I have a question regarding differential diagnosis specifically with respect to Narcissistic Personality Disorder and Social Anxiety Disorder. My question is this, both illnesses hold to the criteria of “being hyper sensitive to criticism”. For someone who is sensitive to criticism how do you differentiate between this symptom being Narcissistic or Social phobic?
What a great question! We all have a certain level of social sensitivity — some folks being socially calloused and others being thin-skinned. In psychiatry, being hypersensitive to social criticism is found in both Social Anxiety Disorder and Narcissistic Personality. The differential diagnosis is made based on the interpretation and reaction to the social criticism.
Imagine a simple social criticism. A co-worker might say “I think your approach to the project is wrong”. An emotionally healthy individual may accept the criticism, consider the input objectively, and decide that their approach needs modification or that the input is another viable opinion.
In Social Anxiety Disorder (SAD) or Social Phobia — the classic feature is one of emotional sensitivity and fear of embarrassment. Given the same criticism, SAD produces an internal-blame reaction creating a sense of rejection, a type of anxious humiliation, and a sense of being judged by others. SAD folks even become sensitive about their reaction — then feeling they are socially incompetent, didn’t handle that correctly, or looked foolish or silly. The reaction to criticism is always self-damaging and self-punishing. Each experience with social criticism lowers their self-esteem, social confidence, and sense of competency.
The Narcissistic Personality, in response to the same criticism, is personally offended that someone would dare question their opinion or approach. Arrogant, conceited and vain — they exhibit external-blame and may react with aggressiveness, anger, or verbal abuse. These folks are famous for the How-Dare-You reaction to social criticism. When they are questioned, especially in public, their narcissistic pride creates a sense of entitlement that then allows them to verbally or socially punish anyone who would question their behavior. If your boss is Narcissistic, for example, you could get fired for questioning their decisions.
As you can see, Internal-Blame or External-Blame produces the same problem in the social and work environment — the truth behind the criticism is ignored and not considered as an option. In both clinical conditions, the reaction becomes more important than the social criticism or discussion. Sadly, the Narcissistic Personality is more likely to find his/her way to a position of authority however, producing some the greatest mistakes and blunders in history. They refuse to listen to their advisors, consider their opinion almost divinely inspired despite evidence that it’s incorrect, and pursue their course despite the public reaction. Narcissistic Personalities in authority typically consider any criticism of their behavior to be the product of “enemies”. They then feel entitled if not selfishly-obligated to reject and ignore all criticism.
In short, people with Social Anxiety Disorder attack themselves in response to social criticism. Narcissistic Personalities immediately attack the person making the criticism. They’re both “hypersensitive” in social situations.
Please read our Important Disclaimer.
All clinical material on this site is peer reviewed by one or more clinical psychologists or other qualified mental health professionals. Originally published by Dr Greg Mulhauser, Managing Editor on .on and last reviewed or updated by