Narcissism or Aspergers: How Would You Diagnose These Cases?
Diagnostic labels should clarify, yet some cases prove fuzzy.
Posted Nov 02, 2015
Distinguishing narcissism from Asperger's syndrome can be complex. Is this an either/or diagnosis? Can there be elements of both? What does each diagnosis suggest about what the person will need to learn for better relationships?
Aspergers, which now is considered a part of autistic spectrum disorders, was defined in DSM IV as follows:
(299.80 DSM-IV) The essential features of Asperger's Disorder are severe and sustained impairment in social interaction and the development of restricted, repetitive patterns of behavior, interest, and activity:
I) Qualitative impairment in social interaction, as manifested by at least two of the following:
(A) marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction
(B) failure to develop peer relationships appropriate to developmental level
(C) a lack of spontaneous seeking to share enjoyment, interest or achievements with other people, (e.g.. by a lack of showing, bringing, or pointing out objects of interest to other people)
(D) lack of social or emotional reciprocity
(II) Restricted repetitive & stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following:
(A) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
(B) apparently inflexible adherence to specific, nonfunctional routines or rituals
(C) stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements)
(D) persistent preoccupation with parts of objects
Having an exaggerated sense of self-importance
Expecting to be recognized as superior even without achievements that warrant it
Exaggerating your achievements and talents
Being preoccupied with fantasies about success, power, brilliance, beauty or the perfect mate
Believing that you are superior and can only be understood by or associate with equally special people
Requiring constant admiration
Having a sense of entitlement
Expecting special favors and unquestioning compliance with your expectations
Taking advantage of others to get what you want
Having an inability or unwillingness to recognize the needs and feelings of others
Being envious of others and believing others envy you
Behaving in an arrogant or haughty manner
Two ambiguous cases:
Both of the following cases were offered as comments by readers of my earlier article on the question of whether narcissism might be the last stop on the train before it enters the land of autistic spectrum disorders.
Thank you to both of the writers, both of whom have given me permission to publish their Comments (the cases) in this article.
Submitted by Isabella on October 25, 2015
A few (lay!) people have related both the terms narcissism and Asperger's to my husband, mostly out of concern for either me or other people in his life. He's also been told by different people that he lacks empathy. All these people took high personal or professional risks to even bring this up. I think I'm generally a smart person, but I am too close to him to see clearly. Will you read a description of his behaviors and help me determine if he falls into one of the two categories? For no other reason than helping me understand and cope better. Like Dr. Heitler said in the article: Compassion is easier with understanding.
Here is what makes him him:
He is the most intelligent person I have ever met.
He is very successful professionally.
He is extremely handsome, charismatic, commands a room and talks about himself and his thoughts and interests way (way, way, way!!!) past the point of passing the ball in the conversation to someone else. He also doesn't seem to get the little clues that tell him when people get bored, confused or uncomfortable with his monologues.
When someone else speaks, he is often very disengaged. Depending on the person, he tries to listen politely, but his fire is out and he looks bored and cannot tolerate it for very long.
I work for him on highly-intense projects and the way he treats me is merciless. He stops at no amount of verbal or emotional abuse to get what he wants out of me. Sleepless night after sleepless he yells at me to get it done, telling me what a complete loser I am, using all of my flaws and struggles to shame and pressure me into getting me to do what he needs from me. Completely oblivious to the fact that I am already killing myself to give him what he needs.
He has a way to greet people (myself included) that I can't quite describe. He walks in a room, looks at nobody, busies himself with something and starts participating in conversations only after a little while. He seems uncomfortable walking up to people, looking them in the eyes and shaking their hand. He will do this in important situations with people he respects, though. It feels like an act compared to the way he usually behaves.
He can't tolerate criticism. It seems like a life-and-death matter. If he can't lawyer himself out of a constructive criticism, a switch flips and he flows into a bad rage. The usual behavior is screaming the 'best' insults at me he can come up with. Anything I have told him in confidence, as a friend, goes. The more hurtful, the better. This happens often. Not occasionally.
A former girlfriend of his once said that talking to him about something he did wrong is totally pointless, because he argues so cleverly, that you lose the argument, even though you know with certainty that you are right. In the end, you walk away wondering why you are such a bad person. This is my experience with him, too. He doesn't give one inch. Goes back to the criticism he can't, for the life of him, allow to be touched by.
He used to not apologize ever. For anything. In recent years (with the help of a business-coach/psychologist he was assigned to work with) he has started apologizing in the following way: I'm sorry you felt bad. Or, more recently, when we just drop a fight and get back into calm waters, he'll hug me at night and say that he's sorry. Very sad and a little bit like a kid. Without being specific, having an adult conversation about it, admitting to real mistakes, seeing my point or understanding my grief or making concrete plans how to fix a 'problem.'
He does not understand how or what I feel. He understands facts, but seems pretty lost when it comes to feelings. He has cues like tears that he understands. When I cry and he is 100% sure that it has nothing to do with him, he can comfort me. On occasion very sweetly. When the tears have something to do with him, he can be brutally cold and cruel.
In conversations, he seems to rely on and understand the spoken words mostly. Not so much facial expressions, body language and energy or history between people. He's not complety lost or weird, just not very tuned in.
He doesn't really have any friends.
He treats people he respects different than people he doesn't respect: Very tuned in with people he respects, while he is almost absent in conversations he has to endure with people he doesn't respect.
At work, he is known to 'steamroll' pretty much everyone except for his superiors. You either do what's right (his way) or you get mowed down. Girls who work for him sometimes cry. I suspect the guys might sometimes cry when they go home.
A commin complaint about him at work is that he lacks people skills, is too brutal and causes too much blood-shed. (Actual terms.)
He hardly ever 'receives' what I say to him. When I talk to him, I feel like I want to talk very loudly, because there is not enough feedback. Like a nod or a smile or an expression of compassion or understanding. Just blank silence. When asked for feedback, he'll say 'What do you want me to say?' or 'I'm thinking.' (I don't think he is. Just hoping for me to stop talking.) I have stopped talking for the most part. I listen. That works better for us.
When I'm perfectly centered and calm and happy and attentive and non-demanding, we're often pretty good. If I have a bad day and need support or just a little room to be moody or just human, I can be sure that he'll turn against me immediately and there will be a terrible fight. It's almost like he takes it personally whenever I'm not 100% perfect and well and happy and availanle to him and he can just not tolerate it even when I tell him that it has nothing to do with him and to just not take me seriously or give me a little room for a bit. This might be a guy-girl thing and pretty normal, though?
This may also be more normal and not too concerning: When I have a problem with a friend or family and I want to vent and just have a sounding board, he takes the side of the other person immediately, no matter how ridiculously he has to bend his own convictions to justify that I am wrong and they are right. He seems totally freaked out when I feel anything other than love towards someone. When asked about it, he tells me that it's just not me to be pissed off at someone and he doesn't like it.
After each fight, I am left feeling so guilty that I sometimes don't know how to go on. It feels like I wounded a defenseless child who has absolutely no idea how to deal. I at least have myself to heal my wounds and it feels like he has nobody at all.
Here is the but:
He is the most generous person I know.
He loves (loves, loves, loves) our dog. He's cuddly and sweet with him and his whole energy changes to love. When our puppy almost died a few years ago, there was real, vulnerable sadness.
He does really care about me. He is committed and faithful and really cares about my happiness. He'll do almost anything I ask for.
He loves spending time with me and seeing me happy.
He genuinely loves nature, travel and animals. His heart does, not his ego.
He wants to do good things. For family, his company and the world at large.
He has gotten better in recent years.
He has a good heart. Under all the layers, I feel like he's just a little boy who is looking for something. I just wish I could figure out what it is that he needs.
I would be very grateful to hear your thoughts.
Submitted by Another Anonymous on October 26, 2015
I've been googling "Asperger's OR autism narcissism" for a couple days and came across this last night. As well as the study about thin sections of the brain in NPD.
My father thought he was charming, but came across to many as manipulative and ruthless, even dangerous. To others he came across as someone who had problems but was worth helping. He was not very smart at all. He seemed to have a lot of people who were glad to see him but at a closer look he had given them something of monetary value or had something over them. He was a compulsive liar. I don't believe the man ever truly cared about anyone. He was incredibly nasty to his family.
He was a successful businessman and kept people who flattered him. He would publicly humiliate anyone who didn't kiss his butt and in some cases try to destroy them socially or financially. He bribed police. He also had some very capable people who did almost all of the work and business roles very well. He himself was almost illiterate and I did not see him as someone who made good decisions. By himself he would have failed miserably. He had been spoiled rotten as a child and set up financially.
I avoided him for years until the last few years of his life when he was dying. I then would talk to him occasionally by phone and I set strict boundaries. I flew out to see him a couple times. By then I had almost no emotional attachment to him- I did it for myself. What amazed me, now that I could see him objectively- rather than through the eyes of an abused frightened child, was how stilted and shallow his understanding of other people was. He had no idea *who* other people were. No real clue as to how others thought or what their motives were if it wasn't something he would think or feel himself. He had developed a list so to speak of what would get others to have the reaction he wanted- very basic; flatter, pay, grovel or threaten. Everyone around him had developed a way to please him without having him go into a singularly destructive rage or a submissive whine- people who worked for him or who did favors for him, respectively.
I saw him grovel and beg his "friend" the police chief to "go after" his wife when she would no longer let him drive- thankfully the Chief didn't but tried to point out he might hurt someone if he drove. The thought of hurting someone else wasn't important to my father. It took the Chief 3 tries to finally get the reaction "*I* couldn't hurt anyone! My driving reactions are fine" with a slight sneer on his face.
All of what I saw made me think my father had brain dysfunction. I thought about Autism or Asperger's but it was meaner and terribly terribly spoiled.
It's easy to be charmed when one does not know a person very well. It's easy to think an N is smart when they are being deceitful and manipulative if our emotions are involved. After all, if we didn't see it coming then they must have been clever, right? I think sometimes it is only when our emotions are not involved, when we have none of our normal emotional charity towards someone, someone who has dis-earned it, that we start to see some of the very weird quirks in NPD reasoning. We come out of a fog. There were huge gaps in reasoning and understanding. Those gaps make abstract thinking really bizarre. Something just doesn't function right.
To be blunt, from reading the German study summary, it seems people with NPD tend to have thinner brain sections and abnormalities in areas which effect empathy and some emotional cognition. I would say, in my father's case, also areas which further social understandings. Everyone seems to think NPD's are more intelligent than most, but I think that's a gross myth. Some are, some aren't, but I'd guess in all there are areas that don't function well.
It's possible that brain scans and studies might find different but similar or close areas of the brain which don't function very well in NPD and Aspergers. Maybe sometimes those areas overlap. Add spoiled rotten and selfish and you could have something really nasty rather than just a learning disability.
Thanks for your article Susan, good and interesting read.
Dr. Heitler's conclusion
The bottom line from my perspective is that there is often overlap between these two syndromes. Is that because some people have both? Is the border between the two disorders a fuzzy boundary, so the label is a function of which features the diagnosis is primarily focusing on?
In my view, the essential feature of narcissism is a listening defect. Narcissistic behavior is behavior that focuses only on oneself—what I want, what I think. This 'all about me' tendency creates, or maybe results in, deficits in ability to hear others thoughts, feelings, preferences, etc. When others insist on trying to be seen or heard, the narcissistic tendencies lead to anger.
As to Aspergers, I regard the addition of social oddities, avoidance of close social interactions, gaze aversion, and difficulties reading others' feelings as signs that Aspergers as well as narcissistic non-listening may be present. Also, narcissistic self-aggrandizement is typically less pronounced or absent with Aspergers. And Aspergers individuals do not as often have the social charm that many individuals with naricissistic features have.
Paradoxically, people with both diagnoses can be very empathic and generous. The bottom line is that these are not all-or-nothing syndromes, and they can easily co-exist. Very complex.
Denver clinical psychologist Susan Heitler, Ph.D, a graduate of Harvard and NYU, is author of From Conflict to Resolution for therapists, and Power of Two, a book, a workbook, and an interactive website that teach the communication skills that sustain positive relationships and successful marriages.