Narcissistic personality disorder: beyond self-regard

We’re are often quick to brand any selfish, vain, or unreasonable person a “narcissist”. But what, exactly, is narcissism and what traits define narcissistic personality disorder?

We’re all human and it’s not unusual for someone to occasionally behave in ways that appear selfish, exploitative, vain, or short on empathy. But it is only when such traits are inflexible, persistent and cause distress that a person can be clinically diagnosed with narcissistic personality disorder (NPD), says Gustaf Pretorius, a clinical psychologist at Mediclinic Denmar Mental Health Services.

Someone with NPD has a different reality to others, he explains. The problem is that they expect other people to adhere to this reality, too. “People with NPD display grandiosity, expect superior treatment from others, and require their continual admiration. They see themselves as unique and have a sense of entitlement, believing they deserve special treatment, and behaving in a way that is arrogant and pompous.”

Different types of narcissists exist under the umbrella of narcissism, Pretorius adds. Exhibitionistic narcissists, for example, openly “exhibit” and may even demand that people recognise their achievements, whether or not these are based on reality. Covert or closet narcissists, however, may be aware of the impact their behaviour has on others and make efforts to mask it. Interactions with them can be especially difficult.

When “normal” becomes pathological

“Taking a lot of selfies doesn’t necessarily translate into a personality disorder,” Pretorius says. “It’s when the person taking those selfies has an issue with their followers that a problem arises – especially if they don’t receive the admiration they believe they should, or if they are criticised. In NPD, this could lead to them to devalue and berate others for not recognising their good looks or talent, for example. They may even break off the relationship.”

This pattern of interacting with others and the way NPD sufferers deal with their feelings, e.g., by taking offence, becomes a problem when the pattern is fixed, chronic, repetitive, and independent of the external environment. “A refusal to deal with reality is another red flag. In these cases, people defend against painful feelings that don’t actually exist.”

Pretorius explains that everyone carries a degree of “normal narcissism”, but this is just a sign of healthy self-esteem. It allows you to recognise and enjoy your achievements, but in a way that leaves room for other people, too. It also allows you to accommodate the differences and individuality of those around you. In other words, some degree of narcissism is a necessary part of a healthy personality. “Narcissism only becomes pathological when it involves self-centeredness and self-involvement to the point of lacking in empathy,” he explains.

Warning signs of narcissism

What, then, are the warning signs that someone’s narcissism has stepped over the boundary of normalcy? “Any subtle, yet continuous sign that the person does not respect you for who you are; perhaps demanding that you feel, behave, speak and think as they believe you should,” Pretorius explains. Often, a narcissist will try to mould those around them, because they want others to mirror or echo their view of themselves and their worldview.

Such behaviour has significant effects on anyone in a relationship with a narcissist. “Narcissistic individuals often feel hurt, offended or even slighted if their partner disagrees with their views. And, because they lack empathy, they cannot understand why they would disagree. It’s not unusual for them to criticise this, and for the partner to feel that they are not good enough as a result.” The person with a pathological narcissistic personality may even act as though they are the victim when they hurt their partner, saying things like “I wouldn’t have hit you if you hadn’t screamed at me.”

Treating the victim of a narcissist

This behaviour is abusive and often problematic for the person in the relationship with the narcissist. People who have suffered at the hands of narcissistic parents may even experience symptoms related to complex post-traumatic stress disorder (PTSD).

Treatment is therefore a gradual process, and there is no one-size-fits-all approach. “There may be complicating factors; for instance, it can be difficult for the partner or even adult child of a person with NPD to break free,” says Pretorius. Patients often ask him if their partners are possibly narcissists, he adds. However, he explains to them that it’s not possible to come to a formal diagnosis without having interviewed the person in question. “I will refer them to responsible popular literature describing narcissistic behaviour. This type of psychoeducation can, in itself, be very healing for the patient with a narcissistic partner.”

On the other hand, patients sometimes complain that their partners have accused them of being narcissists. This can be even more complicated to deal with.

As a result, any therapeutic journey must start with the therapist attempting to understand the dynamics and subtle presentation of narcissistic behaviours, and how this has affected the victim. “The first step is for the patient to become aware of how the abuse has played out in the relationship and how it has affected them,” Pretorius says. “The ultimate goal is to help them understand how to separate their own emotions from those of their partner so that they can assert and defend their own needs in reality. This can be a long and difficult journey, especially if the patient has been in a longstanding relationship with their narcissistic partner.”

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