Today when you have a difficult encounter, it is increasingly common to question whether you are dealing with a narcissist. The term comes from Greek mythology, where the handsome youth Narcissus rejected the advances of the nymph Echo. In punishment, the gods condemned him to look at his own reflection in a pool of water until he withered away and died. The term narcissism came into common usage in the 19th century as a way to describe someone who is self involved. 

Another related term that is sometimes used synonymously is Narcissistic Personality Disorder (NPD).  The two are not the same. What follows is a primer showing why.

Narcissus by Caravaggio (Wikipedia)

What’s the difference between a narcissist and someone who has narcissistic personality disorder?

Put simply: Narcissism is a personality trait indicating excessive self involvement, that depending on one’s point of view, includes all of us on a sliding spectrum. Narcissistic Personality Disorder is a diagnosis for a mental health disorder, defined as a fixed pattern of beliefs and behaviors that are grandiose (overestimate themselves and their abilities), exude qualities of superiority, with an excessive need for admiration and a lack of empathy for others. These qualities are present by early adulthood and often have their roots in childhood. 

Things to look for in determining whether a person exhibits narcissistic traits or those who have NPD are:

  1. Frequency – A narcissist behaves in a self centered way on occasions, whereas NPD is a fixed pattern of behaviors on a regular basis.
  2. Intensity – Narcissism has a varying range of intensity levels in behaviors, from minor self absorption (talking about yourself too much) to a more pathological level (gaslighting, inability to maintain significant relationships). With NPD, the DSM 5 diagnosis requires meeting at least five maladaptive criteria, which produce a higher level intensity of negative consequences in everyday life (contempt for others, view of themselves that is not supported by reality, extreme defensiveness, irritability and jealousy, fragile self esteem, significant relationship issues and a tendency towards  substance abuse).
  3. Insight and Self Awareness –  Narcissists are capable of some insight and self awareness depending on the circumstances and their level of pathology. People with NPD demonstrate little of either. 
  4. Ability to Repair Relationships – Again depending on severity of pathology, narcissists are capable of empathy for others. This allows for them to work on personal change/growth, giving them the potential to repair wounds in relationships. All of those qualities are much more limited in those with NPD.
Photo by Alex Green from Pexels

Origins and Treatment

There isn’t a list of precise causes for NPD or narcissism. There is however, common agreement that both have origins in childhood and the qualities of relationships between family members.  

With both NPD and narcissism, the focus is on disturbances in the relationship between a child and their significant caregivers. This ranges from caregivers’ lack of empathy and not showing approval or demonstrating qualities of a healthy role model, to traumatic events like sexual, emotional or verbal abuse. The result can be arrested development of a child’s emotional growth, leading to the childlike qualities of grandiosity and selfishness continuing into adulthood, often synonymous with narcissism. 

Photo by Juan Pablo Serrano Arenas

It also can lead to the development of a hardened defense mechanism to protect a wounded self image which often correlates with NPD. In both cases, these individuals can be very difficult for others to deal with in the outside world and deeply vulnerable themselves on the inside. It is estimated that five percent of the current population qualify for an NPD diagnosis, with higher rates in men than women. It is impossible to estimate the number of people who are narcissists, but it is a significantly higher number.

Best practice for treatment of both pathological narcissism and NPD is psychotherapy. Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT) are modalities that have empirically demonstrated effective results. Medications for related symptoms like depression and anxiety can also be useful in treatment of these conditions.


You are much more likely to have relationships with people who exhibit narcissistic behaviors, than those who have been or should be diagnosed with NPD. If you are experiencing difficulties in a relationship with someone who in your opinion is: 

  • (i) excessively involved with themselves; 
  • (ii) lacks empathy for you and how you feel; 
  • (iii) does not understand their effect on you and others and 
  • (iv) their behaviors are impacting you or others in a significantly negative way

It makes sense to recommend a consultation with a mental health professional to assess whether further help is needed.

You might also enjoy reading: How the Pandemic Has Changed Our Personalities

*Title photo courtesy of via Flickr

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