There is a tendency in psychology to look backward, especially when evaluating an adult with Narcissistic Personality Disorder, Borderline Personality Disorder, or psychopathic traits. It is remarkably easy to identify childhood behaviors that appear to have been early warning signs. For example, imagine a child was entitled, manipulative, self-centered, emotionally reactive, or lacking empathy. The conclusion often becomes, “The signs were there all along.”
But, I wonder if we have confused retrospective pattern recognition with developmental prediction. As clinicians, we should be careful not to assume that because a pathway can be traced backward, it was inevitable all along.
Recently, I worked with a thoughtful fourteen-year-old who asked me a question that many adults never ask themselves: “Do you think I might be narcissistic?”
He wasn’t defensive or trying to convince me that everyone else was wrong about their comments about his tendency to be viewed as ‘entitled.’ He was genuinely curious and wanted to understand why he thinks the way he does, whether his expectations of other people are realistic, and whether the way he relates to others says something about the kind of person he is becoming.
To me, that curiosity mattered far more than whether he demonstrated a handful of narcissistic traits; especially because, at fourteen years old, his personality isn’t finished developing.
Developmental psychologist Erik Erikson described adolescence as the stage of Identity versus Role Confusion—a period when young people are actively figuring out who they are, what they value, and how they fit into the world around them. Identity is still under construction. Beliefs, expectations, and interpersonal patterns remain remarkably flexible. This is one reason I hesitate when clinicians confidently identify “future personality disorders” in adolescents. Traits may be present, but the developmental process is still unfolding.
As our conversation continued, we moved away from labels and toward understanding. This teenager is growing up between two households, each with remarried parents and additional children. We talked about how navigating different family cultures over many years has likely influenced his expectations, relationships, and even his sense of identity.
As we examined his relationships with caregivers, we noticed a recurring pattern. With one parent, his needs and preferences were often accommodated quickly and with little hesitation. Requests were routinely prioritized, disappointments were softened whenever possible, and that parent frequently adjusted their own plans to avoid letting him down. There was no single defining moment that stood out; rather, it was the cumulative effect of hundreds of ordinary interactions over many years.
That distinction felt important.
No one had intentionally taught this teenager to expect accommodation. Yet, over time, repeated experiences naturally shaped his assumptions about how close relationships function. What initially appeared to be personality traits could just as reasonably be understood as learned expectations.
None of this struck me as evidence of narcissism. Maybe his personality is being shaped by repeated ordinary interactions rather than by isolated defining moments. Maybe this is evidence of learning and conditioning.
Behavior analysts have understood this principle for decades. Skinner’s work on operant conditioning reminds us that behaviors—and just as importantly, expectations—are shaped by their consequences. When certain experiences are consistently reinforced, they naturally become more likely to occur again. The same principle applies to relationships. If a child repeatedly experiences immediate accommodation, it is entirely understandable that responsiveness becomes part of his expectation for how relationships work.
That expectation is learned. It doesn’t necessarily mean the child believes he is superior to others. It doesn’t automatically suggest a personality disorder. It may simply reflect the relational environment in which those expectations developed.
Imagine a prince who has spent his entire childhood with attendants anticipating every need before he even asks. Or a celebrity who becomes accustomed to people rearranging their schedules, overlooking inconveniences, and saying yes simply because of who they are. Over time, those experiences begin to shape what feels “normal.” Expectations gradually shift—not necessarily because of arrogance, but because repeated experiences quietly teach us what to anticipate from the people around us.
Children are no different. When those children later encounter peers, teachers, employers, or romantic partners who don’t respond in the same way, friction naturally develops. They may appear demanding, disappointed, or entitled. The behavior can certainly resemble narcissistic traits, but resemblance should not be confused with explanation.
This is why formulation matters. Rather than asking, “Does this teenager have narcissistic traits?” I found myself asking a different question: “What has this young person been taught to expect from relationships?”
Those are profoundly different questions, and they lead to very different therapeutic conversations.
As our session came to a close, we explored how his expectations might influence the friendships he described as easy to begin but difficult to maintain. We talked about reciprocity, appreciation, flexibility, and how healthy relationships require us not only to recognize our own needs but to remain curious about the needs of others. None of this was presented as criticism. Instead, it became an opportunity to reflect on how expectations develop—and how they can also change.
Perhaps that’s the most hopeful part of working with adolescents. In adolescence, personality isn’t simply waiting to be discovered. Personality is still being shaped by every meaningful relationship, every disappointment, every corrective experience, and every moment of self-reflection. Each of these have the potential to influence who that young person becomes.
Perhaps we should spend less time asking whether we can identify the early signs of an adult diagnosis and more time asking what experiences might alter the developmental path altogether.
Because looking backward almost always produces a coherent story; looking forward requires humility. Children and adolescents are not simply revealing who they will become – they ARE becoming.
