After nearly three decades treating sex and relationship issues in individuals and couples, I can tell you that one of the most common complaints I hear centers on narcissism. Often, I hear a betrayed partner say something like, “My husband is a narcissist. He only thinks about himself. He only acts on what he wants, when he wants it. He doesn’t seem to care about what I want or that his actions might hurt me.” Typically, these betrayed partners are convinced there is something pathologically wrong (clinically diagnosable) with their spouse because his self-centered behavior is so abominable.
Occasionally they are correct and their partner is a clinically diagnosable narcissist, but more often than not their spouse’s behavior is simply a relatively normal version of self-interest that has run off the rails. Usually in such cases, narcissistic behaviors are a self-protective mechanism to cover things like low self-esteem and painful anxiety. For example, cheating on a loving spouse can be a way to boost a flagging self-image. Similarly, excessive drinking (and the bad behaviors that typically accompany it) is a way to numb the pain of stress, anxiety, and similar forms of emotional discomfort. These individuals may look and even behave like individuals with a personality disorder, but that does not necessarily mean they actually have that disorder.
So, what is the difference between individuals who look like clinical narcissists but aren’t and people who really are?
The simple truth is that every person is to some degree narcissistic. We are all a bit self-obsessed and self-interested, and there is nothing at all wrong with that. In fact, as children we are by nature extremely narcissistic. It’s all about us, all the time. As we grow older and become more aware of the world around us, we steadily assign value to the thoughts, feelings, and importance of others and we become less self-centered. We remain relatively self-focused, but we have empathy for and care about the wellbeing of others, too.
Unless, of course, we have Narcissistic Personality Disorder (NPD).
The American Psychiatric Association defines NPD as “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.”[i] NPD differs from a healthy sense of self-focus and self-preservation in numerous ways, but it is primarily distinguished by a disconnection with reality and a willingness to use, belittle, and manipulate others to achieve the desired sense of grandiosity and admiration.
There are nine diagnostic criteria for NPD, any five of which are sufficient for an NPD diagnosis. These criteria include:
- Having a grandiose sense of importance (exaggerating achievements and talents; expecting to be recognized as superior without commensurate achievements).
- Preoccupied with fantasies of unlimited success, power, brilliance, etc.
- Believes that he/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.
- Self-entitled (unreasonable expectations of favorable treatment or automatic compliance with his/her expectations).
- Interpersonally exploitative (takes advantage of others to achieve his/her own ends).
- Lacks empathy.
- Is often envious of others and/or believes others are envious of him/her.
- Arrogant, with haughty behaviors and attitudes.[ii]
Again, every person can look narcissistic at least occasionally, especially individuals with low self-esteem, chronic anxiety, and the like. Such individuals will engage in narcissistic behaviors as a defense mechanism or coping mechanism. That does not mean they are clinical narcissists. It simply means they need to address the underlying issues (low self-esteem, anxiety, shame, etc.) that push them toward bravado that they don’t actually feel.
True narcissists, on the other hand, are convinced of their superiority (and surprised when others do not readily acknowledge it). They believe they deserve power, admiration, and to have their way at all times. Most of all, they lack understanding of and empathy for the rights and needs of others. It simply does not occur to them that the thoughts and feelings of people they perceive as being “less than” themselves are important. And if/when they are told about this fact, they discount it. At most, they pay it lip service, and then they go about the business of satisfying their own desires no matter what.
For individuals who behave in narcissistic ways but are not true narcissists, there is significant hope for change. If they will identify, acknowledge, and address their underlying issues, their narcissistic behaviors will typically abate and empathy will emerge (or re-emerge). There is less hope for change with true narcissists. At times, they will alter their behavior as a way of making their lives easier, but the basic personality disorder of narcissism will likely remain.
[i] American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (Vol. 5), p 669. Washington, DC: American Psychiatric Association.
[ii] American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (Vol. 5), p 669-70. Washington, DC: American Psychiatric Association.