What is narcissistic personality disorder, and why does everyone seem to have it?

The state of the universe.
March 18 2009 7:05 AM

But Enough About You …

What is narcissistic personality disorder, and why does everyone seem to have it?

Illustration by Alex Eben Meyer. Click image to expand.

The narcissists did it. Some commentators are fingering them as the culprits of the financial meltdown. A Bloomberg columnist blamed the conceited for our financial troubles in a piece titled "Harvard Narcissists With MBAs Killed Wall Street." A Wall Street Journal op-ed on California's economy suggested that Gov. Schwarzenegger's desire for voter's love ("It's classic narcissism") helped cause the state's budget debacle. A forthcoming book, The Narcissism Epidemic, says we went on a national binge of I-deserve-it consumption that's now resulting in our economic purging.

Emily Yoffe Emily Yoffe

Emily Yoffe is a regular Slate contributor. She writes the Dear Prudence column. 

This is the cultural moment of the narcissist. In a New Yorker cartoon, Roz Chast suggests a line of narcissist greeting cards ("Wow! Your Birthday's Really Close to Mine!"). John Edwards outed himself as one when forced to confess an adulterous affair. (Given his comical vanity, the deceitful way he used his marriage for his advancement, and his self-elevation as an embodiment of the common man while living in a house the size of an arena, it sounds like a pretty good diagnosis.) New York Times critic Alessandra Stanley wrote of journalists who Twitter, "it's beginning to look more like yet another gateway drug to full-blown media narcissism." And what other malady could explain the simultaneous phenomena of Blago and the Octomom?

Watch Emily Yoffe's appearance on The Colbert Report.

These days, "narcissist" gets tossed around as an all-purpose insult, a description of self-aggrandizing, obnoxious behavior. Unfortunately, the same word is used to describe a quality that comes in three gradations: a characteristic that in the right amount is a normal component of healthy ego; a troublesome trait when there is too much; and a pathological state when it overwhelms a personality. Narcissism fuels drive and ambition, a desire to be recognized for one's accomplishments, a sense that one's life has meaning and importance. The problem occurs when narcissism becomes the primary principle of someone's personality. Its most extreme form is narcissistic personality disorder, a psychological condition that impairs a person's ability to form normal relationships and wreaks havoc on those who have close encounters with it.

A recent study titled "Leader Emergence: The Case of the Narcissistic Leader" describes how narcissists have skills and qualities—confidence, extraversion, a desire for power—that propel them into leadership roles but that when true narcissists are in charge, other aspects of their makeup—a feeling the rules don't apply to them, a need for constant stroking—can have "disastrous consequences." Yes, we're talking about you, former Illinois Gov. Rod Blagojevich. After Blagojevich was caught on tape trying to sell a Senate seat, he reveled in the opportunity to appear on talk shows, making the case that he himself was a victim—self-pity being a favorite narcissist refuge.

A line from a New York Times profile of him is as trenchant a description of narcissism as is found in most psychology textbooks: "[He] is unapologetically late to almost everything, and can treat employees with disdain, cursing and erupting in fury for failings as mundane as neglecting to have at hand at all times his preferred black Paul Mitchell hairbrush." There it all is: the sense that other people don't matter, the belief others are instruments for the narcissist's use, the self-admiration.

Narcissistic personality disorder is not simply about taking normal egoism to extremes. NPD is one of fewer than a dozen personality disorders described by the American Psychiatric Association. These differ from the major mental illnesses, such as schizophrenia and manic-depression, which are believed to have a biological origin. Personality disorders are seen as a failure of character development. Others include anti-social personality disorder (these people are also commonly called "sociopaths" or "Bernie Madoff") and borderline personality disorder (think of Livia Soprano). NPD has been officially recognized by the American Psychiatric Association only since 1980, but descriptions of this syndrome go back to ancient times. The name for it, after all, comes from the Greek myth of Narcissus, the beautiful boy who was unable to love until he saw his own reflection in the water and died pining away at his image.

Elsa Ronningstam, a psychologist at Harvard Medical School who specializes in NPD, points out the myth is not really about self-love but the inability to love. Eleanor Payson, a therapist in Michigan and the author of The Wizard of Oz and Other Narcissists,says of people with NPD, "They have a primitive, undeveloped sense of self." To compensate, they create a grandiose image to distract from an inner state that Payson says is one of "almost malignant anxiety and emptiness."

Octomom Nadya Suleman explained in an interview that she started having her brood so she they would fill "the void, the feeling of emptiness" inside her she said was the result of an unhappy childhood. When the first six kids apparently failed to understand their Sisyphean life's work of making their mother feel loved, Suleman pushed on and had eight more. Perhaps this latest batch—once they get out of the neonatal intensive care unit—will discharge their obligations better.

People with NPD act as if they are special beings who are exceptionally intelligent, accomplished, beautiful, or sexy (or all of the above), to whom lesser people (pretty much everyone else) must bow. For example, the late real estate heiress Leona Helmsley did time in prison for her belief about herself and her husband, "We don't pay taxes. Only little people pay taxes." Narcissists like to leave posthumous landmines in their wills, and in hers Helmsley excluded two grandchildren and left $12 million to the individual she cared about the most, her Maltese, Trouble. (A judge considered the dog's needs and cut its award to $2 million.) Helmsley left a $5.2 billion fortune to a foundation whose mission was to be the care of dogs, a bequest that made her Slate's No. 1 charitable giver of 2008. But the little people may have gotten their revenge. Another judge just ruled that the foundation's trustees may ignore Helmsley's wishes.

Every personality disorder runs on a continuum from mild to severe. People with mild NPD, more than those with mild cases of other personality disorders, can be very high functioning. Their aura of excitement, the force of their personality can be powerfully seductive. The arts, medicine, politics all attract inwardly injured people with an outsize sense of themselves and a desire for the world to recognize them. As columnist Charles Krauthammer noted about the 42nd president, "Clinton craves your adulation (the source of all his troubles)." Ronningstam says part of director Ingmar Bergman's genius was that he could project his narcissistic struggles in a compelling way on-screen. A striking number of successful artistic people with NPD establish their own compounds. Bergman, architect Frank Lloyd Wright, director Stanley Kubrick, and artist Salvador Dalí all retreated to self-created worlds, populated with casts (often revolving) of adoring spouses and assistants.

NPD is a little-studied condition. According to the American Psychiatric Association, about 1 percent of the general population has it. To researchers in the field, this is a significant underestimate.  (One recent study concludes it occurs in 6 percent of Americans.) Psychologists Jean Twenge and W. Keith Campbell, authors of The Narcissism Epidemic, who obviously have a stake in proving there is one, estimate around 10 percent of today's young people have clinical manifestations of NPD. They believe narcissism is a cultural virus that has spread throughout the population over the past several decades.

Those who frequently treat NPD, or its victims, point out one reason the statistics may so underestimate its incidence is that narcissists rarely show up at a therapist's office. There are no pharmaceutical fixes, and therapy is often unsuccessful. If they do seek treatment—usually under duress—a primary outcome is that they drive their therapists bonkers. A study in the American Journal of Psychiatryfound that "clinicians reported feeling anger, resentment, and dread in working with narcissistic personality disorder patients; feeling devalued and criticized by the patient; and finding themselves distracted, avoidant, and wishing to terminate the treatment."

In a paper in Comprehensive Psychiatry, researchers explored whether NPD should even be considered a disorder since the people who have it, by definition, think so highly of themselves. The authors conclude it is a pathological condition but one that uniquely causes "pain and duress" not to the sufferers but to those closest to them. Psychologist Allan N. Schore, an associate clinical professor at the David Geffen School of Medicine at UCLA says NPD can be summed up as, "Contempt of other people and their emotions." People with NPD are convinced there is nothing wrong with them; it's everyone around them who is impossible or crazy. There's some truth to their perception because often the spouse and children of the narcissist have been driven mad by their cruelty, disparagement, rages, and vindictiveness.

The leading theory about the development of NPD is that people get it the old-fashioned, Freudian way: Your parents give it to you. It starts very early when the attachment between infant and caregiver goes awry. In the first years attentive parents instinctively respond to the infant's moods. But cold, neglectful, or abusive parents don't provide the necessary comfort. Paradoxically, over-involved parents can be just as damaging because they convey anxiety and distress in the face of their child's unhappiness. As a result of neglect or smothering, these children don't learn the essential skills of being able to soothe themselves and regulate their feelings. The authors of The Narcissism Epidemic say the drift toward hovering, boosterish parents who want to gratify their child's every impulse will churn out more narcissistically disordered people.

Fortunately, not everyone with this kind of parenting ends up with NPD, which indicates there is a genetic susceptibility as well. Harvard's Ronningstam, in her book Identifying and Understanding the Narcissistic Personality, cites evidence that hypersensitive babies with a low tolerance for frustration and a strong aggressive drive may be particularly vulnerable.

Because the caregiver lacks an empathetic understanding of the baby, the baby's ability to become an empathetic person is impaired. Empathy, the ability to instinctively understand how another person is feeling, is a crucial human attribute, part of what makes us a social species. A chilling lack of empathy is a hallmark of NPD. Shame, that painful sense one has acted in an unacceptable way, is another necessary emotion that is also largely missing from the person with NPD. Since shame feels so terrible, it sounds liberating not to feel it. But psychologist Schore points out a feeling of shame signals that we need to reassess our behavior. "Shame is a moral emotion," he says. "It's without feeling shame that the most horrendous acts occur."

Those involved with someone with NPD frequently say they feel as if they are interacting with a kindergartener. In some way they are. According to a study in the journal Advances in Psychiatric Treatments, narcissists are stuck with the emotional development of 5-year-olds. It's about at age 5 that children start realizing their feelings are not just the result of other people or events but occur within themselves, and that they have control over them. But this understanding does not take place for the narcissist, who continues to see all internal states as having an external cause. Because of narcissists' inability to control their own emotions, they unconsciously experience the world as constantly threatening—thus the tendency toward inexplicable rages, the wild overreactions to the slightest perception of criticism.

Management consultant Michael Maccoby studied narcissistic bosses for his book, The Productive Narcissist: The Promise and Peril of Visionary Leadership. He makes a distinction between leaders with narcissistic traits and those who have full-blown NPD. He says narcissists can be charismatic forces for change—because of their drive, vision, risk-taking, and even ruthlessness, many corporations turn to narcissists for salvation. But such people can become dangerous because their success fuels their already ample grandiosity and feeds the sense they got there by disdaining the normal rules. Maccoby says those working for or doing business with a narcissist have to be careful not be drawn into crossing legal and ethical lines. A good example is Blagojevich, who seemed to have a rare ability to taint almost anyone who took his phone calls. Twenge and Campbell cite studies which show that narcissistic bosses produce volatile results. Their boldness can lead to big short-term success but long-term disaster.

If the observers who say that part of our economic troubles result from a mass case of narcissism, from consumers who thought they should have the house of their dreams financed on bad debt to bankers who thought they deserved eight-figure bonuses for packaging that bad debt, then perhaps we are about to be cured. Twenge and Campbell point out that the 1920s was a narcissistic era whose economic collapse led to the Great Depression and the greatest generation. Perhaps it's time to dig out those Depression-era recipes for humble pie.