Is narcissism a mental health problem? And can you really diagnose it online?

By Paula Ross and Nicole Lee for The Conversation

Is narcissism a mental health problem? And can you really diagnose it online?
It’s not uncommon these days to hear someone – such as an ex romantic partner or a politician – described as a “narcissist”.

Singer Robbie Williams recently told an interviewer he took an online test to see if he was one. He revealed the test suggested a “mild indication of narcissistic personality disorder”.

But what is narcissism, when is it a problem and can an online test really provide a reliable diagnosis?

A fixation on oneself

According to the Greek myth, a beautiful young man called Narcissus fell in love with his own reflection in a pool of water. He stayed staring at it for the rest of his life. His name gave rise to the term “narcissism”, characterised by a fixation on oneself.

Narcissism is a cluster of traits along a range of severity. At one end of the spectrum, people may be confident, charming and well-adapted.

In the middle of the spectrum, people may be overly focused on seeking out status, success and admiration at work or in their social lives. They can have a need to appear perfect, special or superior to others in order to feel OK about themselves.

At the very extreme end, it may become a disorder in which people can be self-centred, grandiose and destructive.

What’s ‘narcissistic personality disorder’?

“Narcissistic personality disorder” is a mental health diagnosis given to people with extremely narcissistic traits. These traits have reached the point where they start to impact on the person’s ability to function at work or socially.

Narcissistic personality disorder is relatively rare. It is estimated around 1% of the population has a diagnosable form of the condition.

Men tend to be more narcissistic than women. There is no evidence that young people are more narcissistic than previous generations at the same age.

Their symptoms are described as “pervasive”, meaning they are obvious across all of a person’s activities, not just in specific situations. So, on the face of it, pop star Robbie William’s insistence his score on the quiz reflected only his narcissistic personality on stage is not quite accurate.

Specialness by association

People with narcissistic personality disorder tend to overestimate their abilities and exaggerate their achievements. And they are surprised or angry when others don’t notice their accomplishments.

They need constant confirmation of their value, specialness or importance. They may have fantasies about power, success, having perfect lives or relationships, believing these are not only achievable but deserved.

People with narcissistic personality disorder might talk a lot about how people in their lives are extra special in some way – such as being the very best at something or leaders in a particular field – because it increases their own sense of specialness by association.

When their status or superiority is challenged they can respond with extreme anger, rage or belittling the person and their opinion. They find it difficult to tolerate the thought they may be flawed or vulnerable in some way.

In relationships, they can have exceedingly high expectations of devotion from partners and friends, but may themselves be low in empathy and lack of awareness of others’ needs. They may be envious of and unable to celebrate the success of others, and respond by devaluing them.

They are often unaware of the impact of their behaviours on others.

How is it diagnosed?

Diagnosis should only be made by a mental health professional. Trying to diagnose yourself or someone else with an online quiz may give you results that are misleading and unhelpful.

Narcissistic personality disorder is a cluster of symptoms on a continuum and many diagnoses share similar symptoms. For a proper diagnosis, a clinician needs to assess which cluster of symptoms is present, how far along the continuum they are, and which other diagnoses to exclude.

But a symptom checklist might help you work out whether you should consider seeing a mental health professional for further assessment or support.

How do people get this way?

We don’t know exactly what causes narcissistic personality disorder.

There is probably a genetic component. Traits such as aggression, poor emotional regulation and low tolerance to distress tend to be high in people diagnosed with narcissistic personality disorder.

Certain experiences in childhood are also more likely to lead to narcissistic personality disorder. These might be either particularly negative, such as trauma or rejection, or overly positive, such as excessive praise or being constantly told you have extraordinary abilities. Parenting styles that are either very neglectful or overly protective are also associated with the development of narcissism.

People with narcissistic personality disorder often have other mental health conditions, particularly mood disorders. They also have a high rate of suicide. These conditions may have a common cause or they may be a result of the difficulties people with narcissistic personality disorder have with social interactions.

Can it be treated?

Narcissistic personality disorder is a lifelong condition that is considered manageable but not curable. There is no standard medicine or psychological treatment for narcissistic personality disorder.

Psychological treatment aims to reduce the severity of symptoms, improve mood, manage impulses, and build communication and relationship skills. One of the main goals of therapy is to develop more realistic expectations of others.

Medicines that help with other mental health problems like anxiety, depression and bipolar disorder may also help reduce some symptoms.

People are more likely to seek help for another mental health condition, such as depression. Getting treatment for these conditions can also positively impact on personality disorder symptoms.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14 (Aus) or 0800 543 354 (NZ).

About the authors

Paula Ross, Sessional psychology lecturer, Australian Catholic University

Nicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin University



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