Podcast Summary: Health Matters – "How Should I Manage A Relationship with a Narcissist?"
Host: Courtney Allison
Guest: Dr. Warren Ng, Psychiatrist, Center for Youth Mental Health at NewYork-Presbyterian
Release Date: November 19, 2025

Episode Overview

This episode of Health Matters examines what narcissism truly means, separating the popular use of the term from its recognized clinical definition. Host Courtney Allison speaks with Dr. Warren Ng to clarify the traits of Narcissistic Personality Disorder (NPD), discuss how narcissism can affect personal and professional relationships, and provide compassionate, practical strategies for navigating the challenges of dealing with narcissistic individuals, whether they’re friends, colleagues, or family.

Key Discussion Points & Insights

1. What Is Narcissism? (01:25–03:57)

• Trait vs. Disorder:

  • Dr. Ng distinguishes between temporarily narcissistic behavior (“state or trait”) and the persistent pattern found in clinical NPD.
  • "Just being narcissistic at that moment...does that make me a narcissistic person? And those can be two different answers." (01:39, Dr. Ng)

• Clinical Definition of NPD:

  • Diagnosis requires at least five out of a list of symptoms, persisting over years.
  • Key traits (the “1G, 2A’s, 2S’s, 4E’s” or “gassy” mnemonic):
    • Grandiosity
    • Admiration (excessive need for)
    • Arrogance
    • Success fantasy, Special/unique feeling
    • Entitlement, Exploitation, Empathy lack, Envy
  • "When you're gassy and feeling uncomfortable, hey, maybe the person around you might have a narcissistic personality disorder." (03:44, Dr. Ng)

2. Prevalence and Gender Differences (04:06–05:48)

• How Common Is NPD?

  • Estimated prevalence in the U.S.: 0–6% of adults.
  • Slightly more frequent in men (7.7%) than in women (4.8%).

• Role of Society:

  • The culture often celebrates or tolerates narcissistic traits more in men and in certain roles, reinforcing behaviors through social values around competition and “celebrity status.”
  • "We also live in a society that really celebrates the culture of narcissism." (05:17, Dr. Ng)

3. Recognizing Narcissists: The Four D’s (05:56–06:52)

• Difficult, Deny, Dismiss, Devalue, Destructive:

  • Narcissists are persistently difficult, deny your perspective, dismiss your concerns, devalue your achievements, and can become destructive or temperamental if thwarted.

  • "There can't be any other (star) except for them. And they also can be destructive...when they don't get their way." (06:18, Dr. Ng)

4. Protecting Yourself and Setting Boundaries (06:52–09:42)

• Self-Protection as Primary:

  • Recognize the difficulty and prioritize your well-being.
  • "The most important thing is really to protect yourself... manage your expectations of this person. They're not going to change." (06:52, Dr. Ng)

• 'No Sugar' Acronym:

  • Narcissists provide:
    • No Shame
    • No Understanding
    • No Guilt
    • No Apology
    • No Remorse
  • "...there's no sugar. So when you’re in a situation where there’s no sugar, you start wondering, I deserve some sweetness in my life." (07:52, Dr. Ng)

• Boundaries:

  • Internal boundaries: Resolve not to let someone diminish your self-worth.
  • Time boundaries: Limit interactions, accept they won’t change, and have an “exit strategy.”
  • "Setting up some internal boundaries is very important in understanding that you have the power, you have the choice, and you are important." (08:44, Dr. Ng)
  • Changing a narcissist is “a myth and a fallacy.” (09:19)

5. Maintaining Your Sense of Self (09:52–11:10)

• Self-Care and Support:

  • Narcissistic dynamics can cause you to “lose yourself” in the relationship.

  • Foster a support network to maintain self-worth.

  • Special note on non-chosen (family) vs. chosen (friends/partners) relationships, and the extra care required in managing expectations and boundaries with family.

  • "They encourage us to lose ourselves because they're the only person in the room." (10:11, Dr. Ng)

6. Family Relationships and Holiday Challenges (11:10–13:49)

• Parent-Child Dynamics:

  • Narcissistic parents impact children by making them feel “ignored, overlooked, undervalued.”
  • Not to repeat unhelpful parental patterns; validate yourself.

• Sibling and Family Gatherings:

  • Set limits on contact/time.
  • Holiday/family gatherings can “create a scenario where you’re like a trapped audience.”
  • Sometimes, “giving them some attention” can diffuse drama.
  • You may need to disengage, and that’s ok: "You have to take care of yourself and...protect yourself. Set your internal boundaries and your limits." (13:22, Dr. Ng)

7. Navigating Narcissism at Work (13:49–15:02)

• With Narcissistic Bosses:

  • Don’t expect praise or validation.
  • Frame your work and communication to align with their goals/interests.
  • "How I can manage that relationship is sometimes mirroring what makes them wonderful...frame everything according to what's important to them." (14:17, Dr. Ng)

• With Narcissistic Coworkers:

  • Seek management when necessary.
  • Limit interactions to protect well-being.

8. Final Takeaways and Closing Thoughts (15:02–15:51)

• Societal Influence and Core Values:
  • Modern culture often rewards narcissism.
  • True success may lie in “good, healthy relationships,” not accolades.
  • “Sometimes the things that society values are not the things that you value. And that’s important to notice the difference.” (15:17, Dr. Ng)

Notable Quotes & Memorable Moments

• “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.”
  Dr. Ng, 00:00 / 07:52

• “Setting up some internal boundaries is very important in understanding that you have the power, you have the choice, and you are important.”
  Dr. Ng, 08:44

• “They encourage us to lose ourselves because they're the only person in the room.”
  Dr. Ng, 10:11

• “How we define success is 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.”
  Dr. Ng, 15:20

Important Timestamps

• 01:39 – Distinguishing narcissistic behavior from personality disorder
• 03:44 – “Gassy” mnemonic for NPD symptoms
• 06:18 – The Four D’s: Signs of narcissistic individuals
• 07:52 – “No sugar” in relationships with narcissists
• 08:44 – Setting internal boundaries
• 10:11 – Maintaining your sense of self
• 13:22 – Limits and decisions in family relationships
• 14:17 – Strategies for working with narcissists
• 15:20 – Rethinking the definition of success

Tone & Language

The conversation remains empathetic, supportive, and practical, with Dr. Ng using memorable acronyms and metaphors (“gassy,” “Ds,” “no sugar”) to make difficult psychological concepts accessible and actionable.

For more from Dr. Ng and expert health advice, listen to the full episode or visit the show notes at Health Matters.