Transcript
Speaker: My sister is a narcissist. I hear this in my office almost every single week from accomplished, intelligent, exhausted women who are at the end of their rope with a sibling who will not help with their aging parent.
Speaker: And here's what I have to tell you. Almost every single time that diagnosis is wrong. Your sister's probably not a narcissist. She might be selfish. she might be avoidant, she may even be unbearable, but she's probably not actually diagnosable with narcissistic personality disorder.
Speaker: And the fact that we keep using clinical language to describe difficult people is doing something to us. It is making the situation worse.
Speaker: Today, I'm gonna tell you why pop psychology is failing you what your sister probably actually is and what to do instead of diagnosing her.
Speaker: So welcome back to the aging parent playbook. I'm Dr. Barbara Sparacino, triple board psychiatrist and the aging parent coach.
Speaker: Today, We are in week three of our Family Dynamics series. Two weeks ago, i told you why you are not parenting your parent.
Speaker: And last week I named the five roles in every caregiving family. And today I wanna take on something that is becoming a cultural problem, diagnostic creep.
Speaker: The way that clinical language has leaked into everyday conversation. The way that narcissists and trauma and boundaries and gaslighting have all become ways to describe people we do not like or situations we do not want deal with.
Speaker: And I want to talk about this as the psychiatrist I am. This is not a hot take. This is not for like a TikTok thread, right? I am someone who has spent 15 years actually treating people with personality disorders. And I'm someone who is watching the misuse of these terms cause real damage in real families, right? So let's talk about your sister.
Speaker: So what is the problem with calling your sister a narcissist?
Speaker: Here is a situation i see over and over again. You are caring for your aging mother, right? You are the responsible one. You call the doctor and you got the medication sorted.
Speaker: You set up the home health aid. Your sister who lives 40 minutes away has not been to see your mother in two months. When you call her to ask her for help, she tells you that you are doing too much or she starts a listing off her own life problems, right? Or she does not call back.
Speaker: Your blood pressure goes up. You are livid. You call your best friend and say, my sister is such a narcissist. And look, I get it. The word feels right.
Speaker: It feels like it captures the totality of your experience, right? The selfishness, the lack of empathy, the way she always makes it about her, the way she has no idea how much you are doing.
Speaker: Narcissist sounds like the right diagnosis, but here's the problem. One, you are not qualified to diagnose her, right?
Speaker: And I say this with love. You are not in the room with her clinically. You haven't done a structured interview. You haven't used and may not even know what that that criteria is, right?
Speaker: You are doing what most people do, which is using a clinical term that has a precise meaning to describe behavior is just frustrating.
Speaker: And it sounds smart, but it's not accurate. Two, personality dis disorder is actually quite rare. The actual prevalence is around 1% of the general population, maybe be a little higher in certain settings.
Speaker: But look, let's be honest, if every sibling in America was actually a narcissist, the disorder would be diagnosed in 20 to 30% of the people. It's people it's not That diagnosis has a specific shape and most people who are called narcissists, you know, don't actually fit that shape, actually meet criteria, right?
Speaker: Three, calling her a narcissist kind of, you know,
Speaker: shortens the conversation, it stifles it, right? The minute you label her you have decided she is unreachable. You have decided that her behavior is fixed, pathological, untreatable in the context of your relationship.
Speaker: You give up, you stop trying. And look, that may be the move you eventually want to make, but it should be a move you make consciously, not a move be you make by accident because you use the wrong word.
Speaker: And four, this is the one that matters most, right? Is a diagnostic. This diagnosis takes you out of the work you actually need to do, right? Because if she is a narcissist, then your job is to manage her, right? To set boundaries with her, to go no contact, to wait for her to change, right?
Speaker: But your sister is probably not a narcissist. So none of these moves are the right moves for your actual situation. You are applying a treatment plan for the wrong diagnosis.
Speaker: And this is what diagnostic creep does. It feels like it's helping. It feels like it's naming the problem, but what it's actually misdirecting your attention.
Speaker: It's giving you a story that sounds clinical and feels validating, but it's not actually describing what is really going on. so
Speaker: Let's talk about what's actually going on. So what your sister probably actually is, right? So most of the time, the sister you've called the narcissist is one of three things.
Speaker: One is she's dealing with her own unresolved relationship with your parent, right? um Many people who cannot help with caregiving cannot help because the relationship with the parent was hard.
Speaker: Maybe the parent was emotionally unavailable. Maybe there was favoritism, right? Maybe she was a difficult child and your mother was harder on her than on you.
Speaker: Maybe she felt overlooked. Maybe she felt blamed. Maybe she was the one who fought with your mother more and now her mother is dying and she doesn't know what to do with that.
Speaker: She is not absent because she is heartless. She is absent because the relationship was complicated, right? And now it's, that too is dying and she doesn't have the tools to deal with it.
Speaker: This isn't narcissism. This is unresolved grief or unresolved childhood injury or, you know, just complicated love. And it is far more common than narcissism.
Speaker: Two, she may be operating in a different family role. Remember last week, the five roles?
Speaker: she maybe She's probably the disappearing sibling or the dependent child or even the critic, right? The disappearing sibling does not show up because the system trained her to assume you would.
Speaker: Right? Someone would. She has not made an active choice to abandon your parent. She is kind of falling into a role that was always going to be hers. The critic doesn't help because criticizing is easier than confronting her own absence. Right?
Speaker: The dependent child does not help because she is still being cared for by the parent. Not the other way around. right None of these are narcissism.
Speaker: They are role adaptations. They are predictable. They are also changeable. Because if you change the system, like we talked about last week, right?
Speaker: Three, she's just selfish. And look, selfishness is not a clinical diagnosis. Sometimes the simplest explanation is the correct one. Your sister might be a selfish, selfish person.
Speaker: She might have always been a selfish person. She might have grown up self-censored and never grown out of it. That is real. that That is painful. And that is a person you might have to limit your relationship with, right?
Speaker: But it's not a personality disorder. It is a character issue, right? And character issues are different. They do not require clinical language. They require honest language.
Speaker: And because when you use clinical language for a character issue, two things happen, right? First, you give the problem more weight than it may need.
Speaker: And second, you take responsibility off of the person because if she's a narcissist, she cannot help it within limits, right? She has a disorder. If she's selfish, she is making a choice.
Speaker: Choices can be confronted disorders, are a little bit more challenging, right? So I want you to consider in your own situation, which is true, is your sister actually struggling with the relationship in a way you can have compassion for?
Speaker: or is she stuck in a family role that the system reinforced? Or is she just a person who has been making selfish choices for a long time?
Speaker: The answer matters. Because the response is different, right? Depending on which one it is.
Speaker: And so why is this cultural moment hurting you, right? And I want to back up and say something about the broader cultural moment we're in, right? We're living through a period where clinical language has flooded into mainstream conversation.
Speaker: Narcissist, bipolar, OCD, trauma, triggering, gaslighting, boundaries, codependent, empath. These terms used to mean specific things in clinical settings.
Speaker: Now, they mean almost anything anyone wants them to mean. I think there are good reasons this has happened, right? People wanted a language to describe their pain.
Speaker: People wanted to feel seen. People wanted to understand themselves, right? Therapy became more accessible. Mental health awareness expanded.
Speaker: All of these are wonderful things. And yet the unintended consequences, what I'm calling diagnostic creep, real diagnostic categories are being used so loosely that they have lost meaning.
Speaker: And when categories lose meaning, the people who actually have those conditions get less help. And the people who do not have them get over pathologized, right?
Speaker: In families, this is causing real damage. Adult children are telling me they have cut off siblings because they have decided the sibling was a narcissist. One, the sibling was actually just difficult.
Speaker: Adult children are telling me that they have set boundaries with their mother when What they actually need is one honest conversation. Adult children are telling me they have trauma from caregiving when what they have is exhaustion and grief.
Speaker: Exhaustion isn't trauma. Grief isn't trauma. Difficulty isn't narcissism. a hard relationship is not gaslighting.
Speaker: Saying no is not setting a boundary. These distinctions matter because when you misdiagnose what is going on, can't if you can't fix it, you can't address it So I'm inviting you today to be a little bit more careful with the language you use.
Speaker: Not because the feelings aren't real, they are, right? But because the wrong word makes the feeling harder to work with, not easier. Your sister may be making your hard your life hard That is the truth, right? The question is what kind of heart and what is the right move as a response, right?
Speaker: So what can we do instead of diagnosing her? So if you're not going to call her a narcissist, right, what do you do? Well, first describe the behavior, not the diagnosis, right? Instead of My sister is such a narcissist. Try, my sister has not been to see my mother in two months. And when I ask her for help, she lists her own problems and changes the subject.
Speaker: That is more accurate and also lets you see the situation clearly. Second, ask yourself three questions, right? Is she struggling with her own unresolved relationship with our parents?
Speaker: Is she stuck in a family role or is she making selfish choices? Each of these has a different response, right? The first wants compassion and time.
Speaker: The second wants a system shift. And the third wants, well, wants a hard conversation and recalibration of what you give her.
Speaker: Third, stop expecting her to be different than she has been.
Speaker: know, people telegraph who they are. If she has been the disappearing sibling for 40 years, she is not going to be the responsible one because your mother sick.
Speaker: If she has been the selfish for 40 years, she's not going to become generous
Speaker: spontaneously because the situation is dire. You can ask her to do specific things. You can be explicit about what you need. but you cannot will her into being a different person.
Speaker: And the sooner you stop expecting that, the sooner you can plan around who she actually is.
Speaker: Four, decide what you want, not what you wish she would give you, what you actually want given who she actually is. Because maybe you want her to come to one doctor's appointment a month.
Speaker: Ask her for that. Specifically, once. Maybe you want her to call your mother every week. Ask her for that. Once.
Speaker: Maybe you want her send money toward the home health aide. Ask her. Once. And then accept what she does or does not do. This is the work.
Speaker: Hi, it's not glamorous and it does not have a clinical name. It's just honest adult to adult relationship work. And it requires you to stop using diagnostic language for things that are not actually diagnoses.
Speaker: Your sister's not a narcissist. She is your sister. And the relationship is what it is right now. The question is, what are you going to do with the truth?
Speaker: So. Let me bring it home. Okay. Most of the time, the sister you have been calling a narcissist is not actually a narcissist.
Speaker: She is probably one of three things. She's struggling with her own complicated relationship with your parent. She's operating in a family role, the system trained her into, or she is making selfish choices.
Speaker: Each of those calls for a different response. None of them call for a clinical diagnosis and or intervention you are not qualified to make.
Speaker: And that is probably not even accurate.
Speaker: don The bigger point is this. Diagnostic creep is hurting families. It feels like clarity, but it's actually a misdirection. When you misdiagnose what is going on,
Speaker: You cannot fix it. So describe the behavior, not a diagnosis, right? Ask the three questions. Stop expecting a different person to show up. Decide what you actually want and then act accordingly.
Speaker: If this episode hit and you are ready to actually have a conversation with your sister instead of diagnosing her, i have something for you.
Speaker: It's called the hard conversation scripts. It is a free PDF I built for adult children who know they need to have these conversations, but don't know how to start, right? There is a script in there for the sister who has been disappearing.
Speaker: There is one for the sibling who is criticizing without helping. There is one for the family member who keeps making it all about themselves.
Speaker: The exact language, word for word, no clinical labels, no diagnoses, just honest adult to adult useful conversation starters. To get it, comment the word scripts on this episode on Instagram and TikTok, and I will send to you instantly, or can grab it directly in the show notes.
Speaker: These are the conversations that change families, not the diagnoses.
Speaker: The conversations.
Speaker: So next week I'm pivoting pillars. We're leaving family dynamics for a minute and we're going into legally ready because every conversation about who should be helping eventually it becomes a conversation about who has authority.
Speaker: And most families have this conversation way too late. We're going to talk about power attorney, the one nobody knows how to ask for, the one that if you do not have it makes everything else so much harder.
Speaker: And I'm gonna tell you as a psychiatrist, why your parent is not refusing to sign because they don't trust you. Until then, take care of yourself and stop diagnosing your sister.
