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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 positiively 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 case I have been treating. The article explores similarities and differences between narcissism and Aspergers, a syndrome which now is being labeled as an 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 “ 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 emerge. These features bear striking resemblance to the features of someone with .

Similarly, Dr. Khalid A. Mansour (a British Arab psychiatrist) has proposed in an article in the Pan Arab Journal of Psychiatry that narcissistic 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, , and 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 -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 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 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 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 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 toward autistic self-isolation, please share links to these studies by writing in the Comments section below.