The story of Narcissus is of a man who fell in love with his own reflection. Through hubris, Narcissus realises that the one thing he loves the most in the world – his reflection, cannot love him back, so he slowly dwindles, starves and dies. This fable from ancient Greece only began to be defined in psychological terms in the late 1800’s as narcissism.
What is narcissism?
The DSM-5 TR defines narcissistic personality disorder as a pervasive pattern of grandiosity, a constant need for admiration, and a lack of empathy, beginning by early adulthood and present in a variety of contexts.[1] Simply put, this is a mental health condition where people have an unreasonably high sense of their own importance. This does not refer to self-love, rather individuals are in love with the idealised, glorified, grandiose image of themselves [2]. And they’re in love with this inflated self-image precisely because it allows them to avoid deep feelings of insecurity.
Narcissists regard themselves as superior, yet they manipulate and rely upon other people to get attention and recognition—a phenomenon known as “narcissist supply.” Those with NPD are frequently charming and charismatic, much like those with antisocial personality disorder (ASPD). Narcissists don’t show their negative behaviour right away [3].
Individuals with NPD present these characteristics:
- A grandiose sense of self-importance
- A need for excessive admiration
- A sense of entitlement
- Interpersonally exploitive behaviour
- A lack of empathy
- A demonstration of arrogant and haughty behaviours or attitudes[4]
- Have an inability or unwillingness to recognize the needs and feelings of others
- Have major problems interacting with others and feel easily slighted.
- Have trouble handling anything they view as criticism
- Frequently demeans, intimidates, bullies, or belittles others
NPD is considered a Cluster B personality disorder. The behaviours associated with Cluster B personality disorders are characterised by erratic, dramatic, or highly emotional responses. In contrast, Cluster C is characterised by worried thoughts and behaviours, and Cluster A is characterised by “odd” thinking and behaviours.
Within Cluster B NPD must be distinguished from other 3 cluster B personality disorders, which are; antisocial personality disorder (ASPD), borderline personality disorder (BPD), histrionic personality disorder (HPD).
NPD is rare, it affects an estimated 1% of the population. It’s important to note that narcissism is a trait and not every narcissist has NPD. Narcissism becomes a disorder when the traits dysfunction a person’s daily functioning.
Types of narcissism:
Not all narcissists are negative. Some narcissists – those with adaptive narcissism – often lean into positive traits and have healthy personalities. On the other hand, maladaptive narcissists are characterized by toxic traits. There are different forms of maladaptive narcissism:
Grandiose/Overt Narcissism:
This is the narcissism that many think of when narcissism is first mentioned. Overt narcissists are typically arrogant, entitled, imposing, and superficial. These individuals can become enraged easily.
Vulnerable/Covert Narcissism:
Covert narcissists are characterized by a more subtle form of power-seeking, where the narcissist seeks to maintain a position of control over others while displaying apparent humility [5]. These individuals display; hypersensitivity, passive aggressive behaviour, neuroticism, anxiety, and a sense of justice. In the extreme, these individuals exhibit behaviours consistent with sociopathy [6]. Vulnerable narcissists have a higher risk of suicide than the grandiose form.
Researchers have found that both of these dimensions of narcissism are linked to antagonism. Antagonism is a state of active hostility or being opposed to something or someone.
Other manifestations of narcissism include:
Communal narcissism: These people could seem martyred or even selfless. But instead of trying to serve others, their inner drive is to win respect and admiration.
Antagonistic narcissism: These individuals are concerned with coming out on top and have a high sense of competitiveness, arrogance, and rivalry.
Malignant narcissism: These individuals are highly manipulative, see others as disposable and a means to an end and often abuse power. This is the most toxic form of narcissism, often referred to as part of the Dark Triad (narcissism, psychopathy, and Machiavellianism) or Dark Tetrad (adding sadism).
Neglectful narcissism: These individuals only interact with people when they want something from them, seeing others as convenient instruments.
Benign narcissism: These individuals are self-centred, focusing on only themselves, and are preoccupied with obsessively caring about what others think of them
Entitled narcissism: These individuals feel that the rules of the world do not apply to them and that their view of the world is correct. They express themselves as being self-righteous.
Development of narcissism:
Genetic factors:
A 2014 study involving 304 pairs of twins suggested that NPD is partially genetically heritable. The study found that grandiosity is 23% heritable and entitlement was 35% heritable. Other research has shown that NPD is slightly more heritable compared to other Cluster B personality disorders. A fun fact is that NPD affects more males than females.
Cognitive factors:
Genetics is not the only factor at play. Certain mindsets can contribute to narcissism. E.g. having an inflated self-image, self-serving bias, need for external validation, lack of empathy, and a sense of entitlement and having rule breaking cognitions.
Parenting styles:
Studies have shown that certain parenting styles can increase the risk for both grandiose and vulnerable narcissism. E.g. over-protectiveness.
An overly protective parent may praise and idolise their child excessively, which can cause the child to grow up feeling entitled and with an exaggerated sense of self-worth, which can lead to grandiose narcissism. However, being too protective of a child can impede their growth in terms of autonomy and self-efficacy. The child may struggle to deal with failure or rejection, feel insecure, be easily upset, be overly sensitive to criticism, and develop vulnerable narcissism as a result.
Parenting influences children in many ways, but it’s important to note that there’s no single parenting style that can cause NPD. [7]
Childhood experiences:
Parental behaviours aren’t always what cause narcissistic personality disorders. There may be a link between negative childhood experiences. Trauma, rejection, neglect and lack of support during childhood can all contribute to developing narcissistic traits. For instance, individuals who endured severe bullying as children may be more prone to exhibit narcissistic tendencies later in life.[8]
Socio-cultural influences:
Research indicates that the culture you grow up in can influence your risk of developing NPD[9]. The risk of developing NPD is higher in individualistic cultures compared to collectivist cultures. Individualistic cultures often promote values such as personal success and competition which can foster narcissistic traits as individuals may feel pressure to prioritise their own achievements and status.
Psychological influences:
An individual’s unique emotions, coping mechanisms and internal structure can contribute to the development of narcissistic traits. An individual with low self-esteem may overcompensate to hide their feelings of inferiority and project a sense of high self-worth and inflated ego. By projecting, the individual’s self-image and fragile ego is protected.
Narcissists tend to have impaired self-awareness and struggle with self-reflection and emotional regulation.
Narcissism and mental health disorders:
A NPD can cause problems in many areas of life such as relationships, work, school or financial matters. It can also cause:
- Depression
- Anxiety
- Bipolar disorder
- Sleep disorders
- Impulse control disorders
- Substance abuse
- Negative impact on relationships
- Paranoia
Narcissism and empathy:
Empathy is the ability to understand and sense other people’s emotions, feelings and thoughts. There are three main types of empathy:
Cognitive – the ability to understand another person’s thoughts or beliefs
Emotional – the ability to feel what another person feels emotionally
Compassionate – doing something about another person’s distress.
Empathy can manifest in many ways. The most basic form of empathy is mirroring behaviours [10]. It gets more complex. It’s necessary to be able to comprehend someone else’s circumstances and emotions without having to go experience them directly. In order to successfully support others, this requires a knowledge of the thoughts and feelings of others.
Empathy is an important factor in identifying people with NPD because, while it is described as diminished, it plays a critical part in exploitation and manipulation. Ritter et al. revealed that people with NPD struggle with emotional empathy but not cognitive empathy, probably because reading others’ emotions can be advantageous for personal gain. Despite the ability to sense emotions in the same way that psychopaths do, people with NPD may have limited empathic functioning due to deficiencies in emotional empathy.
Management and treatment
Treating NPD involves some form of mental health therapy (psychotherapy); CBT, DBT.
There aren’t any medications that treat NPD directly but medications can treat the symptoms that come along with the condition such as anxiety and depression. Some medication may include antidepressants or antipsychotic medications.
Reference:
- Mitra, Paroma, and Dimy Fluyau. “Narcissistic Personality Disorder.” PubMed, StatPearls Publishing, 2021, www.ncbi.nlm.nih.gov/books/NBK556001/#.
- “Narcissistic Personality Disorder: Symptoms, Causes, Help.” org, 3 Nov. 2018, www.helpguide.org/mental-health/personality-disorders/narcissistic-personality-disorder.
- Brennan, Dan. “Narcissism: Symptoms and Signs.” WebMD, 2 Dec. 2020, www.webmd.com/mental-health/narcissism-symptoms-signs.
- Promises Publicity Team. “Narcissistic Personality Disorder: Differentiating It from Self-Confidence – Promises Healthcare.” Promises Healthcare, 27 Oct. 2022, promises.com.sg/narcissistic-personality-disorder-differentiating-it-from-self-confidence/. Accessed 9 Sept. 2024.
- What Is a Covert Narcissist? Understanding the Signs and Symptoms | All Points North. 5 June 2023, apn.com/resources/what-is-a-covert-narcissist-understanding-the-signs-and-symptoms/#:~:text=Overt%20narcissism%20is%20characterized%20by.
- “The Eight Types of Narcissists.” Family Institute, www.family-institute.org/behavioral-health-resources/eight-types-narcissists.
- “What Causes Narcissistic Personality Disorder? — Talkspace.” Mental Health Conditions, 3 May 2024, www.talkspace.com/mental-health/conditions/narcissistic-personality-disorder/causes/#:~:text=Parenting%20influences%20children%20in%20many. Accessed 9 Sept. 2024.
- Farrell, Ann H., and Tracy Vaillancourt. “Bullying Perpetration and Narcissistic Personality Traits across Adolescence: Joint Trajectories and Childhood Risk Factors.” Frontiers in Psychiatry, vol. 11, 10 Nov. 2020, https://doi.org/10.3389/fpsyt.2020.483229.
- Cleveland Clinic. “Narcissistic Personality Disorder | Cleveland Clinic.” Cleveland Clinic, Cleveland Clinic, 3 Aug. 2023, my.clevelandclinic.org/health/diseases/9742-narcissistic-personality-disorder.
- “Types of Empathy | Study.com.” com, 2019, study.com/academy/lesson/types-of-empathy.html.
