When Is Narcissism a Disorder?

Narcissistic Personality as Category or Continuum

Sep 7, 2007
Tami Port

Narcissism: Disease or Dimension of Personality? - Bencur's Narcissus Public Domain

When is narcissism a mental illness? New research indicates that it is all a matter of degree.

What’s the distinction between “normal” narcissism and psychological disorder? In a new study appearing in the May issue of Personality and Individual Differences, two American psychologists examined the contrasting perspectives on narcissism held by social psychologists and clinical psychologists.

Social Psychology and Clinical Psychology

Social psychologists are scientists who study people in their relationship to others and to society as a whole; the discipline where mental state meets social situation.

Clinical psychology focuses on diagnosis and treatment of emotional and behavioral disorders. These mental health clinicians usually have a PhD and work in a medical setting with psychiatrists and other physicians.

Different Perspectives on Narcissism

There are many similarities to how clinical and social psychologists view narcissism, but there is one very important difference. Clinical psychologists classify narcissism as a personality disorder. So, according to their diagnostic criteria, you either have Narcissistic Personality Disorder (NPD) or you don’t.

Unlike clinicians, social psychologists generally view narcissism as a spectrum or dimension of personality, not as a category. They do not believe that there is a specific point within the continuum of narcissism where ‘normal’ suddenly becomes ‘narcissism’.

New Research on Narcissism

In their recently published study, Foster and Campbell (2007) measured narcissism using the Narcissistic Personality Inventory (NPI), an assessment tool often employed for evaluating narcissistic traits in social psychological research.

What Is the NPI?

The Narcissistic Personality Inventory is a forced-choice questionnaire that uses paired statements to assess narcissism in nonclinical, adult populations. In other words, the NPI is used for research on the general public, not necessarily mental health patients.

Although designed to measure narcissistic traits in the general population, the NPI was designed based on the clinical definition of narcissism found in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This diagnostic reference is published by the American Psychiatric Association (APA), and is the manual that mental health professionals most commonly use to diagnose narcissism and other mental disorders.

Because the purpose of the DSM is to diagnose mental illness, the various disorders are presented as specific, discrete categories. However, in the creation of the NPI, this clinical definition of narcissism was used with the assumption that people who don’t have the psychological disorder of narcissism can still display narcissistic traits.

What’s the Difference between Narcissism and Normal?

So is narcissism a distinct disorder, or is it a dimension of personality that can range from mild to extreme? Since the DSM outlines the specific criteria necessary to diagnose a person as having the psychological disorder of NPD, one might expect there to be an abrupt shift or jump in NPI narcissism scores as a point of demarcation between what is considered “normal” and what is mental illness. This is essentially what Foster and Campbell set out to explore.

Narcissism Study Method

The researchers examined 3895 participants from the general population using an on-line version of the NPI. Subjects were presented with 40 paired statements and instructed to choose the one that best described them. For each statement pair, one choice reflected a more narcissistic perspective. For example, “I am much like everybody else” versus “I am an extraordinary person.”

Narcissism Research Results

Analysis of the scores revealed no point at which there was a distinct shift from “normal” to “narcissist.” Rather the scores ranged across a continuum, a finding more in agreement with the social psychological view of narcissism.

This suggests that narcissism is structured similarly to other aspects of general personality, as a range or dimension. For example, considering the characteristic of sociability, one might see it as ranging from shy and socially withdrawn to gregarious and socially outgoing. Foster and Campbell’s research suggests that narcissism also shows a continuum of individuals who do not strongly display narcissistic traits of self-absorption to those who are extremely or pathologically narcissistic.

More Information on Narcissism

There are numerous on-line and in print resources with additional information on narcissism and personality disorders in general, including: Psychology Prof Online, The Mayo Clinic: Mental Health Center and the article What Is a Personality Disorder?: Overview of the Ten Psychological Disorders of Personality.

This Suite 101 article summarizes one study investigating the nature of narcissism. The content of this article is not meant to be used for diagnosis and is not a substitute for professional help and counseling.

Additional Narcissism Sources

Grey, P. (2006). Psychology, 5th Edition. Worth Publishers.

Raskin, R. N., & Hall, C. S. (1979). A narcissistic personality inventory. Psychological Reports, 45.

Raskin, R. N., & Hall, C. S. (1981). The Narcissistic Personality Inventory: Alternate form reliability and further evidence of its construct validity. Journal of Personality Assessment, 45.

Foster, J. D. and Campbell, W. K. (2007). Are there such things as “Narcissists” in social psychology? A taxometric analysis of the Narcissistic Personality Inventory. Personality and Individual Differences, 43, 6.

Tami Port - Tami Port is a college professor of cell and microbiology and creator of ScienceProfOnline.com, a free science education website.

When is Narcissism a Psychological Disorder? - Michelangelo Merisi da Caravaggio, Public Domain

Comments

Sep 8, 2007 8:07 PM

redback :

Very helpful article. :)

I've been reminded, after reading your articles there is 'Statistical' in the DSM 1V title...and why it got there.
And re-reading the 'cautions' and 'criticism' sections in the link I posted here, the history and broader purpose of the DSM 1V...I see there's still some way to go for its consistent use by diagnosticians and researchers.

So, I found it interesting to read in your article that the social and clinical psychologist may rely on different criteria when the ICD-10 has been brought more in line with the DSM 1V ie a need for uniformity. But the clinical psych is surely uninterested in "normal" narcissism as treatment is not sought no needed for it. The scoial psychologist may be more interested in prevention and early intervention as well as trying to find the elusive cut-off point of "normal".

Untreated "normal" vs treated "normal? A normal "narcissist" who develops an undiagnosed mental disorder, say schizophrenia? Does the narcissistic trai impact on how schizophrenia will present itself?

Research in this area is fascinating. And maybe there is scope within the human genome project to examine the whole idea of personality traits or disorders...on mental health.

I'm in the camp that believes personality traits are like healthy limbs. It don't need to be fixed if it aint broke. When it causes a defined 'impairment' (ADL) is the time to question if its a temporary problem or risks a chronic disorder. Tis a transitional shade of grey, not a decimal point threshold..

Sep 12, 2007 9:26 PM

Tami Port :

Redback -

Thanks for your postings. I am always interested in others experience and perspectives on PDs (and on most everything else as well). The many questions, conflicts and subtopics that you present in your postings could certainly give rise to numerous new articles and discussions.

With respect to your closing in the message preceding this one...I couldn't agree more. Mental illnesses have been categorized for the purposes of study, treatment, and of course billing always factors into the mix. Nonetheless, these categories that we have created are...well...categories that we have created! We have defined boundaries of mental health and mental illness when it seems rather apparent that few psychological states are black and white, sick or healthy. Like you, I agree with the social psychologists. Mental health/illness exists in a continuum.

Sep 13, 2007 1:07 AM

redback :

It has been estimated that approx 70% of the psychoses are completely untreatable:
http://www.aprn.net.au/APRN%20Final%20Report_web%20version.pdf

The Australian Psychosis Research Network (APRN) 54-page Final Report per the above hotlink makes interesting reading. The APRN is a claimed world-first uniting of more than 50 separate leading Aussie centres into the one national research unit.

I am an unpaid mental health advocate in an federal election year :) :) so will be pushing for the APRN to receive partnership funding from government to supplement private funding. I'm focusing on preventative measures and see underlying, undiagnosed, under-treated, un-mentioned PDs as problematic, not just end-stage crisis management.

A lifetime ago, in the 80s, we had many staff "diagnosed" with 'adjustment disorder' when they had difficulty coming to terms with "rationalisation" of staff (mass redundancies) that was truly mismanaged. 'Adjustment disorder' had a stigma attached to it for fighting to keep the job or get references for other jobs. This, like 'phobia' seems to be a PD subset?

Our social welfare system has been dragged screaming into the 21st century. But not without pain to system and citizen alike. Everyone deserves a fair go without having to self-identify self incriminating facts...or do they if its at taxpayers' expense? :)

Sep 14, 2007 7:14 PM

redback :

Apologies again. The link I offered is a tad "side-tracked" on the local funding issue which is of less interest internationally, probably.

But it's interesting how relatively inefficient treatment options are in the grand scheme of things and there are scientific techniques going begging. For PDs where tis a treat the symptom focus, maybe there is a greater divide.

I ponder what genetics has to offer for PDs.

Aug 21, 2011 10:15 PM

Guest :

Redback & tamiport - very interesting (so how come no-one has commented further since 2007?).

I'm as sure as I can be (and I'm pretty sure now!) that I married into a family having NPD (and other) personality disorders, and stayed amongst them for over 30 years.

My experience suggests there is indeed a transitional state - from white through grey to black - and that it goes from maybe-not-so-nice, through increasing stages of unacceptability to abhorrent, then to entirely unacceptable (by which point you're divorced, insane or dead). At the entirely unaceptable stage (perhaps before) I found that a particular method of psychopathic behaviour was common - though the narcissists were good at hiding that too, or distracting from the observation of course. It seems to me that the advantage would be to determine the level at which NPD is at before engaging with a sufferer - although of couse they're alluring enough to disguise that too. That's the trouble - you never know where you are with them - or they with themselves. Imagine that you're told you have to enter and cross a minefield, where you're first told there could be hundreds of mines there, or just one, and that about sums the relationship up. The best way is to avoid having to enter a minefield at all, but the alluring narcissist is a minefield.

Normal to abnormal transition points are another minefield - there are so many ways in which narcissistic supplies can be gained, and the need is so expansive and great (in my experience), that it's hard to determine the point at which the characteristic imbalance becomes an abnormality. I became aware that my wife had "done" me for £25,000 in one single incident (with her mothers able assistance and encouragement), but the final figure was in fact over £100,000 - and that's just the known financial cost! The emotional and psychological cost probably outstrips that value by some magnitude - easily so when the cost to our family is taken into consideration.

I'd agree there is a genetic link to narcissistic personality disorder as evident by the ex's mother and her behaviour, ex's maternal uncle (a convicted criminal now missing presumed dead for several years), the ex herself, the ex's younger sister and, perhaps, one of our own sons. I'm also certain that deliberate instilling or encouragement of the disorder from one individual to another (and certainly from elder to younger generations) is a feature of NPD. "She's just like her mother" is a phrase I came to dread, mainly for its accuracy!

I suspect it's the sum total of abnormalities and the effects of them which would determine the seriousness of NPD - and to find that one must first find the truth, which isn't going to be made easy and may still seem incredible (ie; hard to believe) when or IF it is found.

I can't help thinking I'd make a good subject for study if anyone needed to discover the effects of prolonged living with narcissists!

Nov 27, 2011 7:44 PM

Guest :

I agree with the social psychologists study. Narcissistic is more of a trait which could be mild to extreme. If the behavior is on the extreme end of the spectrum, this could impact a persons life and relationships with others Nothing is either black or white.. I have found this to be very helpful.

6 Comments