‘You are constantly told you are evil’: Inside the Lives of Diagnosed Narcissists
Narcissistic Personality Disorder (NPD) is a complex mental health condition often misunderstood and stigmatized. While commonly associated with overt displays of arrogance and a need for admiration, experts are highlighting the existence of a less visible, “covert” form of narcissism, and the challenges in both diagnosis and treatment.
According to clinicians, the current diagnostic criteria, outlined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), primarily captures the “grandiose” or “overt” presentation of NPD – characterized by aggression and attention-seeking behaviors. However, this leaves out a important portion of those affected.
“If you make the diagnosis, then it’s made on the DSM-5 guidelines, were it only captures an aspect of narcissism, which is the more overt, sort of aggressive type of narcissism, but it doesn’t capture the more covert or sensitive form,” explains a clinician named Lee.
The “vulnerable” or “covert” narcissist often presents differently,appearing “far more contained,even self-effacing at times,” making them easily overlooked by healthcare professionals. Despite the differing outward expressions, both grandiose and vulnerable narcissism share a core feature: an inflated sense of self-importance. For covert narcissists, this manifests as hypersensitivity to criticism or a tendency towards a victim mentality, rather than a desire for public acclaim. Both types, though, are “different sides of the same coin.”
Social media presents a double-edged sword. While it can be utilized by individuals with NPD “to maintain their narcissism” by seeking “favourable attention or positive feedback,” experts also acknowledge its potential for positive impact. The public disclosure of a diagnosis, such as American comedian Nick Cannon’s declaration of his NPD in 2024, is seen as beneficial. “When a celebrity…comes out with NPD and says it’s causing me problems, that’s a great message,” states Dr. Campbell.
However, Lee cautions against relying on social media for education or support due to the prevalence of “misinformation.” He also points to a lack of “more structured” details,particularly within the UK’s National Health Service (NHS). “The service for narcissistic individuals is very uneven throughout the UK” and “many clinicians don’t make the diagnosis of narcissism,” partly due to a lack of training and partly due to the negative perception surrounding the diagnosis.
Furthermore, individuals with NPD often don’t seek treatment unless they experience negative consequences from their behavior or are encouraged to do so by loved ones, as those successfully navigating life with the condition may not perceive a need for intervention.
experts are advocating for a shift in understanding. Spring suggests that narcissistic behavior is often a coping mechanism rooted in deep-seated feelings of inadequacy. “A narcissist is attempting to believe that they are the best because that is the coping mechanism for feeling like: ‘I am the worst,'” he explains,suggesting a history of feeling like a “villain” in childhood can lead to overcompensation.
Oberdorf emphasizes the barriers to seeking help, noting that the pervasive negative stereotypes associated with NPD discourage individuals from admitting they have the condition. “If you have a problem, and you are constantly being told that people with your type of specific problem are unworthy, or they’re evil, or they’re horrible people as of this problem, why would you want to admit that you have that problem?”
