In recent years, the concept of narcissism has become increasingly well known. It’s not unusual to hear characters in popular culture such as movies, novels, and TV shows described as narcissists.
While narcissism is actually a normal personality trait, for some people it can become exaggerated which then can become destructive. For others, it is extreme enough to warrant a mental health diagnosis. This is known as Narcissistic Personality Disorder (NPD).
NPD is much more rare than you might think. Research tells us that NPD is diagnosed in between 2% and 16% of the population in clinical settings, which translates as between 0.5-1% of the general population.
What is narcissism and where did the term originate?
An easy way to understand narcissism is as extreme selfishness.
The term originated from an ancient Roman poem by Ovid about Narcissus and Echo.
In Ovid’s myth, Narcissus is a handsome young man who spurns the advances of many potential lovers, including the nymph Echo, named this way because she was cursed to only echo the sounds that others made. After Narcissus rejects Echo, the gods punish him by making him fall in love with his own reflection in a pool. Finding that the object of his love cannot love him back, he pines away and dies.
However, the term as used in psychology is more recent. It has its origins in the late 1800s, but came to prominence in the early 1900s.
In 1913, neurologist and psychoanalyst Ernest Jones described extreme narcissism as a character flaw or “god complex,” suggesting narcissists were aloof, self-important, overconfident, auto-erotic, inaccessible, self-admiring, and exhibitionistic, with fantasies of omnipotence and omniscience. He also observed that narcissists have a high need for uniqueness.
The following year, Freud wrote about narcissism as a necessary part of development that eventually becomes the way in which we love other people. However, for some people this developmental stage is interrupted, meaning that the love and affection meant for other people is turned inwards.
The way we understand narcissism today can be traced back to the work of Robert Waelder in 1925, who described narcissists as “individuals who are condescending, feel superior to others, are preoccupied with admiration, and exhibit a lack of empathy”.
What causes narcissism?
The exact cause of narcissism has not been determined and remains the subject of ongoing research, which suggests it is likely to be caused by a combination of factors. These include:
Childhood abuse and trauma
Upbringing and relationships with caregivers
Personality and temperament
However, different psychological perspectives have their own explanations. For example, in psychoanalysis, narcissism is believed to be a defense mechanism that compensates for underlying feelings of inferiority. Alternatively, social learning perspectives suggest that narcissism consists of genuine underlying beliefs of superiority.
Is narcissism always bad?
No. Narcissism as a personality trait exists along a spectrum, with healthy self esteem, self worth and confidence at one end and pathological (meaning it can be classified as an illness) narcissism at the other.
This means that most people are likely to have narcissistic aspects to their personality, as this is the part of us that we take into a job interview or the part that reassures us that we are worthy.
Some researchers distinguish between these two types of narcissism by terming them as adaptive and maladaptive narcissism.
Adaptive narcissism (also known as productive narcissism) presents with character traits such as authority and self-sufficiency.
Maladaptive narcissism (also known as unproductive narcissism) presents with character traits such as exploitativeness, entitlement, and exhibitionism.
How narcissism affects different types of relationships
Narcissism in all its forms is characterized by a fragile sense of self, and a desire for admiration and importance. The way narcissists derive what they need is through interactions with other people.
Anyone who has found themselves in a relationship of any sort with a narcissist will know that it can be confusing, destructive, and distressing, leaving you reeling.
For the purposes of this article, we will be looking at how narcissism affects the following four types of relationships.
Friendships: Defined as voluntary social relationships that are founded on equality, offer social support, and can be maintained in person or long-distance.
Romantic relationships: From dating to long term relationships, this type of connection tends to involve love between the two people in the relationship.
Family relationships: Including immediate family members such as parents, children and siblings who may have shared a home together, as well as more distant family relationships such as grandparents/children, cousins, aunts, and uncles.
Working relationships: Including colleagues, students, teachers, managers, and anyone else encountered in a non-voluntary, non-familial capacity.
A note on narcissistic families
Narcissistic families (in which one or both parents are narcissistic due to any of the five types of narcissism) are a particularly difficult environment to grow up in, because the needs of the narcissistic parent(s) take precedence over the needs of the children. Not only are the needs of the child secondary to those of the parent(s), but they react to their child’s needs as if they are seriously problematic.
Likewise, the children are expected to prioritize the needs of the parent(s) over anything else, and are taught to fulfill these needs. Any problems experienced by the child are filtered through the lens of the parent(s) and how these problems impact them, rather than exploring what the child might need in a supportive way.
Thinking back to the ancient Roman myth of Narcissus and Echo, within a narcissistic family, the children take the place of Echo, existing only to react and reflect their parent’s needs.
What are the difficulties in making generalizations about narcissists and their relationships?
One of the issues around making universal claims about how narcissism affects relationships is that different research can seem to contradict each other. For example, one classification of personality disorders describes the overt narcissist as one who passively seeks the positive rewards of approval and praise from others, but cares little about the opinions of others.
Some studies have established that narcissists seem to have a very strong need for approval, yet research findings attempting to establish a consistent pattern of narcissists’ “person perception” have been unsuccessful. While one study found narcissists to be conceited and condescending towards others, another piece of research suggests that narcissists exaggerate their own abilities and performance, but engage in little derogation of others. Other research has failed to establish a consistent pattern of response to others for a narcissistic sample.
Despite this, it is possible to highlight some of the ways in which the different types of narcissism may affect relationships. Many romantic partners of narcissists, as well as their parents, children, family members, co-workers, and friends are thought to be directly affected by narcissism of all types.
The research does tell us that Narcissistic Personality Disorder (NPD) is more prevalent in males than females. The statistics suggest that about 18% of males present with NPD, compared to 6% of females in clinical samples, whereas the overall prevalence in the general population is lower but still at greater rates in men (7.7% versus 4.8% for women).
Dr. Jantz helps define narcissism, and what you can do if you are in a relationship with a narcissist. This podcast helps you understand the victimization that can take place and provides actions and techniques you can incorporate to begin healing.
The American Psychiatric Association outlines the criteria that need to be met for a diagnosis of Narcissistic Personality Disorder (NPD) in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).
While there are a variety of subtypes used for classification of NPD, there is a lack of consensus on how many subtypes exist. For the purposes of this article, we will explore five:
1. Overt narcissism
Overt narcissism is a term used to describe the typical presentation of narcissism that you might recognize from its portrayal in popular culture. It’s also closest to the clinical diagnosis of NPD in the DSM-V.
To be diagnosed with NPD, patients need to meet five of the following nine criteria:
A grandiose sense of self-importance
Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
Believing that they are “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
Requiring excessive admiration
A sense of entitlement (unreasonable expectations of especially favorable treatment or automatic compliance with their expectations)
Being interpersonally exploitative (taking advantage of others to achieve their own ends)
Lacking empathy (unwilling to recognize or identify with the feelings and needs of others)
Often being envious of others or believing that others are envious of them
Showing arrogant, haughty behaviors or attitudes
According to a 2013 study, the three key characteristics of NPD are grandiosity, seeking excessive admiration and a lack of empathy. Let’s look at these in a little more detail.
Grandiosity refers to a range of narcissistic behaviors designed to exaggerate skills, accomplishments, and relationships with ‘important’ people. With this sense of superiority, narcissists may monopolize conversations, becoming impatient when others talk about themselves and devalue the achievements of others.
The self-image of a narcissist may be overinflated but it is usually stable. However, occasional periods of insecurity are not uncommon.
Narcissists react with contempt when they become aware that they have hurt someone else, viewing it as a sign of weakness. Their actions and responses are usually deliberate and calculated. However, when others criticize them, narcissists may respond with a disproportionate degree of anger.
Excessive need for admiration refers to a constant desire for positive reinforcement by others. When it does not materialize, the consequences are usually severe.
Low empathy is a clear indicator of narcissism. Empathy refers to being able to take on the point of view of other people, to feel their joy and sorrow, and to care about others’ well being. Empathy is considered to be the foundation for human compassion and morality, and empathetic people are much more aware of the world outside of their own ego.
For those with NPD, however, empathy is unnecessary as they do not perceive the point of view of other people to be relevant to them.
How does overt narcissism affect relationships?
If you are in any sort of relationship with an overt narcissist, you are likely to know about it. Narcissists do not cope well with insecurity and vulnerability. They tend to feel depressed or humiliated when they feel slighted, reacting angrily when others don’t seem to regard them with the admiration they need and feel they deserve. Being on the receiving end of this type of behavior is disorientating, upsetting, and has long-lasting effects.
A tactic that is often used by covert narcissists is shaming which is designed to secure their sense of an elevated position in relation to others. The overt narcissist may be more obvious in their approach to gaining leverage, and you might notice that they attempt to explicitly put you down, criticize you, and are rude and sarcastic.
Their constant desire for admiration and the excessive response when it does not occur often has severe consequences. Overt narcissists are likely to experience an inability to maintain relationships as they constantly seek something better, or when their lack of empathy becomes apparent to their partners. This frequently occurs within friendships, and is particularly obvious when people seem to bounce from friend to friend and do not have long-term friendships from earlier stages of life.
Lack of empathy may become apparent to those in a relationship with someone with NPD when they exhibit a particularly unforgiving nature, and/or their anger and aggression surfaces. Of course, this type of behavior can also affect work relationships or any close group activities, where the consequences to others are irrelevant to the narcissist’s concerns.
2. Covert narcissism
In her recent single Anti-Hero, Taylor Swift references “covert narcissism disguised as altruism.” Covert narcissism is also known as closet narcissism or vulnerable narcissism, which gives some idea of what this type of narcissism is all about. Often, covert narcissists fly under the radar.
Covert narcissism is the counterpart to overt narcissism. The main traits of covert narcissism include:
Sensitivity to criticism
However, while covert narcissists do not have the self-importance you expect from overt narcissists, they can be equally difficult to deal with.
Covert narcissists are not obviously narcissistic when you first meet them. They can be introverted, which is not typical of the narcissistic stereotype. Yet they possess the same fragile sense of self, and desire for admiration and importance as any other type of narcissist, it’s just exhibited in a different way.
One clue is constantly seeking reassurance about their talents, skills, and accomplishments, which may be in the form of putting themselves down and minimizing themselves so that others tell them how good they are.
Other tactics favored by the covert narcissist include blaming and shaming others in order that they can act the victim, passive-aggressive behaviors, creating confusion to make the other person question their version of reality, and ignoring the emotional needs of others.
How does covert narcissism affect relationships?
Because of the differences between overt and covert narcissism, it is often said that overt narcissists are a lot easier to see coming than covert narcissists. Many people find themselves falling victim to the manipulative behaviors of a covert narcissist without realizing what has happened. At this point it is often too late and they are already in emotional pain.
In terms of romantic relationships, the partners of covert narcissists may experience a lack of partnership or reciprocity in the relationship. The covert narcissist can feel difficult to reach, or their victim mentality may pull focus to them and their needs while leaving the other partner out in the cold.
This emotional abuse is a key aspect to look out for in any type of relationship with a covert narcissist. While they may have a more underhand approach to explain why something is your fault and they are not to blame, the goal is, as always, to make you feel small in order to make themselves feel better. They might even pretend to be a victim of your behavior or engage in emotional abuse to put themselves in a position to receive reassurance and praise from you.
3. Antagonistic narcissism
To antagonize means to be unfriendly or hostile to another person, which explains the nature of this type of narcissism. Antagonistic narcissists want to be the best and completely disregard the well being of others in order to achieve their goal.
Some researchers view antagonistic narcissism as a subtype of overt narcissism, but with a greater emphasis on manipulation and aggression.
Not only do antagonistic narcissists use their power and position to manipulate others, they are also adept emotional abusers who derive satisfaction from the suffering they cause other people.
Other traits of the antagonistic narcissist include constant criticism, belittling other people, excessive demands for attention and compliance, feeling entitled to special treatment, exploiting others for personal gain, and physical violence (both threatened and actual).
At the core of antagonistic narcissism is a self-protective tendency to avoid social failure via self-defense. One study from 2017 concluded that antagonistic narcissists are the least forgiving subtype of those with NPD, which fits with their tendency towards vengefulness.
How does antagonistic narcissism affect relationships?
Antagonistic narcissists can be very destructive both to themselves and to those around them, and are characterized by their manipulative and aggressive behavior. They often use others to get what they want, which includes those they are in any type of relationship with.
Because antagonistic narcissists want to be the best in everything they do, those in a relationship with them may feel invisible, as if this is not a partnership but that they are there to serve the narcissist. In other scenarios, the narcissist manipulates the situation to make it look as though their partner is getting everything wrong, deflecting attention and blame to the other person.
Antagonistic narcissists see nothing wrong with exploiting people for their own gain. They are also highly competitive and always need to be the center of attention. Again, this can make the person in relationship with the narcissist feel as though they have been recruited to act in service to the other person, smoothing the way ahead for them to succeed.
Ultimately, this is an unsatisfying relationship for those dealing with an antagonistic narcissist. Not only do you begin to feel invisible but your own sense of self worth can become eroded.
4. Communal narcissism
Communal narcissism is a relatively recently defined subtype of narcissism.
The term describes those who try to maintain an inflated self-view through their seemingly altruistic acts. A communal narcissist views themself as “the best friend someone can have” and imagines the “saint-like” characteristics of moral virtue and adherence to social norms.
Communal narcissists often believe they have excellent social skills, and are particularly attached to their perceived likeability and helpfulness.
While a communal narcissist might sound less harmful than the other subtypes of narcissism, all types of narcissists share a focus on self, and a preoccupation with getting their needs met at the expense of others.
Interestingly, while communal narcissists believe themselves to be trustworthy, good at offering support, listening to the problems of others, and working well with others, the people they interact with do not share these views.
It is unclear whether this desire to present oneself as likable and helpful is an attempt on the part of the communal narcissist to control how people see them or whether it represents how they truly see themselves.
How does communal narcissism affect relationships?
Communal narcissists present as helpful, selfless, knowledgeable, and reliable. It can take a lot to break through this facade in order to see the true motivations behind their actions.
As with all types of narcissism, communal narcissists are preoccupied with their own needs and getting them met at the expense of others.
For example, a communal narcissist colleague might try and do your work for you. When challenged, they might say that they are simply being helpful. Their belief in their own importance means they may believe the company or organization would simply fall apart without them.
Likewise, they may believe they play a more pivotal role in the company than is the case, often taking on the stance of management, looking down on colleagues who take time off work or chastising those who seem uninterested in their job.
5. Malignant narcissism
The Merriam-Webster Dictionary definition of ‘malignant’ in the context of malignant narcissism is:
Passionately and relentlessly malevolent: aggressively malicious
A person with malignant narcissism would meet the clinical definition for Narcissistic Personality Disorder (NPD) alongside features of other personality disorders.
In practice, this could include:
Machiavellianism (manipulativeness, callousness, indifference to morality)
Persistent criminal behavior
Absence of conscience
A psychological need for power
A sense of importance (grandiosity)
Sadism (cruel and controlling behavior)
As with NPD, individuals with malignant narcissism would present with a notable lack of empathy and affiliation.
In terms of clinical definitions, there is little to separate malignant narcissism from psychopathy, which gives an idea of the extreme nature of this type of narcissism.
The complexity of malignant narcissism and its crossover with other disorders may present in a range of different ways, many of which may make it difficult to function day-to-day.
How does malignant narcissism affect relationships?
Malignant narcissism is perhaps the most difficult type of narcissism for those in any sort of relationship with the narcissist. However, malignant narcissists are one of the least common types of narcissists.
Because malignant narcissists tend towards sadism (the gratuitous enjoyment of the pain of others), it is likely they will harm others and enjoy doing so, showing little empathy or regret for any pain they have caused.
Likewise, the only time that malignant narcissists would help others would be if there is immediate gain or recognition to themselves for doing so. Being in any sort of relationship with a person like this would be incredibly challenging, as one of the core aspects of relationships with others is finding ways to support each other.
Ultimately, if you have noticed any of the traits of malignant narcissism in friends, colleagues or loved ones, it’s important to know that they are generally incapable of forming the kinds of deep, meaningful, lasting relationships with others we all need in order to live happy, emotionally secure lives.
How is narcissism treated?
If you find yourself in any type of relationship with a narcissist, you may urge them to seek help for their issues. However, many narcissists are unaware of the impact of their actions and behaviors, and reluctant to accept they may be at fault.
Often, individuals with narcissism seek help for peripheral issues such as anger, depression, or irritability, at which point a therapist or psychiatrist may notice the deeper narcissist tendencies.
Recommended treatment options include talking therapies with an experienced mental health professional. Psychiatric drugs are also used for the treatment of malignant narcissism, such as SSRIs (Selective Serotonin Reuptake Inhibitors such as Prozac or Zoloft).
Treatment for those affected by being in a relationship with a narcissist
If you have been affected by being in a relationship with a narcissist of any kind and would like to explore treatment, The Center • A Place of HOPE can help.
Emotional abuse can leave deep, long-lasting scars. We understand what you have endured. And you have a very safe place here to receive the compassionate care you need. An abusive, traumatic relationship will unfortunately not fully heal with just “time.” Professional therapy can provide the lasting healing and care you need to regain your true self.
Please call during opening hours, Mon-Fri 9am-5pm PT, Verify Insurance or complete the form below.
 Millon T, Grossman S, Millon C, Meagher S, Ramnath R (2004). Personality Disorders in Modern Life (PDF). Wile y. p. 343. ISBN 978-0-471-23734-1.
 Jones E (15 March 2007). Essays in Applied Psycho-Analysis. Lightning Source Inc. p. 472. ISBN 978-1-4067-0338-2.
 “On Narcissism, 1914 by Freud”. SigmundFreud.net. Sigmund Freud.
 Levy KN, Reynoso JS, Wasserman RH, Clarkin JF (2007). “Chapter 9, Narcissistic Personality Disorder”. In O’Donohue WT, Fowler KA, Lilienfeld SO (eds.). Personality Disorders: Toward the DSM-V. SAGE Publications, Inc. p. 235. ISBN 978-1-4129-0422-3.
 O.F. Kernberg. Borderline conditions and pathological narcissism. Aronson, New York (1975)
 T. Millon. Disorders of personality: DSM-III, axis II. Wiley, New York (1981)
 Cai, H., Luo, Y.L.L. (2018). Distinguishing Between Adaptive and Maladaptive Narcissism. In: Hermann, A., Brunell, A., Foster, J. (eds) Handbook of Trait Narcissism. Springer, Cham. https://doi.org/10.1007/978-3-319-92171-6_10
 Millon,T.(1981). Disorders of personality. New York: Wiley
 Atlas, G.D., Them, M.A. Narcissism and Sensitivity to Criticism: A Preliminary Investigation. Curr Psychol 27, 62–76 (2008). https://doi.org/10.1007/s12144-008-9023-0
 Stinson FS, Dawson DA, Goldstein RB, Chou SP, Huang B, Smith SM, Ruan WJ, Pulay AJ, Saha TD, Pickering RP, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. 2008 Jul;69(7):1033-45. doi: 10.4088/jcp.v69n0701. PMID: 18557663; PMCID: PMC2669224.
 Diagnostic and statistical manual of mental disorders : DSM-5 (5th ed.). Arlington, VA: American Psychiatric Association. 2013. pp. 72–669. ISBN 978-0890425541. OCLC 830807378.
 Ronningstam E Weinberg I (2013 Spring) Narcissistic Personality Disorder: Progress in Recognition and Treatment. The Journal of Lifelong Learning in Psychiatry XI: 167-177.
 Caligor, Eve; Levy, Kenneth N.; Yeomans, Frank E. (May 2015). “Narcissistic personality disorder: diagnostic and clinical challenges”. The American Journal of Psychiatry. 172 (5): 415–22. doi:10.1176/appi.ajp.2014.14060723. ISSN 1535-7228. PMID 25930131.
 Ramzi Fatfouta, Virgil Zeigler-Hill, Michela Schröder-Abé, I’m merciful, am I not? Facets of narcissism and forgiveness revisited, Journal of Research in Personality, Volume 70, 2017, Pages 166-173, ISSN 0092-6566, https://doi.org/10.1016/j.jrp.2017.07.007.
 J.E. Gebauer, C. Sedikides, B. Verplanken, G.R. Maio. Communal narcissism. Journal of Personality and Social Psychology, 103 (2012), pp. 854-878, 10.1037/a0029629
 D.L. Paulhus, O.P. John. Egoistic and moralistic biases in self-perception: The interplay of self-deceptive styles with basic traits and motives. Journal of Personality, 66 (1998), pp. 1025-1060, 10.1111/1467-6494.00041
 George, F.R. and Short, D., 2018. The cognitive neuroscience of narcissism. Journal of Brain Behaviour and Cognitive Sciences, 1(1), pp.1-9.
Dr. Gregory Jantz
Pioneering Whole Person Care over thirty years ago, Dr. Gregory Jantz is an innovator in the treatment of mental health. He is a best-selling author of over 45 books, and a go-to media authority on behavioral health afflictions, appearing on CBS, ABC, NBC, Fox, and CNN. Dr. Jantz leads a team of world-class, licensed, and...
‘Toxic’ is becoming an increasingly used word when discussing dysfunctional behaviors. As with its more traditional definition, toxic behavior describes actions or attitudes that are harmful, destructive, or negative to others, oneself, or the environment. Toxic behavior can have serious consequences for individuals, relationships, and communities, leading to stress, conflict,...
Recent technology has presented us with a new, potentially devastating forum for inappropriately sexualized relationships. The Internet with its anonymity and wide-open content can tempt us to cross physical and sexual boundaries.