is narcissism a mental illness

Is Narcissism A Mental Illness or Something More?

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Is narcissism a mental illness? According to the DSM-V, the answer is yes. Narcissistic personality disorder is a mental illness associated with a persistent pattern of entitlement, lack of empathy, and grandiosity. 

However, the DSM-V was released in 2013, almost a decade ago. It might be fair to say that progress in mental health is far behind that of the medical field.  It’s unlikely we’d agree to treatment or surgery based on medical standards from ten years ago, yet this is the general landscape for psychological treatment and diagnoses.

Most clinical or medical sites that discuss Narcissistic Personality Disorder generally repeat the same information regarding traits and symptoms based on the DSM-V criteria. However, Wikipedia gives a more astute description of NPD and its prognosis:

The effectiveness of psychotherapeutic and pharmacological interventions in treating narcissistic personality disorder has yet to be systematically and empirically investigated. Clinical practice guidelines for the disorder have not yet been created, and current treatment recommendations are largely based on theoretical psychodynamic models of NPD and the experiences of clinicians with afflicted individuals in clinical settings.[2]

Most clinical sites wouldn’t dare discuss the bleak outlook of treating narcissism and how it’s more psychopathy of the personality than a mental illness.  That’s what I hope to do in this article. 

Let’s further unpack the question, Is Narcissism a Mental Illness?

Understanding Narcissistic Personality Disorder 

Personality disorders refer to long-term clusters of thoughts, reactions, and internal experiences that fall beyond the normal range of human behavior. Symptoms can occur at any age, although most start showing signs by late adolescence to early adulthood. The paradox is that an individual generally cannot be diagnosed with a personality disorder until the age of 18, reducing the chances of early detection, diagnosis, and intervention.

It was once believed that there was more of a tendency for men to have the disorder, but a review in 2015 found that the numbers are about the same for both men and women. This is likely because men aren’t as forthcoming about suffering abuse at the hands of a woman due to cultural conditioning and toxic masculinity that’s encouraged in young boys as they mature into teenagers and men.

In any event, if you’re looking for the same rehashed information from the DSM-V, you can find it all over the internet.  But, the traits of narcissism listed in the DSM are too rudimentary to give a complete overview of what the disorder truly embodies.  Further, since narcissists are not authentic or forthcoming during therapy, it’s difficult to continue the research that’s needed to make important breakthroughs in the field.

Narcissism has features of mental illness such as delusional thinking, but many professionals do not consider narcissists to be mentally ill. People with mental illness typically respond to psychotherapy and medications that help balance thought patterns and the brain’s chemical neurotransmitters. There is no medication or therapy that will help improve narcissistic personality disorder, which is a disorder of a person’s character.

So, what are we to do? 

Examining the Targets of Narcissistic Abuse

Being in a relationship with a narcissist is often compared to being attacked by a virus that needs a host to survive.  Like any thorough research on viruses and parasites, we need to look more at what the condition of narcissism is doing to its hosts, the targets of narcissistic abuse.

What are the psychological and physical symptoms that occur?  How does it affect longevity and livelihood?  How does it affect a person’s ability to function in everyday life?

The detached, cerebral discussions on narcissism, its origins, its symptoms, and how it causes harm in the lives of people who have Narcissistic Personality Disorder are not helpful anymore and may be doing more harm to society as a whole. 

Additionally, much of the material available on the topic of narcissism encourages us to believe that everyone has narcissism to some degree, and therefore we’re all more like actual narcissists than we think.  Even worse, we have popular figures in the field who say that conditions like Narcissistic Abuse Syndrome aren’t real!   

Related VideoStop Saying Narcissistic Abuse Syndrome Isn’t Real!

Until these forms of invalidation and propaganda are under control, we will continue to fail the people who need help the most regarding narcissism and Narcissistic Personality Disorder – those who suffer the actual brunt of it, the targets of narcissistic abuse.   

We need less sympathy for and less focus on narcissists and more focus and treatment options for those who’ve suffered because of them.

If It’s True That Narcissism Is a Mental Illness, Should You Feel Sorry for The Narcissist?

If you identify as a compassionate, empathic person, it’s normal to feel sorry for anyone who is afflicted with a personality disorder. These feelings may naturally extend to the narcissist in your life.

That said, narcissists often exploit themselves as these tragic, wounded souls. If they experienced trauma, they will draw it out to gain your sympathy. They will use this wound to justify their behavior, even when it’s harmful. 

Subsequently, they demand constant validation and attention from the people around them. To meet these needs, they often manipulate and hurt the people who love them the most.

Narcissists rely on cognitive empathy to pretend they care about you and your needs. They work hard to show that they understand where you’re coming from- only to take advantage of your trust later.

You can feel sorry for them, and your feelings are valid. But keep in mind that the narcissist isn’t unintelligent- they know how to contort and control situations to fit their desired narrative best.

Can Narcissists Actually Change or Get Better?

People must have genuine motivation and willingness if they want to get better. Change, as you likely know, requires concentration and effort. It doesn’t just passively happen. 

Most of the time, narcissists lack this desire. Instead, they are far more preoccupied with maintaining power and control. To truly change, they must be willing to surrender those needs- and narcissists won’t do that.

Furthermore, narcissists must be willing to self-reflect and take accountability for their actions. Because narcissists often perceive the world through a dichotomous lens of “good or bad,” they tend to perceive themselves as “perfect,” whereas others are entirely inferior.

Some narcissists do enter therapy. However, it’s extremely common for narcissists to seek treatment only when they feel threatened. For example, if you’ve given them an ultimatum about ending the relationship, they may decide to “surprise you” by working on themselves. 

These motives, however, tend to be extremely short-lived. Once they feel they’ve restored their homeostasis, they go right back to their usual tactics. 

What If A Narcissist Also Has Other Diagnoses? 

Narcissists may also have other mental health conditions, like depression, anxiety, or substance use disorders. Sometimes, these issues drive the narcissist to seek treatment, whether it’s voluntary or involuntary.

However, it often doesn’t take long for narcissistic traits to emerge. 

  • That therapist is crazy- she doesn’t know what she’s talking about! 
  • That psychiatrist is just pushing meds, and he should lose his medical license. 
  • Everyone is overreacting. I’m fine. Everything is fine.
  • I’m never going to drink/use drugs again. I just needed a quick detox.

In treatment settings, they often present as combative, resistant, and impulsive. Even if they make some strides in treating other symptoms, they rarely address their narcissism. 

As a result, they often relapse or regress consistently. Even if they stop one harmful behavior (such as drinking), they may quickly turn to another substitute (such as gambling compulsively or hoarding).

Why Don’t Narcissists Want to Change? 

As mentioned, most narcissists want to maintain power and control. Having these needs met provides a sense of validation. It reinforces the grandiose images they hold about themselves.

Narcissists don’t want to change because they don’t believe they need to change. Instead, they operate under a framework that everyone or everything else is the problem. 

That’s why you probably feel like you’re always the issue- they’ve tried to condition you to believe that you’re making things difficult. As a result, you have probably tried many different solutions to keep them happy (or off your back!).

And because narcissists tend to have inflated self-esteem, they don’t have a problem with their outlandish behavior. They don’t see it as something they should change. And if others have enabled them, they have even more motive to avoid looking inwards. 

How Can You Cope?

Education is the first step towards healing. You need to be able to identify and label the situation. If you suspect someone you love has narcissism, validate your feelings and take the time to read about the symptoms and behavior.

Having this awareness, even if it’s painful, can be grounding. There is a name for what’s going on, and it doesn’t mean you’re crazy, weak-minded, or overdramatic!

Should You Tell the Narcissist How You Feel?

You might feel tempted to tell the narcissist that they are narcissistic. This strategy often backfires. Narcissists will deny their behavior. Or, to make matters worse, they might “roll with the narcissism,” using it as a rationale for all their manipulation. 

In other words, even if a narcissist has self-awareness and recognizes their issues, it doesn’t mean they actually want to change them. In fact, many narcissists take great pride in their narcissism! 

This phenomenon explains why narcissists seem to get such a rise out of arguments or having enemies- as long as people are engaging with them, they feel important. They get the attention and emotions they desperately crave. 

While most of us cower at the sign of interpersonal tension, narcissists often thrive on it. 

How Can You Protect Yourself?

Don’t diagnose the narcissist or tell them they have a mental illness. In a sick way, they may use this terminology to garner your empathy or compassion. They might also simply gaslight you or smear you to other people.

Instead, remain neutral, detached, and objective. Avoid trying to “fix the problem.” Avoid trying to “heal the narcissist.” Most people aren’t motivated to fix a problem if they don’t see one to begin with. The better question is, how long do you really want to stick around? 

You are responsible for setting limits and potentially going no-contact. You can’t control the narcissist’s thoughts or actions, but you can redefine your relationship with them.

Final Thoughts

Is narcissism a mental illness? Yes, but we also need to remember that it’s psychopathy of the personality and part of the dark triad.

Subsequently, having a mental illness doesn’t excuse irrational or abusive behavior. After all, if a murderer has an antisocial personality disorder, they don’t get a pass for killing someone! Even though narcissism may fit a diagnostic label, it doesn’t mean you have to tolerate someone else’s toxicity. 

Even if you feel sorry for the narcissist, you don’t have to enable their choices or behaviors. Doing so only tends to perpetuate your misery or low self-esteem. 

Recovering from narcissistic abuse is hard, and it’s okay to admit you need help. If you’re ready to go deeper now, check out the #1 therapist-approved online program for narcissistic abuse recovery. This program is so effective, counselors and therapists refer their clients to it and it’s also shared in womens’ shelters across the U.S.  You can see for yourself here.


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7 comments
Karen says August 21, 2021

IT TOOK YEAR TO THINK CLEARLY. CONCLUSION A NARC USES PEOPLE AS A CONVIENENCE YOU TO THEM IS ALL THAT YOU ARE. It took a year to stop my guilt that I exploded with anger that my family were not treated with love but always either a convenience or mostly to our sons partner we were all an inconvenience me my husband and his sister who all oved our son but got in the way and used.

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Steven says June 17, 2021

Narcissists are like “The Fonz”. To admit they were wrong would destroy the whole image they rely upon. That would be too great of a loss for them to bear. Imagine “The Fonz” is no longer “cool”.

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Karen says June 11, 2021

Having now found out so much from others about my sons partner I would say they are insane but know what they are doing within their own minds. I truly think they are nuts something wrong with their brains that effects their personality. They have no filter no understanding of behaving in society . They break rules and I would go as far to say they damaged beyond repair.

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Harold lazarus says May 7, 2021

After two & half years at the hands a narcissist I am convince that it’s not a mental illness I have seen and heard and experience things That as Lead me to believe hundred percent it’s spiritual it’s also quite obvious that the old purpose and action of narcissist is un-natural and I believe Definitely un-treatable and Finally there purpose and ways I’m not human.

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    Karen says September 3, 2021

    Not too sure all I do know is that they are immaturely undeveloped they are as a child who screams for attention and demands you put them first like an infant. They do not see themselves this way so yes possible that they have an undeveloped mind and don’t deal with problems in life the same as others who have adapted grown within a logical field of understanding. I will also state that when people of maturity are under stress and act from years of abuse it may appear the same way because the mind is bombarded and sadly even a mature persons logic goes out of the window. Only after getting help but getting out will you start to think clearly. In other words living with insanity can drive you insane.

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Derrick J (LMFT) says May 7, 2021

I’ve been a licensed Marriage and Family Therapist for going on 13 years – I concur that narcissists are pathological and that recovery / change is rare, because they can’t see the truth of themselves.

Having been victimized by a covert malignant narcissist woman who also demonstrated borderline personality traits, I know too well what their tactics are and how far down the rabbit hole they live. It’s creepy in its own right to say the least.

Personally, I think the behaviors of these people should be criminalized and that they should be incarcerated and made to pay their victim(s) restitution.

I’ve seen their antics in too many family cases (divorce, custody etc) and narcissists will use the legal system to punish their victim using the children and economic drain to crush, demoralize and force compliance to their wishes. Judges have no clue and the judges are not interested in learning about this pathology or the consequences upon the victim and the children.

I think Narcs need to be sanctioned and punished for what they do – the question is, how does this get set up?

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    Kim Saeed says May 10, 2021

    Hi Derrick,

    Thank you for sharing your professional opinion. I think many people would love to see narcissists held accountable for the damage they cause on every level of a person’s life. I hope I’m wrong, but I almost believe that the organizations that could do something here in the US aren’t concerned with forward progress, but with maintaining the status quo for financial gain.

    Reply
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