be overt, in which the behavior is obvious, or covert, where the behavior is more hidden and difficult to pinpoint. 

First described in 1964 by social psychologist Erich Fromm, the term “Malignant Narcissist” is often used to describe those with NPD that also have other personality or mental syndromes in the mix, such as paranoid personality disorder, which appears as fearlessness, the anticipation of betrayal and subsequent seeking of punishment or revenge. 

But is it really narcissism?

Healthy self-esteem is a good thing, the opportune word being “healthy.” Although most individuals have some narcissistic traits that surface at one time or another, according to the DSM-5, “only when these traits are inflexible, maladaptive, persistent and cause significant functional impairment or subjective distress do they constitute narcissistic personality disorder.”

How common is it…really?

Even though the label is applied liberally to explain challenging behavior, in reality, most sources say the prevalence of NPD is estimated to be at only one percent in the general population and two to 16% in clinical populations. NPD has a higher incidence among men versus women, and studies have shown a slight possibility it may run in families. The only way to diagnose this personality disorder is with an evaluation by a trained mental health professional using diagnostic tools such as the Narcissistic Personality Inventory (NPI) or the Millon Clinical Multiaxial Inventory (MCMI.) One thing about this disorder that makes both diagnosis and treatment a challenge is the fact that those who indeed have NPD often fail to acknowledge or recognize they have a problem.

In a world of self-diagnostic quizzes on Facebook and the internet, often, those categorized as narcissists don’t truly possess the clinical traits of the real disorder. When overused as a term for every seemingly selfish or self-absorbed act, it may unfairly label those who aren’t narcissists and devalue the suffering of those who have been victimized by a person with legitimate NPD.

Kimberly Drake can be reached at [email protected]

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