How Can Narcissism Be Misunderstood?
We spend a lot of time thinking about narcissism—researching it, treating it, arguing about it at conferences. And yet, the public conversation (and sometimes even the clinical one) still gets it wrong.
It’s not just because the term is overused on social media (though that doesn’t help). It’s because narcissism itself is a moving target: it’s dimensional, dynamic, and deeply context-dependent.
In this post, I want to unpack some of the ways I see narcissism being misunderstood, even among seasoned professionals. I’m not here to preach; I’ve made some of these mistakes myself. But the more I’ve worked with narcissistic patients and dived into the literature, the more I’ve realized just how much nuance we miss when we talk about “narcissism” like it’s a simple thing.
Spoiler: it’s not. And seeing it clearly—not just through the lens of the DSM—can open up much richer clinical and research possibilities. Let’s dig in.
Why Focusing Only on Narcissistic Personality Disorder Can Trip Us Up
It’s no secret that Narcissistic Personality Disorder (NPD) has dominated both clinical and public understanding of narcissism. We’re trained to look for those nine DSM criteria: grandiosity, fantasies of unlimited success, entitlement, etc. And that’s a useful framework—when you’re trying to diagnose NPD.
But here’s the problem: most narcissism isn’t NPD. And when we only think about narcissism through that narrow diagnostic lens, we miss a huge part of the picture.
Narcissism is a spectrum
Think about it: we all have narcissistic traits to some degree. In fact, a healthy sense of self-worth and the capacity to pursue one’s goals with confidence depend on it. The problem arises when those traits become inflexible, defensive, or extreme.
Research from authors like Wink (1991) and more recent dimensional models like Pincus & Lukowitsky’s (2010) work on grandiose and vulnerable narcissism show that narcissistic traits can vary not just in intensity, but in quality.
Grandiose narcissism looks more like what we expect: arrogance, dominance, attention-seeking. Vulnerable narcissism, on the other hand, involves hypersensitivity, shame, and social withdrawal. Both exist on a continuum—and both can cause significant impairment or distress long before a person meets criteria for NPD.
Diagnostic labels can obscure the nuances
Here’s an example from my own practice. I once worked with a man in his 30s who never would have met criteria for NPD. In fact, he came in for social anxiety. But the more we worked together, the more it became clear that underneath the anxiety was a highly fragile self-image and an intense need for external validation.
He wasn’t grandiose—he was terrified of seeming “less than.” His narcissistic defenses showed up as avoidance and people-pleasing, not arrogance. If I’d been focused only on spotting NPD, I would have missed the underlying narcissistic dynamics entirely.
This is where a dimensional, psychodynamically-informed understanding becomes crucial. Narcissism is about how the self is organized—how it manages needs for admiration, how it defends against shame, how it navigates attachment. A binary diagnosis doesn’t capture that complexity.
We also miss adaptive narcissism
There’s another trap here: when we pathologize all narcissistic traits. The reality is that adaptive narcissism exists, and it can be healthy. Having ambition, pride in one’s work, or the confidence to assert oneself isn’t inherently pathological.
The trouble starts when those traits become rigid and defensive—when self-worth depends entirely on external validation, or when relationships become transactional. Again, nuance matters.
Why this matters for clinical work and research
When we conflate “narcissism” with “NPD,” we end up:
- Missing subtle presentations (especially vulnerable narcissism).
- Overlooking narcissistic dynamics in patients who don’t meet full diagnostic criteria.
- Pathologizing normal or adaptive traits.
- Using imprecise language that confuses both clinicians and the public.
If we can move beyond this narrow frame—if we start thinking about narcissism as a dimensional, developmental, and relational phenomenon—we open up much richer ways of understanding and working with these dynamics. And honestly, I think that’s one of the most exciting frontiers in our field right now.
Up next, I’ll dive into some of the most common misconceptions I still see floating around about narcissism—including a few I used to believe myself.
How We Get Narcissism Wrong: Common Misunderstandings
Even among experts, there are persistent misconceptions about narcissism that skew how we see it in clients, in research participants, and even in ourselves. Some of these come from older models of personality disorders; others come from popular culture or clinical shorthand that oversimplifies complex dynamics.
When I was starting out, I used to fall into some of these traps, too. It’s easy to do. We want neat categories—grandiose narcissists over here, vulnerable people over there. But narcissism doesn’t work that way. It’s dynamic, multifaceted, and deeply relational.
So here’s a list of the misunderstandings I see most often, with some thoughts on why they don’t hold up—and what we might want to consider instead.
Narcissism equals grandiosity
This is probably the most common one. If you ask people—clinicians, researchers, the average person—they’ll often describe a narcissist as arrogant, entitled, self-important. And yes, grandiose narcissism is real and well-documented. But it’s only one part of the picture.
Vulnerable narcissism—which involves feelings of inadequacy, shame, hypersensitivity to criticism, and a fragile self-concept—is just as important, if not more so in many cases. These individuals might not appear arrogant at all. They may be withdrawn, anxious, or preoccupied with how others see them.
Clinical examples of vulnerable narcissism can look like:
- A client who can’t tolerate constructive feedback without spiraling into shame.
- Someone who idealizes others to feel safe, then devalues them when disappointment inevitably arises.
- A person with intense social anxiety rooted in a hidden belief that they are either special or worthless—never simply “good enough.”
When we only look for grandiosity, we miss all of this. Worse, we risk misattuning to what our patients actually need.
Narcissists lack empathy entirely
It’s tempting to say that narcissists lack empathy, full stop. After all, many patients with strong narcissistic traits do seem oblivious to the impact of their behavior on others.
But the reality is more complicated. Narcissistic individuals often have an unstable capacity for empathy. Sometimes they can be exquisitely attuned to others—especially when doing so serves their self-image or relational goals. Other times, they become emotionally unavailable or even cruel when their own needs feel threatened.
This fluctuation matters clinically. I’ve worked with patients who, when they felt safe and secure, could show deep compassion. But when they felt criticized or ashamed, they shut down or attacked. Empathy wasn’t absent; it was contingent. And that pattern is deeply informative.
Narcissism is always maladaptive
This is another one I see a lot in both clinical training and public writing. The idea that narcissism is purely pathological misses a crucial point: narcissistic traits can be adaptive, even essential, in many contexts.
Think about leadership, creative work, public performance. A certain degree of confidence, ambition, and desire for recognition can fuel great achievements. In fact, studies suggest that some narcissistic traits—when balanced and integrated—are associated with resilience and even wellbeing.
Of course, there’s a tipping point. When self-worth becomes too fragile, or when interpersonal exploitation becomes the norm, those same traits can cause harm. But the goal isn’t to eliminate narcissism—it’s to help patients develop a more stable and flexible sense of self.
Narcissistic traits are fixed
Another misconception is that narcissistic traits are static—that once a narcissist, always a narcissist. The data tell a different story. Personality traits, including narcissism, can and do change over time, especially through relational experiences and targeted therapy.
For example, longitudinal studies by researchers like Roberts et al. (2006) and more recently by Wetzel et al. (2020) show that narcissistic traits often decline with age and can shift in response to life transitions. I’ve seen this clinically, too—patients who initially presented with extreme defensiveness and entitlement can, over time, develop greater self-awareness and relational capacity.
It’s not easy. These are deeply ingrained defenses. But change is possible, especially when we approach the work with curiosity and compassion rather than static labels.
Narcissists are easy to spot
Finally, there’s the myth that narcissists are obvious—that you can “just tell.” In reality, many narcissistic presentations are subtle, relational, and context-specific.
I’ve had clients who appeared outwardly modest and self-effacing, but whose inner world was consumed with fantasies of superiority or terror of humiliation. Others seemed charming and generous in public, but engaged in covert manipulation behind the scenes.
If we rely only on superficial cues—charisma, arrogance, success—we’ll miss these quieter forms of narcissistic functioning. A deeper understanding requires attention to how the person regulates their self-worth in relationship to others. That’s where the real dynamics lie.
How Culture and Context Shape Our Understanding of Narcissism
If we want to understand why narcissism is so often misunderstood, we have to talk about culture. Our cultural narratives shape what we notice, how we label it, and what we think it means. And they do this in ways that can both illuxminate and distort the clinical picture.
Cultural scripts about narcissism
Right now, Western cultures—especially in the U.S.—are saturated with discourses about narcissism. It’s the age of social media influencers, personal brands, and the cult of the individual. As a result, grandiose forms of narcissism are highly visible and often conflated with the entire construct.
We see Instagram stars and reality TV personalities and think, “narcissist.” Meanwhile, vulnerable forms go unnoticed—or are pathologized as something else (social anxiety, depression, “low self-esteem”) without recognizing the narcissistic dynamics underneath.
At the same time, pathologizing self-promotion or confidence as narcissism can be culturally biased. In individualistic societies, ambition and self-assertion are often encouraged. In collectivist cultures, the same traits might be viewed as selfish or inappropriate.
Cross-cultural variations in narcissistic expression
Studies like those by Hofstede (2001) and more recent cross-cultural personality research suggest that narcissism doesn’t look the same everywhere. Grandiose traits tend to be more accepted—and sometimes more prevalent—in individualistic cultures. Vulnerable narcissism may be more hidden in collectivist contexts, where interpersonal harmony is prioritized.
Even within the same culture, socioeconomic status, gender norms, and subcultural values influence how narcissistic traits are expressed and perceived. For example:
- In some professional environments (think high-powered corporate or entertainment industries), narcissistic behaviors may be rewarded and normalized.
- In more relational or service-oriented fields, the same behaviors might be seen as toxic or maladaptive.
Recognizing these contextual factors helps us avoid overgeneralizing—and it prompts more nuanced clinical formulations.
Social media and the new narcissism
I can’t talk about cultural context without mentioning social media. Platforms like Instagram, TikTok, and LinkedIn fundamentally change how people manage their public selves—and how they are judged by others.
We often mistake curated self-presentation for narcissism. But it’s more complicated than that. Many people use these platforms strategically without significant narcissistic dynamics. Others with deep narcissistic vulnerabilities may become highly dependent on online validation.
The key is to look at why and how someone is engaging. Is it an adaptive way to connect and promote their work? Or is it a compulsive defense against inner emptiness and shame? The behavior may look similar; the underlying psychology is very different.
The danger of cultural overpathologizing
Finally, we need to be careful about cultural bias in diagnosis and treatment. What looks like narcissism in one cultural context may be normative or even adaptive in another. Conversely, we may under-recognize narcissistic dynamics when they are expressed in culturally sanctioned forms (for example, martyrdom or exaggerated humility).
As clinicians and researchers, we need to:
- Stay attuned to cultural norms and values.
- Examine our own biases about what “healthy” self-functioning looks like.
- Engage with clients’ lived cultural realities rather than imposing a universal model.
Narcissism is a human phenomenon—but it’s always shaped by context. The more we honor that, the more accurately we can understand and help the people we work with.
Final Thoughts
Narcissism is endlessly fascinating—and endlessly tricky. Even for those of us who’ve been studying and treating it for years, there’s always more to learn.
If there’s one takeaway here, it’s this: stay curious. Question the easy labels. Look beneath the surface. Hold space for both grandiose and vulnerable dynamics. And always remember that narcissism is a dynamic, relational process—not a fixed trait or simple diagnosis.
Thanks for reading—and here’s to keeping the conversation evolving.
