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How to identify a narcissist — and cope with their potentially toxic behavior

Narcissistic Personality Disorder is far more complex than mere vanity. Here's how to identify a narcissist and cope with their potentially toxic behavior.
Illustration of person sitting on a pile of heads.
Narcissists are notoriously difficult to deal with because they are masters of manipulation.Rose Wong / for NBC News

The word “narcissist” is one of those tricky terms that is both luxuriously broad in meaning (it’s defined on as “a person who is overly self-involved, and often vain and selfish) as well as clinically specific. A narcissist, from a psychiatric perspective, is a person suffering from Narcissistic Personality Disorder (NPD), a formal diagnosis coined after years of psychoanalytic study. In the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), NPD is defined as a cluster B personality disorder, comprising “a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration and lack of empathy.”

As a mental health writer, I’m interested in exploring narcissism in the latter sense — as a pathology rather than as a lax term for a self-absorbed person. I want to know how narcissism manifests in a person and how one can identify a narcissist and cope with their potentially toxic behavior.

To enlighten me, I turned to a number of experts including David M. Reiss, M.D., a psychiatrist who has specialized in narcissism for over 30 years.

“Narcissism has been around as long as humanity has been around — and has been recognized for that long,” Reiss says. “The term itself comes from the story of Narcissus in Greek mythology, dating back to at least 8 A.D. As to the formal diagnosis, that arises from psychoanalytic thinking, starting with Freud but with different schools of psychology accepting slightly different understandings of the pathology/personality disorder over ensuing years.”

The telltale traits of narcissism go well beyond self-absorption

Diagnosable narcissism is far more complex (and often dangerous) than mere selfishness or vanity. One interesting way to think of one with narcissistic personality disorder is as a big baby — no really, because a baby, like a true narcissist, is concerned only with themselves and their needs.

“We all come into the world with needs that we want to be filled, and no one asks a baby [to reason with them]. They just say ‘Oh here, let me feed you, let me cuddle you and sing to you’,” says Dr. Keith Humphreys, a psychiatrist and professor of psychiatry at Stanford Health Care. “As we grow up, we learn that other people need things, too. Now, we may have moments where we’re very selfish, but it’s on a continuum; not for narcissists though. Narcissists are just stuck there in this bottomless, constant need.”

But narcissism can wear many masks. Here’s a list of telltale traits of a narcissist courtesy of Karaine Sanders, Psy.D, a psychologist in New York.

  • Self-concern, self-centeredness and self-consciousness that is disproportionate
  • Extreme sensitivity to negative feedback or criticism
  • Significant need for approval from others due to inadequacies that are real or imagined
  • Poor self-esteem often expressed through self-deprivation or arrogance
  • Difficulties within most relationships
  • Intolerance for imperfections in others
  • Often idealize others that represent perfection followed by devaluing that very person when they are perceived to have failed them
  • Preoccupation with outward appearance, beauty, wealth, fame, success over morals, virtue or even integrity
  • Poor emotional regulation, aggressive impulses, psychologically fragile
  • Vain, self-righteous and prideful
  • Lack remorse, compassion, empathy for others

Narcissists seldom seek treatment because they can’t self-reflect

We all have some narcissistic qualities, which run along a spectrum. There’s a radical difference, though, between having narcissistic qualities (e.g., being self-centered) and being a full-fledged narcissist.

One should never self-diagnose, but consider this: If you’re worried that you might be a narcissist, you probably are not one. Narcissists generally lack the kind of empathetic self-reflection that might make them wonder if they have a personality disorder. This is partly why narcissism is so seldom treated, Reiss adds, and why it’s presently impossible to truly quantify how many people have the disorder.

“Rarely does someone come to me [as a psychiatrist] and say they read about narcissism and think they are a narcissist,” says Reiss. “If they can recognize narcissistic behavior, then it’s probably not severe. Narcissists can get depressed, anxious, abuse substances and have problems in the family (for which they take no accountability) and usually it’s those types of issues that, as we get into them, we find a narcissistic core.”

If you’re worried that you might be a narcissist, you probably are not one. Narcissists generally lack the kind of empathetic self-reflection that might make them wonder if they have a personality disorder.

The makings of a narcissist: Nature, nurture and character

How does a person become a narcissist? It’s a hotly disputed issue in the world of psychiatry, with a wealth of theories and no one-size-fits-all answer.

“My view is that it’s probably about 25 percent constitutional and 75 percent experiential,” says Reiss. “A narcissist doesn’t necessarily come from a dysfunctional family, but narcissism can occur because a parent or caretaker wasn't able to provide emotional attention, or it could be the flipside: a parent provided too much attention and the child never learned frustration tolerance. It really depends, and the same situation can result in different outcomes for different people.”

Through hard work in therapy, the narcissist can change destructive patterns and cultivate empathy. But, it’s so very difficult to get them to want to do that, or to even acknowledge that their behavior is the cause of so many of their problems, as Dr. Humphreys points out. Sometimes, Humphreys notes, therapy can work against the narcissist’s best interest.

“I am not convinced that therapy actually helps narcissists very much because in a sense it's their fantasy relationship,” says Humphreys. “They get to talk to someone about themselves who doesn't need to share anything about themselves. There's a risk of feeding them through psychotherapy. I don’t know that this treatment would help a true pathological narcissist who tends not to understand that other people are people.”

Narcissists are master manipulators

“Narcissists are notoriously difficult to deal with because they are masters of manipulation,” says Britt Frank, a licensed master social worker. “They are skilled at finding pressure points and know exactly what to say or do to push our most vulnerable and wounded inner parts."

Though narcissists clearly do not have your best interest in mind (because they’re missing or have deactivated compassion for you), they do, as Michele Leno, a psychologist and owner of DML Psychological Services, notes, have the ability to love you.

“Narcissists are capable of love; however, their love feels conditional and wavering because they want to control you,” says Leno.

Just to make it even more complicated, consider that a narcissist can be selective in how/where they present their narcissism.

“Narcissism can be very problematic in some relationships and environments and not in others,” says Reiss. A person may show their narcissistic colors at work, but not at all at home, or vice versa.

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Coping with the narcissist in your life comes down to setting boundaries and cutting ties

Just as we should not self-diagnose, we should resist diagnosing others with Narcissistic Personality Disorder.

“We absolutely can not and should not be doing our own diagnosing of [others],” says Kayce Hodos, LPC. “Only a psychiatrist or therapist should assess and diagnose mental health and/or personality disorders.”

What we can do, and what might help us deal with their toxic behaviors, is identify and name the narcissistic traits we see in the people who we suspect are narcissists. From there, we should try to engage a conversation about it with them and/or our support systems, but if the person is a full-blown narcissist, they’re unlikely to respond favorably. Additionally, if you’re dealing with an authority figure, this may not be a topic you can appropriately bring up.

If you’re stuck with a narcissist who has targeted you, your goal should be getting out of the relationship, or, if it’s a close family member who you don’t wish to cut out of your life, then you need to work very hard on setting boundaries so that they don’t eat you up.

“If you're stuck with a narcissist, basically what you have to do is internally not let them gaslight you,” says Reiss. “Recognize that you understand reality more than they do, but that you're not their therapist or their teacher. Just protect yourself. The key is to make their behavior less harmful to you.”

We should also work on keeping our own narcissistic tendencies in check by asking trusted colleagues and friends to let us know when we’re being too self-centered, ignoring their needs or “making decisions based solely on how we feel, rather than on facts,” says Reiss.

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