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Welcome to Culture Clinic, 番茄社区app's collaboration with Northwell Health offering a healthcare professional's take on the latest viral medical topics.

"Narcissism" has become an increasingly popular topic in the lay press in recent years, but experts say the term is misunderstood, as personality patterns may be distinct from a true diagnosis of narcissistic personality disorder.

番茄社区app spoke with Scott Krakower, DO, of Northwell Health in Glen Oaks, New York, for more context on what narcissism is -- and isn't -- and why the term has garnered considerably more attention.

"I don't know that narcissism has changed over time, but I would say a lot of [the increased attention around it] comes from social media and a more entitled generation," Krakower told 番茄社区app. "Social media has enabled things to be done on a whim, with the expectation everything will be done quickly. But people may be using the wrong word."

Krakower noted that it's "hard to meet the criteria for a full narcissistic personality disorder" as defined by the bible of psychiatry, the Diagnostic and Statistical Manual (DSM).

A true diagnosis involves meeting at least five of nine DSM criteria, including a grandiose sense of self-importance, a need for excessive admiration, a lack of empathy, a sense of entitlement, and a preoccupation with success, power, and brilliance.

"It's a high sense of ego," Krakower said. "Everything revolves around that person. It may have its roots in childhood trauma, or it can be related to personality."

At the same time, the narcissist will be very sensitive to rejection, "where little things can set them off," he added.

Narcissists will often be manipulative, Krakower said, and some of the tactics they use include gaslighting, scapegoating, and frequently putting people down without any good reason for doing so.

Narcissistic personality disorder is not often diagnosed in children or teens, he pointed out. It's far more common in adulthood, as the ego is developing even further through "relationships, partners, jobs, and college," Krakower said.

While it's hard to make an official diagnosis of narcissistic personality disorder, narcissistic tendencies and traits can exist in people, psychologists say.

"Narcissism is in fact a personality pattern. It's a way of relating to the world. It's an adjective to describe their style, much like you would describe someone who is agreeable, or stubborn, or introverted," psychologist Ramani Durvasula, PhD, of California State University, Los Angeles, said in a .

"Narcissism, I believe, is synonymous with pathological insecurity," Durvasula said. "The key to understanding the narcissist is that they feel constantly unstable and empty. The grandiosity is actually an immature defense against these threats to their sense of self, and they're desperate for the world to keep validating them."

"On their good days, they look happy, they're grandiose," she said. "But on their bad days, the facade crumbles quickly and we see disproportionate rage, shame, and vindictiveness."

Despite increased attention to narcissism on social media -- and the way social media may be driving feelings of entitlement and instant gratification -- Krakower said he hasn't seen an uptick in diagnoses of narcissistic personality disorder in his practice.

He noted, however, that psychiatrists may more commonly see narcissistic injury in patients with depression. "It happens when someone has an injury to their already inflated self-esteem, and that inflated ego becomes more inflated in negativistic states of despair," he said. "Then patients become more depressed."

On the other hand, Krakower said he has seen an uptick in borderline personality disorder, which "can go hand-in-hand with narcissistic personality disorder." Both conditions include alterations of the ego, distortions of thinking, grandiose ideas, and that tension between an inflated and a diminished sense of self. However, borderline personality disorder tends to have a greater dysregulation of emotional states, he added.

"That, I've seen more of," he noted. "I think it caught on online and more people thought that they had borderline personality disorder" and sought a psychiatrist's opinion.

He cautioned that not everyone who wonders whether they have borderline personality disorder will indeed have it: "People see it online, then have an expectation you're going to diagnose it."

Nonetheless, he said, the increased awareness has probably helped many more people who truly do have that condition.

"That's the flip side of social media," he said. "Maybe you do have the condition, so you go see a therapist. It may be helpful."

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