Narcissism and narcissistic personality disorder seem to be quite latent personality presentations—they are not commonly presented in therapy as the core presenting problem that a client will present when they come in for treatment. Often times, hence, narcissistic personality disorder is undiagnosed, which goes even more so for narcissism in general.
Is any narcissism also a narcissistic personality disorder?
Unfortunately, not any narcissism and not any narcissist can be diagnosed with narcissistic personality disorder. I am saying unfortunately not because it would be good if that were the case, but because a lot of narcissistic pathology is missed because not all diagnostic criteria for the disorder are met.
Narcissistic personality disorder will only be diagnosed if a person presenting with narcissism meets all diagnostic criteria according to Diagnostic and Statistical Manual of Mental Disorders (DSM). If they don’t, we are likely still facing narcissism, but rather in the manner of narcissistic personality structure or narcissistic personality traits.
Diagnosed disorder is, therefore, at the far end of the spectrum of narcissism. A large proportion of people that present with narcissism may never meet the criteria for the disorder and hence not get diagnosed at all. However, this does not mean that the narcissism they present is not pathological, damaging and that it will not have an impact on their lives at some point.
Narcissism and therapy
But there is another reason for underdiagnoses of narcissism in general. As personality structure, a narcissist will not consider themselves as having any kind of a problem—narcissism will not affect them in the way that it would, according to their opinion, decrease the quality of their life. Hence, a narcissist will not seek psychotherapy for their condition.
Quite contrary, what we will usually see is that partners of narcissists will seek psychotherapy or counselling—either because they think they are the ones doing something wrong in their relationship or because their narcissistic partner forced them to seek help.
Development of narcissism and narcissistic personality disorder
Development of narcissism and narcissistic personality disorder usually traces back to early childhood—into the first few months of life. However, it seems that this does not mean that the narcissistic traits will stop developing in the later stages of childhood.
Narcissism will develop as a false self defence against traumatic experience of relationship loss in early childhood. It is a child’s response to either the lack of relationship or abusive relationship. When we talk about abusive relationship, it doesn’t have to be regarded as abusive by the parent, however, the child can still interpret it as such.
A child that is deprived of a relationship in early childhood will learn to take care of themselves. They will seek acknowledgement and emotional nourishment within themselves. They will develop their false self that will serve the purpose of self-acknowledgement. This will often be the case when the mother is overwhelmed and preoccupied with her own emotional and psychological needs and leaves the child hanging dry in terms of emotional soothing. The child’s real self will be locked in loneliness, whereas the false self that will be put up as a second skin will serve the purpose of self-soothing and self-recognition.
(Read more about the development of narcissism here: Development of Narcissism or Bringing Up a Narcissist)
This developmental process that creates the narcissistic pathology is emphasised, supported and enhanced by today’s cosmopolitan societal values. Parents will, on one hand, raise children to satisfy their own grandiose needs that haven’t been met when they were growing up and, on the other hand, due to lack of physical unavailability, also become emotionally distant from the child. All this will often be topped up by mother’s need to have a special and unique child, which will also result in her acknowledgement of omnipotent traits that the child will be showing and disregarding the child’s normalcy. Narcissist will, therefore, learn to associate their worth as a person with their omnipotent and overblown presentation because they were ignored and unseen as children when they were not meeting their parents’ overindulgence and over-involvement with themselves.
(Read more about the societal impact on narcissism: Narcissism in Narcissistic Society)
Narcissism and relationships
A narcissist will, hence, not be able to engage in intimate and emotional relationships with other people. Their predominant focus will be in satisfying their own emotional needs. Relationships with others will not be based on empathy but will rather be conditional in the way that they will only serve the need of acknowledgement of their false self.
(Read more about narcissism and relationships: Relationship with a Narcissist: Are You in One?)
Their primary wound will usually stem from early shame, which they cover up by their false self. This shame is defended against and covered with anger, rage and righteousness. Once the primal would becomes exposed, narcissist will resort to anger and persecution of others. This is often the case when a narcissist is faced with criticism. Because they regard what they do with who they are, they will be extremely sensitive to any criticism. Criticism will expose their shame and they will resort to overreacting with anger or even rage to escape the feelings of shame.
There will be a strong tendency to equate worth and validity of a person with others’ perception of them. As long as they maintain to keep up with their omnipotent and grandiose false self, they will not report any difficulties in life. It is only once needs of their false self are not met, that they will sink into depression or anxiety—sometimes accompanied by panic attacks and self-harm. It is often times only then when narcissistic personality disorder unveils itself fully and becomes diagnosed in therapy.