What it’s like to be a diagnosed narcissist

“People get almost everything wrong about narcissism because they confuse it with psychopathy.”

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.

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