MANY PEOPLE display narcissistic traits. Among world leaders, for instance, Donald Trump, Benjamin Netanyahu and Vladimir Putin come to mind. And, who has not heard of a boss, former spouse or some religious leader being called a narcissist? So, given how we often use this label, is it right – whether one is a therapist or not – to diagnose people outside of a clinic?Narcissism as a concept is valuable, but caution is as well. In February last year, 33 psychiatrists and psychologists warned in The New York Times that “Mr. Trump’s speech and actions demonstrate an inability to tolerate views different from his own, leading to rage reactions. His words and behavior suggest a profound inability to empathize. Individuals with these traits distort reality to suit their psychological state, attacking facts and those who convey them.” In a book published last October – “The Dangerous Case of Donald Trump” – 27 psychiatrists and mental health experts describe the president’s severe personality disorders. A prominent diagnosis in the book is “Nar cissistic Personality Disorder” (NPD).Chemi Shalev wrote in Ha’aretz last year that Trump and Netanyahu share the trait of narcissism, since both view criticism as a threat and respond by attacking those who criticize them, accordingly.Joseph Burgo makes a similar case in The Atlantic with a piece called, “Vladimir Putin, Narcissist?” Photos of the Russian president scuba-diving, behind the wheel of a race car, demonstrating his skill in martial arts, and baring his chest on horseback only contribute to this categorization. And, Simon Kuper of The Financial Times referred to the Sochi Olympics as “Putin’s narcissistic selftribute.”Narcissist: The labelIt is part of popular culture to label self-involved and self-promoting people narcissists. Those of you who have dealt with a narcissistic wife or husband, or have been hurt by a narcissistic business partner know in your bones that such people are alive and well. Think about a difficult, egocentric, but seductive, person, who claims to think about others but does what’s good for him, behaving as if he is above the rules. At its core, narcissism is about a serious lack of empathy. Does anyone come to mind? The downside to the diagnosis of narcissism is that it’s become a cheap catchphrase for someone you simply dislike. It makes you feel superior because you have a label for that person. Just know that reducing someone to a diagnosis may actually be a sign of your own self-importance, so be careful.Maybe he is just not a nice person (dare we say, an a-hole). It serves the purpose without turning you into an amateur diagnostician. It’s a better choice. Healthy narcissism It's important to make a distinction between people with narcissistic tendencies and those who have Narcissistic Personality Disorder (NPD). Many successful people are narcissistic; that does not mean they are mentally ill, or even problematic. Mental health professionals recognize a spectrum in narcissism, which includes “healthy narcissism” that is instrumental in driving people to work hard, excel and become exceptional. An overly positive view of one’s self can be beneficial; it can help you exude confidence, have charisma and perform well. So, it is no coincidence that politicians often display a generous helping of narcissism.Yet, each and every one of us needs to feel special in some way. It gives our lives purpose and meaning. Remember Grover from Sesame Street singing, “I am special...there is no one just like me.” Note he follows it immediately with, “There is no one just like you.” That is a sign of a healthy person, with good self-esteem and perhaps even a touch of healthy narcissism.Diagnosing narcissism According to the American Psychiatric Association’s “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition” (DSM-V), Narcissistic Personality Disorder is defined by a “grandiose sense of self-importance,” “a need for excessive admiration” and “a preoccupation with fantasies of unlimited success [and] power,” among other symptoms. People with this condition are frequently described as arrogant, self-centered, above the rules, remarkably seductive and respond viciously when crossed. Yet, the authors of DSM-V almost took Narcissistic Personality Disorder out, only to leave it in at the last moment. So what gives? Personality disorders lack the diagnostic reliability of a broken femur, strep throat or breast cancer. Each of these has signs and symptoms, coupled with well-proven laboratory tests that can verify what you are dealing with. While you can get any of these wrong – the breast cancer turns out to be benign, the strep test is a false positive – each is based on solid diagnostic analysis. Without similar grounding, the Narcissistic Personality diagnosis is therefore a controversial concept. King David and narcissism Let’s look at the most admired ruler in Jewish history, King David. What powers gave David the confidence to take on the mighty Goliath, if not a powerful sense of self-confidence, and maybe even an inflated sense of power? Was he a narcissist? And, how about when he arranged for Bathsheba’s husband to be killed in war, so he could take her as a wife? Was that not self-centered exploitation? King Solomon was the most universally respected king of ancient Israel. Nonetheless, he violated commandments in the book of Deuteronomy specifically limiting a king’s wealth, wives and horses. Were his excesses merely an expression of national grandeur, or did King Solomon feel above the rules, a symptom not uncommon to politicians and executives today? Yet, if King David and King Solomon are assessed over time, we see complexity and depth, rather than non-examined self-centeredness. These leaders acknowledged their struggles with anguish and humility. (To be fair, by today’s standards, David’s contrition would not have protected him from prosecution. The degree to which we can judge an ancient by modern standards is well beyond the scope of this piece.) The authors of Ecclesiastes and the Psalms cared deeply about right and wrong, possessing, what is anathema to a narcissist, a powerful sense of moral ownership. Admitting one’s flaws is a high standard; perhaps in the end, it’s what made both David and Solomon truly great.In contrast, narcissistic personalities blame others, time and again. Narcissistic Personality Disorder – the real thing So, do narcissists, i.e. those who actually suffer from NPD, exist? In the fluid world of psychiatric nosology, I think the term narcissist carries weight, particularly for those of us who have seen it in the field. According to decades-old criteria established by the American Psychiatric Association, a diagnosis of mental illness, including NPD, requires that someone’s behavior, emotions, or beliefs cause the individual to suffer significant distress or impairment. The impairment can affect the patient or others around him or her.Unlike people with narcissistic tendencies, who might just experience an inflated sense of self-esteem, people who suffer from NPD often struggle with a less stable sense of identity. Underneath a tough, boastful exterior is often a brittle person. People with NPD consistently have trouble with criticism. Some may: • Become impatient or angry when they don’t receive special treatment • Have significant interpersonal problems and easily feel slighted • React with rage or contempt and try to belittle others to reassert power • Have difficulty regulating emotions and behavior • Feel depressed and moody because they fall short of perfection • Have secret feelings of insecurity, shame, vulnerability and humiliation These folks rarely think anything is wrong with them, so people with NPD seldom seek treatment. If they do, it’s more likely to be for depression, drug or alcohol use, or they’ve been forced to go by a family member or the court. The narcissist will try to please the therapist with her brilliance, warmth, or charm. She will stake out the ways she’s been let down by others and rationalize her own misdeeds. In a divorce, for instance, a narcissist may simply drop the marriage because “the love was not good enough” and then be outraged when her husband feels badly hurt. After all, “isn’t it better that we both should be happy?” Where’s the empathy? The hole in her life is on the inside. Some useful pointersHere are some findings one might encounter in the diagnosis of Narcissistic Personality Disorder. Note that anyone can be self-promoting, grandiose, shallow or mean every now and then. In contrast, with real pathological narcissism, these issues are destructive, consistent and enduring.• Narcissists are remarkably self-centered and non-empathic to the point of exploitation. The normal rules of reciprocity don’t apply to them, seeing others as objects to be used for their needs.• Narcissists as a group have a grandiose view of themselves, and a powerful sense of urgency. Many have real talents, contributing to the worlds of acting, academics, religion, politics, science, finance, literature and, yes, psychology. Their pain is internal – as in a relentless lack of satisfaction – and external – as in the debris of many failed relationships.• Some narcissists are truly charismatic, and it’s easy to be enamored – and fooled – by them. They can make you feel like you’re the only person in the room, while possessing admirable talents, intelligence or looks; it’s a compelling combination.• Yet as grand as they can make you feel, it can all turn on a dime, if you disagree or stand up to them. It’s not an even relationship.• If you have a partner, spouse or ex with these traits, you may not count to her as much as you think; knowing this can help protect you.• Most narcissists are more in love with love than in love with you.• Many people with these characteristics have a tough time aging and good therapy can, at times, help initiate changes. Generally, this happens when their beauty, wealth or accomplishments fail to work for them anymore.Narcissism, as a concept, may help you put some relationships into perspective. If you have these traits, understanding the full picture of narcissism may wake you up to why you’re so chronically demanding, or empty. And, if your partner, rabbi, friend, sibling or parent is narcissistic, you’ll have a better picture of what’s going on.SummarySo, is Netanyahu a narcissist? He certainly possesses a strong ego, knows how to position people and does not seem to welcome critique. Bibi also appears to indulge at other people’s expense, may have skirted the law and, like many, thrives on admiration. Yet, who is going to lead Israel but a per son of unusual ambition, vision, charisma and power? I might suggest that the greatest kings that Israel has ever known, King David and King Solomon, were also indulgent, and yet are revered for their leadership and spiritual depth. I, for one, am not going to diagnose a person who is not a patient. And, if non-clinicians are to make these judgments, let it be historians with greater distance and objectivity. Despite the value of the term, in the end, exert caution when diagnosing political figures, prominent business people, rabbis, friends, relatives, or your children’s classmates as narcissists. We have many potent words for people we don’t like – vain, greedy, manipulative, full of himself/her self, seductive, shallow, slick and dangerous come to mind. They should do.The real narcissists, with their charisma, capability and guile, may not be readily noticed. True pathological narcissists are a breed apart, with many evading detection because they are so good at what they do. Mark Banschick, MD is a Child and Adolescent Psychiatrist, with a practice in Katonah, New York. He is the author of ‘The Intelligent Divorce’ book series, offers a free online divorce course and blogs regularly for Psychology Today. He is also a co-founder of Alums for Campus Fairness (ACF), a StandWithUs non-profit that mobilizes alumni to improve campus life for the pro-Israel community.