Misdiagnosing Narcissism - Generalised Anxiety Disorder GAD
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Misdiagnosing Narcissism as Generalized Anxiety Disorder (GAD)
Summary:
Anxiety disorders, particularly Generalized Anxiety Disorder (GAD), are frequently misdiagnosed as Narcissistic Personality Disorder (NPD).
Introduction:
Anxiety disorders, including GAD, are often mistaken for Narcissistic Personality Disorder. This confusion arises due to the overlapping characteristics that both conditions can exhibit.
Understanding Anxiety Disorders and Narcissism:
Anxiety is characterized by uncontrollable and excessive worry. Common symptoms include obsessive thoughts, compulsive behaviors, restlessness, fatigue, irritability, difficulty concentrating, and physical symptoms like increased heart rate and sweating.
Narcissists are driven by a need for social approval, known as Narcissistic Supply. They experience anxiety because their sense of self-worth depends on external validation. This often makes them irritable and prone to frustration, resulting in outbursts of anger.
Like those with panic attacks and social phobia (another anxiety disorder), narcissists fear embarrassment and criticism. This leads to difficulties in social, work, and romantic environments.
Similarities Between Narcissism and GAD:
Both narcissists and people with GAD can develop obsessions and compulsions. They are often perfectionists, deeply concerned with their performance and competence. As noted in the Diagnostic and Statistical Manual, GAD sufferers, especially children, are:
> "Typically overzealous in seeking approval and require excessive reassurance about their performance and other worries."
This description could easily apply to narcissists as well. Both groups fear being judged and struggle to meet the expectations of an internal critic and inflated self-image.
However, narcissists usually avoid comparison and competition, expecting special treatment instead. They may withdraw from competition, seeing peers as unworthy of their effort. In contrast, individuals with anxiety disorders are often overly invested in their work, with their perfectionist tendencies ironically hindering their success.
Differential Diagnosis:
While it can be tempting to confuse anxiety disorders and pathological narcissism, key differences exist. Both groups seek social approval and can appear haughty or detached. They may experience dysfunction and personal failures. However, narcissists are often proud of who they are (ego-dystonic), while those with anxiety disorders feel distressed and seek help, which is crucial for proper diagnosis.
Conclusion:
Understanding the differences between these disorders is critical for accurate diagnosis and effective treatment. Clinicians must carefully evaluate symptoms to distinguish between narcissism and anxiety disorders like GAD.
References:
- Goldman, Howard G. Review of General Psychiatry, 4th ed. London: Prentice-Hall International, 1995.
- Gelder, Michael, et al. eds. Oxford Textbook of Psychiatry, 3rd ed. London: Oxford University Press, 2000.
- Klein, Melanie. The Writings of Melanie Klein. Ed. Roger Money-Kyrle. New York: Free Press, 1964-75.
- Kernberg, O. Borderline Conditions and Pathological Narcissism. New York: Jason Aronson, 1975.
- Millon, Theodore, and Roger D. Davis. Disorders of Personality: DSM IV and Beyond, 2nd ed. New York: John Wiley and Sons, 1995.
- Millon, Theodore. Personality Disorders in Modern Life. New York: John Wiley and Sons, 2000.
- Schwartz, Lester. "Narcissistic Personality Disorders: A Clinical Discussion." Journal of the Am. Psychoanalytic Association 22 (1974): 292-305.
- Vaknin, Sam. Malignant Self Love - Narcissism Revisited, 6th revised impression. Skopje and Prague: Narcissus Publications, 2005.
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