Is Narcissistic Personality Disorder an Illness?

 

“A choice” you mention? This is where it gets trickier. Yes, they do fully understand right from wrong; they do know how to conceal bad behaviors; they are calculating, and overtly/covertly aggressive. However due to the presence of their disorder they cannot help but behave in very socially unacceptable ways. For them, certain functions (emotionally/ neurologically) operate perfectly, while other functions are very faulty.

 

“Individuals with narcissistic personality disorder constitute some of the highest-functioning patients seen in outpatient settings and also some of the most impaired and intractable…” (Caligor, Levy, & Yeomans, 2014, p 417)

 

Narcissists and psychopaths are disordered in their thoughts (not in the way that schizophrenics are), disordered in emotion processing, and disordered in their sense of self.

Personality disorders just happens to ‘look’ very different from our other mental disorders – they are in a class or category of their own. Their ‘normalcy’ can be difficult to ingest when you simultaneously can see and experience their pathology. But this is what a personality disorder is like.

 

Their horrific behavior is not necessarily a choice when it comes to whether or not they will behave within certain parameters. HOWEVER, they do choose the specific ways they manipulate, harm, dramatize, or abuse others. This is what I want to impress upon you – their chosen behaviors are the choice (a little redundant there) … but not whether or not they will demonstrate the pathology. If they are narcissists or psychopaths, eventually you will see their symptoms (or experience them). They ‘live out’ their symptoms and therefore, the way they treat others is a byproduct of their symptoms. 

 

This illness impacts areas of the brain associated with empathy processing, self awareness, and certain aspects of cognitive processing (e.g., they have a belief system that places them first, superior, and blameless – clearly that is faulty thinking.)

 

Given that this is an illness of the brain, we know what to expect when interacting with a narcissist or psychopath.

Let’s say you tell me there is someone in the next room you would like me to meet. Before I go in, you tell me that she has been diagnosed with narcissistic personality disorder, grandiose type. Before ever speaking to the person, I could easily predict the manner she is going to engage with me. I will know her symptoms, her limiting cognitive distortions, her fragile sense of self, her inability to genuinely connect with me all before walking into the room.

 

 

Because she has a disorder, a mental disorder, that ravages the personality with a certain set of symptoms that will express themselves because they MUST.

 

In that regard she cannot help but lack empathy for me, feel superior to me, feel competitive, dominate the interaction, attempt to make me feel inferior. She may try flattery if that mode of manipulation serves her agenda at the moment. She will be on high alert for my flaws and weaknesses to control the situation or hurt me. Those behaviors are a byproduct of narcissistic personality disorder. I have done nothing more than walk into the room and attempt a conversation; but that will not matter. Because it is not about my behavior or if I’ve done anything wrong – narcissistic personality disorder is the filter through which she lives her life. My behavior or presence did not create her symptoms. In fact, if I demonstrate high empathy and kindness during the meeting, she is more apt to view me as weak, and deserving of her manipulation and disrespect.

 

It is their nature due to the symptoms of that disorder.

 

They cannot turn their disorder off and on – it is personality. They cannot do this any more than someone who is an empathic, compassionate, warm, animal lover could shift to genuine cruelty.  They can choose their behaviors, but they cannot shut off the disorder.

Unfortunately, this will mean they cannot help but not care about you; they all self-enhance; they all externalize blame, and so forth. When they are gaslighting, manipulating, controlling, intimidating, and engaging in hateful behavior – it is a reflection of the disorder.

 

Some have said, “All of that sounds like you’re giving them an excuse! Why are you letting them off the hook? This so called condition is a habit or an addiction or a liking toward being cruel to others. ” (These are actual reasons people have written to me to explain the behavior of narcissists and psychopaths. None of those reasons are supported in the scientific literature.)

 

Unfortunately, some people become upset with psychologists and psychiatrists and assume that because we are categorizing this as a mental illness/ a disorder, we are therefore excusing their bad, perhaps dangerous behavior.

However, I see excuse-making outside the realm of science. We are not here to justify or make allowances for the narcissists’ or psychopaths’ behavior. We seek to recognize it, diagnosis it, and if properly trained, make attempts to treat it.

Psychiatrists, psychologists, and researchers simply describe ‘what is‘ and ‘why‘ when it comes to these conditions. There are certain diagnostic criteria that ‘make up‘ this disorder. Those symptoms are related to how their brain functions and that’s it. Our role and job is not associated with excuse making.

 

Like all conditions associated with behavior, mood, and personality, this condition is related to brain functions. They demonstrate very similar symptoms. This is the reason so many survivors can describe ‘their’ narcissist and feel that most others in their support group are describing the same person. Why? Because it is an illness, a condition, a disorder.

 

Their behavior can be evil, cruel, and frightening.

Their behavior can traumatize people and animals with unspeakable acts.

Because of their patterns, society must have awareness of psychopathy and narcissistic personality disorder. We need to be vigilant, as many pose a risk to our safety. I believe this is a population to be extremely concerned with. I am extremely concerned about the harm they cause not only to their families, but our society as a whole.

 

Discussion of their symptoms and neuroscience is not equivalent to offering an excuse for their behavior. They should always be held accountable for what they say and do. They understand right from wrong and tend to have exceptional manipulation abilities.

Given the symptom criteria of narcissistic personality disorder and psychopathy – I think it would be extremely difficult for this group not to abuse others, particularly the people close to them. It is unsafe, unhealthy, and possibly outright dangerous to be around some of these individuals.

 

 

Please do not put yourself in an unsafe position. Yes, it is sad that they are disordered, but there are doctors out there that work with this population. You cannot change them. Do not risk your mental, physical, financial, health attempting to change them. If this individual is your child, you can try to get them to a mental health professional. If this is your lover … it is safest to cut your ties and walk away in the safest manner possible.

 

In order for people with narcissistic personality disorder and psychopathy to function better they require specialized treatment by a no-nonsense mental health professional, with both parties (patient and doctor) up front about the issue they are treating – narcissistic personality (or psychopathy).

 

Treatment tends to require a tremendous commitment of energy, time, and persistence from them. As many know, given their self-enhancement (“I’m the smartest person you’ll meet.” | “There’s nothing wrong with me”) the likelihood of someone with narcissistic personality disorder entering treatment is low.

 

I hope I answered your question Sue!