“NPD means someone with strong self-love” and “a narcissist is just a bad person” — views like these are now widely circulated. But we need to pause here. What recent research is showing is not simply that there are public misunderstandings about NPD (Narcissistic Personality Disorder), but that distortions in assessment can also enter from the side of medical and psychological professionals. In particular, a 2025 peer-reviewed study showed that clinicians themselves tended to feel anger, reduced empathy, hopelessness, or, conversely, sympathy, sadness, and discomfort depending on the patient presentation, and that these emotional reactions could be related to diagnosis and severity judgments.
In this article, I will first lay out the facts confirmed by research. Then, in my own assessment, I will say that even professionals have not been able to see NPD accurately enough, and that the professional side also bears responsibility for self-checking and correction. What matters here is not to harshly condemn professionals. It is the opposite. NPD is inherently difficult to understand, and because it is an area that is easy to misread at a surface level, professionals also had conditions that made them susceptible to being swept along. Seeing that structure is the starting point for improvement from here.
First, the conclusion
What we can say with relatively solid research support comes down to three points. First, NPD is a highly stigmatized diagnosis both among the public and in clinical settings. Second, clinicians themselves may experience countertransference and emotional bias toward people with NPD or pathological narcissism. Third, those emotional reactions may lead to distortions in diagnosis, severity assessment, and treatment attitude.
And from here on, this is my own assessment. Given that such problems were overlooked for so long, I believe we should say that professionals also have not seen NPD accurately enough. That said, rather than evaluating them as “professionals were immature,” it is more faithful to the facts and more useful to the discussion to say that understanding NPD is still developing, and the professional side also had blind spots in assessment and a responsibility to correct them.
NPD is difficult to detect in the first place
NPD is not simply “self-centeredness.” In the 2025 study by Day et al., pathological narcissism is organized into **grandiosity** and **vulnerability**, two forms that appear quite different. In their study, when 180 clinicians read two hypothetical cases constructed to have the same level of severity, 97% identified the grandiose presentation as NPD, while the vulnerable presentation was judged variously as **depressive disorder 29%, NPD 24%, trauma- and stressor-related disorder 21%, and borderline personality disorder 21%**.
This result is very important. Why? Because it shows that the naive expectation that “a professional should be able to tell at a glance” does not actually hold. NPD may not appear only as obvious self-centeredness; it can also become hard to see when it is buried in vulnerability, depression, or trauma-like presentations. That means if one is pulled along by surface impressions, assessment can easily go off course.
What did the 2025 clinician study show?
What is especially important on this topic right now is a collaborative study published in 2025 in Clinical Psychology & Psychotherapy by researchers from the School of Psychology, University of Wollongong in Australia; Department of Psychology, Bishop’s University in Canada; Department of Psychology, City, St George’s, University of London in the UK; and the Center for Personality Disorder Research / Psychiatric Research Unit STHØVEN and the University of Copenhagen in Denmark. The authors are Nicholas J. S. Day, Marko Biberdzic, Ava Green, Georgia Denmeade, Bo Bach, and Brin F. S. Grenyer.
In this study, clinicians were shown to feel anger, lack of empathy, and hopelessness more often toward grandiose cases, and sympathy, sadness, and discomfort more often toward vulnerable cases. The study also reported that in grandiose cases, more negative clinician attitudes were associated with higher ratings of personality disorder severity. Based on these findings, the authors interpreted that for grandiosity, anger and frustration may create excessive stigma and bias, while for vulnerability, sadness and empathy may lead to underestimation of pathology.
What becomes clear here is that misunderstanding NPD is not caused only by a lack of knowledge. If anger and irritation are strong, the person is more easily seen as “severe” or “problematic.” On the other hand, if they appear pitiable, they are more easily seen as “just hurt.” In other words, what distorts assessment is not only cognition but also emotion. That is why I think the central terms here should be not only “countertransference” but also emotional bias.
Why did my past self react so strongly to this issue?
In the past, whenever I saw someone being treated as if they were definitively “NPD” and therefore a villain by the people around them, I really felt that it was unfair and that they must be suffering. Looking back now, I think part of that was that I was, in some way, superimposing my own experience of being treated as a villain for a long time. This is not a summary of research findings, but my own reflection. Still, it was precisely because of that overlap that I was able to feel an early and strong discomfort with the structure of using a diagnosis to turn someone into a bad person.
Countertransference is not just an old theoretical term
When people hear the word “countertransference,” they may think it sounds like an old theoretical term. But in reality, it is a very practical issue. Day et al.’s 2025 paper concretely showed that the emotional and relational reactions that arise in clinicians when they are with patients can affect diagnosis and treatment.
This also aligns with an empirical study from 2017. The paper Countertransference when working with narcissistic personality disorder: An empirical investigation by clinical psychology researcher Annalisa Tanzilli and colleagues at Sapienza University of Rome in Italy is real and indexed in PubMed. University profile information also confirms that Tanzilli is a faculty member in the Department of Dynamic and Clinical Psychology and Health Studies at the same university.
This study has been cited in later research as showing that clinicians working with patients with NPD are prone to negative countertransference such as anger, feeling criticized, feeling looked down upon, helplessness, inadequacy, and a sense of withdrawal.
In other words, understanding NPD is not enough if we only look at “what kind of person that is”; we also have to look at what happens in the person facing them if we want to grasp the whole picture.
That said, I should add one thing here: my own way of seeing this is often a little different from these reactions. Even when I meet someone who shows grandiose behavior or strong anger, I tend not to see them as simply bad first, but rather to think about what kinds of wounds or defenses may lie behind it. For example, might their mind be moving to prove its own worth because they have been deeply hurt in the past? Or might pain that could not be expressed properly be spilling out as defensive anger? I try to look at those inner movements first.
Conversely, when I encounter someone who cries or strongly presents as a victim, I do not just take their suffering at face value; I also look for the possibility of hidden aggressiveness or manipulativeness. In other words, I do not simply see angry people as bad, nor do I simply see crying people as good. I tend to look at what is operating beneath the surface more than the emotions or impressions that are visible on the outside.
NPD is stigmatized within medicine too
Another important 2025 study is the qualitative research by Ellen F. Finch and Emily J. Mellen. Published in Personality and Mental Health, it organized the structure of NPD stigma through interviews with clinicians who treat NPD. Based on public information, the authors’ affiliations are listed as Ellen F. Finch at Harvard University and Emily J. Mellen at Tufts Medical Center.
The abstract shows that NPD is widely considered to be highly stigmatized, and clinicians reported that it is highly stigmatized both in public and in medical settings.
What matters here is that prejudice is not found only in society at large. It can also enter the medical and psychological professions in the form of wariness, distancing, resignation, and negative expectations toward NPD. That is a very serious problem for patients. If someone is labeled “a narcissist” in public and also tends to be seen as “difficult” or “troublesome” in medical settings, they become doubly likely to be excluded.
A 2021 study had already made the professional-side reality clearer
An important earlier study is the 2021 article in Personality Disorders: Theory, Research, and Treatment. Authored by Owen S. Muir, Jillian N. Weinfeld, Danny Ruiz, Dmitry Ostrovsky, Miguel Fiolhais, and Carlene MacMillan, its ResearchGate preview lists Brooklyn Minds and City University of New York as primary affiliations.
In this paper, NPD is described as an underdiagnosed psychiatric condition. The clinician survey showed that patients with NPD were often seen as difficult and challenging, that clinicians had little treatment experience and high dropout rates, and that clinicians who had received formal lectures or training on NPD reported better outcomes.
The important thing about this study is that it showed the professional side’s “not understanding” as not just a matter of individual quality, but as a systemic and educational issue. There are few opportunities to properly learn about NPD, the evidence base is limited, and countertransference load in the clinical relationship is high. If that is the case, it is no surprise that professionals are swept along. That is why, when we say “even professionals got it wrong,” the accurate way to say it is also to add that this reflects the difficulty of understanding NPD and the inadequacy of the training environment.
The word “narcissist” itself is damaging understanding
Another thing making this even more complicated is the problem of language. A 2026 study published in Acta Psychologica by Michael P. Hengartner, Ahmet Eymir, and Nick Haslam argued that NPD has been affected by concept creep, that is, the gradual expansion of a concept. Their affiliations are listed as the Kalaidos University of Applied Sciences in Switzerland, the Zurich University of Applied Sciences, and the University of Melbourne in Australia.
The paper points out that through conceptual expansion, NPD has come to be used more broadly than the original diagnostic concept, and that the public often uses it synonymously with egoism, exhibitionism, and vanity, frequently also as an insult. It further notes that social scientists and mental health professionals can also contribute to this meaning inflation through overly broad definitions and insufficient explanation.
In other words, it is not enough to say that “the public misunderstands it.” Professional discourse, education, explanation, and social media communication may also have distorted the meaning of NPD and strengthened stigma. Here too, the issue of professional responsibility comes into view.
So “even professionals misread it” is not exaggeration; it is fairly close to reality
Putting these studies together, the phrase “even professionals misread it” is not just provocation. Of course, the researchers themselves do not use such strong wording. But what is actually shown is that clinicians are more likely to be pulled by negative feelings toward grandiosity, and by empathy or sadness toward vulnerability, and as a result, the evaluation can shift even when the level of severity is the same. This is exactly what it means to have one’s way of seeing pulled by emotion.
Once an initial impression forms that “that person is a black sheep,” everything after that becomes easier to interpret in line with that color. And what is troubling is that the person doing the seeing often does not notice that their own way of seeing may be distorted. This is not a formal academic term, but it is a useful metaphor for understanding the current stigma structure around NPD. When a strong preexisting image circulates in society and among professionals that “a narcissist = a bad person,” whatever that person does becomes easier to read through that same lens. And that reading is often less a matter of accurate reality recognition than a perception guided by the label.
What are leading clinicians warning about?
This trend is consistent not only with research but also with the messages of leading clinicians. Dr. Elsa Ronningstam is a **clinical psychologist at McLean Hospital and an adjunct associate professor of psychology in the Department of Psychiatry at Harvard Medical School**. McLean Hospital’s official profile confirms that she specializes in the diagnosis and treatment of narcissism and has researched and spoken in this area for more than 30 years.
In a February 2026 Mass General Brigham EAP article, Everyone is Talking about Narcissism, Ronningstam explains that NPD is part of pathological narcissism and is likely to be underreported and underrecognized because of limited self-awareness, low rates of help-seeking, misdiagnosis, and symptom fluctuation. She also explains that problems with empathy are not simply a zero-or-hundred issue, but can vary with factors such as cognitive attention and the ease of emotional connection.
What is important here is that a leading expert is explaining this topic on the assumption that the flood of words like “narcissism” and “narcissist” can make understanding careless. In other words, this is not just the argument of a few critics; it is something that central clinicians and researchers around the world are also recognizing as needing correction.
Why did I recognize the abnormality of this issue early on?
From here on, I would like to write a little not as a summary of research, but about my own background. The reason I have continued to feel such strong discomfort with this issue is not just a matter of knowledge, but something much more fundamental.
From a long time ago, I have had a tendency not to be easily swept up by the atmosphere of a group or by the impressions of the majority. When I was a child, there was a classmate who was made to look bad and was bullied by everyone. But I could not join that atmosphere. I felt that something was wrong, so I tried to help that child.
However, the result was very painful for me as a child. Because I helped them, the bullying side turned its attention toward me as well, and the child I had helped then began acting in a way that seemed to flatter the bullies. At the time, I felt deeply shocked, as if I had been betrayed. But this experience left one conviction inside me: when a group gets excited by deciding that something is “bad,” the atmosphere itself can be wrong. What is especially troubling is that many people present in the situation do not realize that their own way of seeing may be the distorted one.
So when I saw narcissistic personality disorder being made into a villain online, demonized, and treated by many people as if that were an obvious premise, I thought, “They are all bullying someone who is already weak,” and I did not join that flow. I had already noticed the strangeness of this issue around 2012, and around 2014 I was already writing about its danger in articles. At that time, I did not yet know academic terms like “stigma,” “emotional bias,” or “concept creep.” Even so, I clearly sensed that what was happening was not just a warning to be careful, but a structure close to villainizing someone through a diagnosis, or even moral harassment.
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From here on, this is my assessment
What research can say ends here. From here on, I will state my own assessment clearly.
I believe there has been a problem of professional responsibility in the way NPD has been understood up to now. Because even if public misunderstanding spreads, the medical and psychological fields also tended to treat NPD in an atmosphere of “troublesome,” “difficult,” and “hard to deal with.” As a result, misdiagnosis, underdiagnosis, diagnostic avoidance, superficial support, negative attitudes, and extreme labeling were more likely to be preserved. Research has only recently begun to bring this fully to light, but that does not make the professional-side oversights before that disappear.
That said, I do not mean to say “professionals were bad.” Rather, NPD is originally difficult to understand, cannot be identified from surface impressions alone, and is prone to being distorted by countertransference and emotional bias. That is precisely why I think professionals need not hide their mistakes as shame, but instead take them on as a growth task. To see NPD properly, one must check not only knowledge but also one’s own emotional reactions, moral judgments, dependence on labels, and the influence of social media and mass discourse. It is because this is so difficult that it is not surprising some professionals were swept along. But that is not something we can simply leave at that.
What matters for the general public
What matters for the general public is not to explain a person in one stroke with the word “narcissist.” For someone who has had painful interpersonal experiences, that word may feel temporarily easy to use. But once diagnostic terms and insults get mixed together, understanding becomes very sloppy very quickly. NPD is not just another name for malice, and conversely, the possibility of NPD does not automatically determine whether abuse is present. What matters is not the label but the actual interpersonal patterns, the suffering involved, and the defenses that are operating.
What matters for professionals
What matters for professionals is not to see the problem of NPD only as the patient’s pathology. In diagnostic and treatment settings, clinicians need to carefully distinguish what they themselves are feeling, what those feelings are preventing them from seeing in the patient, and whether their reactions are useful clues to understanding or simply defensive reactions. That is exactly what Day et al.’s study showed. Anger and sympathy are not bad in themselves. The problem is when they take over and decide the assessment.
Summary
What is happening now is not merely a case of “misusing NPD.” NPD is in a state where narcissistic personality disorder as a diagnostic concept, narcissism as a personality trait, and the social label “narcissist” used to blame others have become tangled together. As a result, meaning expands at the linguistic level, dislike and sympathy intensify at the emotional level, and assessment becomes distorted at the cognitive level. I think the most appropriate way to understand this is as a complex stigma structure in which distorted cognition, emotion, and language are interwoven.
And finally, I want to say this strongly: even professionals had some mistaken understandings. But that does not mean professionals are worthless. It means NPD is that difficult. That is why researchers are now working on this issue and are finally beginning to see where the misunderstanding was happening. What is needed now is not to cling to old labels, but to learn from research, check emotional bias, and see patients more accurately. Understanding of NPD is in the middle of revision right now. We need to keep pushing that revision forward.
I myself have experience of gradually clarifying difficult, deeply layered psychological problems and their hidden structures through “writing.” In fact, I have worked on this through a method called “Sayonara Monster.” That is why I think I am able to notice more easily when a complex stigma structure—where emotion, cognition, and language intertwine and distort how someone is seen—is operating around an issue like this and to say, “This is wrong.”
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