Narcissism and OCD

How to identify overlapping conditions.

Posted Sep 25, 2020

Carlos de Toro / Unsplash
Source: Carlos de Toro / Unsplash

The word narcissism seems to make people’s ears perk up. There seems to be a lot of curiosity about how to identify a narcissist and how to deal with them.

I feel this word, narcissist, gets misused very often in American culture. I hear a lot of people defining their former spouse or romantic partner as a "narcissist." It seems the second the relationship fails, the other person's narcissistic tendencies were to blame. How many times have we heard from our friends that their divorce attorney or therapist told them that their ex is a "narcissist?" 

This verbiage also gets flung around to describe people who take a lot of selfies or put a ton of Tik Toks of themselves on social media. I want to make it clear, that none of this qualifies as actual criteria for Narcissistic Personality Disorder (NPD). 

Narcissistic Personality Disorder involves a long-standing pattern of the sufferer needing admiration from other people. These individuals typically cannot handle critical feedback and have a grandiose sense of entitlement. People with this disorder lack a sense of empathy for those around them and are very critical towards others. They usually have a pattern of troubled relationships. People close to the narcissist usually see them as bossy, difficult, rigid, and unsympathetic.

People with NPD are extremely resistant to changing their behavior, even when it’s causing them problems. As with all personality disorders, it is typically those around the narcissist that have a problem with their behavior, but not the NPD sufferer. The NPD sufferer will blame all of the people around them for their struggles. They will not view the situation as their fault and, in therapy, they will present as being highly critical of the people in their environment. Their tendency is to turn the blame on to others.

The people close to the narcissist will usually go along with the NPD individual's requests and demands because it is much easier than dealing with the consequences of going against the narcissist. Some examples of how someone with NPD could react to another not doing what they ask might be an extremely long lecture, cold and distant demeanor, or years of the silent treatment.

When an OCD sufferer also has NPD, it looks different than the OCD person without NPD. For example, when an OCD sufferer has an unwanted and intrusive thought that involves another person, they will usually be aware and empathetic to the idea that they cannot control the other person. They do not feel others should be doing compulsions for them. An OCD sufferer who does not have NPD agrees that their compulsive behaviors are annoying and upsetting to those around them.

Whereas, the OCD individual with NPD operates under the philosophy that everyone around them should do anything and everything to make them feel comfortable. They feel entitled and deserving of that, so, the NPD/OCD person does not see a need to change their own behaviors, rather, they feel that others around them should change. When others do not change, they can become extremely enraged and excessively disappointed. 

For example, I had a client who met the criteria for both OCD and NPD, he was a man in his mid-forties. He was obsessed with having clean floors in his house. He was unable to walk barefoot in his house no matter how clean the floors were. He was extremely controlling of his wife’s floor walking behavior. He once saw her walking barefoot around the house, he demanded that she immediately wash and disinfect her feet before she would get into the bed. She, who typically was always compulsion compliant, forgot one day and got into bed with “contaminated” feet. In response, he spent hours and hours talking to her about the pain she caused him. He spent the next month sleeping in another room and in another bed and ignored her for a few weeks.

An OCD spouse who does not have NPD would also become extremely upset and uncomfortable at the notion of their wife “contaminating” the bed. However, this type of husband would most likely do a lot of compulsive behaviors himself, not involving her, in order to make himself feel comfortable. He might change the sheets, avoid his foot meeting hers under the covers, or wear socks to bed. There is a very good chance he would not say anything at all to his spouse.

The major difference is the OCD spouse who does not have NPD will not feel that his "comfort” is his wife’s responsibility. Typically, he will feel compassionate and empathetic toward his wife. He may think, my wife is exhausted and she needs to sleep. The NPD/OCD individual will not think this way. This person would not have any problem watching their wife change sheets and do their compulsions all through the night. 

Treatment for OCD becomes complicated when there is a co-morbid personality disorder. I utilize a combination of RIP-R and CBT for personality disorders with these clients. Couples and family therapy may also be helpful, as well as Dialectical Behavior Therapy. If you feel you or a loved one is suffering from OCD, please reach out to a licensed mental health professional in your area. 

To find a therapist, please visit the Psychology Today Therapy Directory.