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'Do I Have Asperger's or Narcissistic Personality Disorder?'

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Reader Either Way You Slice It, It's Not Great writes:

My wife and I have been in couples counseling for 6 months and your article "Mr Perfect and his Crazy wife" reminds me very much of our relationship and truthfully I see a lot of myself in "Engaging Narcissists in Couples Counselling."

I'm 32, my wife is 30, both university educated, well travelled and successful in our careers (business owner for me, teacher for her), no children yet but we are trying. Married for 5 years, together for 12. Her family is wealthy, whereas my background is middle class and many of our arguments centre around money or household chores. She's often comparing our situation to how much her parents had at our age or to a particular wealthy couple we are friends with. Basically she's often unhappy with me, and with our situation in life -- and I struggle to see why sometimes. I think objectively we're successful, more so than most people we know and I find life full of reasons to be happy.

Having read your blog and other web sources, I'd come to realise that my behaviour sometimes leaves my wife feeling emotionally unsupported and questioning the strength of our connection. In turn this leads to what I perceive to be her "irrational" unhappiness with our life and emotional acting out.

I've recognised narcissistic traits in my personality since I was a child - I was always "gifted", high IQ, member of Mensa etc and it was sometimes hard not to feel superior. With this in mind I was expecting our therapist to make similar suggestions to the ones in your articles mentioned above and I was starting to wrap my head around how my behaviour was contributing to making my wife unhappy. So it was a complete surprise to me when our therapist suggested during our 3rd session that I might have Asperger's Syndrome.

I wouldn't have been shocked if NPD or even Anti-social personality disorder was suggested, although I think I mostly keep a tight rein on my more negative personality traits as an adult. I've never felt any depression or anxiety that I understand often comes with Asperger's, and I've never had trouble with making friends or other typical ASD behaviours. My only personality traits that seem to count as "symptoms" of anything would be reduced empathy and cognitive processing of social/emotional situations (side effect of IQ being higher than EQ maybe, but it works fine for me). I've never in my life had anyone suggest I had Asperger's before.

So my question is: In your experience, can someone who would qualify for an Asperger's diagnosis sometimes present as a "Mr Perfect" or a Narcissist?

Dear EQYSIIIG,

Great question. Short answer: yes, and it doesn't matter. I actually had a client in my own practice that I diagnosed as a narcissist, and another family therapist later diagnosed him as Asperger's. I think a lot of how clinicians diagnose is based on what they know more about, and what they are familiar with in their practice. We are human, with all the related unconscious biases. (On this note, many more women than men get diagnosed with Borderline Personality Disorder, and many people think that's because of gender biases, such that men with BPD instead get diagnosed with Antisocial Personality Disorder even when they have identical symptoms).

With Asperger's and NPD, a lot of the criteria overlap. The difference is that while all people with Aspergers are narcissistic (not NPD, but self-centered; it's a central trait), all people with Narcissistic Personality Disorder are definitely not aspergers, and can be the total opposite: super smooth and charming. I'm not seeing you in session so I can't pick up on how you come off interpersonally, which would make the difference for me. But if your therapist said Asperger's, there is likely something there to explore.

One possible issue is that many counselors don't want to bring up narcissism as a possibility. Many clients become very defensive if given personality disorder diagnoses and no longer want to engage in treatment, which is the worst outcome for all involved. To be honest, though, I think the quickest way to tell a real narcissist is how much they like the diagnosis. It fits them and makes them feel special, so they embrace it and want to learn more, like Sam Vaknin... and you.

Here's the real question: why does it matter? What matters is that a counselor thinks something is dysfunctional enough about your social interaction that you might have Asperger's, and your wife isn't happy with you. Those two things are enough to make you want to do some massive self-introspection. The diagnosis matters much less than what you do with it. In the Modern Love Asperger's article I posted last night where the guy learned how to be empathic painstakingly and by rote, there is nothing he did that is unique to Asperger's. Anyone, including a narcissist, who struggles with empathy needs to learn it by rote this way.

A diagnosis should be the starting point for working on yourself; it should not become its own reified "thing." There is no blood test for narcissism so you'll never "know" the way you would with cancer. It's what works for you. The client I mentioned earlier liked the Asperger's diagnosis better than my NPD one, and joined some "Aspie" groups and so forth. He worked more on his empathy once he thought of it as an Aspie trait than when he was defensive about being called a narcissist. So maybe he really was Aspie! Either way, it worked for him and gave him a jumping off point and a way to understand and interpret his experience. Unlike him, you seem to be more comfortable with a narcissistic diagnosis, so use that.

I would go so far as to say your focus on what diagnosis you have makes you more Aspergers'-ish, because it's missing the forest (your marriage is failing!) for the trees, but this is getting back to non-essentials. Now that you know your empathy is lacking and it's sabotaging your marriage, let's focus on how to develop this capacity. Here are some suggestions I have for working on empathy as an adult, how to validate others, how to teach empathy to kids (modify for yourself), how to make women happy, and how not to invalidate kids (can be modified for others).

Good luck, and kudos to you for trying to hammer out the problems in your marriage before having children. Keep me updated, you narcissistic Aspie, you. Till we meet again, I remain, The Blogapist Who Updated This Answer With This Post Helping You Determine If You (Or Your Partner!) Is Asperger's or Narcissistic.

This post was originally published here on Dr. Psych Mom. Follow Dr. Rodman on Dr. Psych Mom, Facebook, Instagram, Twitter, and Pinterest. Order her book, How to Talk to Your Kids about Your Divorce: Healthy, Effective Communication Techniques for Your Changing Family. Learn about Dr. Rodman's private practice here. This blog is not intended as diagnosis, assessment, or treatment, and should not replace consultation with your medical provider.