Understanding Narcissism with Grace Tworek, PsyD

Podcast Transcript

John Horton:

Hello, and welcome to another Health Essentials Podcast. I'm John Horton, your host.

Today, we're going to spend some time talking about narcissistic personality disorder, or NPD for short. It's a topic that's as fascinating as it is misunderstood.

Now, you might be thinking, "Oh, I know a narcissist or two." But do you really understand what the term means? Because odds are you've been using it incorrectly and maybe even a little meanly. So we're going to explore NPD from its defining traits to the reasons we should think twice before calling someone a narcissist.

Psychologist Grace Tworek is with us once again to help break it all down. She's one of the many experts at Cleveland Clinic who join us weekly to offer insight into the human experience. So with that, let's dive into the many nuances of narcissism.

Dr. Tworek, thanks for coming back on the show. I always know we're in for a great chat when you're on the schedule.

Dr. Grace Tworek:

Thanks so much for having me. I always love the topics that you guys bring, so I'm happy to be here and share.

John Horton:

Well, today's topic is a good one, and we're obviously here to chat about narcissism. And talk about narcissism, it seems to be at an all-time high in the social media-driven days. I've even seen what has been called an epidemic by some in the field. Is that a fair analogy, or is that just some online clickbait?

Dr. Grace Tworek:

That's a great observation, John, and something that I hear quite often and even see myself in my own social media feeds. So I would say that increasing access to information on mental health, while that can be a positive thing, it can open up doors for people to have conversations that maybe they wouldn't otherwise have. It can also lead to portrayals of mental health in social media that create this idea that something is becoming more prevalent or it's more evident in society than we've ever seen before. But we have no true evidence that rates of narcissism are increasing at a significant rate in society currently.

John Horton:

All right. Well, that's good to know, I guess. So we're starting in a good spot. So as we dig in here, and we've got a lot to cover, let's start with just a basic question, and that's, what is narcissistic personality disorder? Or I guess, thankfully, they shorten it to just NPD.

Dr. Grace Tworek:

So narcissistic personality disorder, or I will also be using NPD as well-

John Horton:

…It's a mouthful. It's a lot to spit out.

Dr. Grace Tworek:

…It's a long one. It's a mental health diagnosis, though, within our Diagnostic and Statistical Manual of Mental Disorders. Also another mouthful, so we refer to that as the DSM. So NPD is under our umbrella of a category that we call Personality Disorders, and it comes with nine different criteria that we would use to formally diagnose someone.

These nine criteria demonstrate what we call a pattern of grandiosity, a need for admiration and lack of empathy that begins typically in early adulthood and is present across a variety of different contexts or situations in one person's life. Folks don't necessarily need to experience all nine of these criteria, but they must experience five of them to meet criteria for diagnosis by a mental health professional.

John Horton:

So nine would be overachieving. So five, you're in, is what I'm hearing.

Dr. Grace Tworek:

Yeah.

John Horton:

All right. Well, look, let's walk through that list of nine criteria or characteristics. Where do you want to start?

Dr. Grace Tworek:

Sure. So typically, the way that these are listed in our DSM really just starts just like that, a list of nine. So why don't I walk through all nine of them for you, list them out and say what they really mean to us, what we're looking for.

John Horton:

That's perfect.

Dr. Grace Tworek:

So number one would be a grandiose sense of self-importance. So what this really means is someone demonstrates a tendency to maybe exaggerate achievements or expects to be recognized as being superior to others even without commensurate achievements. So they might not have actually had those achievements, but they expect others to recognize them as being special or different.

John Horton:

That seems like the classic definition that most people have. That's just that inflated ego sort of thing.

Dr. Grace Tworek:

Exactly. And that is one that we see or hear about often, but it's actually only one of these nine criteria.

Our second point or criteria is fantasies about having or deserving. So this individual may be preoccupied with fantasies of having unlimited success, power, beauty or love. So they have these fantasies that they deserve these things and that they should come to them.

John Horton:

What, they actually make stuff up? I mean, to show that or describe it?

Dr. Grace Tworek:

Sure. So they may make things up or they may believe things to be true that others around them might not be quite connecting those same dots. So they might believe something is true, but in reality, those things that they're expecting or these fantasies that they have are not truly based in reality.

John Horton:

Well, let's go… What's number three?

Dr. Grace Tworek:

Sure. Number three is a sense of self-superiority. So truly just that belief that they are special or unique and can only be understood or should only be understood by people who are also special and unique or people that have high status in society.

John Horton:

So it sounds like a trait of that would be you're constantly thinking people are below you, too, and you might talk down to people a little bit.

Dr. Grace Tworek:

Sure. You may talk down and you may truly believe that only somebody at, quote-unquote, "your level," or somebody who we would see as maybe being, for example, a celebrity would be able to understand what you're going through.

John Horton:

All right. Well, number four.

Dr. Grace Tworek:

Sure. Number four is a need for excessive admiration. So it requires admiration at a high rate from others, and this might actually be experienced by other people in their life as being quite exhausting. So you may feel like you need to empty your energy cup or your empathy cup or your love for others cup fully into this person.

John Horton:

Somebody who always needs a little extra, to be told that they're doing well or fabulous or appreciated.

Dr. Grace Tworek:

Exactly. You hit that right on the head.

John Horton:

Well, moving on… Number five.

Dr. Grace Tworek:

So a sense of entitlement. So this person may have unreasonable expectations of favorable treatment or believe that others should automatically comply with their expectations. So if someone is not following maybe a rule book or an expectation that they have, it would almost seem unfathomable to them that this person would not do something in the way that they expect.

John Horton:

So these are the sort of folks that when they say something, they just expect that everyone is going to accept it and go along.

Dr. Grace Tworek:

And perhaps maybe they should already know that that's the rule.

John Horton:

All right… Number six.

Dr. Grace Tworek:

So this would be exploitative behavior. So taking advantage of others to achieve their own ends. And oftentimes, this comes with a little bit of awareness that they're being exploitative or taking advantage of others, and knowing that ultimately, their own ends or their own needs might be seen as more important than those of others.

John Horton:

Yeah, I think we've all kind of been where you feel like you're manipulated by somebody else in order for them to get what they want.

Dr. Grace Tworek:

Exactly. Exactly. Kind of climbing that ladder and not caring who you leave behind.

John Horton:

All right. Well, number seven.

Dr. Grace Tworek:

So this would be a lack of empathy where this person seems unwilling to recognize or identify with the feelings or needs of others. And that unwilling is an important word in terms of they may not be willing to listen or hear somebody else out.

John Horton:

Yeah, that seems like it goes hand in hand with the exploitative behavior right ahead of it.

Dr. Grace Tworek:

Exactly. Exactly.

John Horton:

Okay, number eight.

Dr. Grace Tworek:

Number eight: frequent envy. So when we think about envy, this can mean they're envious of others or even a belief that others are envious of them despite maybe not having a whole lot of evidence that others truly feel that way.

John Horton:

And then our final one on the list… Number nine.

Dr. Grace Tworek:

Number nine is arrogance. So this person might frequently demonstrate arrogant behaviors or attitudes, just that haughty behavior that maybe they are above, better than, more deserving to be in that situation than other folks around them.

John Horton:

Well, you laid those out beautifully for us. And when we were talking about if you're officially diagnosed with NPD, you would meet five of those criteria. What does “meet that criteria” mean? Because I think if all of us are honest with ourselves, we've probably all shown glimpses of some of those nine at a point in our lives. But when is it that you consistently do it enough where it should be part of a diagnosis?

Dr. Grace Tworek:

Yes. This is a very good question and a very important part of the overarching diagnosis of NPD. So like I said at the beginning when I was first introducing NPD, we need to see these criteria — so maybe not all nine — but five of those criteria as a pervasive pattern. And that word “pervasive” is important because that pattern needs to be demonstrated across this person's life in multiple different contexts. So not only at home, maybe at work, maybe in their social life, and it needs to impact their functioning in these different domains. So it's important for us to recognize that this pattern needs to be seen in multiple different areas because sometimes, a certain person's behavior may shift with a certain person in a certain context. But these traits will be seen across the board, and usually, beginning in early adulthood, we will see that pattern as pretty long-standing and pretty consistent.

John Horton:

As people age, will these traits become even more pronounced?

Dr. Grace Tworek:

So that really depends on the person and depends on their willingness to ask for help if they're noticing that this is impacting them negatively. So this can really depend on access to resources that that person has and perhaps if they have a support system in their life of someone coming to them and saying, "Hey, we are noticing these things." Or maybe perhaps they notice them themselves.

John Horton:

And if you do notice them, I mean, I guess, how do you connect those dots and maybe reach out to someone?

Dr. Grace Tworek:

Sure. So connecting those dots might look a little bit different for each person, but if you're starting to notice that maybe there's a pattern of others saying they don't have enough energy to give you based on what you're needing, or you're noticing others are pulling away, or your relationships in multiple different areas in your life are not as fruitful as they once were, or you feel like you're not getting enough from others when they're telling you that they're giving all the energy that they can or that they're not able to give what you're requiring, this might be a good sign that speaking to a mental health professional could be a really good way to gain some insight into some different skills, through either individual or group therapy, that might help these symptoms or experiences to feel more manageable, and might actually improve the relationships that you have in your personal, work or social life.

John Horton:

Well, now let's talk about the usage of the term “narcissist,” which I know, we all see all over the place. In your view, is it used incorrectly?

Dr. Grace Tworek:

There are definitely important differences between the use of that term “narcissist” and the actual diagnosis of “narcissistic personality disorder.” So, oftentimes, we hear the word narcissist being used for folks who may be selfish in nature, but not always for folks who would actually meet diagnostic criteria for NPD. So like I said, folks with NPD must demonstrate this behavior consistently, beginning in early adulthood, across lots of different areas in their life.

So they're going to behave this way in different settings with different people in their day-to-day lives. It's going to be pretty consistent. And it's important that we recognize that somebody who might be behaving selfishly or maybe treating us unfairly would likely recognize if we were to tell them that they hurt us or that they aren't behaving in a very fair or kind way, that they might be able to level-set with us, have a conversation, and we might be able to see, "OK, this was maybe a one-time thing. I don't see them doing this all the time toward me, or there might be other areas of their life where I've never seen them behave that way." And that's how we can really create those differences.

But ultimately, that word “narcissist” can be kind of overused and isn't always fair if our outcome is to try to have a fruitful conversation with the person that we consider a friend or a loved one.

John Horton:

Well, yeah, and it's usually used just in a very negative way, too. I mean, you're not usually calling somebody a narcissist as a compliment. So I take it that's also something people should think about before they just toss the word out there.

Dr. Grace Tworek:

Absolutely. That term in and of itself can be really harmful and stigmatizing. Using that word “narcissist” or labeling someone with NPD can be really hurtful because NPD is a mental health disorder, and by giving someone this label, they might be shaming them, which can be really damaging to their overall well-being. And if we're not trained to diagnose someone, we may actually be pushing them away from mental health services. They may feel ashamed or they may feel fearful of reaching out to somebody who could be really helpful for them.

But if you are really concerned about someone in your life, you can always offer support — resources — and that will be enough to open up that conversation without using a label or a term that could be hurtful.

John Horton:

So no name-calling, which seems like a good rule of thumb for everything in life. So we definitely take that away from this discussion.

Now, let's switch gears a little bit and talk about how folks should interact with someone who shows narcissistic traits. What's the best approach in dealing with them?

Dr. Grace Tworek:

If you're finding yourself interacting with someone who might demonstrate these types of traits that we're speaking about, there's definitely some ways that we can approach these interactions effectively. These can include setting boundaries. So if you're finding that you have someone in your life who's requesting more time or more energy than you're able to give, letting them know that you have limits, and letting them know what those limits are and that you can only give them what you're able to, and hoping that they'll be able to respect that. And if they aren't, maybe that opens the door for another conversation.

Showing empathy as well. Recognizing that this individual might experience distress if you're not able to give them what they're hoping for. So if you're able to show empathy to someone without giving up your own needs, hopefully, we can strike a balance. And even showing them some support. So being willing to listen can go a really long way for somebody. If you open up the door to having that conversation as you feel comfortable, this might provide that person with a safe space.

And of course, this does not mean providing mental health treatment or giving more energy than you're able to to this person. But if they do express interest or need, you can maybe suggest they speak with their healthcare provider or even reach out to a mental health provider who's qualified to provide those services to them.

John Horton:

Are there even times where it might be a good idea to step away and give yourself a little bit of a gap between you and that person, just so you can reset and maybe, to use the term you keep using, “refill your cup,” energy cup?

Dr. Grace Tworek:

John, yes. Absolutely. If we are finding that somebody is causing us to stress or, like I said, taking more out of that cup than we can give, sometimes, that boundary means that we need to set aside space. And maybe that means, "Hey, I care about you a lot, but this is negatively impacting me, and I need to make sure that I am taking time for myself to take care of myself, too, because I'm also a person that has needs." So sometimes, that does mean walking away, and that might mean that you have to let them know that "I need some space. I need some time. Yes, I am here for you, but there are resources that are meant to help you. And unfortunately, I can't be that right now."

John Horton:

If someone is listening to this podcast and they've just heard all those nine traits, and they're seeing themselves in that and they think they may qualify as having NPD, what kind of steps can they take? What resources are out there that they can access?

Dr. Grace Tworek:

If you're tuning in and you find that these traits resonate with you, the most important thing to know is that you're not alone. There are mental health professionals who can provide a space to share about these experiences, to give you tools to help make these symptoms feel more manageable, and to just give you a place to process those experiences where you know you'll be safe to share. And there's a variety of different treatment options available.

This might be individual therapy or even group therapy options, but the most important part of seeking any sort of therapy or working with a mental health professional is making sure that you feel comfortable with that person, that you can open up and that you can share with them. And that doesn't always happen the first time you meet with a mental health provider.

So if it's your first time and it doesn't quite feel like it clicks, it's OK to try again until you feel that click with a provider that you feel like you could really get along with and really share with.

John Horton:

It sounds like it's a really big step to take. So if you go to do it, give yourself a little bit of grace and know that it's going to be a process.

Dr. Grace Tworek:

You're so right. And I often refer to any form of therapy as a journey. This is the first step in that journey, and each and every one of those steps is important. So give yourself a pat on the back, know that you're headed in the right direction, and if you need a little bit of space or a little bit of self-care after taking that step, that's OK, too.

John Horton:

Well, to wrap things up, Dr. Tworek, are there some common misconceptions about NPD that we should probably try to debunk?

Dr. Grace Tworek:

I like that. I think that's a good way to wrap things up. I think one of the largest misconceptions is that we can diagnose someone if we're not trained based on one single situation or one context in which we've seen a person. People are very dynamic, and when we're in stressful situations, sometimes, people aren't always acting as their best selves or at their 100%. So maybe give people a little bit of grace. But if you are noticing a pattern that's harmful to you, harmful to others, or that you feel concerned about, it's OK to offer support, it's OK to offer resources. And sometimes, that's the best thing that we could do.

John Horton:

Dr. Tworek, thank you so much. I have to tell you, every time you come on, I always feel uplifted after talking with you for a little bit and just ready to go out and tackle just about everything. So thank you, again, for making some time to come in here. I can't wait to have you back.

Dr. Grace Tworek:

Thanks so much, John. I really appreciate that, and I love being here. And I look forward to coming back soon.

John Horton:

Thanks a lot. Bye-bye.

“Narcissism” isn't just a buzzword to describe someone with an inflated ego. It's an actual medical diagnosis. And using the term as a mean-spirited jab just isn't productive. Understanding that may be the key to helping you better handle relationships with anyone who shows a few narcissistic tendencies.

If you liked what you heard today, please hit the Subscribe button and leave a comment to share your thoughts. Until next time, be well.

Speaker 3:

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