Though the term “narcissist” is often used as shorthand for your standard preening, primping, vanity monster — reality stars, Instagram influencers, certain politicians — the actual diagnosis, as it stands in the world of clinical psychology, is considerably more layered, and not uncontroversial. While the DSM IV defined narcissists as necessarily “lacking empathy,” the DSM V softened their terminology, writing only that many narcissists’ empathy is “impaired.” When we use the term colloquially, we might mean only that someone is self-absorbed, or we might mean that they are arrogant — both traits a pathological narcissist might have, but also might not.
In his 2015 book, Rethinking Narcissism: The Bad — and Surprising Good — About Feeling Special, clinical psychologist and Harvard Medical School lecturer Craig Malkin aimed, in part, to resolve some of that mixed messaging. First, he argues, narcissism is something we all have. The core of all narcissism, says Malkin, is “a pervasive, universal human tendency: the drive to feel special, exceptional, unique.” Research tells us that most people (even the really, truly average ones, which is, of course, most of us) think of ourselves as special. Untrue as it may be, this little bit of superiority is a good thing, says Malkin: It makes us dream bigger, work harder, and maybe even live longer. This, says Malkin, is healthy narcissism.
Unhealthy narcissism, meanwhile, refers to a need to feel special, says Malkin. People with narcissistic personality disorder, or NPD, are “ so addicted to feeling special that they lie, steal, cheat, and do whatever it takes in order to get their high,” says Malkin.
But the form in which narcissism can present itself also varies, says Malkin. While most people are familiar with what Malkin calls the “extroverted narcissist” — the braggadocious chest-thumpers — there are also introverted narcissists, whose sense of specialness may derive more from a sense of victimhood than superiority. “These are people who … might feel special because of their emotional pain,” says Malkin. “They agree with statements like ‘I feel I’m temperamentally different from most people,’ or ‘I have problems that nobody else seems to understand.’” (Malkin says this form comes up a lot in teenagers.) Because these narcissists aren’t so showy, or grandiose, they often fly under the radar.
Like psychopathy, narcissism exists on a spectrum, and is not in itself an aberrant trait. Many people with above-average narcissism will live their lives undiagnosed, and successfully, says Malkin, as many cultures reward the kind of demanding, entitled, exploitative behaviors associated with a narcissistic personality. Those who do receive an official diagnosis often do so as a result of a broader psychological evaluation, says Malkin and treatment may involve talk therapy, CBT, DBT, and medications aimed at particular correlative symptoms, like depression.
I spoke to one such person, a 46-year-old man who was diagnosed with narcissistic personality disorder in his mid-30s and was treated for years afterward. [I’ll note here that while his English is pretty much perfect, it is his second language; he is Dutch, and lives in the Netherlands.] That conversation, which has been edited for length, is below.
How did you come to be diagnosed with narcissistic personality disorder?
I lost my job at the end of 2009, and I got depressed over that, very deeply. I was treated, and about a year and a half [later], I was considered cured. Three months later, I was back at the doctor’s because I was depressed again, to a level of suicide. He referred me to a different, older, experienced psychologist, who said “I cannot help you” within 20 minutes of talking. He said, “What you need is much more extensive therapy than I can offer you, because your depression came back so hard that there is probably some underlying cause.” He said he’d refer me, and would advise [the new clinician] to do a personality test first, because he expected there to be some personality issue that caused recurring depression.
They did the personality test, and by process of elimination, it was concluded that it was narcissistic personality disorder. So from that moment on, I started treatment, because I didn’t want to have that. Of course, at that time, I didn’t know that there is no such thing as “I don’t want to have that,” because when you have it, you have it. I just had to learn to live with it. I was in therapy ever since. It lasted six and a half years, and I stopped last year, in 2017.
Did you have any suspicion that you might have NPD, or was it a total surprise?
None, no. Until that day I didn’t even know what it was.
So you kind of learned about people’s perceptions about it at the same time you were learning what it actually meant for you.
Since I’ve been diagnosed with it, I’ve done everything I can to get familiar with the concept of narcissism and narcissistic personality disorder. I became somewhat of a specialist myself, and that makes you very aware of how a lot of people look at it. It hurts to see how other people look at it. In my opinion, a lot of people confuse NPD with psychopathy. There is so much written about malignant narcissism, which, as far as I’m concerned, is pretty much the equivalent of psychopathy. There is a lot of harm done by people whose primary behavior looks like narcissism. But narcissism [primarily affects our] decision-making processes.
I’ll give you an example: Two guys standing at a crossroads, and two old ladies wanting to cross the street. Both guys help a lady out, flirting a little. Old ladies like it when young men help them cross the street and have a laugh. But ask which of the two men is the narcissist, and people cannot answer that, because they have too little information. One of them is a narcissist, and the other is like a Boy Scout. If you explain the internal reasoning of the men — one does it because he’s a Boy Scout, and the other because, across the street, there is a woman he wants to impress, then we understand what narcissism actually is. People judge narcissists’ actions, and they have no clue whether it’s narcissism or not. That’s the part that hurts. Narcissists get blamed for a lot of stuff that’s not even narcissism at all. That’s what personally annoys me. I’m not [excusing] the actions of narcissists, of people with malignant narcissistic tendencies, but a lot of narcissists are looked at in such a way that it makes me reluctant to be honest about the fact that I am diagnosed with NPD.
Do you feel that having NPD affects your daily life?
It still affects my decision-making. Its slows down my decision-making, because I am aware that I’m a narcissist, and I have to second-guess all my decisions. It will be that way until the end of time, which, I think for me personally, is a good thing. If you’re not aware of the fact that you’re narcissistic, you can make wrong decisions. People that are in management or leadership positions can make wrong decisions based on their narcissistic tendencies, and not be aware of it. So for me, it’s a good thing. The fact that I did a lot of research on narcissism provides me with a side job that I make money from. I can help people that have problems related to NPD, or people being victimized by someone with NPD, and help them deal with it.
Do you mean online counseling, or how does that work?
Yes, mostly online counseling. Sometimes real-life counseling, but usually online, because here in Holland, narcissism isn’t really a big problem. Mostly in the United States and Australia, sometimes England, Canada, New Zealand. China, India. They’re all where my clients come from.
What do you talk about?
There are three types of clients. There are those that are actually looking for counseling — I have problems, I need help dealing with those problems. There are also those that think they have been victimized by a narcissist, and after two or three sessions, it turns out that they are the narcissistic personality of the relationship, which surprised me at first, but it tends to be more common than you think. There are those that just want to have the power to deal with it themselves. But as soon as you explain to them why they are so confused, and what happened in their relationship, they understand. It’s a pattern that repeats itself in every relationship between someone who is narcissistic and someone who is not. And then they understand, and they can move on by themselves.
Do you ever refer them to an actual doctor? Obviously, you’re experienced in this field, but you don’t have a degree, right?
Yes. I am getting a psychology degree at this time, but that would still not make me a doctor. So I can never prescribe medicines, but some people I refer to a doctor or a professional psychologist, because some things you can’t do online. You can assess certain things — you can help people, you can give them mindful practices, and you can help them with their thinking patterns, but some people really need regular help with [professional] exercises.
Did you decide to pursue a psychology degree because of your diagnosis?
I have always been interested in how the human mind works, even when I was studying communication. So that was always a part. But when I needed the help myself, it became clear to me that that was something I wanted to do.
I’ve been helped really well, I have to say. Mental health care in Holland is pretty good. A lot of people complain about it, but I cannot share those complaints. I was helped really well. I owe them a lot. I don’t think I would have been talking to you if I did not get the help that I got. I want to give that back, at some point.
What did your treatment entail?
You name it, I’ve had it. CBT, DBT, schema therapy, which is where you focus on the thinking schematics you have. (The patterns that you think along are called schemas.) That was really helpful, because you focus on certain schemas you have difficulty with. They all have names, and mine was “obsessive protector,” because that’s what narcissism is about. It’s about protection. Whenever that schema kicks in, I have to recognize it, learn to find a way around it, and find another schema to compensate for it, or work along with it. It was hard.
And you finished last year?
Yeah. Early last year, I think in February or March. I was called in and they said, “We’re thinking about letting you go.” I said “Why? I’m having fun.” It was a nice group, it was comfortable, everybody was sharing. It was really working for everyone. The therapists said, “Yeah, we can see that you’re having fun, but you’re doing so well.” I was like, oops. I had been in therapy so long I was afraid to stop. They had been holding my hand, so to speak. I didn’t know if I could do it on my own. I was divorced in the meantime, and partially raising my son. I’ve been living on my own, and I wasn’t sure if I wanted to go. I had this impression that they were just going to shut me out and leave me on my own. It was really scary. But they offered me some kind of support that I would build off — at first I’d come in every week for a one-on-one session with one of the therapists, and then every two weeks, and then every four weeks, so I was slowly let go. I was okay with that. I wanted to try, and it went well. I’m still off the leash, so to speak.
Do you see them at all now, or is it sort of that they’re there if you really need them?
Yes. I only have an emergency number. And I’m still on my antidepressants. I have been on those since I got them. They’ve been adapted a couple of times, but I’m not ready to do without them.
Do you feel that NPD played a role in your divorce at all? Or in your personal relationships more broadly?
That’s so hard to say. I met my ex-wife while I had NPD, but when I was not conscious of it. So it’s really kind of a meta question. Would I have ever been with her if I would’ve been conscious of it? Would she have fallen for me if I would’ve been conscious of my NPD? I don’t know. Maybe we wouldn’t have fallen in love at all. I find that very hard to answer.
Having NPD, looking back — I think you say 20/20 hindsight in America — has definitely made maintaining relationships, not just with girlfriends but also with friends and others, difficult, yes. That’s absolutely true.
How does that show up, or what do those challenges look like?
I recall some situations when I have said things without thinking — things I should not have said to people that are close to me, or even to strangers, that may not have been so smart.
Do you recall any particular examples?
At some point I was part of a Taekwondo club where I was also teaching. There was a guy I had only seen once, and I fought him in a match. I talked to him like he was my best friend, which was totally inappropriate, because I’d only see him once. But we were the hosting club, so I was acting like everything’s good, and he actually seemed to be some hot-shot in his club, which I didn’t know. And my teacher later said it was completely inappropriate, what I said to him. I shouldn’t even have talked to him as far as he was concerned. So those kinds of things, just crossing boundaries. You don’t even feel that they exist. If I would have watched other people better, how they treated him, I could have known. But I was totally unaware. I acted like the whole place was mine.
Is that something you feel you learn from when it happens, or is it sort of a repetitive challenge?
I prefer not to be in the center of attention at all. I don’t like that.
Do you mean you avoid it to prevent those traits from surfacing?
I have learned that it makes me more comfortable not being in that position, because I don’t have to behave that way. So it actually makes me feel more like myself not to be there. I’ve learned that by feeling. Until I started therapy, I never knew what I felt. I know I was angry, and I know I was sad. All other feelings were completely strange. So this awareness of what I felt helped me to find my position, and to know more of who I am. I think that is the essence of narcissists, is that they don’t know who they are. That’s why you develop a second self, because the first self is completely unknown to you. Knowing yourself in a truer sense gives you less need for that second self.
What did your second self look like?
“All is good, I don’t care, everything’s fine, everything’s possible. I don’t care, and I can do it.”
So would you say you were arrogant, or just sort of indifferent?
That’s the thing. I have rarely gotten the comment that I was arrogant, because I actually can do a lot. I’m pretty intelligent and I’m pretty handy. So I usually could live up to expectations that way. But inside, I was always doubting myself. That’s still true. I’m still doubting myself right now. I didn’t forget all the things I learned that I can do, but I’m a lot less secure than I was then, when I could just put on the mask and I would just go for it. I would get into a [job interview] and I would put on an air like, “Why the fuck are we having this conversation? Where do I sign?” And now I would go into a [job interview] and I wouldn’t even know what to say. I truly don’t know, because I’ve been looking for jobs now for almost ten years. And it’s just not working. My age does not help, of course, and in spite of my qualifications, it’s very hard to find a job.
How old are you?
What types of jobs do you go out for?
I’ve tried to get back into sales, because that was my previous job, as a sales manager. I’ve also tried to work as a team leader at a call center, because I’ve done that. I’ve tried to get in IT-related business, because I can do that, too. It’s practically impossible.
Can you tell me a little bit about the concept of “supply”?
Narcissism is a defense mechanism. A narcissist lives, has a job, school, and reacts to stuff that happens around them. They will think they fall in love, because they see someone, and they get the hots for this person. A non-narcissist will say that is their “supply” [someone they treat as a sponge or source of attention/resources], but the narcissistic person doesn’t think that way, because they genuinely feel that they are in love. They feel the same, they think the same, they do the same, because they see this person as an addition to their lives, just as you would think, if you fall in love, that this man or woman is an addition to your life.
The only difference is, the narcissistic brain sees the world outside as something they have created. The world outside for a narcissist looks different, because they see this world as they have created it. There are imperfections they do not want to see, so their brain prevents them from seeing them. This person that they fall in love with also has imperfections that they do not want to see, because they need this person to fit into their world. It’s a puzzle piece that exactly fits into that spot where they need it to fit. However, the object of [a non-narcissist’s] affection is able to be flexible, evolve, change with a changing world: You say you want to go out for dinner and have Italian, they say they want Mexican. You cannot come together so you decide to go out for Chinese. In a narcissist’s world, he wants to have pizza, she says she wants Chinese, and he’s confused. How can that perfect puzzle piece not want the same thing he wants? This thing needs to fit exactly where he wants it, where he needs it. That’s where a non-narcissist might say the devaluation phase starts — when it’s cracking, it’s not fitting anymore, and they eventually get discarded. But we narcissists, we don’t think that way. We think it’s confusing. And eventually, it gets all too confusing. And the relationship just doesn’t work.
Now, a malignant narcissist, they will find someone, use that person, and then just get rid of them, because they act proactively. Narcissists act defensively. That’s a big difference. In the way the malignant narcissist would use someone, I think it’s correct to use the word supply.
What do you think people get wrong about NPD?
People get almost everything wrong about narcissism because they confuse it with psychopathy. They attribute a lot of behavior to narcissism due to bad journalism and what I call parroting — one website repeats what another website says, and people get wrongly informed because of it. A lot of information on narcissism on the internet comes from victims of psychopaths, or malignant narcissists, who say ‘This is what they did to me, this is narcissism.” No, it’s not. Real, pure NPD is nothing like that. It’s not violent. It’s not abusive in a deliberate way. Narcissists abuse people, everybody abuses people. Everybody manipulates people. There is no intention to harm people when the behavior itself is narcissistically motivated, because it’s a defense mechanism. If a narcissist hurts you, you hurt him first. I think that’s the most important thing people should know. If they’re fucking with someone who is mentally ill, they should expect to be fucked with back. Because if they’re fucking with someone who is not mentally ill, they expect the same. The difference is that the person who is mentally ill usually does not know what they’re doing to you, especially in the case of someone who is delusional. And narcissists are delusional by default.
Who among your family and friends know about your diagnosis?
All my family — my mother, my brother, my sister, they all know. My father died. Four of my close friends also know. People that aren’t close to me, I don’t call them friends, I call them acquaintances. I’m very picky with the word “friends.” They all know.
I don’t know how old your son is, but does he know?
He’s 9, and he does not know the ins and outs. He knows I have an illness, but not the ins and outs.
What’s your relationship with him like?
Good. We’re like four hands on one belly.
We have this saying here that’s translated as “four hands on one belly,” which means we’re pretty close.
Do you have a relationship with his mom at all?
As little as possible.
Do you think the people who’ve been in relationships with you view those relationships differently than you did? Do you think they’d describe you differently?
Oh, yeah. Well, I can tell you for sure that my son’s mother has a very different view of me than you might now have, and I can tell that by the things [my son] tells me. She lived through my depression, my worst moments. [The first woman I lived with], I think she would think I’m an asshole, and that one I can’t blame. That was in my late 20s, and I can say that I was as inconsiderate of her as she was of me. I did not intend it to be, but in the end I can say it was not much more than an experiment.
Have you been in relationships since your ex-wife?
Yeah, I have a relationship right now. She just brought me coffee.
How do you talk about her diagnosis with her, if at all?
We are a strange bunch. We talk about our diagnoses very openly.
She has one as well?
Oh, yeah. They have one as well. My current partner is diagnosed with dissociative identity disorder.
Oh, is that why you say “they” ?
Yes. She has 21 personalities at this time.
How do you keep track of them all?
I don’t know, I just do.
So is it like you have relationships with 20 people, actually?
Twenty people and a rabbit.
And a rabbit?!
There are four main personalities, and the rest you practically never see.
How long have you been together?
We met online on a psychiatry forum. She lived in Colorado before, and she’s now staying for three months here before she moves to the Philippines, but we’ve been together for three years.
How do you feel today about your diagnosis?
I’m glad I have it. Even if in five years time, it may [not fit], I’m still glad I have it, because I’ve learned a lot from it. I’ve learned a lot about myself. I’m glad I got that diagnosis.