What is narcissism, really? A therapist explains

Published August 1, 2024 by Zencare Team and written by Yuen Chan, LCSW.

Narcissism is a term in our cultural environment that tends to get overused, weaponized, and misappropriated, especially on social media platforms. This is probably because being able to classify a very confusing problem can feel relieving to the general public. In reality, however, the literature on narcissism is wide and vast, and a singular blog post such as this cannot possibly do justice to the ways in which mental health clinicians understand narcissism — the origin of it, the face of it, how to diagnose it, and what happens once you have a so-called diagnosis. My hope is that this blog post will convey the complexity of the issue to prevent name-calling and weaponizing, and to humanize those who really do have narcissistic problems.

How is narcissism “born”?

Narcissism is actually an appropriate developmental stage, which Sigmund Freud termed primary narcissism. When the infant is born, they are solely focused on their own internal state as a means of survival. The baby comes into the world without any awareness of the external environment — for them the only reality they know are the bodily cues that are generated internally. Of course, once outside the womb they are subjected to the environment and all its attendant stimuli which in turn affects how they feel inside — we’ll call that “external reality.” The primary caregiver helps the baby manage their internal stimuli by attuning and intuiting the baby’s needs, which the baby communicates through crying, kicking, cooing, fussing, trying to make eye contact, sucking, turning their head away, etc.

The role of caregiver and environment

When caregivers accurately read baby cues, infants develop a sense of agency and capability. This crucial step in self-formation shows babies they're important and can effect change through communication. Positive reinforcement of their cries for connection helps them view reality as benign, encouraging exploration. A nurturing environment is essential for risk-taking and curiosity.

Sometimes, due to factors like depression, illness, or poverty, caregivers struggle to respond appropriately. When cues are missed or misinterpreted, babies may perceive reality as unhelpful or hostile. This mirrors back that their needs are unimportant, shaping their developing sense of self. Trust is broken, leading to paranoia and nervousness.

This "felt experience" informs personality development. From this trauma, the child becomes hyper-vigilant, manipulating their environment to meet needs and learning to trust only themselves. Shame arises from the implicit understanding that they should be cared for. The personality develops around self-love as a coping strategy, manifesting as grandiosity, externalization of problems, and fault-finding in others—hallmarks of narcissistic personality development.

The development of personality

We develop our personalities from birth, needing to believe in our parents' goodness. When parents can't provide adequate care, children often blame themselves, preferring to believe in their own badness rather than feeling helpless to their circumstances.

Narcissistically fragile individuals grow up believing safety comes from controlling their environment and others, as they perceive external reality as chaotic and harmful. They retreat into an internal reality where they can narrate a story that portrays themselves as good. Compensating for deep feelings of brokenness, they hide insecurities through grandstanding and bragging.

Healthy intimacy requires a shared reality where one can acknowledge failures and apologize. However, narcissists view the world in black and white, either idealizing or devaluing others. When validated, they idealize; when confronted with their perceived worthlessness, they become outraged. They desperately attempt to maintain their self-image as good by dismissing or devaluing others, making others the "bad guy" to preserve their role as the "good guy."

Normal narcissistic problems

When we apply for a new job, ask someone out on a date, go back to school, begin a new job, it’s appropriate for the sense of self to feel exposed, and even the sturdiest among us will employ psychological defenses at those times to help our sense of self remain stable. The true narcissist will use all manner of tactics, but the main one is they try to compensate for their feelings of inferiority by inflating themselves, making themselves look big in order to manage the feelings inside of being very small, which is equated with intense humiliation related to their needs feeling like “too much” to be dealt with. This looks like:

• Pretending not to care
• Dismissing the importance or the impact of rejection
• Stoicism
• Externalizing and blaming everyone else for their situation
• Rewriting history to make it seem like they were victimized

It seems easy to spot but not everyone who has had difficulty in their early environment will develop NPD, and narcissistic fragility undermines many other diagnoses such as schizoid personality disorder, borderline personality disorder, and even obsessive compulsive personality, eating disorders, addictions, to name only a few.  Also, all of us at times will use the above mentioned defenses to help ourselves feel less vulnerable, so just because you see that happening doesn’t mean someone has NPD.

Perfectionism and narcissistic fragility

Perfectionism, common among those without NPD, exemplifies how people manage narcissistic fragility. Striving for perfection attempts to avoid the shame of errors, despite its impossibility. "I should have known better" is the perfectionist's mantra.

Narcissistic fragility exists on a spectrum. Some higher-functioning individuals lead successful lives but remain internally conflicted, overly reliant on external validation. This existence is exhausting, like living in an invisible war zone without hope for peace.

Consider celebrities with seemingly ideal lives—wealth, fame, beauty—yet plagued by suicide, addiction, and crippling insecurities. The sense of self is deeply personal, not necessarily reflected in outward appearances.

Covert narcissism or the “people-pleaser”

To complicate matters, some people deal with a deficient environment by becoming controlling caregivers themselves, and this form of narcissism is usually referred to as “people-pleasing,” or in Swiftie terms the “covert narcissist.” This is harder to recognize because often the person appears almost selfless, they are overly accommodating, agreeable, likable people.  They come off as “chill” but I would underscore that intimacy is always a tough negotiation of conflicting needs, so if someone isn’t able to communicate any of their needs they are likely using similar control tactics as the charmer, but in the inverse.  They want to look like they are good, selfless people, even though they control by negating or denying their own needs. The problem often lies further down the line because they harbor resentment that their needs are never being met and that can lead to ruptures such as:

• Infidelity
• A sudden breakup that seems to come out of nowhere
• Explosive fights that are triggered by a seemingly minor detail
• Passive aggressive comments
• Constant victimization (black and white thinking around perpetrator vs victim — most of us are both)

No matter how things feel at first with a new love, friend, or boss, a true sign of a person’s capacity to engage in healthy intimacy is when you have conflict. It is only at this point will you be able to see how a person reacts when the self comes under attack or stress. If you see emotional withdrawal, hyper-defensiveness, extreme anger, or even the inability to fight at all, you might have someone who struggles with narcissistic fragility, or has a fragile sense of self.

Healthy narcissism and healthy entitlement

A healthy sense of entitlement allows one to ask for needs while understanding they can't always be met. Limits aren't seen as personal rejections. This requires an internal self-soothing mechanism, developed from a good enough childhood, to navigate conflicts over competing needs.

Healthy intimacy balances closeness and distance, dependency and autonomy. A sturdy self withstands "attacks," maintaining continuity even when facing errors. It distinguishes honest oversights from character flaws, allowing for apologies or constructive conflicts.

Normal fights involve heightened emotions. Showing anger doesn't necessarily indicate emotional dysregulation. Relationships with those having a fragile sense of self can be healing, so don't dismiss all people with self-related baggage.

Our culture's perfectionistic view of mental health is problematic. Some relationships have toxic parts, and sometimes enduring strain is part of life and love. Mental health should be analyzed individually, not prescriptively. Mental illness isn't fixed; like physical health, it fluctuates. During difficult times, the mind may need help through rest, therapy, or connection with loved ones. Normalizing mental illness as a fact of life can help manage shame and encourage seeking help when needed.

A word on diagnosis

It’s important to underscore that a mental illness diagnosis is not and cannot fully encompass the whole humanity of a person. People with NPD are full humans, they have complex needs and are themselves products of a failed environment.  However, once they become adults they can be dangerous and unsafe to be close to, and it’s okay to keep or maintain a safe distance.  Often emotional closeness activates the terror of dependency and people can overreact in frightening ways.  Adults (not children) are ultimately responsible and accountable for their toxic, abusive behavior. At times, many people will slip into a toxic response, so what you need to look for is toxicity over time. An occasional slip up where a person calls you a bad name, or overreacts does not a narcissist make. It is the inability and rigidity of relating to another over time that describes the true narcissist.  

What to do next

If you identify with any of the above described internal struggles, it’s very important to seek help with the right mental health practitioner. In my experience, treatment requires an intensive multi-weekly cadence with an experienced clinician because it requires more than just understanding you have a diagnosis, one must recreate a feeling of healthy, safe dependency in order to break through the defenses and to give the person a new experience and perspective of how intimacy can feel enriching, warm, and safe, even in the face of disagreement.  This relationship can heal the fractures of the problems related to the self so that intimacy, one of the most thrilling parts of what it means to be human, becomes possible.