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When Is Narcissism Diagnosable?

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When Is Narcissism Diagnosable?

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When Is Narcissism Diagnosable?

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What is narcissism? We hear the term a lot, and traits of narcissism are on the rise. But what constitutes a true narcissist? Is being selfish narcissistic? Is a lack of kindness narcissistic? There is a bell curve of traits that leads to the diagnosis of Narcissistic Personality Disorder.

Narcissistic Personality Disorder

For a diagnosis of narcissistic personality disorder a person must have five of the following nine symptoms:

  • Grandiosity and overestimates their worth and abilities
  • Belief of being ‘special’ and that only other ‘special’ people are worth time and energy
  • Fanaticizes about success and their own brilliance as well as other personal qualifications that are special
  • Needs constant admiration
  • Has a sense of entitlement, i.e., believing that they are so special, others should give them favorable treatment
  • Exploits others, i.e., takes advantage of people as their right to do so
  • Typically arrogant and self-serving and patronizing of others
  • Lacks empathy, i.e., doesn’t have compassion for others and doesn’t understand these feelings of others
  • Envious of others although they won’t show this and also believes that others are envious of them.

This cluster has symptoms of being dramatic, being overly emotional, and erratic. The narcissist displays symptoms of “grandiosity, need for admiration, and lack of empathy” (DSM-5, pg. 645).

We also know that narcissists are very susceptible to what is called ‘narcissistic injury’ which means that their self esteem is poor and they are easily hurt by others’ criticism and by feelings of losing to others. They do not want others to see their vulnerability so they often act out with rage and hate, especially towards those who they feel cause such injury.

When Narcissism Is A Disorder Not A Trait

Self-absorption is a common trait of teens, especially males. But most teens do grow out of what often seems like total self-absorption that does not allow for the needs of others. One clue of narcissistic traits that continue into adulthood is seeing nothing wrong with yourself no matter what, and believing that everyone and everything around you needs to change to accommodate your needs. Does this inflexibility remind you of someone you know? People like this tend to be crazy-making and hurtful.

We all have some traits related to personality disorders, but a true personality disorder means “traits are inflexible and maladaptive and cause significant functional impairment or subjective distress” (DSM V pg. 647). And one doesn’t just develop a personality disorder; it starts early and continues along the path leading into adulthood.

The Bell Curve Of Narcissism

Like most things in life, narcissism is on a continuum. Think of it like a bell curve.  Down at the bottom of the bell someone may have a few traits. The more traits you have, the higher you are on the curve. You need five or more traits to merit a personality disorder diagnosis. High number of traits can also lead to the anti-social personality disorder diagnosis. But, we all, at times, may demonstrate some narcissistic behaviors such as being overly self-involved at times or fantasize about our wants and needs and our ability to seek such outcomes.

Understanding our own issues and taking responsibility keep us from sliding into narcissism – from narcissism on a low level to that of a pure personality disorder, and we also need to know how to get out from a narcissist's control.


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Carol Anderson, D.Min., ACSW, LMSW, is a licensed clinical social worker with over 25 years of experience in the fields of mental health, addictions, and co-occurring disorders. Her other specialties include grief and trauma, women’s issues, chronic pain management, holistic healing, GLBTQ concerns, and spirituality and transpersonal psychology. Dr. Anderson has been educated and trained in the fields of education, social work, and spirituality, and she holds a Doctor of Ministry degree (non-denominational/interfaith) specializing in spirituality.

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