Understanding narcissism: how to spot narcissists, what causes the mental disorder, and how to deal with them – a psychologist reveals all

• ‘Narcissism’ is trending on Instagram, but many may not know what defines narcissistic personality disorder. An expert outlines the condition’s nine features
• Genes and early childhood trauma can contribute to narcissism, and there may be more narcissists out there than you think, so approaching them correctly is key

Scrolling through her teenage daughter’s social media feed, Samantha pulls a face and says: “Young people these days are so self-absorbed, they’re all narcissists.”

Twenty-five-year old Rebecca recently broke up with her boyfriend. Feeling hurt and at a low ebb, she confides to her best friend: “He’s a narcissist, I’m traumatised.”

Narcissism is trending on social media: a quick search showed Instagram alone has more than 868,000 #narcissism posts.

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That makes it easy to believe that we’re surrounded by egotistical, manipulative and possibly even malevolent people waiting to prey on the unsuspecting.

An Instagram search for #narcissism garners over 868,000 posts. Photo: Instagram

That narcissistic personality disorder (NPD) is actually a clinical diagnosis is often overlooked.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) – the standard classification and diagnostic tool for mental disorders – it is a “cluster B” disorder, which means that afflicted people have difficulties regulating their emotions and behaviour.

A young woman takes a selfie on her smartphone. In the social media age, it’s easy to throw around the term

To increase mental health literacy and awareness, it’s important to have an accurate understanding of the labels we use.

“When people overuse a term and inaccurately describe a situation, it trivialises the situation and waters down the meaning. It may also promote a lot of myths and an inaccurate understanding,” says Candice Powell, a clinical psychologist and chief executive of Hong Kong mental health charity Mind HK.

Core features of NPD in a person, according to the DSM-5, are:

a grandiose sense of self-importance

a sense of entitlement

fantasies of success and power

a desire for excessive admiration

being exploitative

lacking empathy

being envious

having a high status understanding, in other words, believing that they are “special” and can only be understood by, or should only associate with, other special people (or institutions)

exhibiting arrogant behaviours and attitudes

Candice Powell, CEO of mental health charity Mind HK. Photo: Jonathan Wong

To be clinically diagnosed with the condition, a person must exhibit at least five of the nine features.

“Having one or two of these traits is fine. We need some healthy confidence,” Powell says.

“However, if they tap into a lot of criteria and it affects their interpersonal functions with their peers, colleagues or spouse, then it is a disorder.”

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Before we delve into the challenges that narcissists can pose to the people in their immediate sphere, consider that this is a personality disorder which is mixture of genes, early childhood experiences and psychological factors.

Childhood trauma – physical, emotional and sexual abuse, neglect and abandonment – is one of the most common types of trauma that can contribute to the development of narcissism.

It usually begins developing in a person around the age of seven or eight, so these are often people who have had a challenging early life.

Childhood trauma is a main cause of narcissism. Photo: Shutterstock

There are two broad types of narcissists – the overt and the covert. The overt narcissists are easy to recognise because they display a strong sense of superiority and are arrogant.

“They think they are better than others. Verbally and behaviourally they will show they are more important than others. They will mention their achievements and criticise others to highlight themselves as smarter, more beautiful, more intelligent,” Powell says.

When such people show up in the mental healthcare system, they are often the ones who demand out-of-service contact hours.

If we try to understand the whole person … then we will have more empathy with these people Candice Powell, chief executive of mental health charity Mind HK

If the agreement is that they will have a session once a week or once a month, they think they deserve extra and will get angry and complain.

The covert or vulnerable narcissist is harder to spot. They are emotionally fragile and sensitive to even limited amounts of perceived criticism.

“They have more shame, which affects their emotional stability. Their grandiosity is more hidden. In their heart, they think they are better than others, but on the outside, they appear to be humble. When their shame is triggered, they can react with passive aggressive and cold comments,” she says.

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The prognosis is poor for people with NPD. They need long-term therapy – and the motivation to seek such therapy – but will often be unwilling to stay the course. A therapist will give advice and analyse their options, which will make them feel they are not in a superior position and want to leave.

“As a therapist, it requires a lot of patience [to work with someone with NPD]. It is definitely reparenting. You try to be a new parent to establish the trust and proper boundaries and at the same time give unconditional positive regard.

“You try to help them understand that the world can be another way, it is not just about manipulation and control in order to survive,” Powell says.

A man gaslights a woman. Subversive behaviour like this or lying to align others against you are telltale signs you’re dealing with a narcissist. Photo: Shutterstock

And what of the people who show up in therapy reeling from the experience of a parent, spouse or colleague with NPD?

The first step is to recognise what is happening. Gaslighting is one of the most obvious signs you are dealing with a narcissist.

You are accused of forgetting something, but you didn’t. You are blamed for something that you didn’t do. The narcissist in your life aligns people against you to spread lies and keep you isolated.

“If a person is always confused because of inconsistent behaviour – sometimes good, sometimes bad – that is a sign to reflect on the relationship,” Powell says.

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The next step is to establish some boundaries. If you are unable to escape from a narcissist – perhaps they are your parent or boss – then it’s important to maintain a respectable distance.

It is common to feel confused and anxious when dealing with a narcissist. Seek out a mental health professional to talk things through. They can validate what you are experiencing and help you set up boundaries and be assertive.

“Don’t be afraid. When a person is gaslit, a lot of the time they will feel confused, anxious and doubt themselves. Accept this person [with NPD] has a tendency to say things that are incorrect, and lay out the facts. Be assertive. Don’t let that person scare you,” Powell says.

Narcissists may start out popular, but people see through them in the long run

The chances are you know someone with NPD, if not in your immediate circle of family and friends, then in your wider circle. They account for about 1.8 per cent of the population, Powell says. That translates to about one in 50 people.

Mental health literacy has been shown to help reduce stigma, which is a very good thing. Social media can be an effective tool to get important mental health messages out, but these channels are not subjected to any credibility checks.

As we learn the language to understand our experiences and those of people around us, it is important to use the correct terms. And remember to approach others with kindness; you don’t know what happened to make a person behave the way they do.

“If we just see the disorder, we only see the negative side. If we try to understand the whole person – the trauma-informed approach – then we will have more empathy with these people.

“Even though people with NPD don’t have empathy, it’s important for us to be empathetic,” Powell says.

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This article originally appeared on the South China Morning Post (www.scmp.com), the leading news media reporting on China and Asia.

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