Insight is crucial for narcissistic personality disorder | Mental health
The subjects of Lucy Knight’s excellent article on narcissistic personality disorder (NPD) have a common redeeming characteristic: insight (“You’re Constantly Told You’re Bad”: Inside the Lives of Diagnosed Narcissists, October 15). They understand their problem and how it affects others, and they have the humanity and ability to solve it.
A principle of psychiatry is that we all have personality traits, including narcissism, on a spectrum in which they develop into disorders when they negatively affect us or those around us. The most dangerous are at the extremes, where there is little or no insight, and features become bizarre and chaotic.
I experienced this in a once-loved relative who spent seven years trying in court to deprive his siblings of their father’s inheritance, insisting that he was the only one who deserved it. He has no insight and disdains formal diagnosis.
His behavior meets all the conditions for a malignant NPD: egocentrism and grandiosity, lack of empathy, deceptive and manipulative behavior (associated with great charm), paranoia, aggression, resentment, magical thinking, intimidation, loyalty to like-minded individuals (usually autocrats), etc. Ultimately, his campaign failed, but the financial and emotional cost is irreparable.
Does that mean anything to you? This relative is American and fiercely loyal to Donald Trump.
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Even though narcissistic personality disorder is perhaps one of the most stigmatized psychiatric disorders, surely we should question the point of telling anyone that their personality is disturbed? Given that the stigma against personality disorders is higher among mental health personnel than among the general public, it is questionable to apply a label that will cause those who are supposed to care to treat others worse.
Keir Harding
Consultant occupational therapist
