The suicide of "Real Housewives of Beverly Hills" husband Russell Armstrong has spurred a lot of talk about the nature of reality television, with one L.A. Times journalist suggesting "at this point, the willingness to appear on a situational reality show should be classified as a symptom of emotional instability, if not a mental illness in itself." While television critic Mary McNamara might have been engaging in hyperbole for humor's sake, it's hard to deny she has a point.
 
While she was speaking specifically of "The Real Housewives" franchise, you also have to wonder about the sanity of anyone who would appear on, say, shows like "Flavor of Love" or "Teen Moms." Still, though it's easy enough to dismiss reality TV fame hounds as unstable, to what degree are we talking about? Are these people just big personalities harmlessly chasing their fifteen minutes, or is something actually amiss? I talked to psychotherapist Nathan Gehlert, PhD of the Imago Center in Washington D.C. and Dr. Judith Orloff, Assistant Clinical Professor Psychiatry at UCLA and author of "Emotional Freedom" and "Second Sight." The answer is a little more complicated than you might think, but let's just say McNamara might be onto something.
 
Both Orloff and Gehlert mentioned that many reality TV stars exhibit signs of Narcissistic Personality Disorder, or NPD. Reading the list of the nine possible features of NPD, it's easy to see how most of reality TV's biggest stars fall neatly into an NPD diagnosis: symptoms include having a grandiose sense of self-importance; being preoccupied with fantasies of unlimited success, brilliance, beauty or ideal love; having a belief that he or she is "special" and unique and can only be understood by special or high-status people; requiring excessive admiration; having a sense of entitlement; being interpersonally exploitative; lacking empathy; being envious of others; and showing arrogant, haughty behaviors or attitudes.
 
Sound like anyone you've seen on reality TV lately? Or does it sound like everyone you've seen on reality TV lately? Though Gehlert points out that competition shows like "Hell's Kitchen" usually attract a broader mix of personalities, he says, "Having a sense of entitlement, fantasies of success and power and a grandiose sense of importance -- features of NPD -- would definitely motivate someone to be on a show such as 'The Real Housewives." He adds that someone only needs to be identified as having five of the above symptoms to qualify for a diagnosis of NPD. 
 
But having NPD doesn't mean you're truly dysfunctional -- in fact, quite the opposite. "This is not mentally ill, no," says Orloff. "That would be something like schizophrenia…Narcissism is malignant and can cause personal damage, but narcissists run our country and most major business. No one else would want to do those jobs. Narcissists can be brilliant and charming and productive. They have all these good qualities, but it's in personal relationships that they're dangerous…. They lack empathy. They don't have hearts."
 
Whether most reality TV stars are truly NPD or just have narcissistic traits is anyone's guess. For every ugly cat fight there are moments of what appears to be sincere concern and connection, but assessing what behavior is "real" and what is scripted or coerced makes diagnosis from afar impossible. Still, one thing is for certain -- in Hollywood, heartlessness is usually seen as a handy thing to have, and not just for those in front of the camera.
 
Even though much has been made of the mental illness screening process reality TV applicants must go through, the truth is that no producer in his right mind would want to eliminate wannabes who exhibit NPD. "I’m not an industry insider, but I can’t imagine that production teams would want to exclude people with narcissistic, histrionic, or borderline personality disorders, because they make for such good television," says Gehlert. "Even the layperson would recognize that most characters on 'The Real Housewives' are narcissistic exactly because so many of them exhibit narcissistic traits. Narcissism is incredibly easy to recognize, which is exactly why so many of these people show up on reality television – producers select them for the entertainment value."
 
Still, is reality TV such a bad job for a narcissist? In some ways, it sounds like the ideal gig -- all of a narcissist's grandiose ideas about him or herself are reinforced by Hollywood. But for narcissists, too much is never enough -- and when a so-called "star"'s fifteen minutes is up or they're portrayed in a negative way, the loss of status can be devastating. "One theory of NPD is that people who are narcissistic are attempting to counter some perceived personal weakness or shortcoming," says Gehlert. "In essence, it’s a defense mechanism against reality. Clinically, in order to make progress, a person must renounce their narcissism. So, reinforcing someone’s grandiosity is never beneficial to that person because it simply fuels their distorted self-image... Think of narcissism and self-confidence as the volume on your stereo. The right amount of self-confidence is incredibly beneficial to well-being. However, turn the volume up too much and it’s destructive."
 
And not just destructive to the people being filmed. "These shows can also be very destructive if younger people watch them," says Orloff. "They're getting the message, 'You'll be happy if you have so much money or get a nose job or a face lift.' That's all false. Those messages cause girls to become anorexic and boys to feel horrible about themselves. The show I hate the most is the 'Real Housewives of Beverly Hills,' because it gives such a perverted vision of wealth and status. It just makes my skin crawl. But it's free speech. They should have the right to air those shows. But I think they can be destructive."
 
Of course, with a lot of people happily updating their Facebook status every few minutes, maybe reality TV is just a reflection of, well, us. "Our society has bred a new sense of exceptionalism, especially in younger generations," says Gehlert. "Research has shown that people in the Millennial and Gen Y generations are, for instance, much more likely to believe that they’re great people who are destined for success than their counterparts in the Baby Boomer generation. This is notable because today’s youth actually score much further behind their international peers on so many educational markers. Reality shows and social media certainly contribute to this phenomenon because they create a false vision of how success is possible and then give people easy and fun tools of self-promotion. Social media really encourages people to broadcast about their lives, which can seem narcissistic. Many times it is."
 
So, maybe we're all a little narcissistic -- and while the people we watch on television may be more so, their narcissism isn't a form of mental illness (though some reality TV stars may have more severe problems than NPD). Still, the recent bout of media hand wringing could result in changes to the genre.  But what changes would work? It's tempting to look at a recent trend of including therapy sessions in less high-tension reality shows such as "Bethenny Ever After" and "Gene Simmons Family Jewels" as something that might work across the board, but even that wouldn't be an easy fix (though getting some "Real Housewives" into therapy couldn't be a bad thing). Unfortunately, if NPD is the biggest problem for many of these stars, whether or not including this element would be of help is questionable.
 
"It’s incredibly rare for someone with NPD to walk into a therapist’s office and say, 'I’m narcissistic and I need help,' says Gehlert. "People with NPD generally think that their personality is helpful rather than harmful… Sadly, there is still stigma in the U.S. about mental health and therapy. Most of the time, it’s good when real people are seen getting professional help on TV because it reduces this stigma. However, having cameras in the therapy session likely hinders the client from being truly open, honest, and vulnerable. A certain amount of reality TV is about performing; a lot of people will keep performing as long as the cameras are rolling."
 
And, as long as those cameras are rolling, chances are a lot of us will keep watching. "Putting a bunch of narcissistic people together in a high-stakes situation is a bit like orchestrating a train wreck," Gehlert says. "People are going to want to watch, just like we tend to slow down at the site of a car crash to have a look."