The demonization of NPD (Narcissistic Personality Disorder)—branding it as “evil,” an “abuser,” or “someone who can’t be cured”—is a serious problem that hinders diagnosis and treatment. Following the U.S., U.K., Switzerland, and India, a review article pointing out issues of culture, stigma, and misdiagnosis has now also been published in a Pakistani medical journal.
Demonizing NPD should not be allowed—this is beginning to be recognized as an international problem
The issue surrounding narcissistic personality disorder, commonly known as **NPD (Narcissistic Personality Disorder)**, is no longer limited to just a few countries.
At present, concerns about stigma, misunderstanding, demonization, diagnostic distortion, and barriers to treatment access in NPDthe U.S., the U.K., Switzerland, India, and Pakistanhave all been raised in several countries and regions.
In the United States, researchers affiliated with the Harvard University psychology department have reported that stigma toward NPD exists not only in society at large but also in medical and psychological support settings, and that it may become a barrier to diagnosis and treatment.
In the United Kingdom, reports have highlighted the suffering of people diagnosed with NPD who are labeled as “evil” or “abusers,” as well as the problem of social prejudice.
In Switzerland, in the area of forensic psychiatry related to the University of Geneva, the need to avoid stigmatizing labels such as “narcissistic” and to understand personality disorders as mental health issues rather than moral condemnation has been discussed.
In India as well, although not limited to NPD, research has examined stigma from healthcare professionals toward mental illness as a factor that obstructs access to treatment.
And now,a significant review article on culture, stigma, and diagnostic distortion surrounding NPD has also been published in a Pakistani medical journal.
This is a development that should be taken seriously in Japan as well.
A review article on NPD published in a Pakistani medical journal
The article we are highlighting is a review paper published on January 31, 2026, in **Pakistan BioMedical Journal (PBMJ)**.
The title of the paper is
“Insights into Narcissistic Personality Disorder: A Narrative Review with Cultural and Biological Insights from Pakistan”
.
In Japanese, that would be
“Insights into Narcissistic Personality Disorder—A Narrative Review with Cultural and Biological Perspectives from Pakistan”
.
The authors areMisbah Syed, Zainab Shahzad, Cheryl Rajis, Umaima Fazal Lodhi, and Shumaila Zulqar. The corresponding author isShumaila Zulqar, affiliated with theKinnaird College for Women University, Department of Biotechnologyin Lahore, Pakistan. The paper lists January 26, 2026, as the acceptance date and January 31, 2026, as the publication date.
This paper is anarrative reviewthat comprehensively addresses the etiology, diagnosis, genetics, biological factors, and sociocultural context of NPD in Pakistan.
Why this paper matters|It addresses culture, stigma, and misdiagnosis together
What makes this Pakistani review article important is that it does not talk about NPD as merely a “bad personality,” “an abuser,” or “a dangerous person,” but instead addressesculture, stigma, diagnostic mismatch, and barriers to treatment accessat the same time.
The paper points out that empirical research on NPD in Pakistan is still insufficient, that culturally valid diagnostic scales are lacking, and that stigma toward mental health and limited access to psychiatric care are major obstacles to accurate diagnosis and treatment.
It further notes that cultural norms in Pakistani society—such as collectivism, family honor, and social status—may alter how narcissism is expressed and interpreted by others, potentially leading in clinical settings tounder-recognitionandmisclassification.
This is extremely important.
Because the problem of NPD is not simply a matter of “the person has a bad personality.”
Depending on the culture, narcissistic traits may be regarded as “normal behavior,” or, conversely, may be misclassified as pathology without adequate understanding of cultural differences.
In other words,to properly understand NPD,it is necessary to consider not only the diagnosis itself but also the person’s cultural background, family relationships, social expectations, gender roles, and stigma toward mental illnessas wellas all of that in the bigger picture.
The demonization of NPD is not a “language issue” but a treatment barrier
What must be emphasized here is that the demonization of NPD is not merely a “problem of wording.”
“They’re narcissistic, so they’re bad”
“Narcissists can’t be cured”
“All people with NPD are dangerous”
“NPD is the illness of abusers”
“Stay away from people with NPD”
These careless assumptions silence the people affected.
They make them avoid diagnosis.
They take away opportunities to receive treatment.
And if prejudice also seeps into clinicians and supporters, there is a risk that people who should have been connected to care will be overlooked early or wrongly treated as having some other issue.
The Pakistani review article also points out that stigma toward mental health makes diagnosis and treatment difficult. In particular, it notes that women may find it harder to seek treatment because of fear of being excluded from society.
This is a major problem.
Because stigma obstructs treatment.
And when treatment is obstructed, both the person’s suffering and the suffering of their family and those around them are prolonged.
Cultural norms in Pakistani society and the invisibility of NPD
The paper explains that Pakistani society is collectivist and values family pride, social standing, and interdependence. In such a cultural context, the expression of narcissism may differ from that in more individualistic societies.
For example, personal success may be framed not as “one’s own success” but as something that enhances the family’s honor. In that case, grandiose behavior and a strong need for admiration may be seen not as pathology but as culturally accepted behavior.
It is also noted that men may be expected to display authority, dominance, and leadership, and when this overlaps with NPD-like entitlement and dominance, it may be harder to identify as pathology.
On the other hand, narcissism in women may appear in a less conspicuous form through appearance, social status, or success within the family.
In this way, the way NPD appears changes depending on the culture.
That is why, when talking about NPD, we need careful cultural and clinical understanding rather than simplistic villainization.
Protecting victims is a different issue from demonizing NPD
There is something that must not be misunderstood here.
Criticizing the demonization of NPD does not mean denying the suffering of people who have been hurt by NPD-like interpersonal patterns.
It is also a clinical fact that traits associated with NPD can cause serious pain and disruption in relationships. In families, romantic partnerships, and workplace relationships, issues such as dominance, manipulation, lack of empathy, anger, condescension, and blame-shifting can become serious problems.
But that is completely different fromtreating a person who carries an NPD diagnosis as entirely evil.
Protecting victims is necessary.
But turning a diagnosis into a slur is not necessary.
Protecting victims and dehumanizing people through a diagnosis are not the same thing.
On the contrary, demonizing NPD can weaken accurate understanding, early intervention, treatment, family support, relapse prevention, and social safety in all of these areas.
I’ve said many times that almost no one truly understands NPD properly, and that immature people tend to view others negatively. Among them, there may also be projection on the part of the speaker. In some cases, it may even be fabricated. Of course, people with NPD traits can hurt others. This does not mean I am defending such harm when abusive behavior is actually present. The problem is the simplistic trend of saying “NPD equals abuser!” People with NPD can also be victims.
The danger of the simplistic trend of labeling NPD as “the abuser”
What is especially problematic in discussions of NPD isthe tendency to use the diagnosis itself as a synonym for “abuser,” “bad person,” or “dangerous person”.
Of course, people with NPD traits can hurt others in relationships. We should not deny that there are real people who suffer from controlling behavior, condescension, lack of empathy, blame-shifting, anger, and manipulative interactions.
However, when there is actual abusive behavior, addressing that behavior is one thing, and
“NPD means abuser”
“Narcissistic means evil”
“A narcissist is dangerous”
is quite another.
If there is abusive behavior, that behavior should be examined and responsibility should be assigned where appropriate.
But turning the diagnosis itself into a slur and treating the whole person as evil is neither medically nor psychologically accurate.
Projection may be involved on the side of those who label others as NPD
In reality, very few people understand NPD properly.
Even so, social media and online articles are full of discourse that justifies one’s anger or disgust by calling the other person “narcissistic,” “a narcissist,” or “NPD.”
Among these, there may also beprojectionon the part of the person making the accusation.
Projection is a psychological process in which one sees one’s own unacceptable feelings, desires, aggression, jealousy, inferiority, need for admiration, or desire for control as belonging to someone else.
For example, someone who does not want to see the anger or desire for control within themselves may label the other person as “narcissistic.”
Someone who cannot face their own victim mentality or need for validation may attack the other person as “a narcissist.”
Someone who cannot admit their own immaturity or dependency may fix the other person as “the abuser.”
In such cases, the term NPD becomes a tool not for understanding the other person, but for avoiding one’s own inner world.
The danger of using NPD as a fabricated label or smear
Even more serious is when the term NPD is used to socially demonize someone.
In relationship conflicts, divorce, parent-child disputes, workplace clashes, or social media arguments, words such as
“narcissistic”
“NPD”
“moral harassment”
“abuser”
are sometimes used to unilaterally cast the other person as the villain.
Of course, there are cases involving truly serious abuse or mistreatment.
In those cases, the victim’s safety and recovery should be the top priority.
But at the same time, sticking the label of NPD on someone without sufficient fact-checking and denying their whole personality is extremely dangerous.
That is not diagnosis.
That is not understanding.
That is labeling.
If the term NPD becomes a weapon used to silence someone, isolate them, or punish them socially, then the psychiatric diagnostic concept itself is distorted.
People with NPD traits can also be victims
What must not be forgotten is thatpeople with NPD traits themselves can also be victims.
Among people with NPD tendencies, some have experienced childhood wounds, excessive praise, excessive criticism, emotional instability, shame, fear of abandonment, fragile self-worth, and deep interpersonal hurt.
In addition, people who are seen as having NPD may actually be being attacked, misunderstood, exploited, or framed as villains by those around them.
Having narcissistic traits does not necessarily mean a person is always the perpetrator.
They may be behaving problematically in one relationship and hurting in another situation.
They may act abusively in one relationship and be victimized in another.
Human beings are not so simple that they can be neatly divided into “perpetrators” and “victims.”
That is why, when discussing NPD, we must not judge people by diagnosis alone, but instead carefully examine specific facts, behaviors, contexts, and relationships.
We should look at specific actions and facts, not diagnosis labels
What is truly needed in discussions of NPD is not condemnation based on the diagnosis.
What is needed is to look at specific actions and facts.
What happened?
Who did what?
What harm occurred?
Was it a one-time event, or a repeated pattern?
Has the other person’s account been confirmed?
Is there evidence or documentation?
Could there be exaggeration, assumptions, projection, or fabrication?
Has cultural background, family environment, and psychological distress been taken into account?
Without this careful verification,
“NPD means abuser”
is a dangerous conclusion.
It does not support victims.
It does not lead to treatment.
It does not deepen society’s understanding.
To understand NPD correctly does not mean defending harmful behavior associated with NPD.
At the same time, it means not demonizing people by using the diagnosis itself.
Protecting both of these is what society needs going forward.
Research affiliated with Harvard University in the U.S. also views NPD stigma as a problem
In the United States as well, stigma toward NPD has become a subject of research.
A 2025 paper by Ellen F. Finch and Emily J. Mellen published in the journalPersonality and Mental Health,“Labeled, Criticized, Looked Down On”: Characterizing the Stigma of Narcissistic Personality Disorder
shows that NPD is thought to be heavily stigmatized and that this stigma can become a central barrier to diagnosis and treatment.
The author Ellen F. Finch was involved in this paper as a researcher affiliated with the Harvard University psychology department and has conducted research related to pathological narcissism, personality disorders, psychotherapy, and stigma.
This study shows that the demonization of NPD is not just online discourse, but a serious issue that affects medical and psychological care settings as well.
The U.K. has also raised concerns about calling NPD “evil”
In the U.K. too, there have been reports about the suffering of people diagnosed with NPD being lumped together as “evil” or “abusers.”
An article in The Guardian covered the experiences of people diagnosed with NPD, social stigma, the difficulty of diagnosis, and the need for treatment and support. It also introduced the fact that while people with NPD may have serious interpersonal problems, there are also people who try to understand their condition and seek treatment.
This is important.
If people with NPD are labeled as “evil,” it narrows the possibility that they will face their own issues.
It intensifies fear of being diagnosed.
It makes it harder for them to come to treatment.
In other words, demonization is not a solution.
Demonization only drives the problem underground.
In Switzerland and the University of Geneva–related field of forensic psychiatry, the danger of labels is also discussed
In the Swiss/University of Geneva–related field of forensic psychiatry, the problem of labels surrounding personality disorders is also discussed.
In debates about ICD-11 personality disorder diagnosis, avoiding stigmatizing terms such as “paranoid” or “narcissistic” is said to help us understand the person not as a mere villain, but as someone facing a mental health problem.
This is an extremely important perspective when talking about NPD as well.
A diagnosis is not a term for judging people.
A diagnosis is a term for understanding, supporting, and connecting people to treatment.
In India too, the relationship between mental illness stigma and access to care is being studied
In India as well, stigma toward mental illness has been studied as a factor that blocks access to treatment and recovery.
A 2026 study investigated attitudes toward mental illness among non-psychiatrist doctors in India and showed that misunderstanding and stigma around self-disclosure remain.
This research is not limited to NPD.
However, it is important for understanding the structure in which “clinician stigma affects patient access to treatment.”
The same applies to NPD.
If society as a whole holds the image that “NPD = evil,” and that prejudice seeps into medical and support settings, both diagnosis and treatment will be distorted.
Japan needs to confront the problem of NPD demonization more seriously
In Japan too, on social media and in online articles, words such as “narcissistic,” “narcissist,” “moral harassment,” “evil,” and “abuser” are mixed together, and medical and psychological diagnostic concepts are often used as terms of attack and condemnation.
This is extremely dangerous.
In a society where diagnostic labels become insults, people affected by the condition become less likely to ask for help.
Family members also become less able to consult anyone.
Supporters and professionals are more likely to be swayed by public opinion than by careful assessment.
As a result, the possibility of treatment is shut down, and the problem becomes even more serious.
In a society that demonizes NPD, the problem of NPD will not be solved.
Rather, it may be hidden, tangled up, and worsen.
Two perspectives needed to speak about NPD properly
To discuss the problem of NPD correctly, we must hold two perspectives at the same time.
1. The perspective of protecting people who have been hurt by NPD-like interpersonal patterns
People such as family members, partners, friends, and coworkers can be deeply hurt by narcissistic traits.
Their suffering should not be minimized.
The safety, distance, recovery, and support of those who have been harmed are necessary.
2. The perspective of not demonizing people with NPD by diagnosis label alone
At the same time, people with NPD, or those struggling with such tendencies, should not be demonized by the diagnosis itself.
NPD is not a slur.
NPD is not a death sentence for a whole personality.
NPD is not a word used to decide that “this person is evil.”
These two things do not conflict.
Protecting victims and not dehumanizing people with NPD can coexist.
In fact, both are needed.
Demonization is not understanding. Insults are not diagnosis. Labeling is not treatment.
There is something we need to confirm now in discussions of NPD.
Demonization is not understanding.
Insults are not diagnosis.
Labeling is not treatment.
“They’re bad because they’re narcissistic”
“NPD means they can’t be cured”
“All people with NPD are dangerous”
These phrases are neither scientific nor clinical.
They are simply stigma.
And stigma obstructs treatment.
It obstructs diagnosis.
It obstructs the recovery of the person, the safety of those around them, and society’s understanding.
What the message from Pakistan tells Japan
This review article published in a Pakistani medical journal shows the need to rethink NPD within cultural, biological, and diagnostic contexts.
In particular, the point that cultural norms and stigma distort diagnosis and treatment is highly important for Japan as well.
Japanese society also has shame, concern for appearances, family honor, resistance to mental illness, and prejudice against diagnostic labels.
That is why this does not end as “just a Pakistani issue.”
In Japan too, demonization of NPD is serious.
And that demonization may obstruct treatment for the people affected and prolong the suffering of family members and others around them.
Conclusion|Toward a society that stops demonizing NPD and connects people to accurate understanding and treatment
The demonization of NPD is a problem that can no longer be ignored internationally.
The U.S., the U.K., Switzerland, India, and Pakistan.
From multiple countries and regions, voices are being raised about stigma toward mental illness, prejudice against personality disorders, misuse of diagnostic labels, and barriers to treatment access.
Now, the Pakistani medical journal
Pakistan BioMedical Journalhas also published an important review article on culture, stigma, and diagnostic distortion surrounding NPD.This is an important warning for Japan as well.
From a society that consumes NPD as evil to a society that understands NPD accurately and connects people to the support and treatment they need.
That shift is necessary.
Demonizing people with NPD does not solve the problem.
Rather, it can delay diagnosis, obstruct treatment, and prolong the suffering of people around them as well.
That is why we must say this clearly now.
NPD is not a slur.
A diagnosis is not a tool for demonizing people.
Reducing stigma and connecting people to accurate understanding and treatment is the truly necessary social challenge.
References and links
1. Pakistan: NPD review article published in Pakistan BioMedical Journal
Syed, M., Shahzad, Z., Rajis, C., Lodhi, U. F., & Zulqar, S. (2026).
Insights into Narcissistic Personality Disorder: A Narrative Review with Cultural and Biological Insights from Pakistan.
Pakistan BioMedical Journal, 9
(1), 11–19.DOI:
https://doi.org/10.54393/pbmj.v9i1.1321PDF:
https://www.pakistanbmj.com/journal/index.php/pbmj/article/download/1321/967/63482. United States: Research on NPD stigma
Finch, E. F., & Mellen, E. J. (2025).
“Labeled, Criticized, Looked Down On”: Characterizing the Stigma of Narcissistic Personality Disorder.
Personality and Mental Health, 19
(2), e70015.DOI:
https://doi.org/10.1002/pmh.70015PubMed:
https://pubmed.ncbi.nlm.nih.gov/40107324/Wiley:
https://onlinelibrary.wiley.com/doi/10.1002/pmh.700153. United Kingdom: Reporting on people with NPD and stigma
The Guardian. (2025).
“You are constantly told you are evil”: inside the lives of diagnosed narcissists.
URL:
https://www.theguardian.com/society/2025/oct/15/you-are-constantly-told-you-are-evil-inside-the-lives-of-diagnosed-narcissistsThe Guardian. (2025).
Insight is crucial for narcissistic personality disorder.
URL:
https://www.theguardian.com/society/2025/oct/17/insight-is-crucial-for-narcissistic-personality-disorder4. India: Research on clinician stigma toward mental illness
Chatterjee, S. S., et al. (2026).
Stigma Toward Mental Illness Among Non-Psychiatrist Doctors in India: A Cross-Sectional Study.
Psychiatry International, 7
(1), 25.URL:
https://www.mdpi.com/2673-5318/7/1/255. Switzerland/University of Geneva–related: Materials on personality disorder diagnosis and stigma
University of Geneva / Archive ouverte UNIGE.
ICD-11 personality disorder diagnosis and forensic psychiatry-related discussion.
URL:
https://access.archive-ouverte.unige.ch/access/metadata/56d9d43e-65c8-404d-beb7-095548472c9c/download
参考文献・外部リンク
- 01. 2. United States: Research on NPD stigma https://www.pakistanbmj.com/journal/index.php/pbmj/article/download/1321/967/6348
- 02. Wiley: https://pubmed.ncbi.nlm.nih.gov/40107324/
- 03. 3. United Kingdom: Reporting on people with NPD and stigma https://onlinelibrary.wiley.com/doi/10.1002/pmh.70015
- 04. The Guardian. (2025). https://www.theguardian.com/society/2025/oct/15/you-are-constantly-told-you-are-evil-inside-the-lives-of-diagnosed-narcissists
- 05. 4. India: Research on clinician stigma toward mental illness https://www.theguardian.com/society/2025/oct/17/insight-is-crucial-for-narcissistic-personality-disorder
- 06. 5. Switzerland/University of Geneva–related: Materials on personality disorder diagnosis and stigma https://www.mdpi.com/2673-5318/7/1/25
- 07. https://access.archive-ouverte.unige.ch/access/metadata/56d9d43e-65c8-404d-beb7-095548472c9c/download https://access.archive-ouverte.unige.ch/access/metadata/56d9d43e-65c8-404d-beb7-095548472c9c/download



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