Miley Cyrus is a self-confessed narcissist – could you be one too?

Iinherited the narcissism from my father,” Miley Cyrus said in a recent interview.

The singer was telling David Letterman about her childhood during an episode of the Netflix interview series My Next Guest Needs No Introduction, describing how she and her five siblings had moved from Tennessee to Los Angeles to facilitate her career in show business. Siblings the Hannah Montana star didn’t “know anything about” or even think about at the time, she said. “I was moving to LA, and that’s all I really knew,” she added.

Her admission prompted much speculation: is narcissism really something you can inherit genetically, like being able to roll your tongue or having red hair? And is it even possible for someone to be a narcissist if they’re self-aware enough to start considering that they may be one in the first place?

The word “narcissist” is bandied about with increasing regularity these days, casually levelled at an entire generation of selfie-taking social media addicts as well as being the topic of innumerable TikTok videos telling you the signs to watch out for. But beware of making sweeping armchair diagnoses. The first thing to remember is that narcissism is a spectrum. There’s a difference between someone who is narcissistic, or displays some narcissistic traits, and someone who has narcissistic personality disorder, or NPD, a mental health condition recognised by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Helen Villiers is a psycH๏τherapist and, along with Katie McKenna, co-author of the recent bestseller You’re Not the Problem: The Impact of Narcissism and Emotional Abuse and How to Heal. She highlights five main traits she would expect to see in individuals with NPD. “They are: grandiosity, enтιтlement, exploitation, impaired or motivational empathy and impaired self-awareness.”

The first is a feeling of specialness compared to everyone else; the second refers to feeling like you deserve to get anything you want; the third is about using people to get what you want; the fourth involves a lack of empathy or emotional manipulation, using someone else’s empathy against them; and the last is a tendency to blame external factors and other people for problems, never taking responsibility for your own failings.

We all have these traits to some degree – and what’s interesting is that they aren’t all inherently unhealthy if kept in check. In fact, some narcissistic traits, in moderation, can be positive and even integral to living a rich, full life.

“There’s healthy enтιтlement, when it doesn’t come at a cost to other people,” explains McKenna. “For example, if there’s a promotion at work and someone feels a healthy enтιтlement to go for it, because they’ve worked hard enough to get it. The difference with unhealthy enтιтlement is that the person won’t care what they have to do, or who they have to exploit, to get it – and won’t care if they’re qualified or not.”

Grandiosity can also be healthy, giving you a sense of self-worth and self-esteem. “A healthy example is being able to sit here and talk with confidence on a subject we have expertise in,” says Villiers. “But someone with an unhealthy sense of grandiosity would read a Wikipedia page and say they’re an expert. These traits can show up as healthy or unhealthy. And, when they’re unhealthy, they can be extremely toxic to the people around you.”

Dr Craig Malkin, a leading clinical psychologist, Harvard Medical School lecturer and the author of Rethinking Narcissism, draws a clear line between healthy and unhealthy narcissism. “When I looked at all the research, it became clear that the core of narcissism is something called self-enhancement. And self-enhancement is the drive to feel special, exceptional or unique. It’s not self-esteem. It’s not self-confidence. It’s a slightly overly positive view of self.”

While this can obviously be unhealthy when taken to extremes, “the vast majority of happy, healthy people around the world self-enhance. They don’t view themselves as average,” says Malkin. “They see themselves as special, slightly above average – and that, in and of itself, is not a problem.” Furthermore, moderate self-enhancement is ᴀssociated with positive outcomes. “When people moderately self-enhance, they’re able to give and receive in relationships,” he adds. “They persist in the face of failure, and might even live longer, according to some research studies on health outcomes correlated with self-enhancement.”

In fact, if narcissism is a spectrum, then those at the opposite end from people with NPD – those who don’t self-enhance at all – tend to “suffer”, according to Malkin, with increased anxiety and depression. “They suffer from what’s called the ‘sadder but wiser’ effect. They might have a more realistic or slightly dampened sense of self, but they struggle; and, interestingly, they tend to fall into relationships with extremely narcissistic friends and partners who are more than happy to take up all the space that people who don’t self-enhance are willing to cede.”

Self-enhancement only becomes a problem, he argues, when it’s addictive and rigid, and when people use it “as a kind of self-soothing – when, instead of turning to people and relationships for care, connection and mutual emotional involvement, they rely entirely on a sense of value and feeling good about themselves by self-enhancing”.

Clearly, when this happens and narcissism tips into something problematic – when it reaches the extreme levels where someone is diagnosable as having NPD – it can hugely hurt others, and often results in unhealthy and even abusive relationships.

Within NPD, there are different types of narcissist, whose behaviours are distinctive; it might not always present in the ways we imagine. There is the classic caricature, called the “overt” or “extrovert” narcissist: the person who wants to feel like they’re the cleverest, richest, most talented, important or attractive person in the room; the person who chases wealth, status and power at all costs (here’s looking at you, Mr Trump). But then there’s the “covert” or “introverted” narcissist, whose drive to feel special ploughs negative furrows instead. They feel like their pain marks them out, that they’re more sensitive than others, that no one understands them. And the “communal” narcissist is different again, describing those who feel special by virtue of their helpfulness or altruism – the person who believes that no one does as many good deeds as them.

The question of whether nature or nurture creates a narcissist is still up for debate. “With all personality disorders, it seems to be a combination,” says psycH๏τherapist Nicholas Rose. “Regarding NPD, if someone had a struggle in life, maybe they had an early childhood struggle, or found it hard to get attention, or conversely received an awful lot of attention, that would have affected how they felt. Chemicals are released in the body; habits can form.” He stresses that, while it’s often “seductive” to look for a specific childhood trauma to pin the blame on, in reality “it’s usually a lot more complex”.