The Two Narcissists
For many mental health workers and clients, the word “narcissist” now sits at a crossroads of meaning. Among expert diagnosticians, the term often refers to a person with narcissistic personality disorder (NPD)—a formal mental health diagnosis indicating a genuine illness. However, it also carries a second, non-clinical, judgmental meaning: a clinical-sounding synonym for "selfish," "manipulative," or "deceptive."
This post focuses on the second, judgmental meaning of “narcissist” and the potentially harmful consequences of mental health workers using the term in that way. I caution against such usage—especially when working with clients distressed by would-be narcissists in their lives—because it conflates clinical and colloquial meanings, stigmatizes a bona fide disorder, encourages punishing a sick person for their illness, and risks undermining several key principles of effective therapy.
In my view, using "narcissist" pejoratively is more harmful than helpful. One reason is accuracy. Many who use the term blur the clinical and judgmental meanings without realizing it. This can create confusion in sessions: it becomes unclear which definition is being used—or if both are—making communication more difficult and increasing the risk of misunderstanding between client and worker.
Another concern is how the term “narcissist” is often arrived at. When a client describes a harmful relationship, the client's account is typically the only source of information about the alleged narcissist—and it often comes from a place of very real pain. Pain can cloud objectivity. Furthermore, the information supporting any diagnosis is hearsay. While diagnostic guidelines allow for reports from friends and family to contribute to a diagnosis, such information must be considered alongside the direct observations and self-report of the individual being diagnosed—input that is usually missing when the client speaks about a third party.
Scope of practice is also an important issue. Some mental health workers who use "narcissist" diagnostically lack the formal training to make such a diagnosis, and doing so may fall outside their professional role. Even for trained clinicians, and as mentioned above, diagnosing based solely on second-hand accounts would be highly questionable.
When the clinical label is misapplied, inadvertent cruelty often follows. If the person being described does not meet criteria for NPD, applying the label stigmatizes those who truly struggle with the disorder and unfairly equates hurtful behavior with mental illness. If the person does meet criteria for NPD, using "narcissist" judgmentally punishes them for their sickness. Mental health workers serve as ambassadors of the profession; when we use stigmatizing language, clients may carry that stigma into their lives and relationships.
For these reasons, I suggest leaving the clinical use of “narcissist” to diagnosticians—and avoiding its judgmental use altogether.
In addition to the potential social harms, there's also the question of therapeutic helpfulness. From a cognitive-behavioral therapy (CBT) perspective, using “narcissist” as a pejorative violates the principle of avoiding cognitive distortions like "labeling." Labeling reduces a person to a single trait or act—for example, calling someone a "cheater" because they cheated on one test—ignoring the complexity of human behavior and identity.
From a dialectical behavior therapy (DBT) perspective, the judgmental use of “narcissist” conflicts with the mindfulness principle of non-judgmentalness. Mindfulness encourages descriptive, factual language rather than value-laden judgments. It's the difference between using “fat” as a neutral descriptor versus a slur, or “queer” as an identity versus a weapon. Similarly, there is a difference between describing harmful behaviors and labeling someone a “narcissist.” Descriptive language focuses on observable actions, not inferred intentions, emotions, or motives, which is also consistent with DBT. Accurately assessing internal experiences of another person would require sophisticated tools and skills that most workers (even skilled clinicians) don’t routinely possess.
Given these concerns, why do many mental health workers still use “narcissist” judgmentally? Likely because it offers short-term benefits. For clients, the label can help regulate overwhelming emotions—such as guilt and shame—after being harmed or exploited. Blame can provide psychological relief when shame would otherwise be crushing.
Anger, too, can feel empowering. It reminds the client that their pain matters, and can help them resist the pull of a harmful relationship. Labeling the person as a “narcissist” can lend a sense of legitimacy to hurt feelings and validate a client’s pain in a way that feels concrete and affirming.
The label may also benefit the mental health worker. If the worker struggles with countertransference—perhaps from their own experiences with people with narcissistic traits—using the term may feel cathartic. It can also help with rapport-building: validating the client’s description may strengthen the therapeutic alliance, at least initially.
However, in all these cases, I believe "narcissist" should be seen, at best, as a stepping-stone—a temporary label that supports emotional regulation. It may serve as a useful "truck stop" for pain, and less useful as a final destination where client and therapist become trapped by seductive blame and oversimplified labels.
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Do you agree or disagree with these critiques of the judgmental use of "narcissist"? Have you found the term helpful or unhelpful in your own life—or in your work with clients? Please comment and share your thoughts!
“Narcissus” by Caravaggio.