I recently watched a new documentary entitled Narcissist’s Playbook: Empathy Not Included. While the arc of the documentary was informative, both times I watched it, I found myself questioning whether the people portrayed were actual narcissists. I wonder: What happens when we use narcissism as the explanation for abuse? And what is the difference between a clinically diagnosable disorder and pervasive personality traits? Narcissism is obviously having a pop culture moment. The construct in which it was clinically intended has been shifting to the broader social audience—with that comes a broader meaning. Where narcissism has been historically used as a personality disorder, we now seem to be using the term loosely in order to describe an asshole, a selfish person, an abusive person, a manipulative or self-absorbed person. When it comes to using the language of narcissism, it might be more helpful to get clear in naming the abusive behaviors narcissists often engage in.
Even as a clinician trained in assessment and diagnosis, I have not always felt comfortable using the Diagnostic and Statistical Manual (DSM-5) to diagnose personality disorders. What I do feel competent in is identifying both Intimate Partner Violence (IPV) and abuse, which are often rooted in a need for power and control over another. Whenever I hear folks talking about what a “narcissistic society” we are (simply because people might be seeking validation on social media platforms), what comes to mind is that not all abusers are narcissists. However, almost all narcissists engage in abuse.
What is Narcissistic Personality Disorder (NPD)?
Narcissism is often discussed in terms of grandiose and vulnerable presentations (Durvasula, 2024). Grandiose narcissism may be more overt and characterized by an inflated sense of self, entitlement, and a need for admiration, while vulnerable narcissism can present with greater sensitivity to rejection, shame, and threats to self-esteem (this is where more subtle coercive abuse tactics are often used). I also find it interestingly ironic that beneath narcissistic presentations can be significant vulnerability around self-worth, shame, unlovability, and rejection. Narcissists are often haunted by a deep insecurity and a fragile self-esteem that needs constant praise (Durvasula, 2024).
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), NPD is defined by:
“A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the [9] criteria:
- Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
- Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
- Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
- Requires excessive admiration.
- Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).
- Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).
- Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
- Is often envious of others or believes that others are envious of him or her.
- Shows arrogant, haughty behaviors or attitudes.”
People can be dick-ish, treat others with utter lack of human decency, present as uncaring, evil-intended, manipulative, forceful, demanding, dehumanizing, inflated in ego, or aggressive. But those characteristics alone do not equate to them being an actual narcissist. In many conversations today, narcissism is seen on a spectrum. The spectrum and language being applied (especially in this documentary) can begin to water down the actual diagnostic criteria for NPD, blurring the lines around how one ought to navigate someone with these symptoms and even what hope might exist for someone who fits the criteria. This is where I find the lens of abuse to be more helpful.
Concerns With the Casual Use of “Narcissism”
1. It can obscure the actual behavior. Blanket assumptions or universal terms applied to human behavior can take away from the actual behavior that is happening, thus writing patterned behaviors off quickly or lacking insight into what is happening in any given dynamic.
2. It can become blame-shifting. Often, in individual therapy, one might start to frame their unhappiness as blame. If they are quick to deem the other a narcissist, it becomes a convenient way to avoid their own contributions by deflecting responsibility back onto the supposed narcissist.
3. It can become clinically and ethically problematic. Mental health diagnoses require appropriate clinical assessment. Diagnosing someone who is not your client and whom you have not observed or assessed, is inappropriate. When a clinician speaks publicly about narcissism, I think it is important to distinguish between educating the public about recognizable narcissistic patterns and making a clinical diagnosis of a person whom the clinician has not directly assessed. That distinction matters ethically and clinically. This type of treatment can leave little room for change in a relationship and justify avoidant tendencies. Some abusers will even name their victims a narcissist, while engaging in a one-sided smear campaign.
When Using the Narcissism Lens Can Be Helpful
I often use my clients’ language in sessions. If clients start to learn about narcissism, they might begin to label their partner or family members as one. When this happens, I support the client and adopt their language, but I often let them know that it is more within my scope of practice to address the abuse (power and control, internalized misogyny, lack of boundaries, coercive or emotionally abusive dynamics) and the impact that that abuse has on them. I find this approach gives clients more resources and specific, detailed language to help identify what is happening to them and what the impact is on them. This specificity of behavior allows clients to start to look more clearly at what is happening, what their interactive role might be, and the impact it all has on them (i.e., high levels of confusion, boundary violations, low self-esteem, self-doubt, chronic fear, walking on eggshells, loss of self, imbalance of responsibility, lack of change, feeling too needy or that their mental health is the real problem, etc.).
For example:
They don’t pay child support → financial neglect
They repeatedly tell you that you’re imagining things → gaslighting/manipulative behavior
They monitor your whereabouts → controlling behavior
They isolate you from friends/family → social isolation
They repeatedly threaten to leave unless you comply → coercive behavior
They threaten to kill themselves if you leave → coercive control
They refuse to acknowledge your emotional experience → emotional invalidation
They use money to control access to resources (or don’t allow you to work or go to school) → economic abuse
One of the greatest markers of narcissists is that they are not likely to change (Durvasula, 2024). Once clients are able to see that there is no hope for change or accountability with an abusive partner, they are then able to engage in the next step: either a) leave or b) radical acceptance. Choosing radical acceptance requires clear boundaries, less reactivity toward an abuser’s tactics, fewer attempts to defend or clarify, and accepting loss of connection or safety moving forward in that relationship. Because there is more talk and more literature on the concept of narcissism, I do think it has allowed people to become more educated and less tolerant of abusive and harmful tactics they experience in relationships.
Despite these benefits, I will continue to use the language of domestic violence/power and control rather than labeling people with personality types. It might help to note that personality describes patterns within a person, whereas power and control describe what is happening within a relationship.
IPV As a More Helpful Way to View Abuse
With IPV, there are more resources available. We have come a long way in understanding relational abuse. As a result, there are ample resources available to survivors (such as websites, hotlines, legal ramifications, less social pressure to stay, and more services available). When it comes to NPD, research remains limited in the field of Psychology (American Psychiatric Association, 2013).
With IPV, there is more specificity. Specific behavior equals specific outcome. If you just write off his lack of paying child support to mean that he is a narcissist, it limits. His failure to pay child support is an actual act of neglect toward the child and toward his responsibilities. Using precise language to hone in on the behavior allows us to identify the impact in a more accurate way, thus exploring what may be more accurate solutions. The clearer we can see and talk about these behaviors, the more folks are able to identify them as red flags, decrease tolerance for them, take action against them, and protect themselves from them. A person may be engaging in gaslighting behavior, but that does not mean they are a narcissist. A person may be self-inflated, but that does not mean they are a narcissist. A person may be surrounding themselves with people who only align with and agree with them, but that does not automatically mean someone is a narcissist. By sifting out behaviors rather than generalizing a certain personality trait, again, we are able to talk about these experiences more directly and accurately.
Closing Thought
All this to say that perhaps this topic is both/and. I participated in a training on narcissistic abuse last fall, hosted by PESI and led by Dr. Ramani. This means that clinicians are taking a closer look at abuse through the frame of NPD. Both abuse framing and NPD framing do great things to help raise awareness and decrease harm. I am open to ongoing discussions around these topics and am overall happy that we are decreasing our tolerances for harm against others, while increasing the need to hold others accountable for the harm they cause. Perhaps in this process, we might be able to distinguish between NPD and narcissistic traits as we talk about our experiences of others. I don’t think we need fewer conversations about narcissism, but that we may need more precise ones.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.
Breaking Chains LLC. (2026). Narcissist’s Playbook: Empathy not included [Film].
Durvasula, R. (2024). It’s not you: Identifying and healing from narcissistic people. The Open Field.
The Word Mill 