What do people mean when they say "narcissist"?

People say it quite often: "He is a narcissist," "She is a narcissist." The statement is often made, but rarely well-defined or understood. People tend to say it about the difficult people they deal with in their lives.

When people use the word, they usually mean someone who is self-centered to the point of ignoring everyone around them. They think of someone who is emotionally unavailable and hungry for admiration. That same person is fragile the moment they don't get that worship. It is less a diagnosis and more of a warning label people reach for when a relationship feels toxic or exhausting.

Does that sound like you? Are you looking for an explanation of why you are so drained, both physically and emotionally? Do you wonder why you feel like you can't do anything right?

Maybe you are wondering, am I the narcissist or is he? A true narcissist will only see the wrong in other people. When you see your mistakes, then you are on the right track to finding answers. You probably are not a narcissist, but you may be dealing with one.

You see it when your loved one oddly excludes their family from an event because their spouse doesn't want them there. You see it with the cruelty of making fun of a child whose costume doesn't quite fit the narcissist's idea of normal. I remember a preadolescent boy in a unicorn outfit. It looked like a Fortnite skin. The boy was expressing his gaming creativity in a costume. The narcissist accused him of looking like a girl. Paying close attention, you can see the insecurity in the narcissist's micro-expressions. The boy was fine and enjoying his imaginative play. Maybe the narcissist was a little jealous because he was too insecure to be creative and play.

When I hear the term narcissist in my Maryville, Tennessee office, the person using it is typically emotionally exhausted from trying to make an impossible relationship work. They have spent years trying to figure out a way to make their "narcissist" happy. Frequently, a spouse is distressed. The children have been manipulated to believe one parent is inferior or broken. That parent feels hopeless about ever having a healthy relationship with the children.

You are at your wits' end, and you feel like you are going "crazy," are "losing your mind," or "just plain nuts." You can't stand to see anyone else hurt and would do almost anything to stop their pain. Yet here you are, and no one is looking out for you, not even you. You know something has to change; you just don't know what. What you do know is that you need some peace. Maybe you have been dealing with a narcissist.

I think of narcissism as a spectrum. On one end are people who appear completely selfless. On the other is the malignant narcissist who meets the diagnostic criteria for Narcissistic Personality Disorder. Maybe that sentence resonates with you, and you immediately think some version of "I am on the selfless end of the spectrum." You probably don't want to hear that the selfless end of that spectrum is just as unhealthy as the selfish end. Many believe they are selfless. In truth, they are selfish, and the effort is more about ending their own pain than the pain of the one they love. I cover this in another post, "The Narcissist's Opposite."

The true narcissist exploits your effort, and many people end up feeling crushed or destroyed. A narcissist will say or do things that cause you pain and then will enjoy watching you hurt. She will split the housework to her definition of evenly and leave you exhausted because you never do your part the right way. Hers, well, it just never gets done.

What does the diagnosis actually say?

Narcissistic Personality Disorder has a very clear definition, and many professionals break these defining criteria down into subtypes, such as covert and malignant. The diagnosis itself is rarely given, but the condition is more common than most people assume. Estimates vary, but as many as 6.2% of adults may meet criteria for the diagnosis at some point in their lives (Stinson et al., 2008). The criteria are:

DSM-5 diagnostic criteria for Narcissistic Personality Disorder (NPD): a pervasive pattern of grandiosity, need for admiration, and lack of empathy, beginning by early adulthood, shown by five or more of the following:

  1. A grandiose sense of self-importance: exaggerates achievements and talents, expects to be recognized as superior without the accomplishments to match.
  2. Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
  3. A belief that he or she is "special" and unique, and can only be understood by, or should associate with, other special or high-status people.
  4. A need for excessive admiration.
  5. A sense of entitlement: unreasonable expectations of favorable treatment or automatic compliance with his or her wishes.
  6. Interpersonally exploitative: takes advantage of others to reach his or her own ends.
  7. A lack of empathy: unwilling to recognize or identify with the feelings and needs of others.
  8. Often envious of others, or believes others are envious of him or her.
  9. Arrogant, haughty behaviors or attitudes.

Diagnosis also requires that the pattern be stable over time, cause clinically significant distress or impairment in social, occupational, or other important areas of functioning, and is not better explained by another mental disorder, substance use, or medical condition.

The above criteria may describe someone you know, maybe even someone with whom you are close. Trying to satisfy someone with those beliefs may have something to do with why you feel like life is impossible. You may be ready to make some changes. Maybe you are ready for changes that will protect you from someone so committed to exploiting you. You can make them, and I can help you. You don't have to feel as if you are the "crazy" one.

One more note for clarification. Narcissistic relationships do not have to be romantic relationships. Sometimes, you might notice your friend who demands more than you have to offer. The person who accuses you of being jealous, but in reality is jealous themselves. Narcissistic parents may exploit their own children or any other family member. They don't discriminate. They are predators looking for their next challenge. They want a worthy opponent. Think of the hunter who hunts the most dangerous animals in the world, never satisfied until he has taken that lion.

Maybe you can relate to what I am saying. Maybe you can feel yourself trapped in the entangled web of lies, deceit, manipulation, and unbalanced give-and-take in a relationship. There is hope. You can find healing.

If this is you, read the companion piece: The Narcissist's Opposite: Why Your Empathy Is the Hook.

I am Vickie, a Licensed Marriage and Family Therapist in Maryville, TN, and I help people find their footing again after someone has worn them down.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

Stinson, F. S., Dawson, D. A., Goldstein, R. B., Chou, S. P., Huang, B., Smith, S. M., ... Grant, B. F. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 69(7), 1033-1045. https://doi.org/10.4088/jcp.v69n0701

Disclaimer

The information in this article is for educational and informational purposes only. It does not constitute medical, psychological, or legal advice, and it is not a substitute for professional assessment, diagnosis, or treatment. If you are in crisis or need immediate help, call 988 (Suicide & Crisis Lifeline, call or text) or 911, or go to your nearest emergency department. If you are experiencing domestic violence, the National Domestic Violence Hotline is 1-800-799-7233 (text START to 88788). For ongoing mental-health concerns, please consult a qualified therapist, psychologist, psychiatrist, or other licensed mental-health professional.

About the Author

I am Vickie, a Licensed Marriage and Family Therapist in Maryville, TN (TN License #579). I hold a BA in Sociology and Psychology from Carson-Newman University (1989) and a Master of Divinity in Psychology and Counseling from New Orleans Baptist Theological Seminary (1995). I have been a licensed Marriage and Family Therapist in Tennessee since 2005 and a Certified Master ART Practitioner since 2022. Verify my license: https://www.tn.gov/health/health-program-areas/health-professional-boards/pcmft-board.html