What Is A Pathological Narcissist?

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The word “narcissism” derives from an ancient Greek myth. 

In it, the young Narcissus, widely known for his great beauty, rejects the love of the nymph Echo. This angers the gods who curse Narcissus, ensuring that he could only love himself. He gazed at his reflection in the still waters of a pond until he died—either from lack of care or by his own hand, depending on the version.

This somewhat chilling tale doesn’t quite adequately describe the full range of what narcissistic personality disorder, or pathological narcissism, consists of, but it gets at the heart of the matter.

It’s important to understand that there are different kinds of personality disorders like narcissism which is categorized as a Cluster B personality disorder. That means it is characterized by dramatic and unpredictable behavior.

Pathological narcissism indicates a disordered mental state wherein the sufferer thinks little of others and highly of themselves, craves constant attention, uses manipulation to serve their interests, and notably, does not believe they have a disorder

To discover the difference between narcissistic behavior and full-blown pathological narcissism, continue reading.

Pinpointing Pathological Narcissism

It’s important to note that pathological narcissism is a fairly rare diagnosis. Most professionals estimate that only 1% to 5% of the broader population have narcissistic personality disorder. There are far more individuals, however, that exhibit some of the symptoms of pathological narcissism, but not enough for a clear diagnosis.

In order to be diagnosed with pathological narcissism, an individual must display at least five of the following characteristics. This is according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (or DSM-5).

  • Displaying a sense self-importance that is clearly grandiose
  • Harboring fantasies of unlimited power, idealized love, unrestrained success, infinite intelligence, and/or unfading beauty
  • Believing in an unyielding sense of their specialness
  • Desiring to associate only with those in positions of power
  • Needing a constant supply of admiration
  • Possessing a clear sense of entitlement with the expectation that even unreasonable demands will be immediately met
  • Taking advantage of others regularly and without remorse
  • Lacking empathy and compassion coupled with an inability to identify with others
  • Exhibiting envy and arrogance

If you or a loved one consistently present with at least five of these symptoms, then it might be time to consult the help of a professional. Read on for more information about other symptoms and possible treatments.

Other Potential Signs of Pathological Narcissism

The list of symptoms detailed above are only the most disturbing and obvious signs of pathological narcissism. There are a whole host of other behaviors that point to narcissistic personality disorder (NPD), though they can also simply be associated with milder forms of narcissism or they might be characterized differently.

Most narcissists have very fragile egos underneath their bluster. Even while they exaggerate their own achievements and denigrate the accomplishments of others, they are terrified that someone will discover their own lack of self-esteem.

They have difficulty with intimacy, either putting on elaborate (and borderline inappropriate) displays of love or remaining standoffish to loved ones. Often, they will initially come on very strong, only to back away and begin to demean loved ones after the romance has faded. Their sense of alienation from others and from social situations is a constant feeling.

They are often quite charming on the surface, but because they have difficulty managing their emotions, they can quickly become defensive or even aggressive when challenged. They are ironically both manipulative and suspicious of others, believing themselves to be constantly under threat. They are preoccupied with themselves to the exclusion of others’ needs.

RELATED: You might also enjoy learning about these simple questions that can help you identify a pathological narcissist.

Ordinary Narcissism vs. Pathological Narcissism

I have found that understanding the difference between people who exhibit some narcissistic behaviors, even frequently, and those who actually have a pathological disorder helps me to protect myself.

Narcissists are common, and most of us engage in some narcissistic behavior on occasion, but those with a pathological diagnosis are harder to treat and nearly impossible to have a relationship with.

Ordinary Narcissism vs. Pathological Narcissism

You have to decide what level of narcissism is acceptable within any given relationship, but do recognize that people with narcissistic tendencies often get along just fine in life. They might be infuriating at moments, but you can handle their self-centered moments and maintain a relationship with them—if you want.

Pathological narcissists, on the other hand, have no other mode of operation. They are in narcissistic mode all the time.

People who display mild narcissism may often be selfish or self-absorbed, but they can also be approached regarding their behavior. They may react angrily or defensively, but they still maintain the capacity to recognize that others have needs, too.

The pathological narcissist sees the world and everyone in it as mere subjects beholden to their needs and desires. They cannot view the world through any other lens.

When pathological narcissism reaches its most heightened state, it can quickly slide into sociopathic behavior without treatment.

What most prominently marks the difference between narcissistic personality disorder and sociopathic disorder is that sociopaths hurt people with clear intention. Narcissists most often do so as a byproduct of their self-centered actions.

Treating Pathological Narcissism

Unfortunately, no clear set of standards for how to treat pathological narcissism have been firmly established. No class of medications has been identified as a specific treatment for NPD, but some patients have responded to antidepressants or anti-anxiety medications. Additionally, counseling can help.

Basically, various types of psychotherapy are the best options for treatment. This can assist the patient in understanding what motivates their behavior, improving their relationships with others, building their sense of self-worth, and adjusting their expectations to fit with reality. It might also help the patient recognize the impact of their behavior on others and learn to take responsibility.

Cognitive behavioral therapy, in particular, has proven to be a treatment that shows some promise with NPD. In this type of therapy, the patient learns to identify their harmful behaviors and replace them with healthier and more positive ones.

Final Thoughts

Diagnosing someone with pathological narcissism is difficult, as the disorder resides somewhere on the spectrum from mild selfishness to nearly sociopathic conduct. Still, there are some common characteristics that allow you to identify a truly significant disorder.

Mild narcissism will not radically impact a person’s daily life and relationships, while pathological narcissism will.

Engaging with someone whose defining personality trait is narcissism can be difficult, even dangerous. Be sure that you protect yourself should you be entangled with someone who frequently exhibits those disturbing symptoms.

With a better understanding of pathological narcissism, it can also help to understand more about how to handle narcissistic rage. You can find out more about that in the article “7 Tips on How to Handle a Narcissistic Husband when He is in a Rage.


If you want more tips for dealing with narcissists, setting boundaries, and managing emotional triggers, make sure you subscribe to my youtube channel


Narcissistic abuse takes a terrible toll on your life. I’m Patricia, and my mother is a narcissist, so I know what you’re going through. These blog posts will help you understand narcissism better and give you tips for dealing with the narcissists in your life. Healing starts here!

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