A Narcissist by Any Other Name

The challenges of talking about narcissism.

Posted Jan 05, 2019

I am a firm believer that in the world of mental health, there is tremendous need for advocacy. Stigma, lack of access, inadequate funding, and misinformation all hamper our ability to reach all persons in need of services and education. Advocacy can take numerous forms, including lobbying, education, fundraising, and direct service provision. Advocates may focus on mental health overall or on specific mental illnesses or the populations living with them (e.g. schizophrenia, children on the autism spectrum).  

I have faced an interesting backlash of late from people who are advocates for narcissists. It’s an interesting position to take, as the majority of people who have narcissistic traits do not have an actual psychiatric disorder (e.g. narcissistic personality disorder). This diagnosis is relatively rare (prevalence estimates are 3 to 8 percent in the most recent literature), though the pattern of narcissism is far more prevalent.  I, and most others who examine this pattern, have maintained that narcissism is characterized by key patterns—lack of empathy, entitlement, grandiosity, superficiality, arrogance, admiration seeking, difficulties with emotional regulation, a propensity to envy, and difficulties with self-esteem regulation. This pattern evinces itself as an interpersonally challenging space—with relationships often characterized by invalidation, devaluation, conflict, emotional abuse, and an absence of deep intimacy and connection.  People in a relationship with a narcissist will report that over time they experience a number of negative psychological conditions, including anxiety, depressive symptoms, and post-traumatic symptoms, including hyperarousal, withdrawal, hypervigilance, and self-doubt. The “why” of narcissism—why do people develop this pattern—is a nuanced “why” and reflects issues related to attachment, temperament, early invalidation, early overvaluation, parental modeling, cultural factors, and societal inputs. 

The Oxford dictionary announced that toxic was its word of the year for 2018 (and that isn't  because people are interested in chemicals). It's a word that implies harm that comes from exposure to something unhealthy. I am guilty of labeling narcissistic patterns and, frankly, people as “toxic” because of the downstream impacts these patterns have on the people exposed to them. It becomes an interesting conundrum. Psychology and psychiatry in one breath HATE labels, and yet we use them—and often. Perhaps instead of using the “dirty word” narcissism and instead developing a new word, lackofempathygrandiosityvalidationseekingentitledarrogantemotionallydysregulatedenvioussuperficial, could lift some of the sting. It takes in all the territory, and perhaps it will not raise the ire of the community of narcissism advocates.  

When I read the critiques of my work, I always hear them with an ear of wanting to be better and ensuring that I am not fostering bias.  However, I also become very concerned. Because I have spent the past several years hearing hundreds of narratives of clients who have gone hat in hand to numerous therapists who refuse to entertain the word narcissism, and instruct them to go back and work on “communicating” and trying to understand the narcissist's perspective. Such recommendations have in more than a few cases re-perpetrated the emotional abuse issued by the high-conflict, difficult, antagonistic person in the client's life and left the client full of even more self-doubt and self-blame, while attempting to go back and “fix” the situation and “communicate” and “be better.”  At times working with these clients can initially feel more like deprogramming than therapy. People struggle with the dichotomy of guilt for wanting to be rid of these difficult relationships and recognition that they would likely thrive if they could set better boundaries, distance, or even step away entirely from these damaging relational spaces. 

Psychology, like all evolving disciplines, grows only through discourse, and I welcome the critiques and receive them as an opportunity to be better. And I suppose that I should be grateful that the narcissists have their own advocates out there, though I would argue that the world advocates for narcissistic patterns all the time (case in point: social media). It’s their world; we are just trying to survive in it! I have had the privilege of working with clients who engage in numerous narcissistic patterns, and we have done excellent work together in therapy. However, because I also see and hear first hand the deleterious impact of these patterns on their family members, I am going to continue my commitment to working with survivors of narcissistic abuse and providing psychoeducation in the area of narcissism and other high-conflict personalities. And if words like toxic feel uncomfortable, they still fit.  So the next time we therapists encounter the patterns of lackofempathygrandiosityvalidationseekingentitledarrogantemotionallydysregulatedenvioussuperficial, we should be better able to guide our clients before it takes a greater toll on their well-being. it’s a long word, but call it whatever you need to educate yourself and maintain a realistic set of expectations for these patterns.