A psychiatrist explains narcissistic personality disorder, and offers strategies for managing relationships with narcissists.
This week on Health Matters, Courtney talks with Dr. Warren Ng, a psychiatrist at New York Presbyterian and Columbia, and the Community Health Director for the Center for Youth Mental Health at NewYork-Presbyterian. Dr. Ng explains what makes narcissistic traits distinct from narcissistic personality disorders, and offers an in-depth explanation of the symptoms and management strategies for navigating relationships with narcissists, whether colleagues, friends, or family members.
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Dr. Warren Ng is a psychiatrist for children, adolescents, and adults with an interest in HIV, public psychiatry, and family issues. He is the Medical Director of Outpatient Behavioral Health and the Director of clinical services for the Division of Child and Adolescent Psychiatry at Columbia University Irving Medical Center and NewYork-Presbyterian/Morgan Stanley Children's Hospital. He is also the NYP Behavioral Health Service Line Clinical Innovation Officer. He is the President of the American Academy of Child and Adolescent Psychiatry and has been past president of the New York Council on Child and Adolescent Psychiatry. He served on the Assembly and the Council on Children, Adolescents, and Families at the American Psychiatric Association (APA).
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Dr. Warren Ng: When I think of the narcissistic personality disorders, there's no sugar: meaning that there's no shame, there's no understanding, there's no guilt, and there's no apology and no remorse.
Courtney: Welcome to Health Matters, your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I'm Courtney Allison.
The term narcissist is used a lot these days - on social media, in the news, in conversations with friends. It's often a casual label we use to describe self-centered behavior - but narcissism is also a clinical disorder, and it's important to understand the difference.
This week, Dr. Warren Ng, a psychiatrist with the Center for Youth Mental Health at NewYork-Presbyterian, explains the characteristics that make up narcissistic personality disorder. We explore symptoms, and learn strategies for navigating relationships with narcissists, whether family members, colleagues, or friends.
Courtney: Dr. Ng, welcome to Health Matters. It's so great to have you here again.
Dr. Warren Ng: Thank you so much, Courtney.
Courtney: So, today we want to better understand narcissism. It's a word that’s so commonly used and we all probably think we might have a narcissist in our life. So let’s start with the basics: what exactly is narcissism?
Dr. Warren Ng: That's a great place to start. First we have to understand the terms and the words. One of the things that I often think of is narcissism can be thought of as a state or a trait. So thinking about, I can be narcissistic at this moment, but does that make me a narcissistic person? And those can be two different answers. So just being narcissistic at that moment, some of the definitions could be: very self-oriented, I could be very grandiose, but the question is, is that, am I like that most of the time or all of the time? And so we can be narcissistic in the moment, any of us, but not all of us are persistently narcissistic.
Courtney: And so I hear you're saying it seems like there's a difference between narcissistic behaviors and narcissistic disorders. So is there a clinical term if someone is diagnosed?
Dr. Warren Ng: Yes, there is. And I have to say that being a psychiatrist, we use a lot of different terms. And so one of them is narcissistic personality disorder. The definition of a narcissistic personality disorder is really someone who exhibits usually five or more of these different characteristics, usually beginning in early adulthood.
One is grandiosity, the second one is excessive admiration. The third one is arrogance. There's also a fantasy of success, power, or beauty, as well as a sense of being very special or unique. They also have a sense of entitlement as well as can be interpersonally exploitative, and also lack empathy, and is often envious of others and believes that others are envious of them.
And so I think of it as the one G, two A's, two S's, and the four E's. So I generally think of it as gassy. So when you're gassy and feeling uncomfortable, hey, maybe the person around you might have a narcissistic personality disorder,
Courtney: We all might have some of those traits sometimes, but having five or more kind of puts you in the clinical term.
Dr. Warren Ng: Yes, five or more. And it needs to be a pervasive pattern of behavior. So over months or years.
Courtney: Do you know roughly how many people might have narcissistic personality disorder? How common is it?
Dr. Warren Ng: That's a great question and there should be better studies on this, but the ones that I'm referencing are the ones that are in community samples in the United States, and there's an estimated, probably ranging from zero to about 6% of adults who might exhibit narcissistic personality disorder. And in those interviews, it's interesting that the gender difference between them is that even though there's approximately 6.2% of the community, 7.7% of them are male, and 4.8% of them are female.
Courtney: So more common in men.
Dr. Warren Ng: More common in men. And when we think about narcissism and narcissistic behaviors, how are, uh, males and females socialized, and some of the behaviors that I mentioned, whether or not it's grandiosity, admiration, arrogant success, like, do we tolerate that more in men versus women, or different people in different roles? We also live in a society that really celebrates the culture of narcissism. So whether or not it's in celebrity status or whether or not it's really in our social understanding of who gets the gold medal and who wins versus loses. And so I think we generally think about like, how does our culture or society also reinforce some of these, these kinds of behaviors.
Courtney: So we've gone through some of these symptoms. If you suspect there's someone who has narcissistic tendencies in your life, what are the telltale signs?
Dr. Warren Ng: Well, generally, people who are narcissistic or narcissistic personality disorders are often thought of as very difficult. So I think of the Ds and I generally think of the four Ds, difficult being one of them. But they're people who often deny things that are going on, or your version of the story. They also dismiss your concerns because they're really focused on themselves. And they also devalue you. So they're the only star in that universe and there can't be any other except for them. And they also can be destructive and or have a temper when they don't get their way or they don't get what they want.
Courtney: I love all the acronyms you use, the Ds, GAASSEEEE, these are all helpful to remember.
Courtney: So it sounds like it, it could be a difficult person. What's important to know when navigating these relationships if you suspect someone has these four D's?
Dr. Warren Ng: You know, I think the most important thing is really to protect yourself. And when we think about protecting ourselves, it's often acknowledging the fact that you might be in a quote, difficult situation. And first you wanna make sure that you're safe and that there is something that you can do about the situation so that you don't feel trapped or stuck.
And some of the things that I often think of people trying to do is to manage your expectations of this person. They're not going to change. They are going to be very focused on themselves. And also what we often think of is setting some boundaries. We often think of like, what are your casino rules? Like what is your exit strategy? Like, when will you sort of cut the bait? And I think it's important to have those kind of thoughts to consider.
Courtney: I appreciate your emphasis on protecting yourself and it seems like these are good strategies to try to avoid getting hurt.
Dr. Warren Ng: Exactly. And I generally think of another acronym when I think of the narcissistic personality disorder or someone who has those traits is that there's no SUGAR. So no sugar, meaning that there's no shame, there's no understanding, there's no guilt, and there's no apology and no remorse.
So when you're in a situation where there's no SUGAR, start wondering, you know, I deserve some sweetness in my life. And I might be in a situation with someone who has a narcissistic personality disorder.
Courtney: I love that we do deserve sweetness in our life. That's a beautiful guiding principle to try to follow. And so it sounds like boundaries are really important. How can you set boundaries to protect yourself and stay in touch with those parts of our lives?
Dr. Warren Ng: That's a great question, and some of those boundaries, we think of boundaries as what is the space or that line in between myself and the other person.
And I think sometimes acknowledging that I won't let anyone treat me this way. I won't let anyone devalue or upset me, or I won't make anyone make me feel less than. And so setting up some internal boundaries is very important in understanding that you have the power, you have the choice, and you are important.
The other boundary that you can set is really setting up a boundary of like how much time you're gonna spend with someone. Because the important thing to remember is that when you're with someone who has a narcissistic personality disorder, you're not going to change them. They will only change if they want to change and so the idea of us changing them is, is really a myth and a fallacy.
Courtney: These sound like really smart strategies to manage 'cause it just sounds like it's accepting they won't change and how can you look within yourself to manage it and protect yourself.
Dr. Warren Ng: And that's what's most important—taking care of yourself, acknowledging that you're important, that you matter. I think one of the things that is so harmful about being in a dynamic or relationship with someone with narcissistic personality disorder is that they encourage us to lose ourselves because they're the only person in the room. And so that's why it's important that keeping and maintaining a healthy sense of yourself. And that's acknowledging that your feelings matter and that you matter. And also fostering a support network of people who care about you.
And I think one of the things that's important to acknowledge is that there's sometimes the relationships we choose and then the, the ones that we were born into. When we're in relationships that we don't choose, our family or, or others, then those are the ones that we have to really navigate carefully and to manage your expectations, protect yourself, and sometimes setting up some internal boundaries about how much we're willing to give them and how much time we're willing to spend, because we don't want to be in a relationship where we are getting hurt or making us feel less than.
Courtney: So you mentioned some of the different relationships that can be impacted by narcissism and the family. I'd love to spend some time there. How are family relationships impacted by narcissists?
Dr. Warren Ng: I think within families, it's important to acknowledge that sometimes when we have a parent, who has a narcissistic personality or a trait, it really affects how we experience being a child of someone in that relationship. And just to be mindful that generally we may have been ignored, overlooked, undervalued. It's important to be able to give yourself that time and also not to kind of recreate those sometimes problematic parenting styles that are not always healthy, encouraging, validating, and supportive.
If you're in a relationship with family such as a sibling or others, then sometimes we wanna make some decisions about how much time we spend with them, what are our internal boundaries, and what are some of those internal limits that we set on that relationship.
Family get togethers or holiday get togethers are always really very challenging sometimes because if you have someone who's a difficult person they need to be the center of attention. And sometimes those forums actually create a scenario where you're like a trapped audience. You have to there, and they know it. And boy, it's like, I think what's important is that if you can't get good attention, you'll get any attention. And sometimes that's creating drama. That can be creating conflict. So it's important for you to make a choice. Am I gonna engage in fight. Who's gonna win? What's the purpose?
But the important thing there is to give them some attention. Because if you don't give them any attention, then they're just gonna find another way to do it. They desperately need this and this is desperate for their survival. What they're really craving, um, is for everyone to focus on them. but you can maybe either agree to disagree or to take that conversation afterwards or let's table that.
And so for some people, depending on how difficult those situations are, that can be more volatile or dramatic, we may choose not to be there, and that could be a difficult decision. But you have to take care of yourself and you need to, as I mentioned, protect yourself. Set your internal boundaries and your limits.
Courtney: How about at work? How does narcissism show up in a work setting, and what can someone do who has to work with a narcissistic colleague or boss?
Dr. Warren Ng: Great question. I think the important thing is, is that with a boss who is narcissistic, part of working with someone like that is knowing that I'm not expecting them to validate, acknowledge, or celebrate me. So let's sort of table that expectation. So I'm not feeling disappointed. However, what I do know about them is that it's all about them. So how I can manage that relationship is sometimes mirroring what makes them wonderful. I might say that, you know, you're very interested in achieving this goal. This is what I could bring to that goal. So you need to frame everything according to what's important to them.
If it's a coworker, that might be a discussion that you want to engage in with your shared manager. That might be a discussion that you engage in to set some limits about how much you're willing to work with them or how much time you spend with them so that you're not then having to manage some of the aftermath of their behavior.
Courtney: Dr. Ng, thank you, these are such great, thoughtful strategies.
Dr. Warren Ng: I think we live in a world with difficult people and I think we live in a world that celebrates the culture of narcissism. So we need to acknowledge that sometimes the things that society values are not the things that you value. And that's important to notice the difference.
And how we define success as not just making all the money or having all the fame. But how about just having good, healthy relationships. Being able to spend time together with the people we care about.
Courtney: This is such powerful advice, Dr. Ng. You've given us so much to think about. Thank you so much for all your insight on narcissism and how we can deal with narcissists in our lives. It's always such a pleasure talking with you.
Dr. Warren Ng: Thank you so much, Courtney.
Our many thanks to Dr. Warren Ng. I’m Courtney Allison.
Health Matters is a production of NewYork-Presbyterian.
The views shared on this podcast solely reflect the expertise and experience of our guests. To learn more about Dr. Ng’s work with patients, check out the show notes.
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