If you’ve been following the running list of most popular blog posts on Psychology Today , you might get the impression that readers are obsessed with narcissists, especially when it comes to love. Is this the state of modern romance? Are readers, like Dorothy in The Wizard of Oz , truly consumed with fear that the dating pool is full of hidden dangers in the form of narcissists, psychopaths, and psychopaths (oh my!)? And does psychology, or pop psychology, with all its advice on how to spot a narcissist in our romantic partners, really tell us anything useful about how to avoid such danger?
It’s time for a reality check.
In the spirit of my recent post on whether schizophrenia exists, let’s examine whether there really is such a thing as a “narcissist,” and if so, what it might mean. The answer is complicated, because the term has different meanings in psychiatry, psychology, and colloquial speech.
Psychiatry, as a disease-focused medical specialty, eschews the terms “narcissism” or “excessive narcissism” in favor of “narcissistic personality disorder,” a fully developed syndrome, or cluster of symptoms (see DSM-5 criteria here ) associated with significant clinical distress or impairment in functioning. Contrary to what we might expect given readers’ apparent vigilance toward narcissists, the proportion of people with NPD in the general population appears to be quite low. While a lifetime prevalence rate of 6.2% is sometimes cited,1 this figure is based on a national survey of non-clinicians conducted in 1982. Using the same survey data, but requiring that all reported symptoms of NPD be associated with distress or impairment, the revised incidence rate drops to 1%,2 a figure consistent with other surveys that have reported lifetime rates of NPD as low as 0% nationally and, in places like Iowa, as low as 4.4% in New York. The apparent rarity of NPD, coupled with the finding that NPD overlaps significantly with other psychiatric disorders, has been used to argue that NPD should be removed from the DSM-5 altogether and that narcissism is better conceptualized as a continuous trait or “dimension” rather than a categorical diagnosis. 4,5 It was almost removed, but after much debate, NPD was eventually retained in the DSM-5 as a personality disorder with specific diagnostic criteria, while also being included in a separate chapter called the “Alternative DSM-5 Model of Personality Disorders,” with a more dimensional conception that includes both normal personality aspects and pathological personality traits.
The idea that narcissism might be better understood as a continuous trait comes directly from how this construct is modeled in psychology, where the focus is on the full range of human brain function and behavior, not just pathology. According to this model, narcissism is a trait that can range in severity from inadequacy to healthy normality to pathological extremes, at which point it can be linked to narcissistic personality disorder.
In psychological studies, the continuous trait of narcissism is often measured and quantified using the Narcissistic Personality Inventory (NPI), a 40-item scale intended for use in non-clinical populations (i.e., “normal” people who do not have psychological disorders). [Take the test yourself here.] An international survey reported that the average NPI score was 15.2, with the highest average score in the United States (15.3), followed by Europe (15.0), Canada (14.8), Asia (14.3), and the Middle East (13.9). 6 Average NPI scores decline significantly with age (between 15 and 18 for teens, to 11 to 13 for those over 50). Other studies report above-average NPI scores of 17.8 among celebrities and 16.18 among students enrolled in MBA programs.
Considering that the overall range of NPI scores can range from zero to 40, these geographic and occupational differences are actually quite narrow, separated by just a few points. Online sources claim that an NPI score above 17 or 20 might qualify you as either a “narcissist” or a “narcissist,” that violent prisoners have an average score of 23, and that a score above 30 “may be worrisome.” But there is no agreed-upon threshold at which someone is considered a narcissist, although articles in both popular and research psychology are full of examples where being a narcissist equates to having a relatively high NPI score. For example, a 2014 study was promoted in the popular press (see here on the Huffington Post) and blogs (see here on Psychology Today) as suggesting that a single question—“To what extent do you agree with this statement: I am a narcissist”—can determine whether someone is a “narcissist.” But in fact, what the study showed was only that the answer to this single question—rated on a scale of one to seven—was positively correlated with a person’s score on the NPI. 8 This is far from saying anything about how a single question can reveal whether someone is a narcissist, which remains a meaningless and undefined term.
The NPI isn’t very helpful in distinguishing between normal and pathological because that’s not what it’s for. That’s what the DSM-5 criteria for narcissistic personality disorder are for. In fact, a 2013 study found that patients with narcissistic personality disorder did not score significantly higher on the NPI than healthy controls. 9 This distinction illustrates how a psychopath can be considered to lie at the extreme end of a continuous psychological trait, but also how such disorders can still be fundamentally different concepts. In psychiatry, narcissistic personality disorder is more than just extreme or pathological narcissism; It is a cluster of symptoms that include grandiose narcissism along with envy, lack of empathy, and interpersonal exploitation, which are bound to be associated with distress or dysfunction.
In the same vein, the continuous psychological trait of narcissism is more multifaceted than just “self-love,” especially as measured by the Unbiasedness Index. At the healthy point on the continuum, narcissism overlaps significantly with related concepts such as self-confidence, openness, assertiveness, individualism, and the desire to lead. Psychologists Seth Rosenthal and Jill Holley have noted that the Self-Esteem Index may particularly confuse narcissism with self-esteem based on positive responses to questions such as “I am assertive,” “I like to receive compliments,” “I see myself as a good leader,” and “I have good taste when it comes to beauty.”10 When narcissism and self-esteem overlap, it is easy to see why Self-Esteem Index scores are associated with psychological health, optimism, happiness, and social status, and why people with higher scores tend to be seen by others as charming, popular, socially confident, entertaining, attractive, and desirable.
At the more pathological end of the continuum, narcissism as measured by the NPI is associated with self-absorption, vanity, arrogance, entitlement, lack of empathy, and a tendency to exploit others interpersonally. Note that both the NPI and DSM-5 NPD correspond more closely to the “inattentive” or “grandiose” subtype of psychoanalytic narcissism than to the “hypervigilant” or “vulnerable” subtype associated with feelings of shame and underlying inadequacy. However, self-esteem can be low on both variables, which seems to explain why people with NPD score lower on the NPI than we might expect. As a continuum trait, narcissism can cause us problems with both excess and deficiency. Having too much means that an individual is likely to have significant problems in personal relationships and suffer from disappointment due to unrealistic expectations about what they deserve from life. Having too little narcissism can lead to serious difficulties with extreme self-doubt and low self-esteem. Both can lead to anxiety, depression, self-destructive behavior, and suicidal ideation.
Mental health seems to require the right amount of narcissism to make an individual confident, but humble and unassuming; ambitious and successful, but not arrogant and exploitative; and able to love themselves, as well as others. Of course, in reality, few of us have the right amount, which means that most of us struggle at times to maintain a healthy balance.
In the final analysis, then, the term narcissism is meaningless in psychology and should probably be avoided in favor of sticking to talking about narcissism, as there is a lot of overlap between dysfunctional narcissism and adaptive narcissism. Even normal people who do not suffer from a mental illness such as narcissistic personality disorder may suffer from problematic narcissism that exists alongside healthy narcissism (which embodies the Psych Unseen hypothesis).
In the world of relationships, the term narcissist is often used as a pejorative to describe someone who cares more about themselves than you do. In fact, sometimes this is healthy and sometimes it’s not, just as sometimes it means you should move on and sometimes it doesn’t. But trying to figure out whether someone is a narcissist with some kind of test, whether it’s 40 questions or five or just one question, is unlikely to be very helpful. Are you thinking about ending a relationship because of narcissism? Don’t leave your partner because he or she tested positive on some kind of narcissism test—leave because of the behavior that made you worry that your partner was a narcissist in the first place.
On the other hand, if you think your relationship is worth saving, consider exploring your concerns with a therapist, either individually or as a couple. As with any diagnosis, labeling someone a narcissist and making a judgment based on that alone puts you at risk of losing an opportunity to learn more about your mate, yourself, and the way you love.
