On Popular Misconceptions of Narcissism

Narcissus stares at his reflection, painted by the Baroque master Carvaggio, circa 1597-1599.

Source: Public domain

Narcissistic personality disorder (NPD), properly defined and diagnosed, is a severe form of psychopathology. NPD is a compensatory illness, one that attempts to "make up" for deeper-rooted feelings of inadequacy and inferiority, often rooted in disturbed childhood object relations.

All forms of pathological narcissism are marked by the presence of a grandiose fantasy, i.e., a belief in one's current or future success, power, brilliance, or beauty that is incommensurate with one's position in the world (Diamond et al., 2021). Such fantasies are present in both grandiose and vulnerable (or covert) forms of narcissism; in vulnerable presentations, such fantasies are less overt, and they often involve themes of revenge and vindication for perceived past harms.

Frank Yeomans, M.D., Ph.D., a leading expert on narcissistic psychopathology, describes a typical clinical encounter with a narcissistic patient:

When I got to the part of the clinical interview and I said, "You know, most people at some point in their life decide to do some kind of work, some kind of career. Have you thought about that?" Because there was no evidence that she had. And she said, in a very dismissive way, like I was an idiot, "Well, of course I've thought about that. When it's time for me to work, I'm going to be the head of a major film studio in Hollywood."

Grandiose fantasies in NPD are powerful regulators of affect (Finch & Hooley, 2023); that is, they help narcissistic patients sustain themselves in the face of deeper-rooted fears and insecurities. Such fantasies are so central to pathological narcissism that NPD cannot be diagnosed in the absence of them.

NPD is a relatively rare psychiatric disorder. Most estimates place the prevalence of NPD around 1 or 2% of the general population. Nevertheless, there has been an exponential growth of information on NPD on social media platforms in recent years. To some of these social media "experts," NPD is everywhere. Videos and articles with titles such as "How to spot a narcissist" abound.

What is happening here? What accounts for this discrepancy?

My clinical experience is that pathological narcissism is often imputed to others by those who are most prone to splitting themselves. (Splitting is a defense mechanism marked by binary or "black-or-white" thinking.) If one sees the world as simply full of victims and persecutors—and sees oneself as a perpetual victim—then "narcissism" appears everywhere.

Much of what is described as narcissism on social media actually falls into one of three categories: elevated levels of "healthy narcissism" (which is actually adaptive and found in many successful individuals); antisocial personality disorder (violence, exploitativeness, and criminality); and borderline personality disorder (interpersonal manipulativeness, controllingness, and demandingness).

(Incidentally, I believe the historic underdiagnosis of borderline personality disorder in males is attributable, in part, to this misdiagnosis of borderline psychopathology as NPD.)

Narcissism "experts" on social media—including some mental health professionals unskilled and untrained in psychodynamics—miss all three of these things and inaccurately and unscientifically broaden the concept of narcissistic pathology. In addition to being factually incorrect, such misapplication of the diagnosis of NPD distorts the actual clinical understanding and treatment of narcissistic patients by equating them to these other groups.

As defined, NPD is a classic, severe psychiatric presentation that is comprised of a core set of symptoms involving the regulation of self-esteem. But the diagnosis must be applied carefully and judiciously, lest we fail our patients and others.