In this article, the authors seek to better understand the multi-dimensional construct of empathic processing and its relationship with narcissism (both trait and pathological). The authors’ focus is to challenge the idea that narcissistic individuals are directly correlated to a lack of empathy by first reviewing the psychobiology and subtypes of empathy, examining current empirical findings on the empathy-narcissism relationship, presenting three case studies, reviewing the phenotypic overlap of closely related pathologies, and discussing treatment options for a more personalized and precise diagnosis.
Research presented in the article show there is ample biological and psychological evidence that individuals with pathological narcissism have decreased emotional empathy, but few exhibit signs of impairment in cognitive empathy when in comparison to a healthy control group. Data from self-report questionnaires measuring components of empathy reveals the complexity of the empathy-narcissism relationship when the results showed that narcissism, both trait and pathological, are inversely related to cognitive empathy. That is, narcissistic individuals show a pattern of expressing certain levels of cognitive empathy only when it is for their own self-interest so as not to appear vulnerable to others in addition to impaired emotional empathic processing.
As of today, there is little research showing definitive decreased cognitive empathy in narcissistic individuals. The authors review specific empathy-pathology relationships in related pathological disorders to give a more rounded picture of NPD and how to better identify and separate their cognitive and affective processes. Narcissism is a known co-morbid factor of psychopathy and borderline personality disorder, as they share the same symptoms of impulsivity, emotional imbalances, and egotistical behaviors.
Recent imaging studies have shown that, like NPD, psychopathic individuals display a deficit in amygdala function (decreased emotional empathy) yet show normal levels of cognitive empathy in Theory of Mind tasks. While some studies show a similar pattern with BPD, others show normative or even hyperactive activity in the amygdala. In contrast, some studies report that individuals with BPD scored the same in comparison to healthy controls in cognitive empathy tasks, indicating difficulty navigating and controlling their emotions. In comparing psychological assessments of related disorders, the authors conclude that there are multiple facets and relationships between cognitive and emotional empathy and they are all are valid.
The article presents three case studies highlighting two classic types of NPD, grandiose and vulnerable narcissism. While patients with NPD can appear flamboyant and assertive, others show narcissistic traits by displaying a constant victimization mentality. Discerning the differences between the two types depends on the patient’s early experiences and other environmental factors, which further emphasizes the complexities in assessing pathological narcissism. What these case studies have in common is behind their self-important façade, these patients have deep-rooted insecurities stemming from experiences of shame, inadequacy, and inferiority.
In defining pathological narcissism, it is essential to develop a clear sense of the individual’s motives, how they regulate emotions, and their empathic functioning to differentiate between the overall construct of narcissism and how it is expressed through thoughts, feelings, and behaviors. Researchers have determined that grandiose narcissism is characterized by motivation-based empathic disengagement while vulnerable narcissists have a similar framework with BPD in that they display deficient emotion tolerance, meaning they are unable to regulate their emotions and as a result have impaired empathic functioning. These case studies and current empirical and neurological research presented in the article have major implications for treatment of those with pathological narcissism and NPD.
By combining empirical and clinical work, it becomes easier to clarify and discern different phenotypic patterns of narcissism and how they affect empathic functioning, thus, providing a more targeted approach in treatment. The authors conclude that due to the variability of empathic capability among narcissistic individuals, it is naive to think NPD is directly correlated with a simple lack of empathy; instead, it shows a lack of flexible and informed investigational therapeutic interventions and a need to adjust the framework of the narcissism-empathy relationship. To motivate the patient’s ability to empathize and encourage a more flexible way of approaching interpersonal and social interactions, therapists must be aware of the patient’s empathic fluctuations in regard to motivated-based detachment and difficulty regulating emotions, leading to a more proactive understanding of narcissistic empathic functioning.
While it is true that narcissism exists on a continuum, and these traits exist in all of us, it’s important to recognize repeated patterns of narcissistic behavior and where exactly they originate from. Displays of empathic disengagement is a defense mechanism and are an indication of a time where this person felt emotionally neglected themselves. These individuals can hide behind a muted rage or through an overt, egomaniacal idealization they have created for themselves, consequently shutting people out and having an impaired ability to form healthy interpersonal and social relationships. In a sense, they see the world around them as black and white.
It is essential for these people to learn to take a deeper, more reflective look at what they feel they have to defend. Those with pathological narcissism rarely seek treatment because the individual may not even be aware of their narcissistic tendencies due to their inflated sense of self-importance. When they do, they are likely to opt out of treatment because as therapy progresses they become truculent as their internal exchange becomes more pejorative, resulting in deflection and eventually walking away. Therapists must provide a nurturing environment while simultaneously acting as a mirror for these patients, thereby enabling them to become aware of their own triggers in hopes of establishing in them a renewed sense of self through conditions of predictability, justice, and love. Once they have a more true and secure sense of self, the individual can learn to meet others in compassion, empathy, and acceptance.