Personality disorders are characterized by enduring patterns of inner experience and behavior that deviate significantly from the expectations of the individual's culture.

A common question I get asked in my practice as a clinical psychologist is, “Is my partner (partner, spouse, boyfriend, girlfriend, etc.) a narcissist? If you are asking yourself this question, chances are that you may be facing difficulties in your relationship with someone. However, those difficulties are not just due to some disagreements or your loved one suddenly getting cold towards you. You may have noticed some persistent behaviors, such as a lack of empathy or sense of entitlement in that person that makes you wonder whether he/she may be a narcissist.

So, is this person a narcissist?

The short answer to this question is that Narcissistic Personality Disorder (NPD) can only be diagnosed by a mental health professional after a clinical evaluation of the person in question. Therefore, this blog is not intended to diagnose someone but to provide some general information about NPD. Keep in mind that personality disorders are complex, and again, it's crucial to consult with a mental health professional for a proper diagnosis.

What is a Personality Disorder (PD) anyway?

It's important to note that anyone can exhibit narcissistic traits at times, but individuals with NPD display a pervasive and enduring pattern of these behaviors that causes significant distress or impairment.

When considering whether someone has NPD, or a personality disorder in general, my starting point is the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), given that this manual is the American Psychiatric Association’s (APA) standard classification of mental disorders used by mental health professionals here in the United States. Based on the DSM-5, I would like to point out some general features common to all personality disorders including NPD:

Personality disorders are characterized by an “enduring pattern” in the individual’s inner experience and behavior that deviates significantly from the expectations of his or her culture. Note that the keywords here are ENDURING and PATTERN.
The PD pattern is a specific way that the person thinks (about him/herself, about others, and about events), feels, relates to others, or controls his or her impulses. Also, the person expresses the PD pattern in a variety of personal and social situations (at work, with their relatives, etc.) and not just in his/her relationship with you.
The person experiencing a PD has already been presenting the pattern at least since their adolescence or early adulthood. This is an important feature to keep in mind because people with NPD have been already presenting the narcissistic pattern in their relationships prior to you. Or, as I say in educational sessions with my clients, “nobody wakes up in the morning suddenly suffering from a personality disorder”.
The pattern is not a result of a medical/physical condition (for example, head trauma), substance abuse, or another mental disorder (for example, bipolar disorder).
The pattern causes significant distress or impairment in the person’s areas of functioning (for example, social, occupational, etc.).

What is NPD?

Within the conditions described above, the DSM-5 lists specific features of NPD. Overall, NPD is a mental health condition characterized by a pattern of grandiosity, a constant need for admiration, and a lack of empathy for others. Some common traits associated with narcissism include:

Grandiosity: An exaggerated sense of self-importance.
Fantasies of unlimited success, power, brilliance, or beauty: Believing in one's unique qualities and expecting to be recognized as such.
Belief in being special and unique: Feeling that one can only be understood by, or should associate with, other special or high-status people.
Excessive need for admiration: Seeking constant praise and admiration from others.
Sense of entitlement: Expecting special treatment or privileges without regard for others.
Lack of empathy: Difficulty recognizing and understanding the feelings and needs of others.
Envy of others or belief that others are envious of them: Being preoccupied with fantasies of unlimited success and power.

Is the list above all that is needed for a NPD diagnosis?

No. In my clinical practice, in addition to a thorough clinical interview (this is fundamental for the diagnosis), I also typically rely on collateral information and psychological testing prior to determining if someone meets criteria for NPD. A discussion on those tests is beyond the limit of this blog. However, while there is no single psychological test that will conclusively say that someone has NPD, there are well-established psychological assessment tools that can powerfully inform the diagnosis of NPD.

Can someone with NPD affect my mental health?

Narcissistic Personality Disorder (NPD) can have significant impacts on relationships, both romantic and otherwise. It's important to note that the severity of symptoms can vary, and not everyone with narcissistic traits necessarily has NPD. Here are some ways in which NPD may affect relationships:

Lack of Empathy: Individuals with NPD often struggle with empathy, making it difficult for them to understand or share in the feelings of others. This can lead to a lack of emotional support and understanding in the relationship.
Excessive Need for Admiration: People with NPD may constantly seek admiration and validation from their partners. They may require constant attention and struggle to reciprocate attention or praise.
Manipulative Behavior: Narcissists may engage in manipulative behaviors to maintain control and get what they want. This can include emotional manipulation, gaslighting, and using others for personal gain.
Difficulty Maintaining Healthy Boundaries: Narcissists may have difficulty respecting the boundaries of others. They may try to control their partner's life, invade their privacy, or disregard their needs and wishes.
Intense Fear of Rejection or Criticism: Due to fragile self-esteem, individuals with NPD may react strongly to any perceived criticism or rejection. This can lead to defensiveness, anger, or a withdrawal from the relationship.
Unrealistic Expectations: Narcissists may have unrealistic expectations of their partners, expecting them to constantly meet their needs and fulfill their desires without reciprocation.
Difficulty in Resolving Conflict: Narcissists may struggle with conflict resolution because they often prioritize their own needs and desires over the needs of the relationship. They may avoid taking responsibility for their actions and blame others instead.
Cycling Between Idealization and Devaluation: In the early stages of a relationship, a narcissist may idealize their partner, but as the relationship progresses, they may devalue the same person. This can create a cycle of unpredictability and emotional instability.

It's important to note that individuals with NPD may not be aware of the impact of their behavior on others, and they may resist seeking therapy or treatment. If you are in a relationship with someone you suspect has NPD, it may be helpful to seek the guidance of a mental health professional to navigate the challenges and explore potential strategies for coping or seeking support.

Where can I seek help?

As stated at the beginning of this blog, the diagnosis of NPD can be established only by a clinically trained mental health professional. If you are concerned about your partner's behavior, it is recommended to seek the guidance of a mental health professional. At Hello Mental Health, we are equipped to provide a thorough assessment and offer appropriate advice or treatment options based on the specific situation. We are here to help you on your way to a healthier mental state and healthier relationship with those in your life!

Do I have a narcissist in my life?