The subjects of Lucy Knight’s excellent article about narcissistic personality disorder (NPD) have a common redeeming feature: insight (‘You are constantly told you are evil’: inside the lives of diagnosed narcissists, 15 October). They understand their problem and how it affects others, and they have the humanity and capacity to address it.

A tenet of psychiatry is that we all have personality traits, including narcissism, on a spectrum in which they become disorders when they adversely affect us or those around us. The dangerous ones are at the extremes, where there is little or no insight, and the characteristics become bizarre and chaotic.

I have experience of this in a once-loved relative who spent seven years trying through the courts to deprive his siblings of their father’s inheritance, insisting that he was the only one who deserved it. He has no insight and scorns formal diagnosis.

His behaviour ticks all the boxes for malignant NPD: egocentrism and grandiosity, lack of empathy, lying and manipulative behaviour (associated with great charm), paranoia, aggression, grudge-bearing, magical thinking, bullying, loyalty to like-minded individuals (usually autocrats) etc. Ultimately, his campaign failed, but the financial and emotional cost is irreparable.

Does that ring a bell? This relative is American and fiercely loyal to Donald Trump.
Name and address supplied

While narcissistic personality disorder may be one of the most stigmatised psychiatric disorders, surely we should question the value of telling anyone that their personality is disordered? Given that the stigma against personality disorder is higher in mental health staff than in the general public, there is a questionable value to applying a label that will make those who are supposed to care treat people worse.
Keir Harding
Consultant occupational therapist