“Maybe 85 percent of the women in this online chat [I was reading] said they were dating a narcissist or had dated a narcissist,” recalls Ayanna Abrams, Ph.D., a clinical psychologist in Atlanta, who spoke last year about the use of therapy terms throughout social media on the podcast Therapy for Black Girls. “And in my mind, I thought, Unless y’all have been with the same three people, that is statistically not possible.”
In online content from lay folk and experts alike, narcissistic personality disorder (NPD) appears to be wildly prolific. And we understand why: You certainly know someone with one or two narcissistic traits. But do you know anybody with actual NPD? Perhaps not…
The Mayo Clinic defines NPD as “a mental health condition in which people have an unreasonably high sense of their own importance. They need and seek too much attention and want people to admire them. People with this disorder may lack the ability to understand or care about the feelings of others. But behind this mask of extreme confidence, they are not sure of their self-worth and are easily upset by the slightest criticism.”
There are two long acknowledged subtypes of narcissism that, according to older studies, were separate:
- grandiose narcissism, marked by feeling superior and seeking admiration
- vulnerable narcissism, when a person is self-obsessed but self-conscious and defensive
But newer data suggests that grandiose people are often vulnerable. A 2021 study in the Journal of Personality noted that high levels of grandiosity actually increased vulnerability. (This is probably not the kind of two-for-one deal you’re eager to pick up.)
Regardless of accuracy, broad online use of the terms narcissism, narcissistic personality disorder, and narcissistic abuse have had some positive effects, Dr. Abrams tells Mental, including validation of people’s hurt and a sense of community among the traumatized.
“A lot of us struggle with isolation and confusion when things happen to us,” she says. “There are benefits to helping people name experiences—to help them have language that maybe they didn’t have previously for their experiences—and to help them not feel as alone.”
But there is a danger that comes with oversimplification. “There’s a threshold here that shouldn’t be crossed,” says Dr. Abrams. “[When narcissism] is distilled until it’s so small [that we can talk about it] for social media, it loses a lot of its nuance, which is really important in terms of psychological terminology and just how humans experience the world. [On social media], ask: Who is sharing this information? How credible are their sources, whether that be through mental health training or research?”
Let’s Talk #NarcTok
On TikTok, #NarcTok is a sticky hashtag with 4.7 billion views (and counting). Click it, and you’ll find narcissism-focused accounts whose sole output is #NarcTok content, including from mental health professionals, narcissistic abuse survivors, and “self-aware” narcissists themselves.
The latter includes Lee Hammock, who, at @mentalhealness, has 1.7 million followers. Hammock posts videos on spotting narcissists in the wild, and explaining his journey trying to minimize destructive behaviors related to his diagnosis.
But #NarcTok has also been applied to an array of relationship-centric posts. Many #NarcTok vids hit hard, with tense, precise accounts of interactions the poster had with a narcissistically abusive partner or parent (or someone they suspect has NPD).
Others are video versions of the classic Buzzfeed listicle—à la “5 signs your bf is a narcissist”—and often read as generic grievance roundups, including such things as partners withholding physical affection or insisting that they’re right in an argument. (This wide range of narcissism explainers exists on YouTube and other social sites, too, as well as news and health sites.)
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Much of the narcissism-related content on social media appears to be focused more on shock factor, Google ranking, or marketing than on helping anyone. But the digital discourse has zeroed in on an important question that experts have pondered for years.
How Common Is NPD?
Well, that depends on who you ask. The Cleveland Clinic estimates that up to 5 percent of people have NPD. The DSM-5, the official handbook of diagnostic criteria for mental health disorders, suggests it’s up to 6.2 percent—a stat that Mental’s founder, Amy Keller Laird, posted in a video to YouTube.
Commenters begged to differ. “How many people with full-on NPD never get diagnosed and therefore [are] not included in this stat?” wrote one. “Only a small percentage of them are ‘self-aware.’ Most of them will never look into the mirror, not while there is even a slim hope of successfully blaming someone else, of playing the victim.”
Psychologist Jaime Zuckerman, Psy.D., a clinical psychologist who specializes in treating survivors of narcissistic abuse, agrees that NPD is being underestimated. “I guess I have a biased sample, but I’m not hurting for clients at all,” Dr. Zuckerman says. People with narcissism are unlikely to seek help for their disorder, she says, which could (at least partially) account for an underestimation.
Even those who do show up in a therapist’s office may not get an NPD diagnosis simply because it’s challenging to diagnose. “The very act of defining narcissism can be a difficult one, owing to the pleomorphic nature of NPD,” according to Narcissism and Its Discontents, a doctor-penned guidebook for clinicians working with patients with NPD. (It’s cool—we had to look it up, too: “Pleomorphic” means the ability to appear in different forms.)
Some researchers say there isn’t significant data available on NPD. One paper in the American Journal of Psychiatry called it “one of the least studied personality disorders.” As the study authors wrote, because of “the limited research literature, narcissistic personality disorder was initially slated to be omitted from DSM-5. However, in response to feedback from the clinical and research community, this decision was reversed.”
There may be physical evidence of NPD. One study showed that patients diagnosed with NPD had gray matter abnormalities in their left anterior insula, a brain area that relates to emotional empathy. It appears that a true narcissist’s brain is different. There’s just the matter of not knowing how many brains look like this exactly.
“I think there are way more narcissists than we know, but I couldn’t even begin to give a percentage—and if I did, it would still be such a small subset of the population,” Dr. Zuckerman said. “It’s still more likely that a person is not a narcissist than a narcissist. Narcissism is a very distinct blueprint.”
So, what might be mistaken for NPD?
NPD vs. Being Ambitious
Ambition certainly exists outside of narcissism, but it is common among narcissists. One sign that ambition might stem from NPD is when it is extremely unpalatable to others. “It’s about dosage,” says psychiatrist Ken Duckworth, M.D., the chief medical officer at the National Alliance on Mental Illness (NAMI). “A cake with pumpkin spice in it could be fabulous, but no one wants to eat [a cake-sized serving of just] pumpkin spice.”
Another sign that someone’s ambition is born of NPD: It’s not enough to win; they have to beat someone else. Narcissists believe they are superior to others and deserve special treatment, according to a study. They don’t want other people joining them at the top—and will make sure this doesn’t happen.
In their pursuit of social status, a narcissist will assess “whether they can elevate their status or reduce the status of others,” according to a 2020 report. The researchers noted that narcissists assess the situation and then “engage in self-promotion (admiration pathway) or other-derogation (rivalry pathway).” This is, in part, because while narcissism comes with perceptions of grandiosity, it also comes with a very fragile sense of self-worth, per another study.
Some career fields tend to be more narcissist-rich than others, posited psychiatrist Mario Maj, M.D.—then secretary of publications for the World Psychiatric Association—in his book Personality Disorders. This may include…
- Medicine. Dr. Maj cited an old study on first-year medical students, in which 17 percent met the criteria for NPD.
- Military. Another study from the ’90s, pubbed in the journal Military Medicine, stated that among military members diagnosed with certain other personality disorders (think: OCD, borderline, avoidant personality disorder), there was a 20 percent chance that they also had NPD, making it the most common diagnosis among that pool of patients. Military service might appeal to narcissists “because of the focus on appearance, rewards, and public displays of reinforcement,” suggested Brad Johnson, Ph.D., the author of another ‘90s paper in Military Medicine.
- Finance. Another study (we love our studies!) found that finance majors were less empathetic and more narcissistic compared to other business students. (This could be a reason why people steeped in these communities might justifiably believe that NPD is more common than it is.)
- Politics. In one study, experts assessed 42 U.S. Presidents (Washington through Clinton), and found that those who exhibited more narcissistic traits (though were never officially diagnosed with NPD) were more effective at “public persuasiveness, crisis management, agenda setting, and allied behaviors.” But negative results accompanied these strong leadership abilities—namely, unethical behavior.
Again, let’s be clear: Having a lot of ambition isn’t usually as dark as all that. While often eye-roll-inducing, not every #RiseAndGrind enthusiast is nefarious. For example, a person can have an extreme degree of confident assertiveness, which can come off as rude, and this assertiveness is still a net positive.
“Many people [like this] can be found in the United States Senate, or they’re CEOs,” says Dr. Duckworth. “Successful people can have a degree of narcissism—and I don’t consider [ambition] a toxic trait at all. If you believe your ideas or the way you approach the world has value and you want to pursue success, some amount of narcissism is healthy. It can help you reach your goal.”
If you’re like, Wait reallyyyyyy? Duckworth points to authors—he is one!—as another group who might be a little full of themselves. They’d have to be to publish their words, he believes, but that does not mean they have NPD.
Some ambition-related traits that may seem a little narc-y should be cultivated, says Dr. Duckworth. “As a parent, you want a child to be able to stand up for themselves, to exert their own rights. You need a healthy self-esteem to do that—and that is not pathological,” he explains.
Dr. Abrams feels the same. “Most people don’t know that some narcissistic traits are adaptive and can be really healthy for you in terms of confidence—in relying on yourself and being able to be resilient,” she says. “Instead, everything [about these traits] is seen as maladaptive.”
That said, knowing that certain narcissistic traits—like acute assertiveness and confidence—can be beneficial doesn’t mean they’re free of caveats. Ambitious, self-assured non-narcissists should be mindful of how these traits affect others, especially if they want long-term success.
Justin Menkes, a C-suite coach and expert in executive evaluation, believes that high achievers with narcissistic traits need to examine them to become quality leaders. While elevated self-worth can help a person rise in business, it can cause them to falter once they get to the top, because they think less like a team member and more like a competitor, Menkes suggested in a story for the Harvard Business Review.
“It is in their self-interest to change,” he wrote. “Individuals with extreme levels of insecurity—those that cannot remain stable while seeing others succeed—will fail in leadership.”
NPD vs. Being an Asshole
Tons of online content points to the selfishness of narcissists—and that is straight-up accurate. Consider this proof:
- Narcissists aren’t typically generous. A study in Personality and Individual Differences noted that a high narcissism score correlates with lower generosity and high rates of angry retaliation.
- Narcissists are materialistic. One 2022 study shows that narcissists have a deep connection to conspicuous consumption. Now, having a penchant for Gucci doesn’t make you evil. Materialism can become a problem when people put excessive worth on possessions and derive their meaning in life from those things.
- Narcissists lack certain feelings. An analysis of 93 studies by the Society for Personality and Social Psychology found that narcissists have the cognitive empathy to recognize emotional facial expressions…but don’t have the affective empathy, where they feel those feelings back.
But these crappy qualities are hardly owned by narcissists. “People are jerks,” says Dr. Abrams. “Some people are mean; some have really poor communication skills. That doesn’t mean that there are pathologies there.”
It’s also possible that someone who isn’t a narcissist is mimicking the behaviors of one. Let us explain. They might perform self-interested actions—such as never returning a favor or consistently putting their needs first—because that’s how they were raised (*aha moment*). Dr. Zuckerman had a client who was on asshole auto-pilot after growing up with a narcissistic mother, but when it was revealed to him that he was acting like her, he sought help.
“There’s a distinct difference between somebody who has narcissistic personality disorder versus somebody who grew up in a household with a narcissistic parent and models those behaviors,” Dr. Zuckerman says. “They’re doing these things, but it doesn’t have that underlying lack of empathy and vindictiveness and manipulation and disregard for other people. Sometimes we assume someone has a narcissistic personality when really what they have are maladaptive patterns.”
People like that can change, says Dr. Zuckerman. When their actions are called out as hurtful or destructive, they process this and want to do better, “whereas a narcissist does not see any problem in what they do.”
Narcissistic Abuse vs. Abuse
This “spot the difference” activity is perhaps the hardest. What separates narcissistic abuse and general abuse? The former is certainly the latter, but is the reverse true? (Has your brain exploded yet?)
First off, it probably comes as no surprise that a diagnosis associated with low empathy and high aversion to criticism can be a poisonous recipe. There is a strong correlation between a narcissist’s vulnerable traits and anger. And researchers at The Ohio State University—after analyzing 437 independent studies (which included a total of 123,043 participants)—learned that narcissism was a risk factor for verbal and physical aggression.
Narcissistic abuse takes other shapes, too, such as gaslighting and slow isolation, says Dr. Zuckerman. “They might hide your keys or delete your emails and deny it,” she says. “Or they might say, I know Jamie is your best friend, but there’s something about her… You trust her? Really? Or it might be: I’ll drive off this bridge if you don’t have sex with me. That’s not even the most extreme example I could give you.”
This stuff hurts big time. Beyond physical pain, victims of narcissistic abuse reported significant anxiety, depression, and self-aggression, per a 2022 study.
Can abuse by a non-narcissist be similar? Yes, says Dr. Zuckerman. “On the surface, narcissistic abuse can look the same, but the function is different. A narcissistic abuser needs to control your reality.”
A narcissist’s abuse isn’t as reactive as, say, someone who has perhaps inherited poor emotional control. Unlike someone with NPD, who might appear awesome to others, this kind of person obviously sucks to most people.
Dr. Zuckerman says that you can tell a narcissistic abuser from a non-narcissistic abuser because the narcissist will exhibit other narcissistic traits outside of the home. “A narcissist is a narcissist in all domains of their life, which can look like them being extremely philanthropic and charming to others as they abuse you behind closed doors.”
And if your abuser isn’t a narcissist? Abuse is abuse, says Dr. Zuckerman. “I’ll get random messages all the time, like, My partner sent me this text, or My partner left me suddenly, they cheated on me—are they a narcissist?” she says. “I have no idea. It can be a problem when someone gets locked into those definitions.
“My response to a lot of my patients is, Does it matter what the label is?” Dr. Zuckerman continues. “Because if the relationship is not healthy for you, you can know that [without a diagnosis]. And when there’s abuse—even if it’s not narcissistic abuse—I will tell people to leave.”
But as any true crime veteran knows, leaving any abuser can dangerous. We’ll delve more into the topic of leaving an abusive relationship in our next piece on narcissism, including: When and how should you end a relationship? What precautions should you take? And how can you navigate a relationship with an abusive narcissist who you can’t completely cut off, like a boss or co-parent? More to come.
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