Variations on a Theme: Distinguishing Narcissistic Traits from Narcissistic Personality Disorder

Every now and then, a particular mental health disorder is thrown into the spotlight and enters the popular culture lexicon. Right now, Narcissistic Personality Disorder is having such a moment. However, rather than distinguishing narcissistic personality traits from Narcissistic Personality Disorder (NPD), many of these cultural dialogues conflate garden-variety self-centeredness with the pathology of NPD. In doing so, they can limit rather than expand mainstream understanding of these critical issues, minimize the struggles of people whose lives are affected by NPD, and hinder the recognition of the pathological nature of someone’s narcissism.

Narcissism is a common and often relatively benign personality trait characterized by an inflated image of one’s own worth, a strong sense of entitlement, and a tendency to act selfishly. People who have narcissistic tendencies may believe they are smarter, better looking, more talented, and more deserving than other people and appear to be self-involved. These traits can express themselves in two primary ways:

• Grandiose narcissists: Grandiose narcissists are often extroverted, attention-seeking, and power-hungry. They have a strong sense of entitlement and believe that they are superior to others.

• Vulnerable narcissists: Vulnerable narcissists often develop an inflated sense of self as a way of “overcompensating for low self-esteem and a deep-seated sense of shame.” They tend to be emotionally sensitive and are easily threatened by rejection and criticism.

Narcissistic personality traits can integrate themselves within someone’s personality to varying degrees, either throughout their life or at particular points. For example, children and young adults are often highly narcissistic, and this is a developmentally normal state of affairs. These traits may also find expression in older age or when someone becomes successful professionally or financially. While to others these characteristics may be annoying, frustrating, or even viewed as an eccentricity, they generally do not interfere with someone’s life. Moreover, having narcissistic traits does not preclude normal emotional function; you are still able to recognize other people’s worth, experience empathy, and create meaningful bonds with others. In fact, some narcissists leverage these personality traits to contribute to the well-being of others through both personal and professional activities; it is common for surgeons and entrepreneurs to have some narcissistic personality characteristics, for example.

Narcissistic Personality Disorder is a serious and enduring mental illness that affects an estimated 1% of people, 50-75% of whom are men. Unlike people who simply have narcissistic personality traits, NPD is characterized by a fundamental and enduring distorted self-image and the inability to relate to the world around them in a healthy way, causing significant emotional and behavioral impairment. Although the diagnostic criteria involve many of the same personality traits evident in narcissists (arrogance, entitlement, grandiosity, and self-centeredness) and fall into either the grandiose or vulnerable categories, these characteristics must be antagonistic in nature. Additionally, four of the five essential features of NPD in the DSM-5 do not involve personality traits at all, but impairments. In order for a diagnosis of NPD to be established, all of the following impairment-related criteria must be met:

• Impairments in self-functioning, which could manifest in distorted self-identity or self-direction.
• Impairments in interpersonal functioning, shown as an inability to experience empathy or intimacy.
• Impairments must be stable across time and situations.
• Impairments must not be due to developmental stage or environment.
• Impairments cannot be due to substance abuse or another medical condition.

In other words, people with NPD don’t simply like attention and praise. They aren’t just temporarily thoughtless because they’re so wrapped up in themselves that they fail to consider those around them. Instead, people with NPD are fundamentally unable to live normal lives; they do not have the emotional capacity to engage in healthy social interactions, experience loving, generous relationships, or form realistic understandings of themselves. Moreover, they generally don’t care or recognize that their thoughts and behaviors are maladaptive, nor do they seek to change. As a result, people around those who suffer from NPD are often deeply affected, sometimes even traumatized, by their interactions.

If you believe someone you love is suffering from Narcissistic Personality Disorder, it is likely you feel at a loss. After all, one of the most pervasive stereotypes about people with NPD is that they will not and cannot seek treatment. There is, of course, some truth to that statement; people with NPD are typically unlikely to recognize their own NPD and seek help specifically for the disorder itself. However, people with NPD, particularly those who are vulnerable narcissists, may be amenable to seeking treatment for the emotional pain or mental health disorders that often accompany NPD, such as Borderline Personality Disorder, depression, anxiety, and trauma-related disorders. As such, it may be useful to appeal to their desire for relief from other sources of distress.

Achieving diagnostic clarity for Narcissistic Personality Disorder, finding effective treatment, and encouraging treatment adherence can all be challenging but critical steps for helping you and your loved one heal from the pain of NPD. The renowned treatment program at Bridges to Recovery has a comprehensive range of diagnostic and therapeutic tools available to create a complete picture of your loved one’s treatment needs and design meaningful interventions that encourage therapeutic engagement through a mosaic of evidence-based therapies. Here, our skilled clinicians and staff create a welcoming, warm, and comfortable atmosphere free from the judgment or shaming that can push many people with NPD out of treatment. Instead, we honor each person’s unique gifts and seek to restore emotional and behavioral stability through a holistic curriculum of care. If appropriate, we also invite you to stay involved throughout treatment and offer specialized Family & Couples therapy to help you gain a better understanding of what your loved one is experiencing and work towards mending and strengthening your relationship. Narcissistic Personality Disorder doesn’t have to control your life; help is available and healing is possible.

Bridges to Recovery offers comprehensive residential treatment for people struggling with mental health disorders and co-occurring substance abuse and process addictions. Contact us to learn more about our innovative program and how we can help you or your loved one on the path to sustainable healing.