Dear Therapist:

I find the letters and responses to the Couch very informative. Would it be possible for the panelists to share advice on how to detect narcissistic behaviors? I had an awful experience with a narcissistic individual and tried so hard to make it work. However, if I would have been aware of the classic signs of narcissists, I would have realized early on that it would not work. Narcissists are very charismatic people that are very similar to each other. What would be some pointers that would distinguish them and for awareness to prevent future harm? 



As with all personality traits, narcissism exists on a spectrum. And as with most personality disorders (and in fact many other disorders), many people have some symptoms of narcissistic personality disorder.

In order to be officially diagnosed with NPD, a number of symptoms must be present. As with all disorders, diagnosis must be made by a professional with proper training. Without the proper context (achieved through training and experience), it can be easy to under- or over-diagnose. Therefore, any symptoms discussed in this forum are simply educational.

Let’s begin with what is likely the underlying cause of narcissism. Narcissists typically have very low self-esteem. This may seem to fly in the face of reason; after all, narcissists tend to exaggerate their importance—both in their own minds and in their interpersonal relationships. They often feel superior to others, are arrogant, and have a sense of entitlement. At first glance, these all seem to point to rather high self-esteem.

There are two factors that can help us distinguish actions based on good self-esteem from those based on poor self-esteem. The first relates to the need for the actions. Someone who does not need to highlight their own importance—but simply feels positively about themselves—may have good self-esteem. When someone, however, needs to accentuate their sense of importance, this is generally due to a poor underlying sense of self.

Another difference between a normal sense of importance and a narcissistic one is its basis in reality. Narcissists tend to highly exaggerate their importance. They often require constant external validation, and fantasize about what they perceive as perfection in many areas. They tend to consider themselves as superior to other, and are quick to label others as inferior. This is often due to their low self-esteem, and a pathological need to boost it artificially. When someone’s projection of their importance is very different from the reality of their importance, the reason for this is usually based on an emotional need.

Narcissists’ sense of importance, superiority, perfectionism, and exaggeration of talents and achievements can be viewed as annoying but as essentially their problem. However, because of these needs (and their low underlying self-esteem) narcissists often treat others poorly. They can belittle others, have trouble allowing others their opinions, and are often envious of others. They usually are not very empathetic, thinking only of themselves. This can make it easier for them to take advantage of others and to expect others’ lives to revolve around theirs.

Narcissists are often easily insulted and can anger easily—especially when their superiority is challenged—and therefore have trouble relating to others. Basically, narcissists are typically highly insecure. This leads to an overwhelming need for a defense mechanism to “help” them feel more secure. Unfortunately, their defense mechanism leads to further problems for the people in their lives…and for themselves.

Unfortunately, narcissists’ defense mechanisms are usually too strong for them to acknowledge the underlying problem. When they are seen in therapy, it is generally for ancillary issues, like depression, general anxiety or more specific anxieties, relationship issues, or trouble adapting to change. Even when a therapist is able to identify the narcissistic tendencies, it can be very difficult to treat them. Hopefully, this information will help some people to recognize their issues, and to begin changing their lives for the better.

-Yehuda Lieberman, LCSW

 psychotherapist in private practice

 Brooklyn, NY

 author of Self-Esteem: A Primer / 718-258-5317