Narcissistic Personality - Are NPD and Psychopathy the Same?

Are NPD and Psychopathy the Same?

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There's increasing debate about whether narcissistic personality disorder and psychopathy are the same thing. Though I don't know enough to be sure, the more I learn about psychopathy, the more I find it indistinguishable from NPD.

We know from the research that psychopaths have a core, aggressive narcissism that is fundamental to their personality. If you remove that narcissism, you don't have a psychopath.

— forensic psychologist J. Reid Meloy, author of The Psychopathic Mind, as quoted in Hollow Men: Ted Bundy Discusses Possession.

I think you may find a continuum of pathology among those with these disorders. But different disorders? No difference has been established.

Indeed, follows The Psychopathy Checklist (PCL-R). How much do you see here that doesn't fit a malignant narcissist to a "T"?

Factor (cluster) 1: Aggressive narcissism

Glibness/superficial charm

Grandiose sense of self-worth

Pathological lying

Conning/manipulative

Lack of remorse or guilt

Shallow affect

Callous/lack of empathy

Failure to accept responsibility for own actions

Promiscuous sexual behavior

Factor (cluster) 2: Socially deviant lifestyle

Need for stimulation/proneness to boredom

Parasitic lifestyle

Poor behavioral control

Lack of realistic, long-term goals

Impulsivity

Irresponsibility

Juvenile delinquency

Early behavior problems

Many short-term marital relationships

Revocation of conditional release

Criminal versatility

Not much there that doesn't fit the narcissist to a "T," I'm afraid. And when you remove the three items included to make this checklist diagnostic for the prison population, you see virtually no clear difference between psychopathy and malignant narcissism.

One cluster [factor] appeared to be defined largely by aggressive behaviors, the other combined with items from the narcissistic personality disorder. "This [latter] cluster was named psychopathic, because the inclusions of the exploitative narcissistic personality features and the removal of the overly aggressive antisocial aspects creates a syndrome reminiscent of the older psychopathic concept" (Morey, 1998, p. 319).

— Handbook of Psychopathy, by Christopher J. Patrick (p. 162)

Of the traits listed under "aggressive narcissism," only "promiscuous sexual behavior" is merely common among aggressive narcissists and not an actual manifestation of aggressive narcissism. Similarly, of the traits listed under "socially deviant lifestyle," only "many short marital relationships" and "criminal versatility" are merely common among antisocials but not an actual manifestation of Antisocial Personality Disorder.

A person is scored on each of these 20 items with a score of 0, 1, or 2.

0 = item doesn't apply

1 = item somewhat applies

2 = item definitely applies

A normal person scores 3-5. A score of 25-30 or more (out of a possible 40) is used to diagnose psychopathy.

Narcissistic personality disorder has a theoretical and clinical literature that is quite independent of PCL-R studies of psychopathy (Cooper, 1998; Gunderson, Ronningstam, & Smith, 1991; Hare, 1991, 1998; Kernberg, 1970). Nevertheless, psychodynamic views of narcissism do suggest common features (Gacoma, Meloy, & Berg, 1992; Kernberg, 1998; Perry & Cooper, 1989). Antisocial and psychopathic tendencies are conceptualized as being on a continuum with narcissism, with both involving a motivation to dominate, humiliate, and manipulate others. As noted by Stone (1993), "all commenters on psychopathy . . . allude to the attribute of [pathological] narcissism—whether under the rubric of egocentricity, self-indulgence, or some similar term" (p. 292). He went so far as to suggest that "all psychopathic persons are at the same time narcissistic persons" (Stone, 1993, p. 292). Kernberg (1970) has similarly stated that "the antisocial personality may be considered a subgroup of the antisocial personality" (p. 51). Hart and Hare (1998) generally agree that there is a close correspondence between psychopathy and narcissism but suggest instead that "psychopathy can be viewed as a higher order construct with two distinct, albeit related facets, one of which is very similar to the clinical concept of narcissism" (p. 429).

Some of the features of DSM-IV narcissistic personality disorder are explicitly suggestive of psychopathy, notably a grandiose sense of self-importance and arrogant, haughty behaviors (comparable to psychopathic arrogant self-appraisal), lack of empathy and being unwilling to recognize or identify with the feelings and needs of others (closely related to psychopathic lack of empathy), and interpersonal exploitation (corresponding to psychopathic manipulativeness, deceitfulness, and antisocial behaviors). It has even been intimated that narcissistic personality disorder is closer to Cleckley's conceptualization of psychopathy than APD is (Hare et al., 1991; Harpur et al., 1989; Harpur, Hart, & Hare, 2002).

— Handbook of Psychopathy, by Christopher J. Patrick (p. 162)

Yes. That's obvious.

Another reason I am skeptical of there being any real difference between NPD and psychopathy is because the shoddy thinking of the American Psychiatric Association is breathtaking. It really hoses their credibility. In fact, they not only make distinctions where there are none in evidence (between NPD and psychopathy), they obliterate distinctions where there are (between psychopathy and Antisocial Personality Disorder)!

In Psychopathy and Antisocial Personality Disorder: A Case of Diagnostic Confusion, Dr. Robert Hare points out that the American Psychiatric Association has confused Antisocial Personality Disorder with psychopathy in its Diagnostic and Statistical Manual. Yet anyone can see that there is a world of difference between your typical street criminal (antisocial) and your psychopath.

Most of the prison population (about 80%) would easily meet the diagnostic criteria for Antisocial Personality Disorder, scoring high in the Factor 2 traits. But only about 20% of the prison population meet the diagnostic criteria for psychopathy, scoring high in both factors. And that 20% are responsible for at least 50% of the most serious crimes committed. Psychopathic convicts include virtually all serial killers, 50% of all serial and repeat rapists, and 44% of those who murder police officers.

What's more, psychopaths have an astronomical recidivism rate = are repeat offenders. Their recidivism rate is at least 3-5 times higher than the recidivism rate for antisocials (your typical street criminal). And that rate counts only those who get rearrested within a year or two of their release from prison. Presumably that is but a fraction of the actual recidivism rate.

Moreover, the suicide rate among psychopaths is very low, whereas it is high among antisocials.

So how can the American Psychiatric Association see no distinction between APD (sometimes referred to as ASPD) and psychopathy? Give me a break. They thus obscure that difference, dumping the pond of psychopaths into the ocean of antisocials. What better way to make psychopathy go away?

Why should they want to do that? Presumably to preserve a cherished myth — namely that bad people are just good people with bad parents, bad upbringing, poverty, etc. and that by caring for them you can talk these poor victims back into being good. To hell with the 30 years of scientific evidence that this just isn't true and that wealthy psychopaths emerge from wonderful, wealthy families to do horrendous things.

"There's still a lot of opposition — some criminologists, sociologists, and psychologists don't like psychopathy at all," Hare says. "I can spend the entire day going through the literature — it's overwhelming, and unless you're semi-brain-dead you're stunned by it — but a lot of people come out of there and say, 'So what? Psychopathy is a mythological construct.' They have political and social agendas: 'People are inherently good,' they say. 'Just give them a hug, a puppy dog, and a musical instrument and they're all going to be okay.' "

If Hare sounds a little bitter, it's because a decade ago, Correctional Service of Canada asked him to design a treatment program for psychopaths, but just after he submitted the plan in 1992, there were personnel changes at the top of CSC. The new team had a different agenda, which Hare summarizes as, "We don't believe in the badness of people." His plan sank without a trace.

— "Psychopaths Among Us," by Robert Hercz

In other words, again we get "a powerful sense of psychiatry as a profession out of control. Cut off from what ought to be its roots in the basic research community, and at the mercy of the strongest political factions of the moment."

Hare also points out the American Psychiatric Association's insidious switch from defining a disorder as a set of character traits (e.g., egocentricity, deceit, shallow emotion, manipulativeness, selfishness, and lack of empathy, guilt or remorse) to a set of behaviors = getting into trouble with the law.

Consequently, NPD and psychopathy are defined as a bunch of behaviors — a short, select list out of many possible ones. So, for example, let's say we have 24 behaviors common to people believed to have a mental illness. We take 6 and make it our definition of the disease. Then we can take another six and make it the definition of a different disease. We can get four diseases out of one that way.

No wonder only 9-60% of diagnoses agree. No wonder up to 94% of diagnoses error in applying the diagnostic criteria. No wonder so much evidence of bias appears. No wonder clinicians seldom diagnose just one personality disorder in a patient. And no wonder the most popular personality disorder checked off on the diagnosis is "other."

For example, NPD is defined by grandiose conduct. Okay, but how does grandiosity figure into the psychopath? The short list for psychopathy says nothing about grandiosity. Oh, so psychopaths do not say and do grandiose things then, right?

Wrong. Their grandiosity just isn't mentioned on the official list, that's all. So, how can you compare NPD and psychopathy and find a difference then? Answer: You can't, because American Psychiatric Association has their lists of criteria set up so that you are comparing apples with oranges.

Is the psychopath's vaunting grandiosity any different a narcissist's? Do different narcissists vary in their grandiosity? Indeed, all psychopaths are malignant narcissists. So, where is the difference in their grandiosity, pray tell?

Consideration was given in the development of DSM-IV criteria for APD [specifically, psychopathy, because here the authors aren't distinguishing between psychopaths and antisocials -KK] to include the components of PCL-R psychotherapy that are not already contained within the APD criterion set; notably glib charm, arrogance, and lack of empathy (Widiger et al., 1992). The DSM-IV APD field trial focused specifically on this proposal (Widiger et al., 1996). However, one concern was that these features are also central to the diagnosis of narcissistic personality disorder and there inclusion within the criterion set for APD would increase markedly their diagnostic co-occurrence and undermine their differential diagnosis (Widiger & Corbitt, 1995).

— Handbook of Psychopathy, by Christopher J. Patrick (p. 162)

What a crock! That doesn't mean you set up your criteria to make psychopathy and NPD look different: that means you tell the truth and show that there may be no difference! Boy, these guys are glib.

Again, for example, some say that psychopaths have no feelings, whereas narcissists merely lack the full range of normal human feelings. First, that's wrong. Second, it's just a difference in how successfully feelings are repressed; it isn't a different character trait. Narcissists vary in this respect.

In fact, psychopaths are capable of feeling. They are capable of putting themselves in someone's else's skin. They prove that in their sadistic acts of mental cruelty, which show that they do empathize to figure out how to morally demolish their victims. For example, no unfeeling robot would think to reduce the victim to a slave who, in spite of himself, offers himself to be tortured for his killer's pleasure. It takes knowing how that will make the victim feel to dream up such a sick way to be cruel. No robot thinks of making a statement by tossing a victim in a trash bin after he's done with them. Only someone who knows how that would make the dying victim feel would do that.

That's empathy. Perverted empathy, but empathy nonetheless.

The truth is that both narcissists and psychopaths just repress all feelings but the ones they want. By doing this habitually, they may come to experience no feeling except when consciously contemplating how something would feel (rather like the Christian mystic is encouraged to sit and "contemplate" the five wounds of the Christ).

Therefore, some narcissists and psychopaths may simply have gotten better at repressing their feelings than others. They may get better at repressing their feelings over time, and thus become less susceptible to having unwanted feelings surface to consciousness on them. In other words, they could become more unfeeling and thus more closely fit the current description of the psychopath.

You can imagine the same progress with conscience. And likewise with how far an individual pushes the envelope in risk-taking with criminal behavior.

That agrees with those who regard psychopathy as an extreme form of narcissism, as based on a popular model of interpersonal relations. (Click here to see a larger image.)

But it's more complicated than that. For one thing, not all defined personality disorders fit into this model, like borderline, schizotypal, and obsessive-compulsive personality disorders.

Moreover, things besides the disease itself affect its fruit. Things like opportunity, power, status, and environment are other factors that affect how far into criminal behavior a particular individual may go. For example, a factory worker can't get away with as much as a President-for life like Saddam Hussein. So, though he may be sicker, that factory worker probably won't attempt as much. Doubtless, Hussein's pathological narcissism was worsened by his own acts, blurring cause and effect. Also, someone who can prop up his ego on mental cruelty to his family won't be as tempted to become a serial killer as someone who has no family. He may be just as sick in the head though.

So, I question whether the people on either end of this continuum are actually suffering from a different disease (or any "disease" in the medical sense). It's hard to see where you draw the line between narcissism and psychopathy, though much more research is needed to be sure either way.

Those who say there's a difference often seem to be grasping at straws, making out mere individual differences in style as representative of the whole group and then conveniently finding that there are only two kinds, narcissists and psychopaths.

Here's an example of a common stretch that seems an effort to arrive at a preconceived conclusion: Some say that psychopaths are violent criminals like Ted Bundy, and that narcissists look down on evildoers like killers because narcissists are pharisaical.

Well, it's safe to say that Ted Bundy portrayed himself as morally superior to violent criminals whenever he was at a dinner party or on a psychiatrist's couch — before he got caught. How much do you want to bet that was pharisaical? The egregious error here is letting it slip your mind that he talks differently in jail than he does before conviction while free and successfully fooling everyone.

Both narcissists and psychopaths are different people in the dark than in the light of day. Therefore, you must compare the one in the dark with the other in the dark or the one in the light of day with the other in the light of day. But it's invalid to compare the one in the dark with the other in the light of day. Ted Bundy in the dark doesn't compare with himself in the light of day!

Furthermore, the vast majority of psychopaths never commit a physically violent crime, and many narcissists aren't pharisaical. In fact, since all psychopaths are known to be narcissists as well, it doesn't even make sense to describe them as contrasting in any way. That's an egregious error in logic.

In my book, Without Conscience, I argued that we live in a "camouflage society," a society in which some psychopathic traits — egocentricity, lack of concern for others, superficiality, style over substance, being "cool," manipulativeness, and so forth — increasingly are tolerated and even valued. ...Psychopaths have little difficulty infiltrating the domains of business, politics, law enforcement, government, academia and other social structures. It is the egocentric, cold-blooded and remorseless psychopaths who blend into all aspects of society and have such devastating impacts on people around them who send chills down the spines of law enforcement officers.

— Dr. Robert Hare

So much for the idea that a psychopath is a violent criminal. In fact, see Snakes in Suits about psychopaths in the corporate world, by Dr. Paul Babiak and Dr. Robert Hare.

Here's more clutching at straws. 'Narcissists are usually more grandiose, while psychopaths are more exploitative and have a superficial value system.'

Huh? Psychopaths aren't extremely grandiose? Just look at what the criminal psychopath does to his victims. It's all a way of acting out that 'I am God Almighty, and you are dirt.' That isn't any lack of grandiosity: it's grandiosity pumped up to an extreme. What do these people think rape is for? sex? It's about power and domination, and anyone with any sense sees that. What's more, most narcissists and psychopaths camouflage their grandiosity behind a facade of false modesty. The only time you see it is when Mr. Hyde comes out of them. So, the people clutching at this straw know little of real narcissists or psychopaths.

And what is more exploitative? Materially exploiting someone or morally exploiting them? Materially exploiting them for money or for the physical pleasure of beating them up? Morally exploiting them sexually or morally exploiting them psychologically? And how about exploiting people both materially and morally through character assassination to get their job and to seem holier-than-them? That's exploiting a person for the rest of their life! Again, what we see isn't any lack of exploitation: it's exploitation pumped up to an extreme. And what about driving people to suicide? That isn't as exploitative as shooting them dead?

How simple-minded.

Indeed, these sloppy thinkers think that sexual exploitation is material exploitation. Wrong. It's a moral assault much more than a physical one. They also think this (and other violent criminal behavior) is not done to enhance the psychopath's self-image. Ridiculous. The criminally violent psychopath is just going to the ultimate extreme to enhance his self-image. He loves the image of himself as a titan who tramples others. He gets tons more high from that than he would from merely verbally insulting someone. And, again, anyone who thinks knows that.

Yes, there may be a difference, or at least a dividing line, between a malignant narcissist and a full-blown psychopath, but no one has established such a difference.

There are as many styles of narcissist and psychopath as there are narcissists and psychopaths. They aren't clones. In fact, I have that from a narcissist herself. She assessed another narcissist as not a murder threat, not because he'd have any inhibitions about murdering the particular person who felt at risk, but simply because "that isn't his style."

Indeed, many narcissists find it safer and more fulfilling to murder by driving the victim to suicide. That's absolute power. Much grander than just plain, old-fashioned murder.

Similarly, Lee Harvey Oswald wrote in his diary that his persona was created to adapt to his particular environment. And since every narcissist lives in a different environment, every narcissist adapts differently to it. In fact, narcissists don't just have two faces: they have many faces, each a face prepared to meet a certain type of face they meet. Sometimes they want to stand out for attention, and sometimes they want to blend in for approval. So, the same narcissist may have a wildly different persona in a tavern than in church than at home than at work. He's a he-man, a pious and devout church-goer, a bully, and a regular guy all rolled into one.

In this report in the Journal of Abnormal Psychology, Doctors Hare, Hart, and Harpur of the University of British Columbia address criticisms of the current diagnostic criteria for psychopathy, which have wheedled their way into people's heads as a definition of it. The approach focuses on "antisocial behaviors rather than personality traits central to traditional conceptions of psychopathy." Okay, these behaviors are supposed to indicate the underlying personality traits. But sloppy thinking has made people view the behaviors themselves as the disease.

Hence "Psychopaths are those who commit violent crimes" translates in effect to "Psychopathy is committing a violent crime." Right, so up to the day he assassinated President Kennedy, Lee Harvey Oswald was a narcissist. Then he suddenly became a psychopath. Absurd.

But that's exactly what this confusion forces them to say...

People with narcissistic personality disorder sometimes behave irresponsibly because they do not feel that normal social constraints should apply to them; at such times, their behavior may turn antisocial.

— Abnormal Psychology: Chapter 12 - Personality Disorders by Nietzel, Speltz, McCauly, and Bernstein (PDF, 595 KB)

Jeez! OK, what are they then? Narcissistic except while in the act of breaking a law?

In short, Doctors Hare, Hart, and Harpur are absolutely right: you can't define a mental illness as a behavior = an action. It is a kind of THINKING. How can such highly educated people fog up the picture so completely unless they are doing so deliberately? One is forced to question either their IQ or their honesty.

Others cling to assumptions about narcissists made by therapists and researchers taking these pathological liars at their word about themselves. In fact, until recently, they did that about psychopaths too. They believed that psychopaths have a conscience, love their families, don't mean to do evil, and yadda yadda yadda.

Why? Because the psychopaths on their couches said so. That is, the pathological liars on their couches said so.

In the same Journal of Abnormal Psychology article, doctors Hare, Hart, and Harpur cite the same problem:

...clinicians are generally forced to rely to a large extent on patients' memories and self-reports of their past conduct (Widiger et al., 1989) – a state of affairs that is particularly problematic, given that untruthfulness is one of the disorder's symptoms....

Thanks in large part to Dr. Hare himself, studying all those convicted axe murderers in prisons during the past few decades has helped most folks see that psychopaths are lying their heads off when they claim to have a conscience, love their families, not mean to do evil, and yadda yadda yadda.

Yet why have many social workers and other professionals failed to learn that lesson? They prove they haven't by not applying it to anyone not convicted of a violent crime that proves them lying about themselves.

Another egregious error in logic: "If we can't prove they're lying (via a criminal conviction on their record), they're telling the truth." Right. So, Ted Bundy wasn't a psychopath throughout all the murders he committed until he got caught and convicted for one = in effect, psychopathy is getting caught. Absurd.

They make the same mistake with narcissists. They get no information about narcissists' behavior from people who live and work with narcissists. They receive information only from the already diagnosed narcissist in treatment. Of course he says he has a conscience, loves his family, doesn't mean to do evil, and yadda yadda yadda.

When you know someone is a pathological liar, don't assume that he is telling you the truth. What can we expect him to say? — "I like hurting people and just prey on them. I have no conscience. No feelings. No love. No humanity in me at all."

He ain't gonna say that. Nobody would. He only knows it himself in an unwanted moment of self awareness that he quickly re-buries. And, frankly, I actually don't blame narcissists for lying about that. That amounts to saying "I'm evil." Everyone has the right to pursue happiness and therefore to not incriminate themselves.

Therapists and researchers have to get out there and find additional information from other sources to compare these self reports with. And something besides prison time only.

Narcissists are sadistic. The famous narcissist Sam Vaknin admits that (though he seems to contradict himself on the subject). In the absence of experience, pure logic should make anyone realize that narcissists are sadistic. If you need to vaunt yourself on others to feel good about yourself, the more you hurt and humiliate them, the better you'll feel. So, you're gonna wanna hurt and humiliate them as much as you can. That's sadism.

The narcissist's choice of victim is another fact that gives their sadism away: they target the most vulnerable, those they can wound most deeply. That's sadism.

Since long before I knew anything about psychopathy or heard about this debate, I became convinced that narcissists have no conscience. There is not one iota of doubt in my mind about that, because I have seen them do many things, abhorrent or sadistic things, that no one with a conscience could possibly do. And such things do not always leave blood and body parts lying around.

In fact, many normal people have an unconscience about some things. So, a conscience deficit isn't exclusively a trait of the personality disordered.

Most of what weighs on a conscience is loaded there by the moral norms of religion and society. Some of these things aren't even moral. When religion and society are removed, conscience is stripped down to its pure form and we are left with the core human values that people of all religions and cultures embrace. Things like personal honor and integrity and uprightness. Don't lie, cheat, or steal. Don't kill just to kill. And so on. All these moral walls that form our innate and natural conscience are built of empathy.

No empathy? Then you have a psychopath or other narcissist. No conscience at all. Someone capable of doing anything to anyone as lightly as you'd brush a crumb from your sleeve.

Another fallacy you hear is imagining distinctions where there are none. Here's a guy at FAQ Farm trying to distinguish between narcissism and psychopathy...

NPD specifically manifests as a pathological craving for attention. Socio/psychopathy manifests as a pathological disregard for anything but self gratification. To compare the two would be rather like comparing a goal with a methodology.

Took the words right out of my mouth. So, why did he torpedo his own assertion by pointing this out?

Craving attention is craving self-gratification, which is what we get out of attention. So, where's the difference? The criminal psychopath gets no attention out of the person he torturing? or out of the homicide detectives? or out of the press? And, craving something is just the flip-side of having total disregard for anything but. There's no distinction there.

What does change on a continuum through these indistinguishable disorders is the risk taking. Like any drug, or anything that affects us like a drug, we develop a tolerance to it. It takes ever increasing doses to get that high. To "stimulate," if you will. For example, history shows that the ancient Roman arena spectacles steadily increased in barbarity. That was because it took ever-more-stimulating spectacles of torture to sexually excite the spectators and generate the mass sexual orgy that took place in the stands. (Good for business.)

The same thing happens with abusers. The more they get away with, the more they need to get away with. The further they have to push the envelope to get that exhilarating high from having gotten away with something bold and risky.

One narcissist I know of, while trying to drive her sister to suicide, said to her, "I'm to the point of robbing a bank." The pretty school teacher didn't have so much as a traffic ticket on her record. But here she was, attempting murder. For, doing it left-handedly doesn't transubstantiate attempted murder into anything but attempted murder.

It's the same with the brutality and violence (either physical or moral) of the abuse. That too must escalate to keep giving the narcissist satisfaction.

So, some narcissists/psychopaths get to the point of taking greater risks than others. But that isn't a function of how sick they are. It's a function of how addicted they are.

It's also largely a function of how much power they have or what environment they're operating in. Some narcissists get to the point of being more brutal than others. Some get better at repressing their feelings. Some succeed in distancing themselves from themselves better, some get to the point that they don't even feel bodily sensations. That happens to some extent in all narcissists/psychopaths.

But this may be just natural variation within the group. The underlying personality traits seem to be universal among narcissists/psychopaths.

It doesn't even make much sense to say that one is more severe than the other. A powerful person who can't be held to account (e.g., Saddam Hussein) will always go farther than someone whose brother is an FBI agent.

Besides, if you say that those who commit a physically violent crime are the sickest, we're then lead to deduce that the severity of mental illness is a function of the criminal penalty imposed on its expression. Therefore, those who drive others to suicide are mentally healthy! Absurd. They are just sneakier, that's all.

In fact, I see nothing in the profile of a psychopath (as explained in "Predators" for Psychology Today) that isn't in a narcissist, though a narcissist's need for excitement seems to depend on the circumstances and not be constant. I sure see excitability, hypertension, and an almost drunken giddiness with risk taking, though. They seem to be "on" or "off" and are suddenly really dopey when off. But again, this difference could well be just variation of the same personality trait along that continuum though.

Bottom Line: Are NPD and psychopathy the same? No one can say for sure yet, but no legitimate distinction has been found. Just a lot of theorizing by academics and clinicians who haven't backed up their guesses with real science.

The Mask of Sanity by Hervey M. Cleckley, 5th edition, revised 1984 (PDF download)

© 2004 � 2008, Kathleen Krajco � all rights reserved worldwide.
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It was last updated on 3/9/2008.
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