Narcissistic personality disorder: Is narcissism a personality trait or mental illness?

I Am an Article About Narcissism! Read Me!

I Am an Article About Narcissism! Read Me!

Health and medicine explained.
Aug. 24 2014 10:30 PM

Are You a Narcissist?

The tricky psychiatric diagnosis is getting a lot of attention, which is exactly what it wants.

Narcissus painting by Franz Caucig.

Painting by Franz Caucig. Courtesy of the National Gallery of Slovenia/Wikimedia Commons

I would like to dedicate this article about narcissism to a very special person: me. This decision was not made lightly—only after I determined that there was no one else so incandescent, so charming, so wittily expert in the field of personality disorders as the one who appears in my mirror every morning, who in fact jumps out of every reflective surface I can unabashedly stare at during the day. Katy, this one’s for you.

Katy Waldman Katy Waldman

Katy Waldman is Slate’s words correspondent. 

Dedicating a story about narcissism to yourself is a pretty clever idea. I didn’t think of it. Jeffrey Kluger did, in his new book The Narcissist Next Door: Understanding the Monster in Your Family, in Your Office, in Your Bed—in Your World. Kluger’s well-researched and entertaining study of the syndrome du jour pulls in figures as varied as Lance Armstrong, Kim Kardashian, Jayson Blair, and Steve Jobs. It also names “exploitativeness” and “entitlement” as two of the narcissist’s calling cards, hence my ripped-off dedication. (“In keeping with the times: To me,” is his.)

Kluger is far from the first to observe that we live in a culture suffused by low-grade narcissism. Our Instagram accounts, Facebook pages, Twitter feeds, and personal websites refract our lives into a colored light show for all to watch. We come home from building our professional brands, fire up the Netflix stream of reality television, and bop our heads along to “Feeling Myself” by (“Look up in the mirror, the mirror look at me. The mirror be like baby you the [best], goddammit.”) As I’ve written before, a 2008 study by the researcher Jean Twenge found that college students score higher on the Narcissistic Personality Inventory now than they did in 1979 and that more of them consider themselves “above average.” (Twenge has inspired a small cottage industry of debunkers and detractors, some of whom point to sinking crime rates and increased community engagement to show that young people ought to be pretty proud of themselves.) A study from the National Institutes of Health determined that 9.4 percent of 20- to 29-year-olds exhibit extreme narcissism, compared with 3.2 percent of those older than 65. You might argue that those results say more about youth than about our particular societal moment, but it’s almost a distinction without a difference—youth culture is dominant right now, with a bonanza of hit YA novels, highbrow cartoons, and exalted wunderkinds.


But for some experts, narcissism is more than a character flaw, a developmental stage, or an adaptation to social norms. It’s a diagnosis, inscribed in the bible of mental illness, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Narcissistic personality disorder belongs to a suite of personality disorders first codified in 1980. These diagnostic categories were controversial from the start, and psychiatrists continue to argue about how to define them and whether they should be in the DSM. Personality disorders are more subtle than schizophrenia, depression, or other classic psychiatric maladies, and as currently construed, they’re widespread: About 9.1 percent of Americans have a personality disorder. Borderline, obsessive-compulsive, and antisocial syndromes are among the most common; narcissistic personality disorder is estimated to afflict 1 percent of the population.

Patients with NPD display “pathological” traits such as grandiosity, self-centeredness, and a constant need for attention and admiration (the ego-feeding goodies known as “narcissistic supply”). Their relationships suffer as a result of impaired empathy, even as they rely heavily on others for “self-definition and self-esteem regulation.” Additional choice phrases from the DSM-5 criteria include “excessively attuned to the reactions of others,” “goal-setting is based on gaining approval from others,” and “firmly holding to the belief that one is better than others.” (For narcissists, “others” may be dullsville and inferior, but those others still end up twirling a lot of puppet strings.)

You can take a 40-question quiz to gauge your egomania. (Imagine the one-sided conversations: I got a 40! What’d you get? I don’t care.) But because your score ticks higher every time you agree with a statement like “I am a good leader” or “I like being complimented,” some say the survey, designed by psychiatrists Robert Raskin and Howard Terry in 1988, does a better job of reflecting self-esteem—or human nature—than narcissism. Just this month, researchers unveiled a simpler method for determining whether someone is a narcissist: Ask them, “Are you a narcissist?” “People who are willing to admit they are more narcissistic than others probably actually are more narcissistic,” explained Ohio State University psychologist Brad Bushman. “They believe they are superior to other people and are fine with saying that publicly.”

In order to qualify as pathological, narcissistic tendencies must impair functioning in real and painful ways. The self-absorption must not be explicable by age (toddlers are notorious tyrants) or socio-cultural environment (football stars are encouraged to act like Roman emperors). A true narcissist is all ego, unfettered and clumsy—he sees only himself, and yet the vision is opaque to him. He thrashes around in desires he can’t understand. Perhaps he loves No. 1 uncomplicatedly, or perhaps there is loathing mixed in. In her Harper’s piece “Me, Myself, and Id,” Laura Kipnis writes that the narcissist “lives as though surrounded by mirrors, but he doesn’t like what he sees.”

While this portrait may look familiar, it also has a slippery, everywhere-at-once quality. The looseness of the DSM symptoms (“personal standards are unreasonably high in order to see oneself as exceptional, or too low based on a sense of entitlement”; “over- or underestimation of own effect on others”) and the proliferation of subtypes (“fragile,” “amorous,” “compensatory,” “paranoid,” “phallic”) make it all seem uncomfortably broad. I think of Virginia Woolf’s warning: “It is far harder to kill a phantom than a reality.” When you create a label, the label can acquire a life of its own.

This might be happening with narcissism, Kipnis argues. For all their cultural ubiquity, narcissists are elusive figures. They are us in the aggregate and sometimes her but never me. Kipnis points out that the vampiric, spotlight-stealing narcissist has historically been introduced to explain why we normals aren’t getting the attention we deserve. The floridly conceited Christopher Lasch couldn’t understand how his Harvard roommate, John Updike, appeared to sail so effortlessly into renown. So he wrote The Culture of Narcissism. In the 1970s and 1980s, narcissistic patients had one symptom in common—they made their therapists feel underappreciated. (Kipnis cites an analyst who found his narcissistic clients distressingly “demanding, controlling, tyrannizing, insatiable, and destructive.” “You start to wonder whether the shrinks are the ones who need validation and affirmation,” she remarks.) Today they are co-workers, acquaintances, and lovers whose rampaging egos trample our own poor yearnings underfoot. What if condemning others for narcissism—for failing to give us what we need—is how we avoid facing our own insignificance? What if the word is just an accusation we hurl when we feel lonely, anonymous, unloved?