The word “narcissist” is one of those tricky terms that is both luxuriously broad in meaning (it’s defined on Dictionary.com as “a person who is overly self-involved, and often vain and selfish) as well as clinically specific. A narcissist, from a psychiatric perspective, is a person suffering from Narcissistic Personality Disorder (NPD), a formal diagnosis coined after years of psychoanalytic study. In the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), NPD is defined as a cluster B personality disorder, comprising “a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration and lack of empathy.”

As a mental health writer, I’m interested in exploring narcissism in the latter sense — as a pathology rather than as a lax term for a self-absorbed person. I want to know how narcissism manifests in a person and how one can identify a narcissist and cope with their potentially toxic behavior.

To enlighten me, I turned to a number of experts including David M. Reiss, M.D., a psychiatrist who has specialized in narcissism for over 30 years.

“Narcissism has been around as long as humanity has been around — and has been recognized for that long,” Reiss says. “The term itself comes from the story of Narcissus in Greek mythology, dating back to at least 8 A.D. As to the formal diagnosis, that arises from psychoanalytic thinking, starting with Freud but with different schools of psychology accepting slightly different understandings of the pathology/personality disorder over ensuing years.”

The telltale traits of narcissism go well beyond self-absorption

Diagnosable narcissism is far more complex (and often dangerous) than mere selfishness or vanity. One interesting way to think of one with narcissistic personality disorder is as a big baby — no really, because a baby, like a true narcissist, is concerned only with themselves and their needs.

“We all come into the world with needs that we want to be filled, and no one asks a baby [to reason with them]. They just say ‘Oh here, let me feed you, let me cuddle you and sing to you’,” says Dr. Keith Humphreys, a psychiatrist and professor of psychiatry at Stanford Health Care. “As we grow up, we learn that other people need things, too. Now, we may have moments where we’re very selfish, but it’s on a continuum; not for narcissists though. Narcissists are just stuck there in this bottomless, constant need.”

But narcissism can wear many masks. Here’s a list of telltale traits of a narcissist courtesy of Karaine Sanders, Psy.D, a psychologist in New York.

Self-concern, self-centeredness and self-consciousness that is disproportionate

Extreme sensitivity to negative feedback or criticism

Significant need for approval from others due to inadequacies that are real or imagined

Poor self-esteem often expressed through self-deprivation or arrogance

Difficulties within most relationships

Intolerance for imperfections in others

Often idealize others that represent perfection followed by devaluing that very person when they are perceived to have failed them

Preoccupation with outward appearance, beauty, wealth, fame, success over morals, virtue or even integrity

Poor emotional regulation, aggressive impulses, psychologically fragile

Vain, self-righteous and prideful

Lack remorse, compassion, empathy for others

Narcissists seldom seek treatment because they can’t self-reflect

We all have some narcissistic qualities, which run along a spectrum. There’s a radical difference, though, between having narcissistic qualities (e.g., being self-centered) and being a full-fledged narcissist.

One should never self-diagnose, but consider this: If you’re worried that you might be a narcissist, you probably are not one. Narcissists generally lack the kind of empathetic self-reflection that might make them wonder if they have a personality disorder. This is partly why narcissism is so seldom treated, Reiss adds, and why it’s presently impossible to truly quantify how many people have the disorder.

“Rarely does someone come to me [as a psychiatrist] and say they read about narcissism and think they are a narcissist,” says Reiss. “If they can recognize narcissistic behavior, then it’s probably not severe. Narcissists can get depressed, anxious, abuse substances and have problems in the family (for which they take no accountability) and usually it’s those types of issues that, as we get into them, we find a narcissistic core.”