If you are connected with a very pathological narcissist, there is a high probability that you have experienced ongoing stress, and are blamed for any strain that is present.

Narcissism is a pattern on a spectrum. It includes tendencies toward controlling attitudes and behaviors, low empathy, self-centeredness, sense of entitlement, need for superiority, need to feel important, excessive defensiveness, and exploitive behaviors.  Each person has moments when these traits show up, and when they are persistent, we refer to it as narcissism. Some individuals, however, have an extra measure of pathology making their narcissistic traits especially problematic. Their penchant for control and manipulation makes relationships quite toxic.  This is called pathological narcissism.

If you can understand what you are up against, you can be freed from the unnecessary emotional baggage they wish to impose upon you.  Narcissists wish to dominate you, but that can happen only as you cede your will to them.

A primary feature I watch for to determine if narcissism is of the extreme nature is the exaggerated disregard for others needs and feelings.  Pathological narcissists have very low empathy to the extent that they register little or no remorse for the pain they cause. They do not see, nor do they care about another’s dignity. They are characterized by hostile feelings, especially in moments of disagreements, and their anger is aggressive.  They show disdain for accountability, and they feel beholden to no one other than themselves.  In simple terms, they are just plain mean.

If you are entangled with someone who shows signs of pathological narcissism, there is a high probability that the narcissist sized you up and determined that you would be vulnerable to their manipulative schemes. You were chosen.  These people are predators looking for those they can emotionally dominate.  That being the case, they have “assigned” you the role of the inferior member of the team.  To them, theirs is the only voice that matters, and they hope you forget to listen to yours.

Knowing this, you can determine to choose a different path.  You’re not required to be that person’s emotional punching bag.  Knowledge is power, so once you become enlightened about life on the far end of the narcissistic spectrum, you can become poised to make decisions about how you should proceed. 

Following is a list of 20 primary indicators of pathological narcissism. 

With the narcissist in mind, place a check next to the indicators that are consistent within that person.  Once you get a score, we will determine how to interpret what you experience.

  • Feeling truly exceptional, they find few (if any) flaws within themselves.
  • Zero need to reciprocate the good deeds others give toward them. “I’m deserving, you are not.”
  • No sensitivity to the pain they inflict upon others.
  • Will vilify and punish anyone who corrects them or attempts to call them out.
  • A vain attitude of superiority over others.
  • Never does good without the expectation for a personal payoff.
  • Caustic and destructive in the midst of anger or conflict.
  • Willfully deceptive.  Keeper of secrets.
  • Disdain for rules.  “You need rules, but they don’t apply to me.”
  • No discernable sense of life’s meaning or purpose beyond self-promotion.
  • In any relationship, they must be in control; they must be the final authority.
  • Mentally, emotionally abusive, sometimes including physical abuse or   threats.
  • Absolutely will not reveal personal hurts or errors in judgment.
  • Criticism and scrutiny are chronic.
  • Expectation of privileged and favored treatment is strong.
  • Readily devalues and ridicules those deemed “less-than.”
  • Talks at you, not with you.  Uses forceful, rigid reasoning. Communication is one-way.
  • Drawn toward people or activities that represent power.
  • Awkward, uncomfortable with tender emotions or the need to show compassion.
  • Impressed with outer displays of exceptionalism (possessions, titles, associations, social connections, physical appearance, awards, etc.)


If you checked 1-6 items, there is a low likelihood of pathological narcissism.  Each person is capable of moments when discernment is missing.  In this person’s case, when insensitivities occur, you should find them open to discussing your concerns.  Narcissistic pathology is possible with these people, but apparently not common.  Usually when individuals have only a few such narcissistic leanings, they are capable of making healthy and reasonable adjustments.

If you checked 7-12 items, the likelihood of pathological narcissism is fairly prominent.  Though not entirely consumed with oneself, these individuals have enough self-serving tendencies that it is more than just a passing matter.  They are likely to perpetuate strain and tension in many relationships.  They may have an inclination toward creating a positive public image, but they can be much less engaging once they are out of the spotlight.  Discussions with these people might produce productive adjustments, but they will need strong accountability measures.  They are likely to fall back onto old habits rather easily.

If you checked 13 or more items, there is a strong indication for pathological narcissism.  Self-absorption and manipulative behaviors define this person.  They have a low capacity for collaboration in relationships, and they are not at all willing to consider the needs and perspectives of those surrounding them.  Inevitably, they lack the sufficient empathy to do the work of relationship problem solving. To these people, engagements with others are merely transactions.  They see the people surrounding them as tools to further their self-serving plans.  When others refuse to bow to their entitled ways, they are quite willing to discard them, and the results are predictably painful.  If you find yourself entangled with such a person, you are likely to suffer emotionally with a broad array of emotional reactions.  These people are toxic.

Your Response

When you are connected with a pathological narcissist, there are certain do’s and don’ts to remember.  These are people who are not likely to receive input, nor are they inclined to change.  Being very full of themselves, they shun input from those they deem inferior.  They truly believe they need no adjustment.

When these narcissists persist in their dysfunctional ways, don’t:

     *Plead for them to be more understanding.  It won’t happen.

     *Defend or justify your feelings, attitudes, or behaviors.  They will only use it as an opportunity to be more demeaning.

     *Attempt to teach them the better ways to respond.  They already think they are better.

      *Threaten them or make insulting remarks.  It will only inflame them.

      *Assume you are an inadequate person.  To the narcissist, you are inadequate, but they don’t have a good track record for being objective.

     *Assume they will become nicer if you just appease them and do as they command.  That is called enablement.

Instead, there are some positive ways to respond to the pathological narcissist.  Keep in mind that these responses are not for the purpose of making them see the light.  Rather, they are for the purpose of positioning yourself to be the healthiest version of yourself.  Given the fact that pathological narcissists are not team players, you will need to take upon yourself the task of self-care, knowing they will not appreciate your perspective. 

When faced with pathological narcissists, do:

*Accept the reality of your situation.  The relationship is not what you wish for, yet it simply is what it is.

*Be firm with your personal boundaries.  Pathological narcissists want to direct your decisions and priorities.  But it is okay, even necessary, to say “no” or “I have other plans,” or “I’m not going to participate in this debate.”

*Be strategic.  Pick and choose carefully if and when you will spend time with this person.  Keep your exposures minimal, and when possible, have allies with you. 

*Expose yourself to people who appreciate you for who you are.  Pathological narcissists like to isolate you from others, but you are under no obligation to appease.  Let others remind you that you are appreciated for who you are.

*Anticipate scenarios when the narcissist will likely act out.  Rehearse in advance your strategies for self-care.

*Exit the relationship if that is an option.  The longer you remain under the influence of a pathological narcissist, the more it will generate emotional duress.  You deserve better.

A key component of healthy living is the willingness to receive insight and positive suggestions.  Healthy people want to grow and they welcome the opportunity to learn.  But a fatal trait often accompanies this healthy mindset.  That is, healthy people want others to join them in the effort. With like-minded individuals, this can be rewarding. But with pathological narcissists, it can be disastrous. 

Know what you are facing, and rather than putting all your efforts into either changing or appeasing the pathological narcissist, take care of your legitimate needs. 

Les Carter, Ph.D.