Narcissism: A Fad Diagnosis that Lacks Scientific (Empirical) Support
Actually, narcissism is a very old diagnosis but in recent years it has become a very popular diagnosis to the point of becoming a therapy fad. In my previous posting, I used the fad “diagnosis” narcissism as an example of bogus online “diagnosis” from both licensed mental health professionals who really should know better and people lacking any credentials but who nevertheless believe they are an expert, having attended the University of Google.
That’s bad enough, but in this posting I am going to take things a step further. Even under the very best of circumstances, when Narcissistic Personality Disorder (NPD) is “properly” assessed for in the office of a licensed mental health professional, the scientific evidence for this disorder and for the whole construct of narcissism is lacking.
Recently much ado was made over the fact that the future issue of DSM, DSM V to be published in 2013 has NPD along with four other PDs have been slated for elimination as personality disorders. What is not mentioned in the NY Times article is that what the committee has come to recognize is that traits associated with these personality disorders exist in virtually everyone and it’s only a matter of degree.
For this reason, given that virtually everyone has degrees of so-called narcissism, one cannot possibly diagnose NPD by reading someone’s postings on the internet. Without having full knowledge of a person’s life which involves taking a full, detailed history there is no way that conclusion can be come to based on what the person writes on the internet. Even a person with just a little bit of narcissism (which virtually everyone has) might have that bit brought out in a given situation that would come out in an internet posting and then taken out of context and blown out of proportion, especially by people who have been angered by what the person had to say.
What the DSM V is replacing NPD with is what is known as a dimensional assessment, an assessment procedure that will assess the degree of a number of personality traits, including narcissism, so as Michael Anestis has pointed out and explained so well on his blog, narcissism itself hasn’t actually been eliminated, although the personality disorder as a diagnostic category has.
However, a number of scientifically-oriented psychologists have argued something more basic than that. The fact is that scientific evidence for the validity of narcissism, per se, is lacking. This means that essentially, an elaborate assessment instrument has been created for a construct of highly questionable validity. Note that a valid and reliable assessment tool does not mean that the constructs in that assessment tool are necessarily based on anything with scientific support. The principle of garbage-in-garbage-out applies.
In his book, What is Mental Illness (2001, Harvard University Press) the Harvard Psychologist Richard J. McNally who himself served on DSM IV committees, had the following to say about narcissism and its lack of scientific support:
The scientific evidence pertaining to narcissistic, paranoid, dependent, histrionic, obsessive-compulsive and passive-aggressive personality disorders is nearly nonexistent despite their appearance in DSM in 1980 (McNally, 2011, p. 198).
Although future editions of DSM strive to improve and be more scientific, the DSM is still far from scientific and is more a matter of politics and consensus that includes the input of people who do not necessarily abide by scientific evidence, but instead adhere to clinical lore and authority.
The bottom line is even at best, Narcissism has highly questionable scientific validity. What does that say about all the fad therapy lore that involves proclaiming that someone had a narcissistic parent or deciding someone whose postings one did not like is a narcissist?
The notion of having a narcissistic parent explaining ones difficulties has spread like wildfire throughout the internet, following the publication of a pop psychology book. An example can be found in the blog of another WordPress blogger in a posting entitled Reduced to a Syndrome, who felt this book perfectly explained her life. People might be wondering, if something seems to ring so true and fit so perfectly, is that not compelling evidence?
In a word, no. A number of experiments have been done where people were given fake personality tests and then given what they were told was a personalized evaluation to read based on the fake test. The catch is that everyone in the group was given the same personalized “evaluation” that word for word, said exactly the same thing for each participant. In such experiments, very commonly a huge percentage of people believe that the bogus, “evaluation” explained them to a tee.
Scott Lilienfeld, who recently gave a talk on pseudoscience at FSU gave an illustration of when he did this experiment with a large class of people. After giving the “evaluations” before he revealed that they were not valid and that everyone got the same evaluation, he got many very positive responses from the participants who felt the evaluations were spot on. One middle-aged woman in the class raised her hand and said that after having had years and years of therapy, this “evaluation” explained her life better than any therapist ever had in the years of therapy she experienced. He then had the painful task of breaking the news to her and the rest of the class, who had largely bought into it, that the test and the evaluation were completely bogus and that everyone in the class had been given the same evaluation. This shows how easy it is to convince people that something “fits” — even something utterly bogus. It is human nature for us to look for what fits, so that doesn’t mean that these people are stupid. What it means is that it is very important for people to be aware of how they might be fooled by bogus notions. It is particularly easy to fool with people who are searching for answers to a personal problem they have been unable to resolve.
The so-called “profile” for women who were raised by a narcissistic mother is a profile that could fit a number of women to a tee — being focused on career to the point where they are considered a “workaholic” (although that term is also debatable) and who are not satisfied with their lack of personal relationships (again, a common problem). However, there is no evidence whatsoever that this is caused by having had a narcissistic parent. There are all kinds of other possible explanations. Therapists promoting this kind of notion say that their evidence is that people who come to them for therapy confirm that this is correct. Again, that is circular reasoning. People come in, searching for answers, the therapist who already believes in the theory gives the interpretation to the client who is already hungering for an explanation, it seems to fit (just as the bogus evaluation given to the class by Scott Lilienfeld seemed to “fit”) and that further confirms things. That is a far cry from scientific evidence.