When Does Self-Confidence Become Narcissism

Hello, and I am your host, Dr. Valda Crowder, also known as Dr. V. I'm a board certified emergency medicine physician committed to empowering you about important health information. We are going to talk about Behind the Mask, Understanding Narcissism. This is a two-part show because I believe this is such an important topic. So the word narcissistic or narcissism is used pretty loosely these days. I hear people use it related to an ex, a boss, a friend, someone they're no longer dating, but there is a real clinical picture behind this word. And most people who get called a narcissist may have narcissistic tendencies, but may not actually have the actual diagnosis. And there are people out there that actually fit the pattern who never get called out at all. So today I'm gonna really break it down to say what actually is narcissism, how is it diagnosed, what are the different types, whether men and women exhibit it differently. And then next Monday, which will be part two, we'll go in depth a little bit further and we'll talk about what are the red flags to watch for, what to do if someone in your family or friend group is exhibiting these tendencies, how it's treated, and how these traits can show up in the headlines of our news, and also in leadership, possibly in the companies that you work for. So let's start first with narcissists and the term narcissism. So narcissist was a Greek mythology figure. He was an extraordinarily handsome young man, and he often rejected the affection of others. He became captivated by his own reflection in a pool of water, and he could not pull himself away. So he got closer and closer to this pool of water so that he could get closer and closer to his own beautiful, handsome reflection, and that led to him drowning in the pool of water. And that is how the term narcissism has come about. Narcissism can be a lot of different things. You can have people that have just personality traits that are a little narcissistic, you can have a pattern of interpersonal behavior, you can have psychological characteristics, you can have pathologic or maladaptive patterns where people may be responding to something that they dealt with growing up. And then you can actually have diagnosable narcissistic personality disorder. So let's start first with the full thing. So the full thing is narcissistic personality disorder. It is estimated to affect somewhere between 1 and 6% of adults. Um, and it is not really, you know, what you run into day and day and day. It is a true diagnosis. It involves a lot of dramatic, emotional, and erratic behavior. To meet the criteria, someone needs to actually show a long-standing pattern. Um, and often that pattern has been present since early adulthood. It can include grandiosity, um, a need for admiration, and is also importantly associated with a lack of empathy. And when we have certain traits that we use to actually diagnose narcissistic personality, and there's nine traits, and I'm gonna go through them. In order for someone to be diagnosed with narcissistic personality disorder, they have to meet five of the nine traits. So, trait number one is a grandiose sense of self-importance. Trait number two is a preoccupation with fantasies of unlimited success, unlimited power, brilliance, beauty, or maybe some ideal love. There's also number three is a belief that they're special. They can only be understood or can only associate with other people of special or high status category. Number four is there's a need for excessive admiration. They're always looking for either a compliment or a crowd clapping for them or something along that line. Number five is a sense of entitlement. And with this sense of entitlement, they actually expect favorable treatment, they expect automatic compliance from other people, or they may expect that the rules do not apply to them. Number six is interpersonal exploitation. So, what you will find with this is that they will often take advantage of others to get what they want. So there's a manipulation component to this. Um, and some people, if they're in relationship with a narcissist at the end of their relationship or at some point in time during their relationship, they'll look back and realize I was really manipulated because this person wanted to get X, Y, and Z from me. Uh, number seven is a lack of empathy for others' feelings and needs. Um, so they're very much into what they need themselves, but they're totally uninterested and may not even recognize that someone else has feelings or someone else has needs. Uh, number eight is an envy. Uh, they frequently have an envy of other people, or they may have a belief that other people are envious of them. Uh, number nine is you may see arrogant or haughty behaviors or you know, very attitude of um, I'm better, I'm better than everyone else. So to actually have the diagnosis of narcissistic personality disorder, those are the nine characteristics. You have to actually meet five of those characteristics in order to get a formal diagnosis of narcissistic personality disorder. And and I remind people, narcissistic personality disorder is actually diagnosed by a psychiatrist, someone who's finished medical school and actually gone through the clinical uh training to actually distinguish it from other things that can sometimes look a bit a bit similar. So let me tell you what some behaviors that are not uh narcissistic personality disorders. Um, you know, you may have people who enjoy compliments, that by itself is not narcissistic personality disorder. Uh, you have people sometimes that are very proud of their accomplishments, or they they like attention, or they want to be liked. Um, you have folks sometimes that post a lot of photos of themselves, um, or they may have a high level of confidence. So these are not, this is not narcissistic personality disorder. Narcissistic personality disorder, again, are five of those nine characteristics that I actually uh went through. So, just as an on-air reminder, this is a full clinical diagnosis. It is not a checklist for labeling people in your lives, um, it's an actual diagnosis and it requires a licensed clinical provider to actually really evaluate the person and actually make uh that diagnosis. It is not something that we do by looking at someone's Twitter feed or Facebook feed. Narcissism doesn't just show up one way. So, this is the other reason why it's really important that it be diagnosed by someone who is a clinician, because there are several different types of narcissism. Um, and when I go through them, you know, you can kind of hear and feel the difference and the distinction. So the one that people probably notice the most are the grandiose or what we call the overt narcissist. This is a classic version of narcissism. They're outwardly extremely confident, extremely dominant, uh, they may feel entitled, um, they're uh attention-seeking. Um, they may be extremely charming at first, but they can quickly turn into mean and nasty. Um, the grandiose narcissist um will sometimes even put themselves on the level of of God or historical figures. Um, they will also um very much want to name things after themselves. You will see where that's very, very important to a grandiose narcissist because they want all of the outward projection of themselves and who they are. Then we have what we call the vulnerable narcissist. Also, some people call it a covert narcissist. This patient this person may present as a little bit more insecure, they may seem to be easily wounded by criticism, and their grandiosity lives more internally. Um, they may have private fantasies about superiority rather than perform things out loud. So, one thing about a covert narcissist, a covert narcissist will often be someone that can actually say, I'm sorry, but a covert narcissist is still highly manipulative and will use others to make himself or herself look better. Um, then you have a malignant narcissism. Um, this is a grandiose narcissist or the or the overt narcissist that we talked about earlier, um, but it can be uh associated with very antisocial traits. So they may be aggressive, they may be paranoid and think that people are constantly coming after them. Um they may be uh potentially more harmful to others. Um they they sometimes have some component of um harm either to themselves or harm either to others in order to actually uh get what they're interested in getting. Lastly, there is a communal narcissist, and this is someone whose self-image is really built upon being unusually generous. So they are either unusually generous, unusually moral, unusually selfless, while the underlying drive is still admiration and self-it self-importance rather than genuine altruism. So, a little bit about the research on narcissism is there's really no rules for one particular person. It can kind of present in a lot of different ways. Um, there's been a lot of meta-analysis uh over the decades, and what it has found is that men tend to, on average, score somewhat higher on the grandiose narcissism overall, um, especially on entitlement and willing willingness to exploit others. Um, where when it you look at things like vanity and the other forms of narcissism, you'll find that it will be um equally distributed um between uh men and women. The vulnerable or or the covert subtype of narcissism also does not really show a gender gap. And research researchers think that a lot of times covert narcissism gets missed, um, particularly in women, um, because when someone will um say they're sorry um or show some remorse, um, some people actually um miss that as uh narcissism and they think of narcissism only as sort of the the chest thumping um demanding, commanding um narcissist that actually feels like they're all powerful. Um socialization is really a big important piece of this. Um I remind people that often our our culture actually rewards dominance uh and rewards people that are overly confident. Um, so you'll find that this behavior is often very much associated with success, and narcissists can be found in very high positions in the government, in corporations, um, and um they can sometimes be rewarded for these behaviors. All right, it looks like we've got a caller on line one. All right, Dr.

Myers, you'd like to join this conversation? Yes, yes, thank you. This is very interesting. Uh we have one prominent individual who fits the category you're talking about right now in the White House. Yes, and I'd be interested to see if Yeah, would you uh for people that might have a personality like that in their family, how do you deal with a personality like that? What are the ways that you can interact with them or help them not be so self-centered?

Yeah, so so well a couple of things. So so narcissism is a little bit more than being self-centered because they're not only uh self-centered, but they're manipulative and they um they can have a lack of empathy, right? And also a lack of insight. So one of the things that you'll find with a narcissist is that um I tell people don't ever tell a narcissist there's an they are a narcissist. Okay, they're going to, they're gonna reject any diagnosis or any labeling, particularly from a family member that's not a clinician. So often what happens with narcissists is this type of behavior leads to um some negative outcomes. And as a result of those negative outcomes, they may wind up in a psychiatrist's office. And it's usually in that setting that they actually begin to grapple with some of these things. But when you actually have a narcissist in your family, the last thing you should do is call them a narcissist to their face. That will actually lead to what we call narcissistic rage, and they will actually become defensive, they may become retaliatory, and they may actually become violent and dangerous. So I think that's really the most important thing that I would tell people if you're dealing with this sort of person, um, the main thing is don't tell them they're a narcissist. The second thing I would say is to recognize that they're really only motivated if there's something in it for them, right? So, and then you have to set up boundaries such that you're not manipulated. So, a lot of times if people have narcissists in their family, they have experienced being actually manipulated by the narcissist. And you have to figure out sometimes how to create some boundaries and some distance so that you're not manipulated. And then they have to go on their own personal journey around sort of figuring out what's going on with them and actually getting the help that they need.

Does that help? Oh, thank you. Yes, thank you very much. And just one last question before I hang up. So, can a narcissist become violent? You said they could have rage? Absolutely. Could that be a person that could be a domestic violence perpetrator?

Abs ab absolutely. Absolutely. So so let me the so the basic fear that leads to a narcissist is that they feel like they are not good enough. So internally or at their core, a narcissist is extremely insecure. And so they create this outward persona of, you know, I am exceptional or I am powerful or I am all knowledgeable or I am the most beautiful to sort of cover up their their insecurity. So they have a very, very fragile sense of self-esteem. So they can't, that's why they cannot admit a mistake. So when you you're talking about, you know, the narcissist that we that we all see in the news very frequently, cannot admit a mistake. Because a mistake then means that they're being exposed for the inadequate person that they fear that they are. And when you begin to expose who they really are, they can absolutely go into narcissistic rage. And like I said, that can include denial, it can include anger, blaming, defensiveness, retaliation, and it can also include violence.

Wow. Well, thank you so much for that information. Very helpful.

Thank you. All right. So uh to hear more of today's topics and other critical health issues, listen to my podcast, What the Health is Happening. That is where we are giving you the inside scoop on health matters from breaking news to life-changing medical updates. It is available on all podcast platforms, What the Health is Happening. Please download and subscribe today. You guys have been downloading and subscribing, and I want to thank you because we are now in the top 10 on Apple Podcasts in the United States. So I really, really want to appreciate you guys getting on there and getting this information. All right, we're just gonna do a quick segment here on news you can use. So we're gonna talk about narcissistic leaders. This was a study that came out and narcissistic leaders and how they are more likely to fight remote work. So this was a new study that came out this year, and the title of the study is called Worship Me at the Office Altar. It's published in the Journal of Organizational Behavior and Human Decision Processes, and it found that leaders who scored higher on narcissism were also more likely to publicly oppose remote and hybrid work arrangements. Researchers surveyed hundreds of leaders and then ran a follow-up experiment testing how a narcissistic mindset shaped attitudes towards flexible work arrangements. The theory being that an in-office mandate doubles as a stage for the narcissistic leader to be seen and to be complimented and to be admired. So this is worth remembering next time your boss insists that everyone be back to work five days a week. All right, I'm gonna take a couple of questions that we got emailed uh that I got emailed to us. And Todd asks, is narcissism something that people are born with, or does it come from how they were raised? So this is an interesting question, and so we don't really have the complete answer to this. And what what we have found is it seems like narcissism does not have a singular cause. So there are genetic tendencies, there's temperament, there's environment, and there's all of these things that really play a role. So one of the things that we have found, though, is in the parenting. So excessive praise of children as they're growing up can lead to someone actually having more narcissistic tendencies. And also you can have narcissistic tendencies associated with someone who has excessive criticism growing up. So there's no there's no attachments, there's there's there's no real single cause, but these are some of the things that we're actually um sort of seeing. I think that this is an area that's going to be investigated further. All right, we've got a call on line one. Hello. Hi, Danielle. Hi, how are you, Dr. B? How are you? How are you?

I am fairly lately.

Good, good, good, good.

This is just amazing hearing what you were saying about narcissists. And it is kind of um almost like just about everyone can have a little bit of narcissism in them. I guess narcissists, then it was like, oh wow, well no, that's not me, or that's not that person, that's not that person. And I love how you add it in, but don't go on people's Facebook pages and don't go to your family members and friends labeling them narcissists because you need that diagnosis from a clinical psychiatrist, which makes a lot of sense. And um, so Dr. Um Dr. Meyer said some of the things I was going to add first to clear that up, but what you just stated as well about um enforcing people to come back to work and to be seen, it's almost like they need to have that power and control.

Right.

And so that's what I took from that as well, the power and control. And sometimes, I don't know if different family members and friends we call different people narcissists all the time, or if someone's in different relationships, and it sometimes doesn't go right or wrong as a narcissist, is not necessarily from when you explain the whole, you know, platform of what a narcissist is when you took it, you know, all the way through. It just seems like some of these people are just interesting or being well as opposed to uh a real live narcissist.

So so I tell people that, you know, a difficult personality or someone who is selfish or self centered, it does not rise to the level of a narcissistic personality disorder. Right? Somebody can just be, you know, a difficult personality. That doesn't necessarily make them someone who actually has a narcissistic personality disorder. I think one thing that's important is someone with a true narcissistic personality disorder. Really doesn't have any control or insight into this behavior. There's a true lack of insight. And we kind of see that on the public stage on the news, like the lack of lack of insight and a lack of awareness of how they're actually being um how they're portraying themselves and how they're being received. See a narcissist really doesn't care how they're being received.

Yeah. Well, we look at some of them on a regular basis.

Right. Right.

So thank you so much. This is very informative, and I'll definitely share this with individuals who couldn't make this call.

Okay, you're welcome. You're welcome. All right. I got another call, another question here from James, and I thought this was really an important question. And he said, Is narcissism the same thing as psychopath and sociopath? And so, no, it is not. And this is also why um it is really, really important that a clinician diagnose, because psychopathy and sociopath can also be associated with some forms of uh grandiosity. So they sometimes can also have um a really grandiose uh feeling. So I I just wanted to just show just share a little bit, you know, sociopath is a uh another term, and I have probably need to do another show on sociopath because that's another term that people actually throw out a lot. And someone who is a sociopath is what we call antisocial personality disorder. They have a true disregard for anyone else's rights, anyone else's uh feelings. Um they manipulate, they lie, they deceive, they have a very high high sense of being very, very impulsive. They usually have are engaged with uh the criminal uh the criminal system uh at a very young age. Uh before they are 20 years old, um they usually have been either incarcerated or arrested or in some way, shape, or form involved with the criminal criminal justice system. Um they also um are very unlikely to uh be able to um like go to college or finish college because there's such a disregard for structures. And then psychopathy is where someone has a real lack of remorse or a callousness, um, and they have less impulsivity, um, so they're able to control their behavior a little bit more, but they will often also have some grandiosity. Um, and so I I bring that up because a group of um a group of psychiatrists actually, based upon uh our president's behavior, um, actually uh listed him as high on the level of psychopathy. Um and I think somewhere around 35 or 40 psychiatrists uh felt that um he's not mentally uh mentally stable enough um to be in the position uh that he is in in our government. Um and they sent a letter to Congress regarding that in 2017. I will actually uh talk more about that on uh on the show on Monday. So alrighty, I want to thank you guys for joining us today. Um again, if you want to hear more about these types of topics, make sure to join me on the podcast, What the Health is Happening. Narcissism isn't just an insult, insult to throw around, it is a real spectrum and a real disease with a very specific clinical definition. And knowing that definition helps you use the word more carefully and spot when real when it really, really matters. Um, we'll be back next week to talk about narcissism part two. Um, and in that I'm gonna talk about the red flags to watch for, um, what to do, some more about what to do if someone's in your family or friend group, and how these traits show up in leadership and in the headlines. I want to thank you guys for joining me. If you have any topics that you want me to discuss, please make sure to reach out to me at info at askdrv.us. That's info at askdrv.us. Thank you for joining me today.