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The Deceptive Disguise of Narcissism
There has been a lot of talk in the media lately about narcissism and narcissistic personality disorder. You might say it’s the diagnosis du jour among the lay public.
Narcissistic personality disorder was retained in DSM-5, but, like all the personality disorders, took on a dimensional or trait facet. Previously, one was diagnosed as either having or not having a personality disorder; with the revision, it’s possible to diagnose a personality disorder on a continuum of trait domains or facets, not just a list of qualifying personality patterns.
The essential features of a personality disorder are impairments in personality functioning (self and interpersonal) and the presence of pathological personality traits. In narcissistic personality disorder, these personality traits are characterized by:
- Grandiosity: Feelings of entitlement, either overt or covert; self-centeredness; condescension toward others, even while being superficially charming in some situations.
- Attention seeking: Attempts to attract and be the focus of the attention of others; admiration seeking; manipulative.
- The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations.
The holidays bring together people we don’t see often, either at work functions or family gatherings. And at those times, we may be struck by the presence of these narcissistic traits in fellow revelers.
But hold on. What if someone who seems narcissistic and self-absorbed is not charming at all—and in fact is outright rude? And what if he doesn’t seem able to manipulate social interactions, but instead often seems awkward or uncomfortable around others? And what if his rude comments don’t seem rooted in a desire to be mean? In fact, what if he often has no idea why others take offense to what was just a “factual” comment?
These social/emotional deficits bring us to another possibility: Asperger Syndrome. Asperger Syndrome is one of several previously separate subtypes of autism that were folded into the single diagnosis autism spectrum disorder (ASD) with the publication of DSM-5 in 2013. Here are some characteristics of what used to be called Asperger Syndrome:
- Average or above-average intelligence;
- Difficulties in empathizing with others and understanding another person’s point of view; failure to develop peer relationships appropriate to developmental level;
- Difficulties engaging in social routines such as conversations and ‘small talk’; lack of spontaneous seeking to share enjoyment, interest or achievements with other people, (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people);
- Problems with controlling feelings such as anger, depression and/or anxiety;
- A preference for routines and schedules which can result in stress or anxiety if disrupted;
- Specialized fields of interest or hobbies, such as train schedules or collecting obscure types of beers.
The overlap of self-centeredness and lack of empathy can prevent easy differentiation between narcissistic personality disorder and ASD, especially at the milder end of the spectrum. In one study of 54 young adults with Asperger Syndrome, considerable overlap was found among symptoms of Asperger Syndrome and certain personality disorders, especially Cluster A or C and particularly in men. This overlap may make it difficult to address the issues of self-absorption, lack of empathy, and problems with social skills in therapy with adults who have never been diagnosed with ASD and lead to the therapist concluding he has little to offer.
As more children with ASD are being diagnosed and services made available for them, it is inevitable that many adults with ASD who missed being diagnosed and receiving services as a child will come to therapeutic attention. There is a need for therapists to be able to recognize these adults and also a need for social skills training for adults in communities. Although it is more efficacious to find and help young children address social skills, research has shown that social skills groups are generally effective in improving skills of individuals with ASD or high-functioning autism, even adults. One such example is a social skills group for adults in Minneapolis, Minnesota, run by a man with ASD and his partner.
We need more groups like this and more recognition of ASD by therapists, and by society as a whole.
References
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC: American Psychiatric Association; 2013.
Lugnegård T, Unenge Hallerbäck MU, Gillberg C. Personality disorders and autism spectrum disorders: what are the connections? Comprehensive Psychiatry. 2012;53(4):333–340.
Leslie Durr, PhD, RN, PMHCNS-BC is an advanced practice psychiatric-mental health nurse with a private psychotherapy practice in Charlottesville, Virginia.
The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors.
