Health – “You probably think this song is about you”

I’ve heard a lot of people described as narcissists lately, from politicians to bosses to relatives. This usually means the person is selfish, insecure and lacks empathy. They tend to demand priority for their wants and react badly to correction. For a narcissist, it really is “all about them”. Sometimes this overlaps with the concept of a “crazy maker”, a person who disrupts everything by their erratic and demanding behaviour. 

Although amateur psychoanalysis has its appeal, we have to be careful with terms like narcissism, which has a strict definition in the DSM (see my last article). As recently as 2016, the American Psychiatric Association has warned its members against diagnosing public figures without examining them.

The following features point to the diagnosis:

• Inflated self-esteem or a grandiose sense of self-importance or superiority
• Craving admiration
• Exploitative relationships (i.e., manipulation)
• Little to no empathy
• Identity is easily disturbed (that is, can’t handle criticism)
• Lack of attachment and intimacy
• Feelings of depression or emptiness when not validated
• A sense of entitlement
• Can feel like others are envious of them, or may envy others

The paradox built into this syndrome is that the sense of superiority and excessive confidence may co-exist with and spring from a fragile ego easily damaged by criticism.

While self-confidence and no particular desire to please others can drive achievement (hence the preponderance among CEOs), the outcome is usually marred by poor relationships and emotional instability. As one psychologist has said, “narcissists are so addicted to feeling special that they lie, steal, cheat, and do whatever it takes in order to get their high”. Usually this doesn’t end well. 

An interesting side note is our current understanding of “empathy”. It actually has two aspects – the ability to imagine what someone else is thinking or feeling (cognitive empathy) and an appropriate emotional response to others’ thoughts and feelings (affective empathy). 

Narcissists can be quite good at the former, shrewdly discerning what motivates and influences other people, but are impaired in their effective response. That is why they can be charming and manipulative, playing mind games and so on, but not caring how this might hurt somebody else. Being married to one can be a nightmare. 

The effect of aging on narcissism is complex. Sometimes men, in particular, come to realise that their mindset is just not working for them and become more self-aware and humble. But ageing can also threaten an identity based on appearance and achievement, exacerbating narcissistic traits.

Treatment is difficult. A built-in resistance to accepting fault and exaggerated self-assessment are barriers to intervention. Sometimes the person has to hit “rock bottom” or be charmed into therapy because it focuses on what makes them tick (it is about them). Unfortunately, love from another person is not enough. If you are involved with a narcissist, it is essential to set strict boundaries and be willing to exit the relationship if it becomes abusive.