Narcissus didn’t fall in love with himself. In rejection of the false beauties of the physical world, he fell in love with a reflection of himself, a version he wished could come to life. Over time, Narcissus wasted away at the water's edge, enthralled by a face that was his, and yet, not him. In the disorder named after him, narcissistic personality disorder (NPD), something similar happens: the real self wanes, displaced by an idealized image that must be constantly maintained.

Across popular media, people with NPD are almost always portrayed the same way: haughty, charming, and supremely self-assured. This set of behaviors is classified as grandiose narcissism. However, researchers also recognize a vulnerable form, marked by hypersensitivity and shame, in which the same entitlement hides behind insecurity. People high in vulnerable narcissism often harbor grandiose fantasies, privately convinced they are uniquely gifted –– similar to grandiose narcissism. What contrasts the two is a crushing fear of failure in the vulnerable demographic, coupled with an acute sensitivity to criticism, which often keeps them from acting on those beliefs.

The boundary between the two forms may be thinner than it appears. In a 2017 fMRI study , researchers at the University of Graz in Austria showed men with ranging levels of narcissism photographs of their own faces. If narcissism were simple self-love, the mirror would have served as a rewarding stimulus. Instead, in the highly narcissistic men selected for the confident, grandiose traits that popular media portrays, the fMRI revealed heightened activity in the dorsal anterior cingulate cortex, a brain region tied to conflict monitoring and negative affect. It also showed increased signals from the ventral anterior cingulate, which processes negative information about the self. While the subjects were, on some level, pleased to view themselves, it also highlighted their own flaws and caused participants to hyperfixate. Later work by the same group found that at the highest levels of grandiose narcissism, vulnerable narcissism increasingly coexists, suggesting the two are like mirrors of one another.

These findings matter beyond a laboratory environment. Even the DSM-5 , the leading manual by which clinical disorders are characterized, focuses on the grandiose aspects of NPD (high self-importance, need for admiration, lack of empathy, etc.). People whose narcissism surfaces instead as shame, anxiety, or depression may never be recognized as narcissistic at all.

Compounding this, because people with NPD rarely seek help for narcissism, clinicians usually meet them only after major emotional upheaval. These meetings are focused on presentations of a patient with NPD after failure or rejection. As a result, vulnerable patients are often treated for the depression or anxiety on the surface , while the narcissism beneath goes unrecognized, leaving the underlying pattern intact and the cycle free to repeat.

Popular culture casts the narcissist as a villain content with himself, but the evidence suggests a self that must be constantly monitored and acted upon. This self greets its own reflection akin to a threat, which pushes the self into a cycle of doubt and distress. It may be beneficial to realize that, like Narcissus at the water's edge, many are less enchanted by their reflection than trapped by it.