Narcissistic personality disorder is a separate disorder, but there is much overlap.
Narcissistic traits are inherently part of antisocial personality disorder, and antisocial traits are inherently part of narcissistic personality disorder. Is there more work to be done on defining these disorders?
About Antisocial Personality Disorder
From PsychCentral: “Antisocial personality disorder is a disorder that is characterized by a long-standing pattern of disregard for other people’s rights, often crossing the line and violating those rights. A person with antisocial personality disorder (APD) often feels little or no empathy toward other people, and doesn’t see the problem in bending or breaking the law for their own needs or wants.
“Individuals with Antisocial Personality Disorder frequently lack empathy and tend to be callous, cynical, and contemptuous of the feelings, rights, and sufferings of others. They may have an inflated and arrogant self-appraisal (e.g., feel that ordinary work is beneath them or lack a realistic concern about their current problems or their future) and may be excessively opinionated, self-assured, or cocky. They may display a glib, superficial charm and can be quite voluble and verbally facile (e.g., using technical terms or jargon that might impress someone who is unfamiliar with the topic).
“Antisocial personality disorder is diagnosed when a person’s pattern of antisocial behavior has occurred since age 15 (although only adults 18 years or older can be diagnosed with this disorder) and consists of the majority of these symptoms:
- Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
- Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
- Impulsivity or failure to plan ahead
- Irritability and aggressiveness, as indicated by repeated physical fights or assaults
- Reckless disregard for safety of self or others
- Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
- Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another
Read more about APD.
About Narcissistic Personality Disorder
From PsychCentral.com: The symptoms of narcissistic personality disorder include: grandiose sense of importance, preoccupation with unlimited success, belief that one is special and unique, exploitative of others, lacks empathy, is arrogant, and is jealous of others. These symptoms cause significant distress in a person’s life.
In order for a person to be diagnosed with narcissistic personality disorder (NPD) they must meet five or more of the following symptoms:
- 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 very strong sense of entitlement, e.g., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
- Is exploitative of others, e.g., takes advantage of others to achieve his or her own ends
- Lacks empathy, e.g., 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
- Regularly shows arrogant, haughty behaviors or attitudes
Read more about NPD.
Thoughts/Feelings vs. Behavior/Actions
“Feelings are the thoughts of the heart.” (A Little Bit of Soul)
Because thoughts and feelings are experienced subjectively, the difference between them can be somewhat blurry. For those with antisocial personality disorder, a psychopath is often described as devoid of (most) feelings and emotions and thinking in a cold calculating manner, while a sociopath is said to have more feelings and emotions and thinking in a less organized manner. In any case, the symptoms on the checklist for antisocial personality disorder are for the most part described/expressed as behaviors.
For narcissists, most of the symptoms on the checklist are described/expressed as thoughts and feelings. When stepping back and taking a look at these disorders as listed in the DSM, it appears that we determine whether someone meets the criteria for APD largely by assessing their behavior, but with NPD, we determine whether someone meets the criteria largely by assessing their inner world, their thoughts and feelings (often by observing their speech and behavior.)
Blurry and Confusing
Points of overlap between these personality disorders might be blurry so that even when taking time with assessments, it might be hard for a clinician to tease these out as two separate disorders. Indeed, psychopaths might manipulate by not sharing their most anti-social and narcissistic thoughts. They even can play-act humility and caring (The Psychopath Test by Jon Ronson offers real-life examples of this.)
And of course narcissists who want to be admired, might not reveal thoughts and feelings that would usually be perceived as selfish or uncaring, including thoughts and feelings that are symptoms of NPD or APD.
It can be quite difficult to diagnose APD and NPD. Perhaps it is somewhat easier in the case of those with APD who tend towards to the “sociopathic” expression of the disorder, who have more trouble concealing their emotions.
The problem with diagnosing lies in part with the efforts to categorize personality disorders and their symptoms. One issue is that most of the symptoms occur along a spectrum–someone may present with even the majority of symptoms of NPD, but they may be less intense, on the lower-end of the spectrum.
Could a rating system of intensity of impairment be helpful? Some clinicians and researchers believe so.
Also, even though personality disorder checklists require repeated and consistent examples of the items on the checklist, across person, time and place, many individuals have the ability to enter into a grey-zone when under duress. For some this can occur when under mild duress like an exam in school; for others, the duress has to be extreme such as a very important competition or when one is threatened. While it’s true that situational/occasional symptoms are not considered evidence of a personality disorder, they might offer some clues as to what causes these disorders.
Some say psychopaths are born, not made, and sociopaths are a combination of genes and the family environment (or lack of one.) Some say narcissists are completely a product of the environment they grew up in (see Alice Miller.)
There have been 5 editions of the DSM since it was first published in the 1950s. Each one adds and/or drops and/or reclassifies disorders. When my colleagues and I have time to wax philosophical, we ask: Are we any closer to finalizing these diagnoses? Are we any closer to prevention or cure? Should we be addressing these personality disorders from a more holistic perspective, including the spiritual?