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Psychopathy is not a clinical disorder

Stephen Bear in CBB UK 2016As the media, armchair psychologists, and “experts” (including those who offer views without a personal assessment) more and more confuse and conflate narcissism and psychopathy, it is probably useful to have another look at the differences. As many people don’t seem to realize, psychopathy is not a clinical term. It is not a psychiatric diagnosis recognized by the “bible” of mental health classifications, the Diagnostic and Statistical Manual of Mental Health Disorders, currently in its fifth revision, known as the DSM-5, and published by the American Psychiatric Association. Similarly, it is not included in the World Health Organization’s International Classification of Diseases, or ICD-10 for short. No, psychopathy is a legal concept that was originally developed to predict the risk of violence and reoffending of criminals. The clinical diagnosis most closely related to psychopathy is an antisocial personality disorder (APD).

Clinical criteria for Antisocial Personality Disorder

So, what are the respective criteria for a diagnosis of narcissistic or antisocial personality disorder? For APD, the DSM-5 requires significant impairments in self-functioning (ego-centrism and self-directed goal-setting without regard for norms and rules) and interpersonal functioning (lack of empathy, and the inability to be intimate on an equal basis). Personality traits include those oriented to antagonism (manipulativeness, deceitfulness, callousness, and hostility) and those related to disinhibition (irresponsibility, impulsivity, and risk-taking). These behaviors and traits are reasonably stable over time and not be better explained by a person’s developmental stage or their sociocultural environment.

Clinical criteria for Narcissistic Personality Disorder

NPD is also characterized by significant impairments in self-functioning and interpersonal functioning, but there are important distinctions. The former refers to an exaggerated self-appraisal compared to others, and goal-setting based on gaining approval, entitlement, and seeing oneself as exceptional. The latter requires an impaired ability to recognize or identify with the feelings and needs of others, and superficial relationships to serve the self-esteem. Antagonistic personality traits are also present, regarding beliefs of grandiosity (i.e. entitlement, being better than others, and condescending) and attention-seeking through excessive attempts and dramatic behavior. These features must also be stable and independent of age- and sociocultural-related contexts.

8 Differences in narcissistic and antisocial personalities

As is evident from the diagnostic criteria, there are some similarities between narcissistic and antisocial personalities, but also clear distinctions. Both have issues with interpersonal functioning but from a different basis that manifests because of separate needs.

(1) Narcissists seek attention and admiration rather than functional gain.

The first difference is that narcissists desperately needs a so-called narcissistic supply to sustain their self-esteem. They incessantly search for positive feedback, approval, affirmation, love, and admiration from those around them and will go to excessive lengths to satisfy this craving. They believe they deserve and need it to feel good about themselves.
For antisocial personalities, their demeanor is more aggressive in a quest to get the things that they need, which is mostly material gain, power, and control. Therefore, their focus is on functional benefits rather than to stroke their egos.

(2) Narcissists try to cling to relationships, antisocial individuals don’t.

For narcissists, relationships are an important aspect of providing them with validation and recognition. Antisocial persons, on the other hand, build and discard relationships purely by what they can benefit from it financially or psychologically. When a partnership sours, the narcissist will try to cling to it because it defines his value somehow. The antisocial person will simply discard a partner without a second thought if he or she has outlasted their usefulness.

(3) Narcissists have, feel, and display emotions; the antisocial brain is wired differently.

Callousness is a hallmark of the antisocial personality. Neuroscientists have come to believe that the structure and activity of the prefrontal cortex, a region of the brain that covers the front part of the frontal lobe, is a major factor in this trait. This part is integrally linked to a person’s personality, social functioning, decision-making, and rule learning. Research have shown that structural and functional anomalies in the prefrontal cortex are related to remorselessness and impulsive antisocial behavior. Their brains are just wired differently, which renders the experience and expression of emotions impossible. Some become adept in mirroring emotions that are expected of them, but it is not genuine.
Narcissists have, feel, and display emotions. They are just too self-absorbed at times to pay attention to, respect and sympathize with others’ feelings. For them, everything is about themselves. Their experiences and feelings are all that counts, and everyone else has a duty to attend to their needs, they believe.

(4) The needs of a narcissist are more overt.

Narcissists wear their needs on their sleeves for all to see. It is clear that they value themselves different to other persons and feel entitled to respect and admiration. They will do nearly anything to fulfill this need, including using emotional displays. Antisocial personalities don’t use emotions, apart from anger when they are wronged, and, even then, it is more of a calculated use of aggression than honest feelings. Instead, they use cunning, manipulation, deceit, and threats to get what they want. Although there is often nothing subtle about it, their intentions may be unclear at times.

(5) Narcissists are more trusting and less suspicious.

As narcissists need the approval of other people and are impulsive with poor emotion regulation, they are inherently more trusting and may appear naïve. Antisocial individuals are hardened, cannot be manipulated with emotions, and are naturally suspicious of others. But, instead of being generally pervasive, their paranoia is often directed as aggression at a particular object or person that is seen to stand in their way of achieving their goals.

(6) Narcissists take revenge when their pride is wounded.

Where a narcissist may try to exact revenge when their pride is hurt, an antisocial person doesn’t have such tendencies. Unless an act of aggression can help them obtain a need, they will just not see the worth in making the effort to take revenge.

(7) Narcissists are self-obsessed rather than driven by self-interest.

Narcissistic persons are driven and motivated by self-obsession that is benchmarked against others’ “lesser” value. They badly need positive feedback from others to keep their ego intact and confirm their worth. A typical antisocial individual only cares about protecting and building their self-interest. What others think of him is not his problem and doesn’t concern him one bit.

(8) Narcissists are more reactive rather than proactive

Narcissists are not meticulous planners and react to others’ actions rather than behaving thoughtfully. Mostly, they live from moment to moment, and from stimulus to stimulus. They respond rashly to perceived rejections and disrespect. Antisocial persons, as they are impulsive risk-takers, will also react instinctively at times when someone presents a threat to their self-interest. However, they are often excellent planners to, and capable of putting in place and executing a long-term plan.

Narcissistic and antisocial traits sometimes co-exist

However, to complicate matters in certain cases, there are positive correlations between narcissism and antisocial personalities, and the conditions can be comorbid, which means that they sometimes co-exist. Although only NPD is associated with affective issues such as depression and anxiety, both NPD and APD often co-occur with drug and alcohol use problems, albeit for different reasons. In APD, it is part of their risk-taking and impulsivity, while, in NPD, it may be self-medication or impressing a crowd. So, although there is a little bit of an overlap between NPD and APD features, the symptoms rarely co-occur sufficiently to justify a dual diagnosis.

Therefore, there are enough differences to distinguish narcissism from an antisocial personality, and the recent conflating of personality types in the media are uninformed and confusing

Joan Swart, PsyD

Joan Swart, PsyD

Forensic Psychologist | Business Developer at Open Forest LLC
Joan is a forensic psychologist, lecturer, and author of “Treating Adolescents with Family-Based Mindfulness” published by Springer in 2015 and “Homicide: A Forensic Psychology Casebook” published by CRC Press in 2016. She is a business developer at Open Forest LLC. Open Forest LLC provides online psychoeducation and self-help programs aimed at improving many conditions, including depression, anxiety, ADHD, and mindfulness.
Joan Swart, PsyD


Forensic psychologist, #narcissist, #psychopath, other PDs | Business developer at | #pug lover | masters #powerlifting
Joan Swart, PsyD
Joan Swart, PsyD

4 thoughts on “8 Differences Between a Narcissist and an Antisocial Personality

  1. According to Svrakic (1985) emotional profile of antisocial PD is similar to narcissistic PD.

  2. Joan, as a layperson having long-term experience with family members and close (former) friends who individually meet the diagnostic criteria for NPD and ASPD, I read your piece with interest.

    I would like to comment on three of your points:

    (1) Narcissists seek attention and admiration rather than functional gain:

    A person with NPD can outwardly appear to be driven by materialistic wealth; however, one must be close to the individual to know the actual motivators. One close friend meeting all the diagnostic criteria for NPD seemed quite obsessed with his pursuit of materialistic wealth, but, factually, he was laser-focused on the STATUS that wealth and business success brought him through association and attention from others who were already successful (placed him in the circle in which he so desired to be a member). He also minimized all significant contributions to his business by others and falsely took credit for all. The situation was not for financial gain; it was so he could – and did – stand and claim, “This is what I did all by myself. I didn’t need anyone.” (‘Look at me! Look at me!’)

    I do disagree with your assessment of control, though. People with NPD are the most controlling people I’ve ever experienced: they control their identity; they control different personas for different people and situations; they control the narrative; and they attempt to control those close to them as a function of their entitlement as well as to gain / maintain compliance in reinforcing their fantasy world (which people with ASPD don’t seem to exhibit; they seem firmly rooted in identity and reality) and to mitigate the risk of exposure. I’ve not experienced one person with NPD – covert or overt – who could just ‘rest and be’.

    (5) Narcissists are more trusting and less suspicious:

    Paranoid personality disorder (PPD) is often co-morbid with NPD. A person with whom I had a romantic relationship who is unquestionably NPD but of the covert type (covert rather than overt grandiosity fantasy), was highly paranoid meeting all the diagnostic criteria for PPD except one. My opinion, based on behavioral experience with him, is that the paranoia was driven by an overwhelming fear of exposure for who he really is rather than the street angel as he presented to the public. He had a limited awareness of his “weaknesses” (his description), and suffered short periods of low self-esteem. Though, as soon as attention from others was increased, he shifted to grandiosity but not exceedingly overt. Paranoia was always an underlying presence that became prominent during a rage or following a narcissistic injury, often to benign situations or comments he perceived as an “attacks” (his description), or in situations where there was a greater risk of exposure because he had limited control. He was always on guard protecting his persona and believed people were “out to ruin him”.

    (8) Narcissists are more reactive rather than proactive:

    Your statements are accurate until one considers a narcissistic injury severe enough to create revenge fantasy or when the person wants to “discard” a former friend on his / her terms and not on the terms of the person who ended the relationship. Then a person with NPD can become a very careful and, often, a long term planner to exact their revenge and “settle the score”, as I have personally and painfully learned.

    Thanks for writing the piece and sharing the information.

  3. Number to nailed it for me in my attempt at a differential diagnosis thank you for this checklist although check this list should never be used without a trained experience psychiatric provider to interpret the results.

  4. Thank you for writing this short and informative piece. As a psychologist who works primarily with schizophrenics and street homeless in the Criminal Justice System, I have a lot of experience with ASPD, but never really noticed NPD– so this helps me to sort out those issues and to give it a different lense. Thanks!

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