It is common for PLACE members to share stories of being told by their child that they are “narcissists” or have narcissistic personality disorder (NPD), often without having ever met a clinician. This “diagnosis by proxy” is problematic for a number of reasons.
Being called a narcissist implies a clinical diagnosis of NPD. Bear in mind that NPD is estimated to occur in about 0.5% of the US population. For comparison, a diagnosis of dissociative identity disorder is estimated to occur in about 1% of the US population. In my years as a clinician, I’ve met one person with DID, yet dozens (if not hundreds) of PLACE members have reported their EAC labeling them with NPD. This over-identification skews public perception of NPD, and misrepresents the actual clinical picture.
Two important needs are at play here: the need for licensing boards to act, and for the public to be more discerning. Many social media content creators are neither licensed nor qualified, and their use of clinical language is powerful and potentially dangerous. It may come as no surprise that it is unethical for a therapist to diagnose someone they have not evaluated directly. If an EAC claims their therapist “said my parent has NPD,” it’s worth questioning the validity and legality of such a statement. In reality, making diagnostic statements about third parties without a formal evaluation is grounds for potential action by state licensing boards. I would like to see the boards require that counselors who endorse client estrangement document that they have met and evaluated the parent(s).
An extraordinary amount of distress and confusion result from misused diagnostic labels, especially when coming from our own children. The damage is not only reputational but relational, contributing to deeper estrangement and interfering with the repair of relationships. Furthermore, these by proxy diagnoses dilute public perception of people actually diagnosed with NPD. The unethical behavior of social media personalities also stands to damage the reputations of competent, ethical counselors.
And though PLACE does not diagnose, as a qualified professional I’ve not encountered even one participant whose behaviors made me wonder if they have NPD. A mental health assessment should be done by licensed, qualified individuals who have completed the requisite postgraduate work, a supervised internship (or equivalent), and any other criteria set by their state.
Please remember that being labeled doesn’t make something clinically true. The misuse of psychological language is a societal trend, not a personal truth. Do not internalize unsupported or unethical diagnostic claims. Take comfort in the truth.
