Family and Caregiver Schizophrenia Discussion Forum

What is the difference between narcicissm and schizophrenia?

A few years ago I went to my local Carer’s Support Group and the man there asked me and my mother about my sister. Once we had described her he asked me, “What is worse? Her narcicissm or her schizophrenia?” I replied that her narcicissm was worse.

Does anyone know the difference? I find that I can sit and listen to her delusional thinking all right, but it’s when she tries to control me, to the point of controlling what I have for dinner, controlling my friends, it’s that behaviour that is oppressive to me. It’s like she’s in control of everything.

Can someone tell me the difference and do they have a loved one who displays narcicissitic traits and is this part of schizophrenia?

I don’t have direct experience with comorbid clinical narcissism and SZ. My brother has bipolar disorder not schizophrenia. He does exhibit some narcissistic traits, but they tend to wax and wane with his illness.

To answer your question, SZ is a thought disorder, while narcissism is a personality disorder. The underlying cause for SZ is a brain disfunction usually occurring in adolescence and young adulthood, leading to hallucinations and aberrant thought patterns like delusions. The theory of the underlying cause for narcissism relates to vulnerable children with harmful parenting, and narcissism begins earlier in life as personality is developed. Aberrant behaviors and perceptions are related to preservation of their ego concept and they look to the world for validation. People with SZ tend to look within, and tend more to blame the world for lack of validation as a defense when they are decompensating.

A classic tell of a true narcissist is lack of empathy, while many people with SZ can be quite empathetic when stable. For example Dr. Amador’s brother with SZ died when struck by a car while helping a woman load groceries on a bus. The act of helping someone without some transactional gain is foreign to a narcissist, and likely wouldn’t happen.

This is not to say people with SZ can’t be self-centered and greedy when ill, it just comes from a different place and it’s more of a transient function. And narcissistic traits don’t necessarily accompany SZ. You can stabilize someone with SZ with medication and they can become less self-centered and ego driven. To my knowledge, less so or not so with narcissists.

My opinion is the narcissistic traits of people with SZ are less harmful to society as a whole as they tend not to be as socially adept and functional and largely harm loved ones and caregivers. While a clinical narcissist is more socially adept and can inflict emotional injury on larger groups of people.

Edit: corrected that it was Dr. Amador’s brother not son who died. I realized the mistake earlier, but see I missed fixing it.

Disclaimer: While I am a part-time caregiver of my brother and father with SMI, I was diagnosed with SZA over thirty years ago. I’m an advocate of appropriate drug treatments for SMI, but I feel they are incomplete treatments and additional CBT, supportive talk and psychosocial therapies are helpful where feasible. Any drug advice is from personal experience or research and not a substitute for qualified Psychiatric care.


Great detailed explanation by @Maggotbrane with lived experience! I will just add: Narcicissm is NOT a characteristic of SZ. But it could be a behavioral component (must better described above) for that person. Each person is different. SZ can dramatically affect a person’s behavior to the point that the person does things he or she would never otherwise do, but often, the character of the person with SZ before the onset of the illness continues to be evident.


That ‘lack of empathy’ mentioned above seems pretty keynote to narcissism. I like to describe narcissism as a complete lack of boundaries. The person isn’t able to identify where they end and the rest of the world and other people begin. In my personal experience with severe narcissists, (I’ve unfortunately endured a few) it doesn’t seem uncommon for their behaviors to carry some sadistic undertones even. Keep in mind too that people can exhibit ‘narcissistic’ behaviors and not necessarily be diagnosable with ‘narcissistic personality disorder’.

(So many things well said there, MB, by the way)

I think some confusion about narcissism and SZ stems from people confusing narcissistic traits with true narcissism. My sister is a bit of a “narcissism-hunter“ who finds narcissism around every corner, mainly in family members she feels injured by at one time or another and struggles to understand their motivations—ergo they are narcissists. My father and I are her favorites (or are just less bad :wink:), so we escape this “diagnosis”. “Narcissism-hunters” need validation too, so I get pulled aside to hear her theories. Now I know more about narcissism than I’d care to.

I don’t mean to devalue the pain of people who encounter true narcissists, just that you have to be careful bandying the term and using it as a cop-out or excuse to distance yourself from people you feel hurt by and struggle to understand.

There’s more written about overlaps between Schizoid and Schizotypal and narcissistic personality disorders. These are slightly better fits, because behaviors and traits develop earlier in life, are fairly constant and eschew the pathology and prodromal model of SZ.

Differences are clearer if you look at how each views society and social interaction. A person with a Schizoid personality disorder is more indifferent to social interaction and society, finding it difficult to navigate and of little value to them. It’s similar to the experience of people on the autism spectrum. People with Schizotypal personality disorders withdraw from society and social interaction from feelings of being misunderstood and injured by it. It’s like schizophrenia-light, a perpetual prodrome. A person with active SZ is too preoccupied and disabled by hallucinations and thought disorders to interact socially in meaningful or thoughtful ways, and may act out in elemental ways to get their needs met. Whereas someone with a narcissistic disorder views social interaction and society in general as a game to be played, exploited and won at all costs to their sole benefit.

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Hi all,
Thank you for your replies. I’m beginning to think that my main problem is with my sister’s narcissism and not her schizophrenia. She seems to have a real problem with me and not my other sister. For example, she just walked into my room and picked up a piece of brown paper that I had been saving. WHen I told her to put it down she threw it down and walked up to me very aggressively.
This is because she just asked me if I wanted to go to the shop or not with her. I had just travelled into the city with her, paid for parking.
I think she has a real problem with me and I don’t know what it is. She doesn’t act like this with my other sister, or with anyone else in the family. It’s all directed at me. I think I’m going to phone her keyworker and ask to speak with him because I can’t take it anymore.
If she has real schizophrenia then that isn’t the problem. I can listen to her talk about her delusions all day long. It’s the consistent aggressive attitude towards me that I can’t stand and it’s harming me.

it goes along with their delusions. Its part of the illness but not the person

So if a SZA demonstrates controlling behavior like where to go and when, who to be around, is that is part of the illness or is that narcissism?

Sometimes it feels like the whole world revolves around them and their delusions especially when they aren’t on medicine. It’s really unfair.

Interesting you mention the controlling behavior. I’ve wondered that myself. It’s caused problems with my untreated sz partner over the years, him getting extremely agitated whenever I’d leave the house and he knew I’d be seeing other people, wether it was close long time friends that I’d see every week to him having tantrums in the middle of conversations because I’d casually mention an interesting dialogue I‘d had with a bus driver that day. At some points it was bad enough when we’d be in public he’d get angry and full of accusations when I’d have conversations with our servers or cashiers. It’s tough. I have a close girlfriend who also has an adult son with paranoid sz and he’s the same way but worse. He monitors all her phone calls and demands to look back through her phone to read all her text messages from that day when she gets home from work, most of which are work related. Now, is that the paranoia and delusions of the illness enacting or is that a good old fashioned character flaw where these guys are just possessive, jealous and insecure? I’ve wondered this myself…
She’s funny. She calls it him being ‘protective’ of her. I guess perspective really is everything!

Now I wasn’t in a relationship when I developed SZA, but I know that it was important to me to control my environment to reduce my anxiety over symptoms. I’d draw the shades and keep it dark or run fans and add other white noise to reduce stimulus, walk to the other side of the street when strangers appeared, talk to the “FBI” when alone who “obviously” were listening in from next door, and other odd superstitious rituals. I speculate this may be an elaborate form of this wrapped up in delusions rooted in fears of abandonment.

In hiking there’s a saying “you pack your fears”, meaning you will carry and be burdened the most by things you are afraid of running out of or losing. The same can be said for emotional baggage. I’ve never been the jealous type, as I always thought it was counterproductive and would inevitably push partners away, but I could see how this could happen and how it would be a difficult behavior to extinguish. It’s hard to prove the negative in the face of delusions.

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Is it possible that she treats you this way because she feels most comfortable and secure with you? Do you think?
I often feel what you’re saying. How do we set boundaries?

Unfair isn’t really the word I’d choose but f*** yeah it’s one-sided a lot of the time. Keep reminding myself to do the small things for ME to maintain that consistency that our loved ones need and that, yes, I often too feel is being manipulated and undermined.

I can follow your speculation. Interesting.

“You pack your fears‘…It’s hard to prove the negative in the face of delusions.”

What I get from this is:
We all have our own experiences in life that effect us and bring us to this point as the people we are today, and it’s also our own choice as to how much of that we choose to hold close or to brush off and carry on. We learn as we go what is essential and what is not.
“It’s hard to prove the negative in the face of delusions” seems to me to be a statement on ability for internal rational self assessment. Difficult to acknowledge, assess and be accountable for actions that are distasteful or wrong when our true beliefs have no basis in fact or reality (aka delusion). Because our belief (delusion) is our reality and so our actions are justified and right in the delusional mind.

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@Wisdom I’m glad other people get it! I found it very difficult to set boundaries with my non medicated spouse. Everything was in absolutes and nothing could be rationalized. Very difficult to live like that.

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@Wisdom yes lots of manipulation and wanting things to go their way due to symptoms. Maybe it makes them more comfortable but makes things hard for the other person. I would like to think that if the person suffering with SZA is medicated then perhaps you could talk to them and maybe even go to therapy together about communication, respect, and boundaries.

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@Wisdom yes,yes,yes! I still think to this day that my spouse can see nothing wrong with any of his actions because of his strong delusions which justify his actions. Such an unfortunate situation.

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Communication, Respect, Trust, Boundaries… so HUGE when we’re talking about our spouses or partners and a healthy meaningful relationship, right? I mean, most people would say these are the core things that give a marriage or partnership it’s strength, meaning and durability. But when our significant other is afflicted with these types of mental health and brain diseases, it’s almost like these core things that are supposed to be the very foundation of Us as a couple are the very things that we have to fight tooth and nail to even have. This is the root cause of a great deal of my deepest sadness in my love for my partner. And Us as a pair. And it has, over time, caused me to suffer some depression. It’s just heartbreaking and I’ve often felt so beaten. I gave up years ago trying to get my MI partner with zero insight in to see a psychiatrist (ideally a neuropsychiatrist alongside a good therapist) and started focusing on trying to get him in for couple’s counseling hoping that this guise of ‘it’s me also that’s the problem, let’s talk about it together with someone who can help Us” instead of him thinking we are saying it’s HIM that’s sick and needs help and him feeling he’s being persecuted, that eventually he’d participate and perhaps just maybe that would be the small stepping stone that might one day facilitate his willingness to see the psychiatrist and maybe even consider meds. Baby steps, right? … I gotta tell you though, it’s been ten years we’ve been together, that I’ve been trying. He has yet to agree to make the appointment with the counselor without a fuss. What can I say. I have high hopes. And I keep trying, with love, everyday. Some might even say at this point that I have ridiculously high hopes and that I’M the delusional one for still believing we can make change. Ha! And I’ll do it again tomorrow!

(I apologize. I may have gone a bit off thread topic.)

I find your take on what I wrote interesting, although it wasn’t my original intent. Aphorisms take on meanings of their own depending on point of view.

It illuminates a divide in thinking between the cared-for and caregiver. My point on it’s hard to prove a negative in the face of delusions is more literal. Delusions and conspiracy theories seem tailor-made to defy proof. Can I ‘prove’ aliens don’t exist, or the FBI isn’t following me or my girlfriend’s not cheating on, or conspiring against me? Well, no, and neither can anyone else. I can present evidence supporting suspicions one way or another, but ultimately you can’t be sure.

It reminds me of an argument from my epistemology class in college philosophy. I believe it was Decartes, but I might be wrong, who said he believed God was not an evil deceiver in reply to the question whether life was an illusion. You end up having to trust something or someone if you hope to stay in recovery, that’s why I think LEAP is a powerful tool— it rebuilds trust.

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Hi Maggotbrain,
What is LEAP?

And how have you gotten this level of insight??? Congratulations!! How did you beat schizophrenia? Apologies if you’ve still got it, but you have insight. How did you get it?

It’s so frustrating for me at the minute. My sister is slipping again.

Any advice/tips/insight so I could see her point of view would be welcome. Thanks.

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The following video is a good introduction to LEAP:

It’s a communication method that can help build trust with people with anasognosia (lack of insight into illness). The presenter, Dr. Amador, wrote a book presenting LEAP called “I’m not sick, I don’t need help”.

Not all people with SZ, SZA and bipolar disorder have anasognosia, and may have insight to varying degrees. I had some insight into my illness early on, but was adamantly against drug treatment. I spent a little over a year in talk therapy with a Jungian Analyst, before realizing drug treatment might help me. My recovery predated Dr. Amador’s book, but my psychotherapy served largely as the Listen and Empathize portions of my LEAP process. I live with SZA; I haven’t “beat” it. I see a psychiatrist periodically and maintain vigilance against possible symptoms.