If you’ve ever searched the internet for an explanation for your romantic partner’s bad behavior, you’ve likely noticed that there’s a tendency to attribute almost anything negative to Narcissistic Personality Disorder (NPD). Unfortunately, most people who label others as narcissists aren’t trained in the differential diagnosis of personality disorders. This means they overdiagnose people as narcissists when another type of psychological problem might be a better explanation for the behavior. A common mistake is to ignore the possibility that your partner has schizotypal personality disorder, not NPD. Let me give you an example.

Liz and Bob

My new client Liz came into therapy with me because she had recently discovered that her husband, Bob, had been cheating. Liz was shocked and devastated. They had only been married for ten months and Bob had been pursuing Liz for years, begging her to marry him. It made no sense to Liz that he would cheat on her now that they were finally together.

Their History: Liz was married to someone else when she met Bob at a party. They enjoyed talking to each other and found that they had a lot in common. After the party, Bob started connecting with Liz. It started small. He started following her on Instagram. He started “liking” her posts on social media. He sent her sweet text messages. Gradually, it became clear to Liz that Bob wanted more than just friendship.

When Liz told Bob that she was happy in her marriage and uncomfortable with the romantic turn their relationship was taking, Bob confessed that he was madly in love with her and couldn’t think of anyone else. He believed that they were meant to be together. He said that he had never felt this way about anyone before. Bob then began to pursue her relentlessly. Eventually, seduced by his passion, his thoughtful talents, and his many displays of love for her, Liz gave in and began an affair with Bob. But that wasn’t enough for him. Bob said that he wanted all of her, not just sex. He then spent two years trying to convince her to divorce her husband and marry him. Finally, Liz gave in to Bob’s pleas and left her husband for him. All was well until she was divorced and she and Bob were married. Shortly after their honeymoon, it was as if a switch had been turned off and Bob suddenly lost all interest in her. He began finding ways to distance himself emotionally and physically. He even got a new job that required him to travel more for work. When Liz confronted him about his sudden emotional absence, he denied that anything had changed and told her she was imagining things.

Liz had taken a peek at Bob’s phone while he was in the shower and found emotional text messages from another woman on it. Liz was shocked. Her whole world had fallen apart. She began researching “cheating husbands” and “sudden loss of interest in a partner” online. She came across multiple sites that all said that these were traits of narcissistic husbands and that now that the “love bombing” was over, she should expect to be devalued and discarded any day. She chose me as a therapist because my name had come up so often as someone very knowledgeable about narcissism and relationships.

But… was Bob a narcissist? Did he qualify for a diagnosis of Narcissistic Personality Disorder?

Liz was surprised that I didn’t immediately jump on the narcissism bandwagon. I continued to ask her questions about her husband, his childhood, his past relationships, and his behavior. I began to think that a different diagnosis might be more appropriate. Liz asked if I could have a private session with her husband to get a personal impression and ask him some questions. When I met Bob, I realized that he did not have Narcissistic Personality Disorder. Bob was more likely to have Schizotypal Personality Disorder. To explain why, let me give you a brief introduction and comparison between these two very different personality disorders.

Please note that I will be using the terms “narcissistic” and “schizotypal” as shorthand ways of referring to people who qualify for a diagnosis of Narcissistic Personality Disorder or Schizotypal Personality Disorder.

What is Narcissistic Personality Disorder?

Narcissistic Personality Disorder can be thought of as an adaptation to a childhood situation that left the person with a personality disorder characterized by unstable self-esteem and little or no emotional empathy for others. Many of my narcissistic clients report growing up in a household ruled by a controlling, narcissistic parent where they were expected to obey and respect. High achievement was valued, while empathy and compassion were not.

Narcissistic Goals: The main goals of people with the exhibitionist narcissist subtype are to appear special, achieve high status, become the center of attention, and be recognized as “the best.” The main goals of the covert narcissist subtype are to avoid the spotlight and feel special by gaining the approval of people they consider ideal. The main goal of the malignant narcissist subtype is to sadistically destroy the self-esteem and pleasure of others.

Narcissistic Fears: All narcissists fear being exposed as incompetent, average, or imperfect. Additionally, people with the covert narcissist subtype are unable to muster enough defensive grandiosity to present themselves as special. They avoid the spotlight because being the center of attention makes them feel too exposed and vulnerable.

Dysfunctional Relationship Pattern: Narcissists typically start by idealizing their lovers and showering them with praise. Then, as the couple gets to know each other better, the narcissistic partner begins to discover flaws in their partner. They may try to convince their new partner to change so that they better fit the narcissist’s idea of ​​perfection. When that doesn’t work, narcissists begin to devalue their partner. Praise is replaced with blame. They may betray their now-devalued partner or dump the person. Instead of the idealized, passionate love they experienced during courtship, they now feel bored, annoyed, or indifferent—just when the average person would begin to relax and enjoy the increased intimacy that comes with intimacy.

What is Schizotypal Personality Disorder?

Schizotypal Personality Disorder (SPD) begins in early childhood as an adaptation by a particular child to a home situation that contains a combination of severe abuse, neglect, and intrusiveness by the child’s caregivers. My clients with schizophrenia generally have much more psychological trauma than my narcissistic clients. They report that by the age of seven, they realize that they cannot rely on anyone to have their best interests in mind. They decide at an early age that the safest and best option is to become completely independent as soon as possible, to control the amount of contact they have with others, and to be very careful about who they trust. Almost all of them learned to disengage from their bodies when they were abused as children and now disengage automatically whenever they feel stressed, even when they don’t want to.

Schizophrenia Goals: My clients with schizophrenia want to maintain their independence and keep others at a safe interpersonal distance.

Schizophrenia Dilemma: Ralph Klein (1995) notes that the basic schizophrenia dilemma is that individuals with schizophrenia feel insecure when they are in intimate relationships; but when they retreat to a safe distance, they may withdraw and then find it difficult to reconnect with people. When this happens, they are prone to falling into a very specific type of depression characterized by existential despair—the feeling that life is inherently meaningless and that real human connection is impossible. Note how this type of depression differs from narcissistic depression, which is characterized primarily by shame about oneself.
Dissociative Fears: The main dissociative fears include loss of independence, being controlled by other people, being seen as a tool to be used rather than a real person with rights and feelings, and having their work or property taken over by other people. Dysfunctional Relationship Style: People with DID manage their level of intimacy by finding ways to maintain emotional distance. This translates into having limited relationships or being in and out of relationships. When there are no barriers to full intimacy, they may try to protect themselves by unconsciously shutting down their feelings. The latter includes suddenly falling in love with someone once they become available for a real relationship.

Bob’s New Analysis

Bob’s behavior toward Liz could not be explained by the typical problems of narcissistic relationships: problems with self-esteem regulation, inability to love, grandiosity, perfectionism, hierarchical thinking, striving for status, and lack of emotional empathy. It was better explained by the problems associated with schizotypal personality disorder: fear of intimacy, the need to control the distance between people, and the worry that the only way to avoid being trapped and controlled is to dilute intimacy either by choosing unavailable people or by bringing someone else into the relationship.

You may wonder: Why does Bob’s diagnosis matter? He was still cheating on Liz and putting distance between them. You can’t have a happy marriage that way. However, a correct diagnosis can help you understand the underlying motivations behind relationship problems and highlight issues that need to be addressed.

In typical schizotypal fashion, once Bob married Liz and her ex-husband was no longer a barrier to full intimacy, Bob felt fearful and suppressed his feelings. He then took a mistress to create more distance between himself and Liz. Bob didn’t do this because he discovered that Liz wasn’t perfect (a typical narcissistic reason). He wasn’t bored with Liz or devaluing her as narcissists do. His intimacy fears were triggered by Liz’s availability, and he was panicking and sabotaging the relationship.

Despite how hurtful and betrayed Liz felt by Bob’s behavior, this situation was easier to treat than narcissistic devaluing. Bob’s situation wasn’t complicated by the narcissist’s need to be seen as flawless. Once Bob gained some insight into his motivations, he was able to work through his fear of being vulnerable in front of another human being in therapy.

Bottom line: At this point, narcissism was in the spotlight while the general public was largely unaware of DID and its effects on relationships. Many harmful behaviors are attributed solely to NPD, such as infidelity, sudden emotional or physical withdrawal, lack of intimacy, and sending mixed messages. The truth is that these behaviors can also be the result of clumsy attempts by partners with DID to maintain a safe emotional distance.

The problem is that most people, even experienced therapists, are unfamiliar with the common signs of DID. As a result, many people shout “narcissist!” when they should be whispering “schizophrenic.”