Typically a therapist can “detect” a narcissistic client as soon as their first appointment begins. Narcissistic clients often present as well spoken, charming, smart and talkative. They want to demonstrate to the therapist and overtly (or covertly) convey that they are “a good person”.
How is narcissistic personality disorder diagnosed? A mental health professional such as a psychologist or psychiatrist (psychotherapist) can determine if you have key symptoms of NPD. Your psychotherapist will give you questionnaires and then talk with you. You'll go over what's causing you distress.
Covert narcissism traits
Some telling traits associated with NPD include: An over-inflated sense of self-importance. Lack of empathy. A need for excessive admiration.
Draw attention to a narcissist's contradictions to expose them. Malignant narcissists will share incompatible ideas and statements as it suits them. Whenever you spot an inconsistency, nicely comment on it in a roundabout way without being combative.
The therapist must require two things from the therapeutic relationship with a person who has narcissistic tendencies: respect and collaboration. Respect for and collaboration with others is challenging—some might say impossible—for people with narcissism.
They're often introverted, sensitive, and prone to experiencing anxiety and shame. They may also struggle to maintain close friendships as they focus heavily on themselves, require attention, and are hyper-sensitive to perceived criticism.
Based on overlapping symptoms, Borderline Personality Disorder (BPD) and Narcissistic Personality Disorder (NPD) are often mistaken for one another.
Habitual Non-Listening
Ever spoken with someone who responded dismissively to everything you said? Narcissists brush aside or deprecate what others say instead of truly listening.
Narcissists are often in therapy to blame others and build a case for their victimhood. Therapists also report that sometimes the narcissist goes to therapy on their own because they're upset that someone in their life is setting boundaries and limits or has called them out on their behaviors.
“To what extent do you agree with this statement: 'I am a narcissist.'” Scientists believe that this question could be all researchers need to make a quick and easy diagnosis of narcissism.
An often effective way to point out a person's narcissism, while at the same time allowing the individual flexibility to change, is to separate the behavior from the person. For instance, instead of stating “you're a narcissist,” say “you're acting like a narcissist,” or “this [specify the behavior] is narcissistic.”
Key points. Narcissists are fully aware that they are narcissistic and have a reputation as such. Narcissists would rather be admired than liked. Narcissists are masters at making first impressions, leading them to do better with short-term relationships.
Mild: A mildly narcissistic person might be egotistical or boastful about their accomplishments but still function well in society.
Your tears also put the spotlight on you, which is unacceptable for a narcissist. Another reason your tears may anger the narcissist is the fact that they may feel controlled by your tears. After all, they often use their own tears to manipulate and control others.
They sometimes lead to the Serotonin syndrome, which includes agitation and exacerbates the rage attacks typical of a narcissist. SSRIs do lead at times to delirium and a manic phase and even to psychotic microepisodes.
This means someone living with narcissistic traits may cry from regret or remorse, but not with empathy at its source. They may feel embarrassed, for example, about being criticized for their part in a distressing situation. They may feel sadness or regret that whatever happened paints them in a negative light.
Narcissistic personality disorder involves a pattern of self-centered, arrogant thinking and behavior, a lack of empathy and consideration for other people, and an excessive need for admiration. Others often describe people with NPD as cocky, manipulative, selfish, patronizing, and demanding.
There are three facets of narcissism: agentic, antagonistic, and neurotic.
They have a sense of entitlement and expect favorable treatment. They take advantage of others to achieve their goals. They lack empathy and don't try to identify with the needs of others. They envy others or believe others envy them.
Typically, if you're really, truly a narcissist, you probably won't really know or be able to recognize that you are one. And if you do realize that you're pretty self-centered, you might not think that there's anything wrong with that.
People with narcissistic personality disorder tend not to perceive that they themselves may have a mental health problem, and thus may be less likely to seek evaluation or treatment.