SO, THERE’S SOMEONE in your life who, superficially at least, has an unusually high regard for themselves. We all know someone like this – perhaps a parent, a spouse, a friend, or a work colleague.

You might have liked them at first; they might have oozed charisma, charm and energy. But their makeup flakes as time goes by, revealing them to be self-centred, arrogant and entitled.

They lack empathy in situations that call for it. They tend to blame or gaslight. They dream of high achievement or authority and are jealous of others who might achieve it before them. And if you dent their surprisingly fragile ego or forget to account for their needs, they throw a tantrum until sufficiently soothed by your deference.

The term narcissism originates in Greek mythology, a tale in which the impossibly handsome Narcissus falls in love with his own image when he chances upon it reflected in a pool of water. The poor young fellow is so incapable of drawing himself away from the pool that he eventually dies of starvation. But when we talk about the narcissist in the modern day, we really mean narcissistic personality disorder, which is a clinical diagnosis represented in an estimated 1-2% of the population.

Narcissistic traits

It’s worth noting that a small amount of narcissism is healthy in everyone. A certain self-confidence and ambition will help you to advocate for yourself and pursue goals in life without excessive self-doubt.

And we all have personalities, right? Some more than others, perhaps, but where does the word “disorder” come into it? Well, because psychiatric and psychological conditions might otherwise dissolve into mere fragmented opinion, professionals prefer specific criteria for diagnosis.

One such entity is the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). According to the DSM-5, personality disorders require evidence of persistent, inflexible, distressing patterns of behaviour that differ markedly from what’s considered culturally normal. Such disorders affect how a person thinks, feels, controls impulses and interacts with others, and make it hard for the person to adjust to various personal and social situations – at home, at work, out with friends, and so forth. Personality disorders are not considered mental illness per se.

Various different personality disorders exist but the DSM-5 says the narcissistic type has five or more of the following:

(1) Grandiose self-importance with a tendency to exaggerate their talents and achievements, and an expectation that others will recognise them as superior,

(2) A preoccupation with fantasies of unlimited success, power, brilliance and beauty,

(3) A belief that they are so unique that they can only really be understood by, or should associate with, other special, high-status people,

(4) An insatiable need to be admired,

(5) An unreasonable sense of entitlement to favourable treatment or having others automatically do as they say,

(6) The tendency to take advantage of others,

(7) A lack of empathy,

(8) Envy of others or the belief that others envy them,

(9) Arrogant, haughty behaviours or attitudes.

Now, we all know a few eccentric people so, before you go off diagnosing all your friends (and maybe yourself) with a narcissistic personality disorder, bear in mind that personality disorders must be diagnosed by a suitably qualified clinician following a thorough clinical assessment.

Some researchers are of the view that there are really three varieties of narcissist – agentic, communal and vulnerable. The agentic narcissist is the archetype, if you like. Think of Tony Stark as Iron Man. That person who regards themselves as better than others. To feel good, they shamelessly put others down. Status is more important to them than intimacy. And they have an endless ability to promote themselves and engage in rivalry with others. They are generally less well-liked than they think they are.

Alamy Stock Photo Alamy Stock Photo

The communal narcissist is a little different. They offer their time and services to an excessive degree, often when you neither want nor need their help. It is not altruism per se that drives them, but rather a moral superiority and an insatiable need to be admired and praised for what they do. Think of the fictional preacher in so many clichéd movies.

Finally, the vulnerable narcissist has the most fragile ego of all. On the one hand, their chronically low self-esteem leaves them anxious, insecure and socially awkward. But, like all narcissists, they are also fundamentally self-centred and egotistic. They relentlessly try and fail to attract the attention they are convinced they automatically deserve, which makes them feel angry and appear hostile. An example might be the young Holden Caulfield in J.D. Salinger’s The Catcher in the Rye.

So, what causes all this? Is it seed or soil? Although there are a few studies here and there suggesting a role for genetics in the development of narcissistic personality disorder, most researchers are of the view that environmental upbringing plays a far larger role.

With agentic and communal narcissists, overindulgent parenting during childhood can lead to an exalted self-image that needs to be nurtured relentlessly by others during adulthood. Conversely, vulnerable narcissists are more often the product of excessive harsh criticism during childhood. It’s important to remember that narcissists are people too, who deserve kindness as much as anyone else. Some may benefit from professional help if they accept it. 

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How to manage life with a narcissist

But if they’re driving you up the wall, is there anything you can do about it? It can be particularly challenging where someone with a narcissistic personality disorder has legitimate power over you, as in the case of a parent over a child or a boss over an employee. 

Narcissus, detail from Echo and Narcissus, John William Waterhouse, 1903. Alamy Stock Photo Alamy Stock Photo

Here, the narcissist is able at a whim to deny you something you intrinsically need. But there are six things you might consider:

Ration direct confrontation: If you go in too strongly, the narcissist, who is usually sensitive to even the mildest criticism, may become angry. Tactfully emphasise common goals to achieve mutually beneficial change.

Don’t let the narcissist push your buttons: Learn skills for remaining calm – deep breathing, yoga, mindfulness. Focus on the essential goals of your interaction.

Enforce clear and consistent boundaries: Narcissists are great at maintaining their own boundaries but will give little thought to crossing yours. Be clear about what you will and won’t accept in your relationship, and politely stand up for yourself when boundaries are crossed. Do what you say you’ll do.

Set clear expectation: Narcissists can get carried away with fantasy promises that they never follow through. Politely insist on accountability. For example, meetings with a narcissistic boss should have an agenda. Keep minutes with explicit action points.

If all else fails, leave: Putting some distance between you and the narcissist will reduce their influence over you. This is not always easy, for example, with a narcissistic spouse or parent, or if you love your job despite fearing your boss. But your skills may be transferable. Evaluate the harm versus the good of remaining where you are.

Seek professional help if you need it: Narcissists can be quite subtle, and are experts at persuading you to alter your reality. Gaslighting abounds. This can affect your self-esteem and leave you prone to anxiety, depression and addiction. Identify when you need help. Realise you are not to blame.

Dr Stephen McWilliams is a consultant psychiatrist at St John of God Hospital, Stillorgan, Co Dublin, a Clinical Associate Professor at the School of Medicine, University College Dublin, and an Honorary Clinical Senior Lecturer at RCSI University of Medicine and Health Sciences. His book, Psychopath? Why We Are Charmed by the Anti-hero, is published by Mercier Press. @McWilliamsMD Useful Websites - www.psychologicalsociety.ie, www.stjohnofgodhospital.ie, www.aware.ie.