This is something that people caught up in toxic relationships agonize about and spend months or even years ruminating over. Is the person I’m with a narcissist or not? Are they just a bit moody/impatient/rude/insensitive etc? How can I tell? How can you diagnose a narcissist?
People caught up in abusive dynamics want certainty above all else – they just want to know for sure that the person they’re with is a narcissist, perhaps because they feel this is what will give them the permission to leave the relationship. Unfortunately, it’s usually not that simple and we don’t get the certainty we’re looking for, but there are still ways of diagnosing narcissism and narcissists.
If someone consistently displays at least 5 of the 9 traits of NPD as defined by the Diagnostic and Statistical Manual (DSM), then they can generally be considered a narcissist. However, formal diagnosis can only be done by a mental health professional.
However, we realize that formal diagnostic criteria can be wordy, technical, hard to “pick through” and also hard to apply and see examples of in terms of how the person actually behaves in real life.
Therefore, we’ll follow up with some other more “informal” suggestions and criteria for diagnosing narcissists in your life, plus an important re-framing of the entire issue to pull one step back from formal diagnosis, and simply ask broader questions about the person’s abusive behavior that can help readers to see the issue in clearer terms.
Using The 9 DSM Traits Of NPD
One of the most widely used formal diagnostic criteria of narcissism is the Narcissistic Personality Disorder (NPD) classification, as defined by the Diagnostic and Statistical Manual (DSM):
Here are the 9 formal traits of NPD, as per the DSM-5:
- A grandiose sense of self-importance
- Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
- Believing that they are “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
- Requiring excessive admiration
- A sense of entitlement (unreasonable expectations of especially favorable treatment or automatic compliance with their expectations)
- Being interpersonally exploitative (taking advantage of others to achieve their own ends)
- Lacking empathy (unwilling to recognize or identify with the feelings and needs of others)
- Often being envious of others or believing that others are envious of them
- Showing arrogant, haughty behaviors or attitudes
If a person consistently displays at least 5 or more of these 9 traits across time and contexts, they can be considered by the DSM criteria to have Narcissistic Personality Disorder.
Therefore, if a person is display a majority of these traits, they can be considered to be a narcissist (bear in mind though that there are other diagnostic criteria).
Formal Diagnosis of NPD Can Only Be Done By A Professional
It’s important to caveat the criteria covered in the above section by saying that formal diagnosis of NPD can only be done by a licensed mental health professional well trained in the Cluster B personality disorders (the category of disorders to which Narcissistic Personality Disorder belongs).
Formal diagnosis of narcissism is not really for “armchair” psychologists or people not trained in psychology/psychiatry or diagnosis. Moreover, victims of narcissists and narcissistic abuse are often so confused by all the gas-lighting and other toxic behaviors they’ve been subjected to that they can’t even distinguish reality from fiction anymore, such has the abuse distorted their perception of reality.
In other words, it’s not really for people “caught up in” this abuse to make the diagnosis (we’ll offer some much simpler criteria further below).
Moreover, there are some other caveats and problems with this issue of “diagnosing” personality disorders such as narcissism:
- NPD needs to be formally diagnosed by a trained professional, but narcissists will rarely ever submit to any kind of therapeutic process (in the rare cases they do, it’s a strategic move in the moment and never sincere or genuine). Cluster B disordered individuals in general are characterized by a sense of arrogance, superiority and entitlement, and don’t believe there is a anything wrong with them in the first place.
- The DSM criteria isn’t the only diagnostic criteria, and there is widespread disagreement even among experts about the origin, structure and diagnosis of personality disorders.
- Related to this, diagnoses will often differ between different therapists – one professional may diagnose NPD and another may not. Plus some therapist are not even properly trained in personality disorders.
- Even if a narcissist does go to a therapist and is diagnosed as having NPD, it won’t make any difference to their behavior. None of their toxic patterns will change, and they’ll often arrogantly rebut and reject the diagnosis (their personality is built on denial). A disordered person can never be made to change by telling them who or what they are, or giving them a formal diagnosis of their disorder.
Therefore, this whole area of diagnosing narcissists/NPD and personality disorders in general is fraught with problems. If as a person you’re so “caught up” and confused in a toxic entanglement with someone that you don’t even know what to believe any more, it is advised to find a suitable therapist to discuss the issue with.
Important Reframe Of This Question
Because of the problems with formal diagnosis, and the confusing and distorting effect that narcissistic abuse can have on victims it can be useful to pull away from diagnostic criteria, and frame this issue in a different way.
This superb video from Richard Grannon re-frames this entire question in a way that’s very important to consider – why does getting a diagnosis even matter, and why are you even asking this question? If a person is abusing/hurting you and not stopping, that should be plenty a strong enough signal.
Reformulating This Issue – Formal Diagnosis Doesn’t Even Matter (Important Video)
Here are 3 simple alternative criteria to use when deciding whether to leave (not formally diagnose) an abusive person:
- Is the person being abusive or not?
- If yes, is this a consistent pattern of behavior that’s been displayed across time? (not just one-off)
- If yes, have you or someone else asked them to stop, and have they failed to stop?
If the answer to all three of these questions is Yes, then you may leave the relationship. Formal diagnosis of personality disorders like NPD, ASPD, BPD is irrelevant and doesn’t matter. It seems logical that any healthy person would seek to leave any relationship that’s abusive if they can.
This is a very important re-frame that’s worth considering for anyone getting “hung up” and ruminating over whether or not a certain person matches the criteria for NPD or another personality disorder, and in the process continuing to endure abuse instead of getting out.
If they’re treating you badly consistently and they’re not stopping, that’s enough! You don’t need to ask any more questions or engage in “diagnosis” (some people waste months or years on this). You don’t need to also have to waste time “explaining the basics of human decency and respect to a grown adult”, as one author in this space puts it. This person is abusive and you should end any relationship you have with them if you have the ability to do so.
More Signs You’re With A Narcissistically Abusive Person
Notice I use the term “narcissistically abusive person”, because there are an increasing number of people in the modern world who may not qualify as having a full blown personality disorder such as NPD, but still act at times as though they do, with the same patterns of toxic communication and other abusive behaviors. Again, diagnosis is not important in this sense.
Here are some other things to look for, broken down into a few different categories:
5 alternative (older, more traditional) terms that can describe narcissism from the embedded video above (from Richard Grannon):
- Egomania – Ego comes first and foremost in the person. Very self involved, self obsessed and ego driven – narcissists are always on an ego trip, “scoring on points” with people, always looking to “one up” and “win” over others. Will be triggered and react in a rageful, disproportionate way if their (fragile) ego is slighted.
- Fantasy – Actively engaged in fantasy (not purely sexual, but the traditional, wider connotation of a fantasy image of oneself or others). Relentlessly fantasising and day-dreaming over their own self perceived importance and “greatness”, their own grandiose image of themselves Partly covered in DSM trait #2.
- Moral deviance/degeneracy – Also what used to be covered by the term “psychopathy”, (it used to be a broader term in past times). Living their lives in a way that is conspicuously absent of any kind of proper moral/ethical standards or boundaries.
- Psychosis – I’d back this one up based on my own experiences. A full blown narcissist’s identity is so firmly built on the defense mechanism of DENIAL that they can actually be argued to have a psychotic break with reality. Also when in extremely intense rage reactions/break-downs, they will seem to be psychotic in the sense they aren’t perceiving reality accurately any more. Narcissists often willingly form their own psychotic delusions and try to bring others into this delusion.
- Con Artistry – The manipulative/conning trait is often reserved for the Psychopathy Checklist, but is applied to narcissists here also. Refers to the overly charming, seductive, smarmy, smooth-talking traits present in many narcissists, designed to manipulate others into giving them what they want. You won’t find many narcissists without any ability to charm and “sweet talk” others very effectively. With narcissists, it’s all about image and effect, not substance or reality.
Some other signs in the person that I would add to this:
Denial/Projection – If you constantly find yourself butting against the two defense mechanisms of denial and projection, it’s a huge red flag for Cluster B personality disorders. Narcissists continually deny reality with a completely straight face, and also project onto others what they’re doing themselves, or traits which actually belong to them.
Gas-lighting – If you find the other person consistently saying things didn’t happen when they did (or vice versa), or weren’t said when they were (or vice versa), and you have proof and documented evidence they’re wrong, this is known as gas-lighting and is a psychological abuse tactic designed to erode a person’s grip on reality. If you see this happening systematically and also increasing (narcissists/sociopaths often gradually ramp up the gas-lighting over time), then you’re right away in pathological personality territory with the person doing it, and it is advised to dis-engage.
Provocative & Reaction Seeking – This is another common trait with all Cluster B disorders, including narcissism. These people are always seeking to provoke and goad others into emotional reactions, since this is what “feeds” or “inflates” them. Look out for someone who always seems to be trying to provoke you, put you on the defensive, or get you into an irritated or agitated state with their behavior. Also watch out for someone who seems to get a “kick” or “rise” out of upsetting you in some way (you’ll often see smirking with Cluster B disorders).
“Custer B is the .. definition of reaction seeking or dramatic personality disorders. This is not ‘I want to go away and sit on my own in my room’, this is ‘I need to annoy you to live. I need to hurt you to feel OK. I need to cause chaos and drama wherever I go just to feel basically alright’”.
Some things to look for in yourself that can also be signs:
Looking for Answers – A clear sign that reading this blog article is probably part of. See this excellent video. Bottom line – If you’re asking the questions “is this abuse? Is this person I’d dealing with a narcissist? Is this narcissistic abuse?” and searching online for answers – that’s your answer. It is!
Mindset Changes – Once a narcissist starts ramping up their abuse, you will see negative changes in your own mental state. You’ll be less calm, composed and easy-going, and more moody, impatient and possibly depressed. Your relationships with other people apart from the abusive person will often also deteriorate; you’ll find yourself more isolated. You’ll also see an increase in rumination, where you’re pondering, wondering and going-over interactions/conversations in your head (searching around this topic online is one part of that). Watch out for an increase in these negative states, especially if they didn’t really characterize your overall makeup before you met this person. Overall, narcissistic abuse will pull you out of the present moment and your body, and more into your head and thoughts (rumination, numbing, dissociation and detachment).
Somatic Changes – Feeds in to the mental changes. Narcissistic abuse does pull you out of your body and can lead to numbness if prolonged, but in the earlier stages, your body will tell you something is wrong with this person. If you’re observing a growing sense of dis-ease and distress manifesting somatically (in your body), that’s another crucial sign of narcissistic abuse and dealing with a disordered person. Can include heightened anxiety, difficulty sleeping, health/immune issues, an excessive “on edge” alertness, especially when around them. With Cluster B abuse, there can also be this weird alternating pattern between worry/panic and a strange calmness, that will break you down over time (don’t be fooled by the calm “lulls”). Palpitations and other strong reactions whenever the phone rings is also another classic sign. Pay attention to your “gut feel” and intuition. In more technical terms, intuition can be defined as your body/somatic space communicating with you non-verbally.
Some Other Tests For Narcissism
Here are some other method of testing for narcissism/NPD in a person, both formal and informal:
Narcissistic Personality Inventory (NPI) – An alternative or complement to the DSM 5 criteria that measures and assesses narcissistic traits. A quicker and more economical questionnaire based assessment criteria, with the NPI-8 proving quite effective. Grandiose Exhibitionism (GE) and Leadership/Authority (L/A) are two personality traits especially focused on. An alternative to the DSM-5 but still quite technical and formal.
Growth Question – A simple, more informal test, that I think came from one of Richard Grannon’s seminars – just ask the narcissist, once you’ve got to know them: “in what way would you grow or change?”. And wait for some stupid, ridiculous answer, that isn’t even a proper answer. Narcissists, and the Cluster B disorders in general, have zero concept of growth, change, maturing, vocation or evolution. They’re superficial, concerned only with image/effect, and strictly power and emotional reaction fixated, and therefore any kind of growth or change in the deeper sense of the word is meaningless to them. And this will reflect in the really silly answers they give to this question. More generally, it’s often impossible to ever have a serious, sincere, meaningful discussion with a narcissist, because they don’t know how to. I had this experience when I asked a narcissist: “what do you need to let go of in life?”. His answer – “I dunno, a dog lead?”. Hopefully you get the idea.
The Smiling No Test – Also comes from Richard Grannon. Narcissists hate being told no or rejected, so doing this to them, but also while maintaining a calm, cheerful demeanor yourself, is a sure-fire way to irritate them and make them show their true colors. Just try repeatedly saying no to them, in a calm, composed way, not being drawn into further engagement (broken-record), while also smiling and remaining cheerful. If the person you’re dealing with is a narcissist, this will draw a rageful response from them.