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  • Muriel Radocchio, LCSW

Narcissism: Not just the Tony Sopranos of the world

We've all seen information on social media about abuse from narcissists. Confused about what a narcissist is? That makes total sense. The term “narcissist” is often thrown around to describe anyone who is self-absorbed. However, the term is often misused and therefore narcissism is misunderstood.


So, what is narcissism?

The word narcissism originated from the mythical character Narcissus who fell in love with his reflection and would look at himself for long periods of time. Psychologists thought of this character while outlining a list of symptoms for narcissistic personality disorder (NPD) in 1980, due to the expression of inflated abilities and importance that can occur with this disorder.


When we say "narcissism," we're talking about narcissistic personality disorder, which is classified as a personality disorder in the Diagnostic and Statistical Manual 5 (DSM 5). The term "narcissist" is sometimes used to describe a person diagnosed with NPD.


It's important to note that a personality disorder is not considered a mental illness, but is a diagnosable disorder warranting clinical attention and treatment. According to the American Psychiatric Association, a personality disorder is defined as "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment". It's a personality that doesn't quite fit into the expectations of culture, and leads to issues in the person's life. Since what is disordered are personality traits, and not mental health symptoms, the disorder persists throughout life and doesn't change much over time or circumstances.


The DSM 5 defines narcissistic personality disorder (specifically) as "A pervasive pattern of grandiosity (fantasy or behavior), need for admiration, and with lack of empathy, beginning by early adulthood...".


Now, going back to our boy Narcissus, it's definitely possible for someone with NPD to come across as pleased with themselves. When we start to explore what is underneath these expressions of inflated self-worth, you'd be surprised to know that deep down, many believe the exact opposite. This is where the need for admiration comes in. People with NPD have a need to receive accolades from others to continue their ideas of grandiosity which exist either inherently, or are there to cover up deep-seated insecurities. With that being said, they also believe they don’t need others to depend on. Either way, this dependence on others to receive consistent respect and approval can cause the person with NPD to see others as being present solely to meet their needs. A lack of empathy is present, as well as a lack of caring for the needs of others.



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What is someone diagnosed with NPD really like?

The DSM 5 outlines the personality traits/symptoms of a person with NPD. In order for someone to be diagnosed with NPD, they must meet the outlined diagnosis criteria as well as have at least 5 of the following:

  • Has a grandiose sense of self-importance (e.g., exaggerates achievements, expects to be recognized as superior without actually completing the achievements)

  • Is preoccupied with fantasies of success, power, brilliance, beauty, or perfect love

  • Believes that they are "special" and can only be understood by or should only associate with other special people (or institutions)

  • Requires excessive admiration

  • Has a sense of entitlement, such as an unreasonable expectation of favorable treatment or compliance with his or her expectations)

  • Is exploitative and takes advantage of others to achieve their own ends.

  • Lacks empathy and is unwilling to identify with the needs of others

  • Is often envious of others or believes that others are envious of them

  • Shows arrogant, haughty behaviors and attitudes

NPD is also often associated with manipulative behavior as well as desires to lead or rule over others. It is important to remember, however, that a person needs only to have 5 of the above 9 listed criteria, and therefore traits can vary.


With the above traits, it's not hard to imagine that someone with NPD would struggle with maintaining relationships and social responsibilities, including work. It could prove to be difficult to fall into a corporate structure as a subordinate, or to bounce-back after receiving critical feedback. Interpersonal dynamics at work and the nuances of having healthy relationships with coworkers could suffer greatly during competition for promotions or trying to get attention from superiors. A person with NPD could find interpersonal work dynamics impossible to navigate.



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With that being said, there are plenty of examples of people with NPD being very successful leaders including politicians and CEO's of successful companies. Yup... yet another paradox. People with NPD who strive to achieve higher-level goals and accolades will, at times, achieve these goals. Due to their grandiosity, they may apply to jobs or promotions that others feel they are not qualified for. They may also have the mentality that they do not care who they need to step on in their path to success.


Outside of work, personal relationships are also inherently difficult for people with NPD. According to the above criteria, people with NPD may be wrought with jealousy of others who may have more power or success than they do, and at the same time, hold a belief that they are superior to them. This could cause people with NPD to lie about their own successes when socializing. It is difficult for someone with NPD to have close relationships with others due to a lack of empathy. If there’s an argument or disagreement, the person with NPD might not be able to view where someone else is coming from. People with NPD may, in turn, end friendships and relationships frequently after arguments, or avoid others who they feel are in need of their support.


With interpersonal relationships being shallow or tumultuous, as well as struggling to maintain a stable sense of worth and competence, those with NPD could experience anger towards others when their needs for admiration are not met and the ego is threatened. For someone with NPD, feelings of shame and guilt could be intolerable, and may present as anger or rage towards others. They may hold significant grudges towards others whom they feel have withheld admiration or insulted them as a way to continue to view them as inferior.



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Are narcissists bad people?

A darker side of NPD can present itself when someone engages in exploitative behavior and manipulation. It is important to note that not everyone with NPD engages in this behavior, and if they do, it can be to varying degrees. Those with NPD can exploit others in order to meet their needs of admiration and/or to maintain a sense of a strong and stable ego. In addition to this, someone with NPD may overlook the needs of others due to their lack of empathy and focus on meeting their own needs. Summed up very nicely by Susanne Braun in her 2017 article Leader Narcissism and Outcomes in Organizations (see link below): "In other words, narcissists may not intend to harm others, but they are oblivious to others' wellbeing as long as their own needs for self-affirmation and external validation are fulfilled."


In the media, there are a lot of extreme examples. Don’t worry, we’re getting there! Examples of less extreme exploitative or manipulative behavior could include hoarding resources for themselves (think Jeff Besos building a $500 million yacht vs. a $450 million yacht and giving $50 million to charity), bending the truth to avoid embarrassment or arguments, and lying to avoid getting in trouble at work. Someone with NPD having both a sense of entitlement as well as a lack of empathy for others could lead to more harmful exploitative behaviors as well. Those behaviors can include gaslighting, seeking revenge, controlling behavior in relationships, violence, and abuse.



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What about Logan Roy, Tony Soprano, and Dirty John?

We seem to have an appetite for the inner-workings of ruthless leaders and CEOs and the potential drama that follows. The HBO show Succession is filled with examples of NPD behavior, particularly with the patriarch Logan Roy. Logan shows plenty of examples of manipulating his children in order to advance his interests and company, however the most stark example may be (SPOILER ALERT) his decision to have his son Kendall take the blame for abuse that occurred at the company, rather than himself.


We can’t write about narcissism in the media without talking about Tony Soprano. The HBO show The Sopranos included many scenes with Tony actively in therapy with Dr. Melfi, working on anxiety and stress related to being a mob boss. Therapy scenes, however, also included Tony talking about struggles with NPD traits, which for him presented as an inability to understand the needs and emotions of others and anger towards others for having such needs and demands of him. Tony also hides his symptoms of panic as well as his need for mental health treatment from almost everyone in his life due to perceiving this as a weakness. His need to hide perceived weakness is clear throughout the series, as is his inability to tolerate criticism, or even light teasing.



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Then we have Netflix’s Dirty John’s series one covering of John Meehan, which is based on a true story. John meets and seduces Debra Newell and lies and manipulates her from the beginning of their relationship in order to push the relationship forward quickly and benefit from Debra’s financial success. When Debra’s daughter’s suspected John may be a fraud, he did everything in his power to discredit them and isolate Debra. John displays NPD traits including a grandiose sense of self-worth and exaggeration of his accomplishments, shows a sense of entitlement, and certainly engages in exploitative behavior with a lack of empathy.


Notice that these three examples are all men? Yeah, that’s not a coincidence. According to the American Psychiatric Association in 2013, 50%-75% of people diagnosed with NPD were men. Since then, it is widely recognized that the trend of NPD being more common in men than women has continued. Women with NPD are less often represented in the media, however examples do exist, including Regina George from the movie Mean Girls (“So you agree, you think you’re really pretty?”) and Miranda Priestly from The Devil Wears Prada (“Oh don’t be ridiculous Andrea. Everybody wants this. Everybody wants to be us”). The difference in these characters, however, (besides being women of course) is that they tend to come around in the end of the movie, understanding and maybe even respecting those who had once been against them. In reality, however, this is extremely unlikely with someone really diagnosed with NPD. Women included.



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Could someone with Narcissistic personality disorder be in my life?

Yes. NPD is pretty prevalent in the US, with a rate between 1%-15%. There are a lot of factors that make NPD a difficult disorder to tally up, including that people with NPD don’t often seek treatment for NPD alone. People with NPD typically have grandiosity, so they aren’t likely to think they have an issue that needs attending to. Since people with NPD are likely to have a co-occuring mental health or substance abuse disorder, if they do enter mental health treatment, the diagnosis of NPD could be missed.


The best way to help someone with NPD is to assist them with seeking treatment. Since NPD is not a mental illness, there are no medications for NPD. The treatment lies solely in long-term therapy and group therapy. Some people with NPD will take medications to assist with their co-occurring disorders' symptoms, including potential depression or anxiety. Using general search engines you could find a therapist who specializes in personality disorders, or NPD in particular, in the individual’s area. Like most of us, people with NPD need support and encouragement with their treatment. People with NPD crave praise, and this is a great way to meet this need and encourage this behavior. NPD is a challenging disorder to live with. Understanding the traits can improve your ability to provide empathy, and learning ways to hold boundaries around harmful behaviors could help protect you from negative consequences.



 


Psychology Today also offers an article on ways to set boundaries with people with NPD:

https://www.psychologytoday.com/us/blog/narcissism-demystified/202006/7-ways-set-boundaries-narcissists


If you believe you are experiencing abuse by your partner, contact the National Domestic Violence Hotline by calling 800-799-7233, or texting START to 88788. In an emergency, call 911.



References:


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).


Braun, S. (2017). Leader narcissism and outcomes in organizations: A review at multiple levels of analysis and implications for future research. Frontiers in Psychology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5437163/


Brummelman, E., Tomaes, S., Nelemans, S.A., Bushman, B.J. (2015). Origins of narcissism in children. Psychological and Cognitive Sciences. https://www.pnas.org/doi/10.1073/pnas.1420870112


Brunell, A.B., Davis, M.S., Schley, D.R., Eng, A.L., van Dulmen, M.H.M., Wester, K.L., Flannery, D.J. (2013). A new measure of interpersonal exploitativeness. Frontiers in Psychology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3665920/


Cherry, K (2021, October 11). Narcissistic personality disorder symptoms and history. Personality Psychology. https://www.verywellmind.com/the-history-of-narcissistic-personality-disorder-2795569#:~:text=In%201980%2C%20narcissistic%20personality%20disorder,were%20established%20for%20its%20diagnosis.


Green, A., Charles, K. (2019). Voicing victims of narcissistic partners: A qualitative analysis of responses to narcissistic injury and self-esteem regulation. SAGE Open. https://journals.sagepub.com/doi/10.1177/2158244019846693


Kacel, E.L., Ennis, N., Pereira, D.B. (2017). Narcissistic Personality Disorder in Clinical Health Psychology Practice: Case Studies of Comorbid Psychological Distress and Life-Limiting Illness. Behavioral Medicine, 43(3), 156-164. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5819598/


Mitra, P., Fluyau, D. (2022). Narcissistic Personality Disorder. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK556001/


Cover Image Photo Credit: Good Housekeeping

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