Narcissism: Should It Be in the DSM?

Narcissistic personality disorder is being dropped from the DSM. But is narcissism really a quaint relic of a more modest time, or is it just time to redefine it? By Casey Schwartz

There was an irony to the timing of this week's announcement that the new version of the Diagnostic Statistical Manual—the DSM, the bible for mental-health professionals—will no longer contain narcissistic personality disorder. The announcement came in the midst of a news cycle dominated by Julian Assange, the cocksure founder of WikiLeaks, doling out government secrets at his own discretion.

But is Assange a narcissist? Narcissistic personality disorder was first defined in 1967. The DSM-IV defines the essential feature of narcissism as "a pervasive pattern of grandiosity, need for admiration, and lack of empathy that begins in early adulthood and is present in a variety of contexts." It's a definition that was set before the rise of social networking, reality TV, or partisan news channels designed to confirm our every opinion. Perhaps it truly is time to update it.

“A grandiose self is the sine qua non of narcissism,” says Peter Freed, assistant professor of clinical psychiatry at Columbia University. It is the hallmark symptom, the conviction that one is owed greatness, independent of talent or discipline. In other words, believing that your every movement deserves a camera crew is one of the disorder’s diagnostic criteria. But today, such an attribute is considered normal—modesty has become a liability. In a culture where the fantasy of fame is realized by the unlikeliest contenders, is it still grandiose to believe that the world should watch and admire you?

Everybody has narcissistic traits, and many of these are healthy, even required, to be a success in certain segments of the modern world. “Narcissism is not a disease,” says Freed. "It’s an evolutionary strategy that can be incredibly successful—when it works, ” Today, grandiosity can get the average schlub anything from a reality-TV show to 100,000 Twitter followers. Joe the Plumber was, by definition, a "regular Joe" who became instantly famous via the 24-hour news cycle. Justin Bieber was discovered on YouTube. In such an environment, it's natural—even smart—to be narcissistic enough to think you could be the next celebrity, because you could be.

And what of tweets, Foursquare check-ins, and Facebook status updates? Justin Frank, a psychoanalyst and Daily Beast contributor, regards these new forums as a positive form of self-regard, an opportunity for psychological “self-repair" in which individuals can achieve the feeling of being applauded that may have been lacking in childhood. In this sense, Frank says, there’s something valuable about the availability of a venue for a fragile ego to pump itself up, without resorting to the dangerous behaviors so common among the personality disorders.

Today, it's natural—even smart—to be narcissistic enough to think you could be the next celebrity, because you could be.

Not everyone agrees. In the Facebook culture of banal declarations—in which "So and So is waiting for the cable guy!!” is followed by a chorus of enthused "So and So Likes This" responses—Frank Yeomans, a professor of psychiatry at Cornell Medical School, sees an “infantile narcissism” playing out. Facebook, he says, is like “an adult show and tell. If you’re a 2 year old, it’s normal that you say boo and everybody thinks, you’re so great. And if you’re 3 and you tie your shoes, everybody says that’s wonderful. A truly mature adult can pat himself on the back. He doesn’t need everyone around him to do it for him.”

And "he" might now be a "she." Narcissism has become such a valued personality trait that it's broken through the gender barrier. For decades, it was seen as a predominantly male disorder. Now, says Harris Stratyner, a professor of psychiatry at Mt. Sinai Medical School, it's increasingly common in women.

In part, this shift can be understood in terms of what Robert Millman, a psychiatrist at Harvard, first described as “acquired situational narcissism”—the idea that narcissistic personality disorder can come on well into adulthood—not as an early coping mechanism for an underfed childhood, but in response to significant professional achievements. Now that adult women are surging ahead in their careers, competing with the top dogs, and outpacing men in college and certain sectors of the workforce, they are subject to the same blow-up of grandiose thinking that has long affected their male counterparts.

Stratyner believes it is unwise to remove the narcissism diagnosis from the DSM, not only because it’s a legitimate construct, but also because it will have real repercussions for treatment. In fact, it is perhaps the worst to tinker with, he says. Of all the disorders, the narcissist is the most invested in discrediting anything that he perceives as an insult. If it’s no longer a disorder, “the narcissistic patient will say to you as a therapist, 'Hey, the DSM-V doesn’t even believe in it, so what are you labeling me for with that?'”

Maybe they have a point.

Casey Schwartz is a graduate of Brown University and has a master's in psychodynamic neuroscience from University College London. She has previously written for The New York Sun and ABC News. Currently, she's working on a book about the brain world.