What Makes Someone a True Narcissist? We Asked a Therapist

The Real Housewives of New York City ladies' trip to Miami turned explosive for Bethenny Frankel and Luann de Lesseps when Bethenny became fed up with Lu's recent behavior.  

There was Lu choosing to hit to an AA meeting instead of spending time with Barbara Kavovit. She went for a swim instead of helping Sonja Morgan through a bad night. She posed with her cabaret picture downtown instead of lunching with the gals. 

Enough is enough, says Bethenny.

But Luann still doesn't understand why exactly everyone is pissed at her. On The Real Housewives of New York City After Show (clip above), she said, "I think Bethenny's got a lot of issues and a lot of anger and a lot of stuff going on in there. It's not just about me. I think her breakdown had a lot to do with Dennis, with her own anger and her own issues and her dating and her guilt and there were a lot of things bottled up in that explosion," she explained. "At this point, I'm dealing with a bunch of gangsters. It's really Lu against the motley crew."

What can you do when a once-close friend seems to only be thinking of themselves? And what defines a narcissist?

"It's incredibly difficult to be friends with or have a relationship with a true narcissist," New York City-based therapist Liz Lasky told Personal Space. "The incessant need for recognition, admiration, and attention can be very hard to deal with."

But there is a difference between selfishness and being a narcissist. 

"Someone with a narcissistic personality disorder will have the inability to understand feedback from others on how they are coming across, making it near impossible to have a fruitful conversation about how they are being entitled, grandiose, self-centered, and callous," Lasky added.

But, she added, "In many ways, Luann is picking herself back up after years of substance use and the trauma of a divorce, another marriage and subsequent divorce, being arrested, and going to rehab."

"Sometimes people need to focus on themselves in order to heal," Lasky explained. "In other ways, Luann's relationships are falling apart because of how she's acting. Ultimately, it will be up to her to decide if her current way of living is worth the cost of her relationships."

Her friends will have to make a similar decision, she said. 

"What is the cost of being friends with someone like this? Are they willing to put up with the one-sidedness of the friendship just for friendship's sake? That will be up to them and is a personal decision.  Many people put up very strong boundaries when it comes to relationships likes this."

Lasky said people often throw around the word "narcissist" when they talk about her, but that they should be careful because people who are diagnosed with it really do need help.

"I'd like to be VERY clear: I tread carefully when I talk about narcissistic personality disorder and Luann simply because I've never met her or assessed her for it. If she is truly suffering from such a disorder, my hope is she will be able to get the help that she needs."