B (3:50)

We all might have some of those traits sometimes. But having five or more kind of puts you in the clinical term.

A (3:57)

Yes, five or more. And it needs to be a pervasive pattern of behavior. So over months or years, do you

B (4:06)

know roughly how many people might have narcissistic personality disorder? How common is it?

A (4:11)

That's a great question, and there should be better studies on this. But the ones that I'm referencing are the ones that are in community samples in the United States. And there's an estimated probably ranging from 0 to about 6% of adults who might exhibit narcissistic personality disorder. And in those interviews, it's interesting that the gender difference between them is that even though there's approximately 6.2% of the community, 7.7% of them are male and 4.8% of them are female.

B (4:51)

So more common in men.

A (4:53)

More common in men. And when we think about narcissism and narcissistic behaviors, how are males and females socialized? And some of the behaviors that I mentioned, whether or not it's grandiosity, admiration, arrogance, success, like, do we tolerate that more in men versus women or different people in different roles, we also live in a society that really celebrates the culture of narcissism. So whether or not it's in celebrity status or whether or not it's really in our social understanding of who gets the gold medal and who wins versus loses. And so I think we generally think about, like, how does our culture or society also reinforce some of these kinds of behaviors?

B (5:48)

So we've gone through some of these symptoms. If you suspect there's someone who has narcissistic tendencies in your life, what are the telltale signs?

A (5:56)

Well, generally, people who are narcissistic or narcissistic personality disorders are often thought of as very difficult. So I think of the Ds, and I generally think of the four Ds, difficult being one of them. But they're people who often deny things that are going on or your version of the story. They also dismiss your concerns because they're really focused on themselves, and they also devalue you. So they're the only star in that universe, and there can't be any other except for them. And they also can be destructive and. Or have a temper when they don't get their way or they don't get what they want.

B (6:38)

I love all the acronyms you use. The D's, gassy. These are all helpful to remember. So it sounds like it could be a difficult person. What's important to know when navigating these relationships? If you suspect someone has these four

A (6:52)

Ds, you know, I think the most important thing is really to protect yourself. And when we think about protecting ourselves, it's often acknowledging the fact that you might be in a difficult situation. And first you want to make sure that you're safe and that there is something that you can do about the situation so that you don't feel trapped or stuck. And some of the things that I often think of people trying to do is to manage your expectations of this person. They're not going to change. They are going to be very focused on themselves. And also, what we often think of is setting some boundaries. We often think of, like, what are your casino rules? Like, what is your exit strategy? Like, when will you sort of cut the bait? And I think it's important to have those kind of thoughts to consider.

B (7:47)

I appreciate your emphasis on protecting yourself. And it seems like these are good strategies to try to avoid getting hurt.

A (7:52)

Exactly. I generally think of another acronym when I think of the narcissistic personality disorder or someone who has those traits, is that there's no sugar. So no sugar, meaning that there's no shame. There's no understanding, there's no guilt, and there's no apology and no remorse. So when you're in a situation where there's no sugar, you start wondering, you know, I deserve some sweetness in my life, and I might be in a situation with someone who has a narcissistic personality disorder.

B (8:29)

I love that. We do deserve sweetness in our life. Thank you. That's a beautiful guiding principle to try to follow. And so it sounds like boundaries are really important. How can you set boundaries to protect yourself and stay in touch with these parts of our lives?

A (8:44)

That's a great question. And some of those boundaries, we think of boundaries as what is the space or that line in between myself and the other person? And I think sometimes acknowledging that I won't let anyone treat me this way, I won't Let anyone devalue or upset me, or I won't make anyone make me feel less than. And so setting up some internal boundaries is very important in understanding that you have the power, you have the choice, and you are important. The other boundary that you can set is really setting up a boundary of, like, how much time you're going to spend with someone. Because the important thing to remember is that when you're with someone who has narcissistic personality disorder, you're not going to change them. They will only change if they want to change. And so the idea of us changing them is really a myth and a fallacy.

B (9:42)

These sound like really smart strategies to manage because it just sounds like it's accepting they won't change. And how can you look within yourself to manage it and protect yourself?

A (9:52)

And that's what's most important, taking care of yourself, acknowledging that you're important, that you matter. I think one of the things that is so harmful about being in a dynamic or relationship with someone with narcissistic personality disorder is that they encourage us to lose ourselves because they're the only person in the room. And so that's why it's important that keeping and maintaining a healthy sense of yourself, and that's acknowledging that your feelings matter and that you matter and also fostering a support network of people who care about you. And I think one of the things that's important to acknowledge is that there's sometimes the relationships we choose, and then the ones that we were born into when we're in relationships that we don't choose our family or others, then those are the ones that we have to really navigate carefully and to manage our expectations. Protect yourself. And sometimes setting up some internal boundaries about how much we're willing to give them and how much time we're willing to spend because we don't want to be in a relationship where we are getting hurt or making us feel less than.

B (11:10)

So you mentioned some of the different relationships that can be impacted by narcissism and the family. I'd love to spend some time there. How are family relationships impacted by narcissists?

A (11:21)

I think within families, it's important to acknowledge that sometimes when we have a parent who has a narcissistic personality or traitor, it really affects how we experience being a child of someone in that relationship. And just to be mindful that generally we may have been ignored, overlooked, undervalued. It's important to be able to give yourself that time and also not to kind of recreate those sometimes problematic parenting Styles that are not always healthy, encouraging, validating and supportive. If you're in a relationship with family, such as a sibling or others, then sometimes we want to make some decisions about how much time we spend with them. What are our internal boundaries and what are some of those internal limits that we set on that relationship? Family get togethers or holiday get togethers are always really very challenging sometimes because if you have someone who's a difficult person, they need to be the center of attention. And sometimes those forms actually create a scenario where you're like a trapped audience. They know it and boy, it's like, I think what's important is that if you can't get good attention, you'll get any attention. And sometimes that's creating drama that can be creating conflict. So it's important for you to make a choice. Am I going to engage in this fight? Who's going to win? What's the purpose? But the important thing there is to give them some attention. Because if you don't give them any attention, then they're just going to find another way to do it. They desperately need this and this is desperate for their survival. What they're really craving is for everyone to focus on them. But you can maybe either agree to disagree or to take that conversation afterwards or let's table that. And so for some people, depending on how difficult those situations are, that can be more volatile or dramatic. We may choose not to be there and that could be a difficult decision. But you have to take care of yourself and you need to, as I mentioned, protect yourself. Set your internal boundaries and your limits.

B (13:49)

How about at work? How does narcissism show up in a work setting? And what can someone do who has to work with a narcissistic colleague or boss?

A (13:57)

Great question. I think the important thing is, is that with a boss who is narcissistic, part of working with someone like that is knowing that I'm not expecting them to validate, acknowledge or celebrate me. So let's sort of table that expectation so I'm not feeling disappointed. However, what I do know about them is that it's all about them. So how I can manage that relationship is sometimes mirroring what makes them wonderful. I might say that, you know, you're very interested in achieving this goal. This is what I could bring to that goal. So you need to frame everything according to what's important to them. If it's a co worker, that might be a discussion that you want to engage in with your shared manager, that might be a discussion that you engage in. To set some limits about how much you're willing to work with them or how much time you spend with them so that you're not then having to manage some of the aftermath of their behavior.

B (15:02)

Dr. Ng, thank you. These are such great, thoughtful strategies.

A (15:05)

I think we live in a world with difficult people, and I think we live in a world that celebrates the culture of narcissism. So we need to acknowledge that sometimes the things that society values are not the things that you value. And that's important to notice the difference. And 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.

B (15:37)

This is such powerful advice. Dr. Ng, you've given us so much to think about. Thank you so much. Thank you so much for all your insight on narcissism and how we can deal with narcissists in our lives. It's always such a pleasure talking with you.

A (15:51)

Thank you so much, Courtney.

B (15:56)

Our Many thanks to Dr. Warren Ng. I'm Courtney Allison. Health Matters is a production of New York Presbyterians. The views shared on this podcast solely reflect the expertise and experience of our guests. To learn more about Dr. Ng's work with patients, check out the Show Notes. New York Presbyterian is here to help you stay amazing at every stage of your life. To get the latest episodes of Health Matters, be sure to follow and subscribe on Apple Podcasts, Spotify, or wherever you get podcasts.