![]() ![]() Most often, “lack of empathy” is included as a signifier of the diagnosis and is highlighted in both the clinician’s and lay public’s impression of narcissistic individuals. From the early clinical conceptualizations of narcissistic personality disorder (NPD) to the introduction of NPD in the DSM–III ( APA, 1980), impaired empathic processing has been considered a hallmark of pathological narcissism and NPD ( Adler, 1986 Akhtar, 1989, 2003 Cooper, 1998 Kernberg, 1983, 1985 Kohut, 1966 Ronningstam, 2005 Watson, Grisham, Trotter, & Biderman, 1984 Watson & Morris, 1991). ![]() Narcissism and empathy have long been considered interrelated. Ultimately, by recognizing the multifaceted relationship between empathy and narcissism, and moving away from an all or nothing belief that those with NPD simply lack empathy, therapists may better understand narcissistic patients’ behavior and motivational structure. ![]() Given the complexity of narcissism and empathy, we propose that multiple relationships can exist between these constructs. Because this research is limited, we also present empathy-based findings for related syndromes (borderline and psychopathy). Additionally, we summarize the literature on empathy and NPD, which largely associates this disorder with deficient emotional empathy, and dysfunctional rather than deficient cognitive empathy. We present 3 case studies highlighting the variability in empathic functioning in people with NPD. The goal of this practice review is to bridge the gap between our psychobiological understanding of empathy and its clinical manifestations in NPD. Consistent with this presentation, research illustrates that empathy is multidimensional, involving 2 distinct emotional and cognitive processes associated with a capacity to respectively understand and respond to others’ mental and affective states. However, clinical presentations of NPD suggest that empathy is not simply deficient in these individuals, but dysfunctional and subject to a diverse set of motivational and situational factors. ![]() A lack of empathy is often cited as the primary distinguishing feature of NPD. Narcissistic personality disorder (NPD) is associated with an assortment of characteristics that undermine interpersonal functioning. ![]()
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