Narcissism and ASD

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Narcissism and autistic spectrum disorders tend to co-occur in families. I regard narcissism as a listening disorder, that is as a difficulty hearing and responding positively to others' perspectives. Sam Vaknin however, who describes himself as a narcissist, posts prolific and insightful articles about narcissism on the internet. One of these articles recently caught my eye as it shed an interesting light on a couples counseling case I have been treating. The article explores similarities and differences between narcissism and Aspergers, a syndrome which now is being labeled as an autistic spectrum disorder.

Vaknin views narcissists, including himself, as able to interact with high levels of social skills in situations where impressing someone they look up to is important to them. As he says: narcissists appear sociable and socially even highly capable when they are interacting with someone whom they regard as having potential to fulfill their desire for admiration, power and other “narcissistic supplies.” At the same time, he points out, once a narcissistic person has begun to devalue the other, self-absorption and deficits in their ability to experience empathy emerge. These features bear striking resemblance to the features of someone with Asperger's.

Similarly, Dr. Khalid A. Mansour (a British Arab psychiatrist) has proposed in an article in the Pan Arab Journal of Psychiatry that narcissistic personality may merit classification as an autistic spectrum disorder.

Dr. Mansour writes, “There is now significant level of agreement that emotional processing problems like: lack of empathy, poor self-awareness, self-centredness, poor reciprocation of emotion, poor ability to maintain emotional relationships, anxiety, and anger outbursts are more or less central features of autism (10, 50,51)."

Interesting. When I first read the above paragraph, I thought Dr. Mansour was writing about severe narcissism. His description fits both narcissism and autistic spectrum disorders. Hmmm.

Dr. Mansour similarly quotes from the ICM-10 listing these features of autism:

Self-centeredness; inappropriate to developmental level and cultural expectations
Poor self-awareness, poor ability to develop remorse or learn from mistakes
Poor empathy or appreciation of others feelings
Poor ability to reciprocate emotions.
Hostile dependency on safe relations.
Failure to develop emotional relationships appropriate to developmental level and social norms
Treating people as objects or preferring objects over them

Again, this list certainly sounds a lot like narcissism.

Dr. Monsour concludes: “… it is noticeable that people with NPD, do not show a major degree of functioning problems in stress-free environment or when they are supported (except that they are perceived as 'not pleasant characters' to deal with). However, under stress and without support they can become quite dysfunctional in a way not far from what we usually see in Asperger’s syndrome.“

Theory of mind: Another autism spectrum and narcissism similarity?

Another perspective that suggests similarities between narcissism and autistic spectrum disorders involves Theory of Mind. The website Autism-World describes this phenomenon nicely:

"One of the key traits in people with autism is that they lack what is known in psychology as a ‘theory of mind’, which is also known as ‘mindblindness.' Theory of mind (T.O.M) means the ability to understand that other people have a mind and thoughts that differ from our own. This means that people with autism will often only be able to see things from their own point of view, they cannot imagine how something may affect someone else; which may be why you see them as self-centered."

Sounds a lot like narcissism!

People who are narcissistic experience difficulties when differences arise between themselves and others because of this deficit in "theory of mind." It is hard for them to believe that there is another side to the issue that troubles them because they believe that their view is the only view, that they are always "right," and that listening to the other's feelings either makes them at fault or may block their ability to get what they want.

As I explain in my book The Power of Two, to proceed collaboratively both parties in a relationship need to be able to voice their concerns. Both also need to be able to hear and take seriously the other's perspective.

If autism spectrum disorders are genetic…

In my clinical practice, I have been struck by the frequency with which neither parent of an autistic spectrum child presents with an autistic spectrum disorder, and yet one parent does appear to be significantly narcissistic with difficulties empathizing with others and digesting others’ perspectives.

Narcissism as the next-to-the-last stop on the train to the autistic spectrum disorders.

Many spouses in my couples therapy practice express relief when they hear my speculation that narcissism may be a milder version of what with increased severity would become Asperger's—and with even more self-absorption and difficulty taking in others’ perspectives would be labeled autism.

If narcissistic personality disorder tendencies stem from neuro-biological deficits and/or brain anomalies that cause difficulties with empathy, then it becomes easier to empathize with rather than become angry at an emotionally-deaf loved one.

Two complex diagnostic cases of autistic spectrum or Aspergers versus narcissism

I'd love your feedback on these cases, both of which were written in as comments to this article.

Note that I treat many cases where narcissism is involved. I have far less experience clinically with autistic spectrum/Asperger's cases, so I very much value what I have been learning from your comments.

Meanwhile, I am hoping that readers will keep in mind the distinction between narcissism and malignant narcissism. Narcissists in general just don't pick up on what others are saying and feeling. They are not necessarily mean. Intentional desires to hurt occurs just in a sub-category of narcissism, what therapists refer to as malignant narcissism.

Future research

I look forward to reading what neuroscience research finds in the way of biological clues as to why narcissism and Asperger's seem linked.

Meanwhile, if you know of research suggesting why the line that departs out from normal social and emotional intelligence toward autistic self-isolation, please share links to these studies by writing in the Comments section below.

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January 27, 2021 ADDENDUM

Many of you have been writing very helpful reactions to this article in the Comments section. The following list includes so many important observations that I am adding it now (lightly edited) to the main article. Meanwhile, thank you to all of you who have been sharing your views.

From a reader:

1) These similarities are based on how autism might look like from the outside. Here's my view of what autism actually is.

A) self centeredness: autistic people might be perceived as self centered from the outside. The thing is the autistic brain processes information in such a different way, that they actually perceive the world very differently from non-autistic people. This leads to very few commonalities with other people and the fact that autistic people always need to watch out for their own needs, since no one else seems to understand them.

B) poor self awareness. It might seem like this from the outside, but autistic people are extremely aware of themselves. What they struggle with is understanding social situations. Autistic people are not born with and don’t have the possibility to develop a “social autopilot” when they are babies due to their brain being in constant overstimulation. That means that they very often don’t know what they do wrong and therefore also can’t correct it. They are however very aware that something is wrong.

C) poor empathy. No no no no! There are different types of empathy. Many autistic people struggle with cognitive empathy which is the way of by thought understanding how the other person feels and needs, even if it’s different from themselves. Emotional empathy is often found extremely strong in autistic individuals, to the point that they cannot endure feeling from other people and can’t know if the feeling belong to themselves or the other person.
Cognitive empathy can be learned, which autistic individuals are very capable of doing.
It might also be that autistic individuals express their empathy in ways not understood by neurotypical peers, leading to the belief that empathy wasn’t expressed at all.
I would also go so far as to say that autistic individuals have the same or often better trained cognitive empathy as non-autistics because autistic people are taught their whole life how to read and understand what neurotypicals need in different situations, even if it seems very strange to oneself. Neurotypical people however don’t need to learn how an autistic mind works, what needs autistic people have and therefore very often do not show empathy with them.

This is called the double empathy problem.

D) poor ability to reciprocate emotions: it might seem that autistic people don’t understand or show emotions, the fact is they struggle very hard to read facial expressions and body language, they also often express own emotions in different ways than neurotypicals are used to. This is however not the same as lacking this ability. Autistic individuals are very keen on learning how to read other people and know what other people feel and when they know they also try expressing emotions which would fit in a way that is understood. This takes extreme amounts of energy because they have to analyze body language and social cues manually, again because of the lack of a social autopilot.
Again: double empathy problem.
Also: masking and camouflage in autism.

E) dependency on safe relations. Wow. If anyone would be just one day in an autistic mind they would know why safe relations, safety of all kinds, is so very important to autistic individuals. It might seem hostile from the outside, but it’s more often extreme anxiety and frustration. Not to understand social situations intuitively makes all relations very unsafe and difficult. To have one safe person to depend on can make life go from anxiety hell to livable. I’m not saying more. Just stop judging us and try understand us instead.

F) failure to develop emotional relationships. Yes some autistic people are unable to do this. And very many are not. Many autistic are in healthy, good relationships with other autistics or non-autistic individuals. Some autistics don’t have the same need to form deep emotional relationships in the same way non-autistics have. The autistic brain works differently, autistic individuals have different needs and often have difficulties understanding the needs of other, expressing own thoughts and needs and are very often experiencing to be misunderstood. If the partner would learn to communicate in a direct way to help the autistic person understand the signs sadly often lost on the person with autism, and be open to listen to the specific and often misunderstood needs of the autistic individual, they might not have this problem anymore.
Again: double empathy problem.
And how the autistic brain works differently.

Also a lot of autistic people have disabilities in bodily functions, like information processing and movement. This might seem from the outside that they never learned to “function” as adults, but is in fact a disability and should be treated as such. It is not a failure, but a lack of support from the people around them and from the society as such.

G) treating people as objects or preferring objects. This is really one of the most misunderstood things about autism. The problem autistic individuals are facing is not that they don’t care about people, it’s that they don’t understand them and are themselves usually misunderstood when they try to express themselves. A lot of autistics are so interested in other people, how they function, what they need and how they can help them, that they make it their special interest, some even study psychology and become therapists. Autistic individuals are in constant social under stimulation, having to try to fit rules and norms they don’t understand, so often not understanding when people show affection or not receiving affection at all. They constantly try to please people around them, often with the result giving up their own self. They are very aware of people around them not finding them “good enough”, experiencing constant rejection from people they try to connect with. Complex PTSD is very common in autistic individuals and autistics are more often experiencing abuse than non-autistic people.

At the same time, a brain which is constantly over stimulated from sensory input often find a sense of calm and security in things that don’t move around, make noises or expect you to behave in a certain way. This is why many autistic people often connect strongly with objects and find it very hard to connect to people. This does however not mean they do not see people as people, or that they do not care about how other people are feeling.

2) to compare a neurological developmental difference to a personality disorder is from a professional point of view very strange. A personality disorder isn’t allowed to be diagnosed in children, it is something that one evolves into in youth or early adulthood. Autism is something most often diagnosed in children, although sadly often missed in the “higher functioning” individuals, it’s seen even in babies.

3) just because something cooccurs in several families, does not mean it is genetically connected. To research if something is genetically linked, you need to look to twins, as they have done with autistic people. Identical twins are more often both autistic than only one. Not identical twins often have only one autistic. To see if narcissistic behavior is genetically linked with autism, one would have to find that one identical twin had autism and the other developed narcissistic behavior.

There might be several other reasons for the two to occur in the same family:
A) autistic people often are more prone to experiencing traumas, they struggle with understanding social situations and might therefore also more often find themselves in a codependent relationship/ relationship with trauma bonding. These kinds of relationships are often found with narcissistic people, as people with narcissistic behavior often find ways to make other people dependent on them,

B) having a child with autism can be a very heavy burden. To have your own baby not look at you, not want to spend time with you can be emotionally damaging. There might be reason to believe that some mothers develop narcissistic behavior to protect themselves from this rejection.

C) relatives to autistic people often have several autistic traits even without being autistic. This might lead to a sense of not being understood, similar, but not the same, as autistic people experience. Such a traumatic experience might lead to different coping mechanisms where narcissistic behavior might be one. Because they have the understanding of social situations, which they wouldn’t have if they were autistic, they are able to manipulate others into giving them what they want to fill the need they don’t know how to get otherwise. This does however not mean that narcissistic behavior in itself is genetically linked to autism. Other coping strategies might be other personality disorders or other mental disorders.

4) an autistic person lacks the ability to understand social situations intuitively. They do not harm other people willingly any more than non-autistic people do. To be able to manipulate people you have to be very good at understanding social situations, body language and social cues. Autistic people might seem similar from the outside, but they more often hate themselves than think themselves better, they more often have no idea what just happened and why they are different, than think themselves better than anyone or deserving anything. Often autistic people feel so misunderstood, rejected and not respected that they are only expressing the need for the same respect that other people are willing to give non-autistic individuals. This is not a fault on the individual, it’s a fault on society for not respecting people who are different on the same level just because they don’t understand them. It has nothing at all to do with autism in itself.

That doesn't mean negative actions can't be punished, only that we need to eradicate the mindset that they inherently should be excluded regardless of their behaviours.

Hard for me to feel sympathy for people who inflict pain and harm on others. I do not care if they have a mental illness or trauma, I would rather keep them away. This does not mean they shouldn't seek treatment. Heck even people have become serial criminals or dangerous criminals, we still lock them away regardless of their bad childhood and their trauma or mental illness.

I'm not sure what sympathy for people who hurt others has to do with autism and NPD appearing to be adjacent disorders with significant shared traits.

It's literally in the criteria and have you ever been with people who couldn't see things from your perspective and were gaslighting you, this is abusive behavior. This causes harm to others.

Or people who are controlling and this also causes harm to others.

I dated a guy with BPD and he displayed narcissistic behavior and yes it harmed me.

Anyone that calls you a liar is an abuser because they are dismissing your feelings and how it looked to you and dismissing your experience. I have also dealt with it as well and that is harmful behavior they are inflicting on you. This is a black and white way of seeing what is the truth or not and if it doesn't fit your view and your narrative, that person must be lying. Yeah I avoid these people and cut all contact with them. I don't need abusers.

Autistic people can be abusive as well and I also don't give them any sympathy. Never tell victims they should try and understand their abusers and their bullies and so on. I don't care what illness or disorder they have, if they act abusive due to their symptoms, I treat them as such and it's for my own safety.

Yeah this topic is triggering for me so maybe I shouldn't have opened this thread.

https://www.psychologytoday.com/us/blog/resolution-not-conflict/201406/do-you-think-narcissism-autistic-spectrum-disorder

^ Good insights.

I feel like stigma is part of the problem. Most people with stigmatized mental health conditions are mostly decent people, the bulk of whom strive to overcome the tendencies their PD makes them prone to. If we treat people with NPD, or borderline or who meet most of the criteria for AsPD as inherently toxic and irredeemable it only harms them while doing nothing to resolve whatever problem they might potentially represent.

That doesn't mean negative actions can't be punished, only that we need to eradicate the mindset that they inherently should be excluded regardless of their behaviours.