It’s a common term to hear these days, as this writer did while eavesdropping in a cafe recently. “That’s such a narcissist response,” said the fortysomething man to his dining companion. “I know! It’s all about her,” she said. “We had to sell the house!”

At any given moment, it seems someone is likely to be calling someone else a narcissist. “It’s penetrating popular culture to the point that any person you may have had a bad relationship with is a ‘narcissist’,” says psychologist Dr James Collett.

Public figures and celebrities are not immune. Former US president Donald Trump – “I know words; I have the best words” – has attracted “narcissist” tags galore, including, on occasion, from mental health professionals. Rapper Kanye West (now known as Ye) – “I’m a creative genius” – has been called a narcissist, as has Kim Kardashian, who once snapped 6000 selfies during a four-day holiday in Mexico.

These personalities may appear to us to be modern-day versions of Narcissus, the beautiful young man in Greek mythology who loved no one until he saw his own reflection. (He was still single and gazing at himself when he died.)

But narcissism is more nuanced than that. People can show narcissistic traits. Some might have more of these traits than others. A rare few might be diagnosed with a personality disorder. Others might be plain old vain or self-centred or diligent on social media. “When someone’s clinically diagnosed with narcissism, it’s often a very different thing to them just kind of being a jerk,” says Collett.

So, what makes someone a narcissist? How can you tell? What’s it like to live with a narcissist? And can narcissism be treated?

Who are narcissists?

Collett recalls a psychology session with a man who had lost his job and was having relationship problems. Collett asked him about his sexual functioning – a standard question from psychologists that can shed light on the state of an individual’s relationship. “He wouldn’t shut up about it,” says Collett. “He just kept talking about all these attractive women who want him. ‘And here’s this girl I’m seeing now’ – and the guy literally pulls out his phone and starts showing me photos. ‘Look at that, James, don’t you wish you could get a woman like that?’ You just kind of want to cover your eyes – please, please stop!”

Sound like your co-worker or that annoying ex?

Not so fast.

Being conceited or boastful is one thing, being diagnosed with narcissistic personality disorder (NPD), as this patient was, is another. “They want to establish a dynamic where they’re better than you,” says Collett. It’s a narcissist’s “go-to strategy for every single interaction”, he says. “It’s inflexible across context.” The Diagnostic and Statistical Manual of Mental Disorders (known as the DSM) says people who suffer from NPD display a collection of “maladaptive” personality traits: a pervasive pattern of grandiosity, need for admiration, lack of empathy and a sense of “interpersonal” entitlement. They are exploitative, arrogant and prone to envy. Only 1 per cent of the global population meet these criteria.

“It’s not just about, ‘Oh look at me, look at me.’ It’s more like, ‘I look at you and think, if you are here to worship me, that’s good; if you’re not, you have no value.’”

But they are vulnerable, too. Dr Neil Jeyasingam, a psychiatrist at the University of Sydney who has researched personality disorders and treated people with NPD, describes NPD sufferers as “basically like blown-up balloons; you prick them and they will burst”. “A narcissistic personality disorder [sufferer] is one who cannot survive without endless admiration from others. If there’s any potential threat to the idea that they’re not God’s gift to the world, they decompensate horribly,” he says. “That’s the difference pathologically: it’s not just about, ‘Oh look at me, look at me.’ It’s more like, ‘I look at you and think, if you are here to worship me, that’s good; if you’re not, you have no value.’” He prefers “vain” or “self-absorbed” for people who are merely full of themselves.

Forensic psychiatrist Dr Danny Sullivan works at Melbourne’s high-security mental health centre, the Thomas Embling Hospital. “We all have forms of self-deception, but with narcissistic personality disorder, they’re much more accentuated and they pervade the person’s existence,” Sullivan says. “They’re manifest in their employment, in the way they interact with their partners – they’ll always be the person who can do something better than someone else.”

One study in the United States recounts the case of a medical resident who drank “two to three” bottles of wine to fend off anxiety about an evaluation of his surgery skills – and thought himself “a real genius” to be able to perform those surgeries while drunk. “Thinking of himself as an exceptional human being, he believed that his drinking was excusable, if not commendable, that common rules did not apply to him,” reads the report into his treatment for narcissism, in Focus: The Journal of Lifelong Learning In Psychiatry. He sought treatment only at his wife’s urging when she noticed he had drinking-related tremors.

Crucially, to be clinically diagnosed as a narcissist, the person must be suffering as a result of their personality. No suffering, no diagnosis.

“Everyone has a personality. It’s only a disorder when it causes extreme distress, suffering and impairment.”

“Everyone has a personality,” said Allen Frances, a psychiatrist who wrote the rules for diagnosing mental disorders in the DSM. “It’s not wrong to have a personality; it’s not mentally ill to have a personality. It’s only a disorder when it causes extreme distress, suffering and impairment [to the person].” Frances recently argued that, although Trump demonstrates “in pure form every single symptom” of NPD, the former president doesn’t meet the threshold for a diagnosis. “Trump certainly causes severe distress and impairment in others, but his narcissism doesn’t seem to affect him that way,” he wrote.

So, you either have the disorder, or you’re free of its problems, entirely?

Unfortunately not.

Many people who don’t meet the threshold for an NPD diagnosis can still have “clinically significant” levels of narcissistic traits. Sullivan likens it to being tuned in to a particular radio station, but with the volume turned down. “So, they’ve got personality features which other people recognise [as narcissistic] but the degree of damage or harm is not so great,” says Sullivan. “They’re less intractable. They’re self-obsessed ... [but] they probably have a little more insight into the fact that things aren’t quite right for them. They’ve got problematic relationships but can sustain a relationship.”

Can you spot a narcissist?

“Oh gosh, no,” says Jeyasingam. “You’d probably think this was a person that was really nice and really friendly and really keen for me to get to know them.”

In fact, they want to make you one of their boosters.

“People with personality disorders ... have particular things which are exaggerated which makes them very interesting and entertaining to watch behave,” says Jeyasingam, noting pop culture representations of narcissistic types such as drug dealer Walter White in Breaking Bad and the womanising Barney in How I Met Your Mother. “But [in real life] they can’t grow, they can’t develop, they can’t achieve what their actual potential could be in life. Their capacity for social relationships is limited.”

Behavioural psychology professor W. Keith Campbell, one of the foremost narcissism experts in the US, puts prospective narcissism study participants into hypothetical social scenarios to select the ones who are high in narcissistic qualities. “We’ll run them through the experiment, [and tell them], ‘Oh, bummer, no one picked you [for something] ... You failed the test. Is it your fault or do you want to blame the professor? Oh, [you want to] blame the professor.’ You set up social interactions to see how people respond.”

In 2013, Campbell and colleagues studied the 42 US presidents up to George W. Bush to test a hypothesis that “grandiose” narcissism was a “double-edged sword” in leaders. They found that where it existed it was associated with public persuasiveness, crisis management and agenda setting – as well as “impeachment resolutions and unethical behaviour”. Campbell says Lyndon B. Johnson rated “high in narcissism”. (Johnson famously pulled down his pants and brandished his wares to a group of journalists after one asked why the US was involved in the Vietnam War. “This is why,” he said, as he revealed himself.) “He made horrible decisions because of ego,” Campbell says. John F. Kennedy also rated high, he says. “You go, ‘That’s a great dude but not a guy you want to marry, necessarily.’

“That’s the complexity, though. Everyone loves that priest, loves that physician, loves those politicians – except his freaking wife and kids, or her husband and daughters.”

But not all narcissists are grandiose. Some people with NPD might be distant and aloof. Others appear modest and unassuming. It’s not uncommon that when narcissists stop receiving external validation, they present to psychologists with low mood and appear profoundly withdrawn and depressed.

What damage do narcissists do?

“It’s actually quite a disability,” says Sullivan. “You end up with a person whose life can be an absolute train wreck, and it’s all their own making. They constantly make poor choices, and they can’t relinquish or accept that someone might do something better.”

While there is no causal relationship between being a narcissist and committing crimes or enacting violence, a narcissist’s lack of empathy can lead to conflict and abuse – which a narcissist will frame as someone else’s problem. “They will talk about how a person simply failed to acknowledge that they were far more brilliant than anyone in the room, that was why they were abusive towards them,” says Sullivan, who has assessed people for criminal court cases involving fraud and sexual assault.

“People with narcissistic personality disorder are much more prepared to override the rights of others because they so prioritise their own rights – or feel that they are thoroughly deserving.” A person with NPD who has, for instance, committed sexual assault might minimise the other person’s experience, says Sullivan. “So they’re less likely to be able to appreciate the degree of harm a person’s reported. Or they might disregard it as the person lying to advantage themselves – because that’s the way a narcissistic person navigates the world, they lie to advantage themselves.”

Even in prison, Sullivan has seen numerous narcissists demand “exceptional treatment”. “Look, they can come out with some really quite staggering, self-inflated concepts,” he says. “[They’ll say] ‘The ordinary prison psychologists aren’t smart enough to deal with my problems, so I’d like you to organise my own psychologist to come in from outside.’ They’ll say, ‘Well, I’m not like the other ones here. I need a special bed. I need day leave. I need this, I need that.’ Not because of any specific health-based reasons but simply because they deserve it.”

“When you see them, it’s normally because life has shown them, in a very difficult way, that maybe they’re not perfect.”

Often, the culmination is a “narcissistic crash”, after a narcissist has lost their job, or relationship, or their children have abandoned them. In other words: the world stops validating the way they see themselves. “They’re not going to a psychologist and saying, ‘I think I’m really good, can you help with that?’” says Collett. “When you see them, it’s normally because life has shown them, in a very difficult way, that maybe they’re not perfect.”

In the most extreme cases, it can lead to suicide. “On two occasions she felt such fear of losing her competence – and hence her reputation in the lab and appreciation of her supervisor – that she saw ending her life as the only way out,” reads the Focus case study of a 24-year-old research assistant who attempted to end her life twice before seeking treatment for narcissism.

What’s it like to live with a narcissist?

Clinical psychologist Tamara Cavenett has seen the partners of narcissists in floods of tears in her office. Narcissists are not entirely incapable of seeing another person’s point of view, says Cavenett, who heads the Australian Psychological Society, it’s just not an “easily reached-for thinking process”. Where an average person will feel compassion for someone who trips and falls down, she says, a narcissist will naturally “skip over” that person’s point of view because they’re more focused on what the impact of someone tripping is on them.

To live with a narcissist can be “quite soul-destroying”, she says. “Because it’s so frustrating, you can’t ever get your own needs acknowledged, your own perspective understood.”

Campbell compares being in a relationship with someone with NPD to trying cocaine. “The trade-off is the same,” says Campbell, author of The handbook of narcissism and narcissistic personality disorder. “‘I love this cocaine, it’s great!’ Then, two weeks later, you’re like, ‘I haven’t slept in two weeks, I keep listening to disco, I don’t know what’s going on with me, I’m losing my mind.’ I’m like, ‘You shouldn’t have done the cocaine!’ Cocaine is kind of a liar. It’s the same with narcissism,” he says. “They want to feel important and special, and they’re looking at you as a tool for them to become powerful or think they’re special or important.

“They approach you like buying a new suit, or buying a new car. You get trashed in relationships if what you want from somebody is affection or love. It’s terrifying.”

“So if they start dating you, it’s the same as them buying a new Porsche. It’s fungible. You are like an object. They approach you like buying a new suit, or buying a new car. You get trashed in relationships if what you want from somebody is affection or love. It’s terrifying.”

The same can go for a narcissist’s children. For instance, if a child is an accomplished athlete, musician or actor, “these kids get psychologically wrecked”, says Campbell. “Their love is only within this narrow band of performance. If they fail, they lose love.”

Abuse isn’t uncommon in relationships with narcissists. “We can imagine if you are extremely arrogant and self-centred, that’s going to be a fairly fertile environment for abuse,” says Collett. There’s a term for that too. “Narcissistic abuse” is distinguished by a cluster of behaviours that include vengefulness, being unforgiving, lying, manipulation, ostracising victims from others and withdrawing communication as a way of resolving conflict.

A narcissist will often impose double standards too, says Sullivan. “A person will demand loyalty from their partner but consider it appropriate to have extramarital affairs.”

Are narcissists born or bred?

“The top child psychologist researchers are very clear: with almost everything [mental health conditions] it’s both,” says Cavenett. “They think you need both genetics, which creates a limitation on your expression of anything, and then an environment that alters where you fall in a given narrowed spectrum.”

Certain environments will more likely produce a narcissist though, she says: “one that doesn’t teach perspective-taking” or the importance of another person’s point of view; or one that constantly rewards superficial, attention-seeking behaviours. “It’s really looking at what behaviours are often being reinforced in the environment. Think how many times they’re told, ‘You’re really successful because you won a medal’ versus ‘How did you behave towards everyone else when you won that medal?’”

The theory is they are essentially ignored and abandoned by their mothers and cope with it by creating an inflated sense of artificial self-esteem.

Behind the disorder, say experts, is the absence of – or the presence of an extremely damaged – self-esteem. Narcissism is an unconscious defence mechanism used to bolster someone whose sense of self is fragile, according to the prevailing psychological theory. One influential study by a US psychiatrist suggested narcissists experience emotional neglect in their childhood, particularly from their mothers, says Jeyasingam. “Harry Stacks Sullivan studied more than 100 young males who had narcissistic personality disorder, and he found almost all of them had maternal issues. The theory is they are essentially ignored and abandoned by their mothers and cope with it by creating an inflated sense of artificial self-esteem [to compensate].”

The patients he’s seen with NPD – all men – had “serious emotional disruption” with their mothers, he says.

But while much of the literature about NPD points to men suffering from the disorder in greater numbers than women, it is inconclusive, as much research has only been conducted on men, says Jeyasingam. Narcissism might not be detected as easily in women. “They’re more subtle in their interactions,” he says. “With men, it’s ‘Look at me, look at this amazing tower I built.’”

People with NPD will often suffer from other personality disorders or aspects of other personality disorders, says Sullivan. For instance, there’s an overlap between narcissistic and anti-social personality disorders, with features of psychopathy, he says. Both people with NPD and psychopathy will exploit others to get their needs met. “The main difference is that the focus of psychopathy is on people using and harming other people, whereas the focus of narcissism is on oneself.” A narcissist harms their victims unintentionally with their self-obsessed behaviour. “So the collateral damage in psychopathy is external. And with narcissistic personality disorder, the focus is very much on the individual, the self, and all other people are subsidiary to that.”

Is there any treatment for narcissism?

“It’s a big deal to get rid of, to treat it,” says Jeyasingam. “It’s not like you throw on a medication and they’re better.”

Psychodynamic therapy, which focuses on the roots of emotional suffering, is the main treatment. It has its roots in the works of Sigmund Freud, who postulates in a 1914 paper, On Narcissism: An Introduction, that “primary narcissism” is a stage of development when an infant is aware of others only as an extension of themselves. Some people, Freud reasons, get stuck in this stage, and remain unable to love another person as separate from themselves.

Says Jeyasingam: “If the [psychodynamic] treatment is done properly, they get worse [before they get better] because they feel that core of emptiness which they have built an entire shell to protect themselves from. That’s part of the treatment. It’s about being able to recognise that core, so you can start to develop [self-esteem] again.”

Cavenett has seen people greatly improve with therapy. “I’ve certainly had people who’ve had their relationships back on track, whose relationships – with partners and children – are more engaged.”

Collett is trialling a video intervention program for people with narcissistic traits. The videos will show sufferers how to use journals and meditation to disrupt their self-critical thoughts and practise self-compassion. “So the idea is that this breaks down the need for that wall” and extends participants’ focus beyond themselves to other people. “[It’s about helping them to] understand that it’s all right to have things that don’t go well. There doesn’t have to be a reason or a sense to that, and it doesn’t have to mean that you’re a failure as a person.”

If you or anyone you know needs support call Lifeline 131 114, or Beyond Blue 1300 224 636.