Self-indulgent sabotage: A psychiatrist explains the dangers of over-diagnosing narcissism

The son of a nymph and a river-god, Narcissus was a sight for sore eyes. With long locks like an ancient Greek Timothée Chalamet and soft features like Harry Styles, he was so attractive, as the myth goes, that he couldn’t look away from his own reflection, withered away and died.

These days, it seems we all know a modern-day Narcissus, and people are throwing around the term narcissist, rooted in the Greek myth, to label this kind of self-centered behavior all over the internet. Spend five minutes on TikTok, and you’ll probably come across at least one video about narcissistic parents or how to spot narcissism in romantic partners. 

But are narcissists really increasing in number? Where do we draw the line between positive associations with oneself, like confidence or self-love and toxic egotism? And is there any danger of amateurly diagnosing narcissistic personality disorder? Salon took these questions to Craig Malkin Ph.D., a psychiatrist and lecturer for Harvard Medical School, who is also the author of “Rethinking Narcissism The Secret to Recognizing and Coping with Narcissists.”

The conversation has been edited for length and clarity.

Can you distinguish between narcissistic personality disorder and narcissistic traits? 

We have to start with the definition of narcissism, and the simplest way of understanding it is to think of narcissism as the drive to feel special, exceptional or unique and to stand out from the other nearly a billion people on the planet in some way. The core of narcissism is something called self-enhancement, and it’s also best understood as a pervasive, universal human trait. We know that it’s pervasive because you can measure it cross-culturally using measures like the Narcissistic Personality Inventory (NPI). … But you can also understand it as an adaptation or survival strategy that is self-soothing or coping by maintaining this feeling of being special. 

People who are well above average on that trait — [which is determined] by clinicians like myself sitting in the room with them and interacting with them and talking about relationships — compared to others, that’s what we define as a narcissist. They’re elevated in narcissism but that does not mean they’re disordered.

Of the number of people high enough on the trait to be called narcissists, you’re going to have a percentage who have narcissistic personality disorder (NPD). This is best understood as people who are so driven to feel special, exceptional and unique compared to others, that they would lie, steal, cheat or do whatever it takes in order to maintain that feeling about themselves.

They demonstrate what I call the core of pathological narcissism or the “triple e.” Exploitation: doing whatever it takes no matter the cost to others, potentially even hurting them in order to feel special. Entitlement: acting as if the world should bow to their will. And empathy impairments: being so driven to maintain that sense of being special compared to others that people lose sight of the needs and feelings of those around them. 

Roughly speaking, you’re probably going to see about one in 10 people who are high enough on the trait to be considered a narcissist. One percent of the population is going to be so narcissistic that they meet the criteria for NPD, according to the DSM, [the manual psychiatrists use to diagnose mental illness.]

Is there a rise in narcissism?

My best conclusion based on the evidence is, no, there is not a rise in narcissistic traits. Most of the types [of narcissists] that we’re talking about here are loud, extroverted and thrive on attention — not all people who are narcissistic do. 

What I do see is that there’s been an increase in the ease with which somebody like that can make themselves heard, and make themselves heard loudly. So it starts to feel like we’re surrounded by it when we’re really talking about a handful of people who are high in narcissistic traits and have gotten really adept at seeming to be everywhere.

Could it be also that we, as a society, are becoming more aware of narcissism? Or could it be that we’re kind of over-prescribing or over-labeling — trying to fit everything into a category? 

I think we are getting better [at recognizing narcissism]. People are more educated, but there’s all sorts of misinformation out there that reduces all narcissism to pathological narcissism. That’s hugely problematic especially because it gets confusing when we’re talking about different types of narcissism. They don’t all look the same.

But people definitely have more information. They know the more narcissistic someone is, the more likely they are to put someone else down to make themselves feel better. These are kinds of behavior patterns. The problem is, everybody at times can slip into more narcissistic behaviors. There’s a difference between somebody who is behaving narcissistically and the one who is a narcissist.

I think it’s true that people are getting better at spotting the kind of behaviors that are called narcissistic. … We’re actually really good at spotting [extroverted narcissists]. There are a number of studies where you just have somebody describe this person who, it turns out, does turn out to be a narcissist. Most people, when they read that description, or they interact with this person, they’re like, “Oh, yeah, they’re a narcissist.” We’re not so good at spotting pathological narcissism. 

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What is the danger in overusing the term narcissist?

Even some people in my field are doing that and reducing it in a way that actually isn’t very helpful, and then it becomes a stigmatizing label. As soon as people are using the language in that way, you can define them as a label, and then you don’t have to consider them as a whole person. They’re just a narcissist. … If that’s the filter that we’re using, we can’t even recognize [narcissism in ourselves] without feeling somehow like it diminishes us or it makes us an awful, horrible person. 

My specialty is to help people struggling in relationships with someone who is narcissistic, but I also help people who are diagnosed with NPD. It’s easy to reduce all of narcissism to, “These people are evil and we don’t need to contend with them.” First of all, there are the risks that we just discussed, with moments of narcissism within ourselves.

But there’s an even greater risk that there’s going to be people out there with narcissistic personality disorder, who want to change their behaviors or want to reflect and want to get better. The message out there for them is: If you’re narcissistic in any way, you’re completely bad; there’s no hope for you. People just write you off. Now, you’ve got a segment of the population that actually is suffering, people with whom I work, who are facing such stigma, that they feel that there’s no possibility for them to ever change course, or to have a better life.

How can narcissism be a healthy or helpful trait? 

The core of narcissism is something called self-enhancement, or positive illusion. It’s only a problem when people become rigidly invested in believing in themselves in this overly positive view of themselves, that they are smarter than others, more capable, more whatever. When it’s held loosely, when it’s not untrue, we know it’s healthy. That’s an expression of narcissism that is healthy.

If you look at studies of people around the world who don’t think of themselves as average, who actually think of themselves in a slightly overinflated way, who hold these positive illusions, they are often happier in life. They persist in the face of failure. They’re able to give and receive in relationships — all healthy things. They may even live longer, according to one study, because there’s a health benefit to having those feelings. That is healthy narcissism. 

Another way you can think about that is having slightly rose-colored glasses for the self, world and future. We also know from the same research that people who don’t have any of that suffer. They’re often more anxious and depressed. They tend to see themselves, the world and the future more realistically — it’s actually something called the sadder-but-wiser effect. It is not helpful, turns out, to not have any of those rose-colored glasses. It can actually get in the way in all kinds of ways in people’s lives, including in their relationships.

We can think of narcissism as a drive to feel special, exceptional and unique. A little of that is actually kind of a buffer and helps create some kind of resilience. Again, it’s only when people cling to it so fiercely, that they can’t accept blame — that they can’t reflect on themselves. 

Are there parallels to be drawn for this happening with other disorders where people start loosely tossing around a term? One that comes to mind for me is “empath.” I hear people say that all the time. I’m not sure if they’re actually empaths, but it’s become another kind of label.

It happens all the time. In history, when the public gets ahold of a term, it starts to get overused, loses some of its meaning and might even get improperly used. That’s what happened with schizophrenia. Because of the derivation of the term and because it literally meant “split,” people decided schizophrenia meant split personality. That’s not what schizophrenia is, but for a while, it started to take on these connotations that have absolutely nothing to do with the disorder. This also happens with terms like psychopath and empath.

[People] lose any kind of nuance and the understanding that most of these traits can be measured on the spectrum, most people fall somewhere around it and there’s an implication of where you are along the spectrum but there’s even nuances in that. As soon as people start using these terms as these rigid, inflexible character descriptions, that’s where we have problems, where it’s either used to write somebody off or to write ourselves off: “I can’t help it because I’m an empath.” Then how do I participate in relationships in a way that perpetuates this feeling about myself? Maybe I need to be angry sometimes, and maybe I’m uncomfortable with anger, but if it just gets dismissed as some inherent aspect of character, then it can’t ever be amended or changed.

Is there something special about narcissism or narcissistic traits that have made them kind of stand out to become more popular in the lexicon? And I do see there’s kind of an irony there. 

The people who come to see me for help with NPD have some capacity to reflect, some self-awareness, at least enough to be able to say, “I think I’m having problems and I need to look at it. I need help.” But the less capacity people with NPD have for that, the more they can be very disruptive and aggressive in relationships.

It helps to explain a lot of real nasty behaviors. Not all of it, because not all people with NPD are abusive, for example. Again, it depends on any number of factors. But some are, and it becomes a really handy way for those who have survived abusive relationships to understand and explain what’s going on. The problem is, anybody can be abusive.

There are all sorts of different personality disorders where people become abusive, too. Even somebody with obsessive-compulsive personality disorder — if they feel like their rigid controls have been threatened, they might become abusive. So there’s a danger in reducing all abusers to people that have NPD. 

Think of narcissism as the drive to feel special, exceptional and unique. If you think about that trait, there are lots of ways to feel special, right? So this gets confusing, too. People get very hung up on that, and I think it’s kind of a caricature of the narcissist we all know and loathe. These are people who are extroverted or grandiose, “obvious” narcissists or “overt” narcissists — those are all names for the same type. They feel special by virtue of their wealth. They feel especially smart compared to others — positive things. 

But then there are people who are extremely narcissistic and feel special because of negative qualities. They feel like the most misunderstood person in the room, the ugliest person in the room — no one has suffered as much as they have. That’s the more introverted, covert or vulnerable narcissistic presentation. 

So there’s this problem again too, of [people thinking] these are people who are full of themselves and feel good about themselves. The reality is, the introvert or covert narcissist very often shies from attention. They feel socially anxious. They don’t want all eyes on them in a room and they don’t feel particularly good about themselves.