Akhtar, S. (1989) | References | Narcissus and the Child

What This Research Found

Salman Akhtar's 1989 article transformed clinical understanding of narcissistic personality disorder by revealing that what appears on the surface is only half the story. Drawing on decades of psychoanalytic observation and case study, Akhtar demonstrated that narcissists simultaneously display visible "overt" features and hidden "covert" features—and that understanding both dimensions is essential for accurate diagnosis and treatment.

The overt-covert distinction: Akhtar proposed that narcissistic personality disorder manifests through paired characteristics across every domain of functioning. The overt presentation—what the world typically sees—includes grandiosity, arrogance, apparent self-sufficiency, exhibitionism, and entitlement. The covert presentation—often invisible even to clinicians—includes chronic uncertainty, inferiority feelings masked by grandiosity, deep emptiness, emotional shallowness, and profound fragility. Every narcissist possesses both dimensions; what varies is which dominates their presentation. This framework resolved longstanding clinical puzzles about why apparently invincible narcissists could collapse under minor criticism.

The six domains of narcissistic pathology: Akhtar mapped narcissistic features across six areas of psychosocial functioning, creating a comprehensive clinical portrait. In self-concept, the overt narcissist displays grandiosity and self-importance while covertly experiencing chronic uncertainty and inferiority. In interpersonal relations, surface exploitation and dismissiveness mask inability to depend on others and corrosive envy. Social adaptation shows apparent ambitiousness concealing aimlessness and deep insincerity. Ethics reveal overt disregard for rules alongside covert corruptibility. Love and sexuality involve seductive surface behaviour hiding inability for genuine intimacy. Cognitive style presents apparent decisiveness masking chronic indecision and superficial knowledge.

The projection mechanism: Akhtar illuminated how narcissists manage their intolerable covert features through massive projection—attributing their own disowned qualities to others. The hostility, manipulativeness, and envy that the narcissist cannot acknowledge in themselves become attributed to everyone around them. This explains why narcissists construct paranoid worldviews populated with envious, hostile people: they are seeing their own qualities reflected everywhere they look. Relationships become zero-sum competitions because that is genuinely how the narcissist approaches connection—and they project this orientation onto others.

Differential diagnosis clarity: The overt-covert framework enabled more accurate differential diagnosis from related personality disorders. Unlike borderline personality disorder, narcissistic identity disturbance involves inflated rather than chaotic self-image. Unlike antisocial personality disorder, narcissists seek admiration and maintain social charm. Unlike histrionic personality disorder, narcissistic seductiveness serves power rather than nurturance needs. Akhtar's comprehensive mapping helped clinicians recognise NPD even when vulnerable presentations mimicked depression or anxiety disorders.

How This Research Is Used in the Book

Akhtar's work appears in Chapter 18: Can Narcissus Be Healed? to explain how narcissists construct their distorted reality through projection—and why this makes both genuine self-understanding and authentic relationships virtually impossible:

"Through projection, narcissists construct entire paranoid worldviews, populating their world with envious, hostile, manipulative people—because these are their own disowned qualities. Relationships become zero-sum competitions because that is how they approach connection. Others' success feels like personal attack because their own success depends on others' failure. This projected reality becomes so convincing that alternative perspectives seem absurd."

This citation supports the book's analysis of why narcissistic personality disorder remains so treatment-resistant: the very mechanisms that maintain the disorder—grandiosity that blocks insight, projection that externalises all problems, fragility that makes self-examination feel catastrophic—prevent the sustained self-reflection that therapy requires. Akhtar's framework helps readers understand that the narcissist's apparent confidence masks profound vulnerability, while their blaming of others reflects projection of their own intolerable qualities rather than accurate perception.

Why This Matters for Survivors

If you have been in relationship with a narcissist, Akhtar's research provides crucial clarity about experiences that may have left you profoundly confused.

Your perception of contradictions was accurate. You may have sensed that the confident, grandiose person you knew was hiding profound fragility underneath. You may have been bewildered by how quickly they shifted from seeming invincible to devastated by minor criticism. Akhtar's framework validates this perception: the contradictions are real and built into the disorder itself. The overt grandiosity you witnessed coexists with covert vulnerability—both are genuine aspects of the narcissist's fractured self. You were not imagining the "two different people" who seemed to inhabit the same body.

Their accusations revealed their own psychology. When the narcissist accused you of being jealous, manipulative, hostile, or selfish, you may have searched yourself desperately for evidence of these qualities. Akhtar's analysis of projection suggests you were looking in the wrong direction. The narcissist projects their own disowned qualities onto others because they cannot tolerate awareness of these traits in themselves. Their accusations were a map of their own interior—not yours. The jealousy they accused you of feeling was their jealousy. The manipulation they condemned was their manipulation. Understanding projection can help you stop absorbing blame for the narcissist's own psychological struggles.

Their worldview was constructed, not accurate. The narcissist may have convinced you that you were surrounded by enemies, that others were jealous of them (or of you by extension), that the world was full of hostile and manipulative people. Akhtar explains that this paranoid worldview is constructed through projection—the narcissist sees their own qualities everywhere because they cannot acknowledge them internally. The world is not actually as hostile as the narcissist perceives it. Their reality distortion was convincing precisely because they believed it so completely—but it was never an accurate map of the social environment.

The emptiness you sensed was real. Many survivors describe an uncanny feeling that "nothing was there" behind the narcissist's confident facade. Akhtar's description of covert features—chronic emptiness, emotional shallowness, fragile self-esteem—validates this perception. The grandiose surface was never grounded in genuine substance because the narcissist lacks stable internal structures for self-worth and emotional regulation. Nothing you could provide would fill the void, because the emptiness is structural—a feature of how they are organised psychologically, not a gap you failed to fill.

Clinical Implications

For psychiatrists, psychologists, and trauma-informed clinicians, Akhtar's overt-covert framework has direct implications for assessment, diagnosis, and treatment.

Assess both dimensions systematically. Clinicians who focus only on overt features may miss narcissism when vulnerable presentations dominate—the patient who presents as anxious, depressed, or victimised may have underlying grandiosity invisible to standard assessment. Conversely, focusing only on covert features may miss narcissism when grandiose defenses are robust. Akhtar's six-domain framework provides a comprehensive checklist: systematically evaluate self-concept, interpersonal relations, social adaptation, ethics, love and sexuality, and cognitive style—asking about both visible behaviours and hidden inner experiences in each domain.

The presenting problem may mask the personality structure. Narcissistic patients rarely present requesting treatment for narcissism. They present with depression following narcissistic injury, anxiety about narcissistic supply disruption, or relationship conflicts blamed entirely on others. Akhtar's framework helps clinicians look beneath presenting symptoms to underlying personality organisation. The depressed patient whose mood improves dramatically with external success; the anxious patient whose worry centres on status and reputation; the relationship-troubled patient who describes every partner as inadequate—these patterns suggest narcissistic structure warranting specific assessment.

Differential diagnosis requires nuance. The overt-covert distinction helps separate NPD from mimics. Vulnerable narcissism can appear similar to depression (chronic emptiness, low self-esteem) but includes underlying grandiosity and entitlement absent in pure depression. It can resemble borderline personality disorder (identity disturbance, interpersonal difficulties) but features inflated rather than chaotic self-image. It can mimic anxiety disorders (chronic uncertainty, sensitivity to evaluation) but involves grandiose fantasies and empathy deficits that distinguish it. Systematic assessment of both overt and covert features across Akhtar's six domains improves diagnostic accuracy.

Therapeutic alliance faces dual challenges. The narcissist's overt features—grandiosity, entitlement, dismissiveness—create obvious obstacles to therapeutic alliance. But covert features pose subtler challenges: the fragile self-esteem that experiences interpretation as attack, the hidden envy of the therapist's competence, the inability to tolerate dependency implicit in the help-seeking role. Akhtar's framework prepares clinicians to expect these hidden dynamics and to address them without personalising the patient's devaluation or colluding with their grandiosity.

Survivors require specialised understanding. Patients who present after relationships with narcissists—as partners, children, or employees—often carry internalised dynamics from these relationships. They may have adopted the narcissist's projected qualities, believing themselves to be the inadequate or manipulative one. They may doubt their own perceptions after sustained gaslighting. They may struggle to identify the covert features in the narcissist because these were so carefully hidden. Helping survivors understand Akhtar's overt-covert framework can support their recovery by explaining the contradictions they witnessed and validating perceptions they were taught to doubt.

Broader Implications

Akhtar's phenomenological framework extends beyond individual clinical encounters to illuminate patterns across relationships, families, and institutions.

The Double Life of the Public Narcissist

Public figures—corporate leaders, politicians, celebrities—may display dramatic overt-covert splits that confuse observers. The executive who inspires devoted followers with apparent confidence may privately rage at subordinates who fail to provide adequate narcissistic supply. The politician who projects strength may be devastated by criticism that would barely register for a psychologically healthy person. Akhtar's framework explains how the same individual can appear invincible in public and fragile in private. This split is not hypocrisy in the usual sense—it reflects the genuine bifurcation of the narcissistic self.

Family System Dynamics

Within families, different members may encounter primarily overt or primarily covert features depending on their role. The golden child who provides supply may see more of the grandiose, confident parent; the scapegoat who triggers narcissistic injury may encounter more of the rageful, fragile aspects. Siblings may struggle to reconcile their different experiences of the same parent—one insisting "they were wonderful" while another describes abuse. Akhtar's framework helps family members understand they experienced the same parent's different facets, not different parents.

Projection in Workplace Dynamics

Akhtar's analysis of projection illuminates common workplace dynamics. The narcissistic manager who accuses subordinates of lacking commitment may be projecting their own disengagement. The colleague who sees conspiracies against them may be projecting their own competitive hostility. The leader who perceives the organisation as full of envious enemies is seeing their own envy reflected everywhere. Recognising projection can help targets avoid internalising unjust criticism while understanding the psychological source of accusations levelled against them.

Legal and Custody Implications

In high-conflict divorce and custody situations, narcissistic parents often deploy massive projection. They accuse the other parent of precisely what they themselves are doing: alienating children, pursuing self-interest at children's expense, being emotionally abusive. Evaluators trained in Akhtar's framework can look for the overt-covert split—the parent who presents as victim may covertly be perpetrator. Understanding that narcissists genuinely believe their projections (they are not consciously lying) helps legal professionals assess without being manipulated by convincing victim presentations.

Cultural Expressions and Social Media

Akhtar's framework illuminates contemporary cultural dynamics around self-presentation. Social media platforms encourage overt narcissistic display—curated images of success, constant documentation of achievements—while covert features (insecurity, emptiness, hunger for validation) drive the compulsive seeking of likes and followers. The platform incentivises surface grandiosity while providing narcissistic supply that temporarily soothes but never satisfies covert emptiness. Understanding the overt-covert dynamic helps explain both why these platforms are so compelling and why they often increase rather than decrease psychological distress.

The Question of Change

Akhtar's framework has implications for whether narcissists can change. The overt features—grandiosity, entitlement, exploitation—provide real advantages that create resistance to change. But the covert features—emptiness, fragility, chronic dissatisfaction—create genuine suffering that could potentially motivate treatment. Access to covert vulnerability may be essential for therapeutic engagement: narcissists whose defenses crack sufficiently to experience their hidden distress may be more amenable to treatment than those whose overt defenses remain impenetrable. This suggests therapeutic windows following narcissistic collapse when covert features temporarily predominate.

Limitations and Considerations

Despite its clinical utility, Akhtar's framework has important limitations.

Phenomenological description, not causal explanation. Akhtar's article describes what narcissism looks like across multiple domains but does not explain why these features develop or cluster together. The overt-covert pairing is documented, not theoretically derived. Subsequent work by Kernberg, Kohut, and others provides developmental theories, but these remain debated. Clinicians should use Akhtar's framework for assessment while recognising that phenomenological description does not equal causal understanding.

Cultural and historical specificity. Akhtar's observations derive primarily from clinical work with American patients in the 1970s and 1980s. What constitutes "pathological" grandiosity or entitlement may vary across cultures and historical periods. Behaviours considered narcissistically disordered in one context might be normative or even valued in another. Clinicians should consider cultural factors when applying the framework, particularly with patients from collectivist cultures where Western concepts of healthy self-esteem may not directly translate.

Overlap with other constructs. The overt-covert distinction overlaps with, but is not identical to, other narcissism typologies: grandiose versus vulnerable narcissism, entitled versus dependent narcissism, oblivious versus hypervigilant narcissism. These constructs capture similar phenomena from different theoretical angles. Clinicians and researchers should be aware that terminology varies across literature and that Akhtar's specific framework is one way of carving up narcissistic phenomenology.

Individual variation within the framework. Not every narcissist displays every feature Akhtar describes. Some individuals show pronounced grandiosity with minimal apparent vulnerability; others show the reverse. The six-domain framework is comprehensive but represents a prototype rather than a necessary-and-sufficient checklist. Clinical judgement remains essential for applying the framework to individual cases, and absence of specific features does not necessarily rule out narcissistic pathology if the overall pattern fits.

Historical Context

Akhtar's 1989 article appeared at a pivotal moment in the evolution of narcissism as a clinical concept. The DSM-III (1980) had established narcissistic personality disorder as a formal diagnosis just nine years earlier, but the field lacked consensus on what narcissism actually looked like in clinical practice. Kernberg and Kohut had proposed competing psychoanalytic models of narcissism, but their theoretical frameworks could be difficult to translate into clinical recognition.

Akhtar's contribution was phenomenological rather than theoretical—he systematically catalogued what clinicians actually observed in narcissistic patients. By organising these observations into the overt-covert framework across six functional domains, he created a clinical checklist that bridged theoretical camps. Whether one favored Kernberg's object relations approach or Kohut's self-psychology, Akhtar's descriptive framework provided common ground for recognition and diagnosis.

The article's influence extended beyond psychoanalytic circles. As DSM-IV (1994) was being developed, the overt-covert distinction informed discussions about how to characterise NPD criteria. Subsequent editions and the dimensional models proposed for DSM-5 continued to grapple with how to capture narcissism's paradoxical combination of grandiosity and vulnerability—a paradox Akhtar's framework had articulated clearly.

Akhtar's position at the intersection of Eastern and Western perspectives also shaped his contribution. His training in both Indian psychiatric traditions and American psychoanalysis, combined with his poetic sensibility, may have attuned him to the contradictions and complexities that more narrowly focused observers missed. His ability to hold paradox without forcing resolution—the narcissist is genuinely grandiose AND genuinely fragile—reflected a sophisticated clinical orientation that continues to influence the field.

Narcissistic Personality Disorder: Descriptive Features and Differential Diagnosis

APA Citation