CoChat
Sign Up
Cited by 137Personality Disorders and PsychopathologyPersonality Traits and PsychologyPsychopathy, Forensic Psychiatry, Sexual Offending

Empathy in narcissistic personality disorder: From clinical and empirical perspectives.

Open access
Baskin-Sommers, Arielle, Krusemark, Elizabeth, Ronningstam, Elsa·2014·Personality Disorders: Theory, Research, and Treatment
DOI 10.1037/per0000061PMC PMC4415495
Open this paper in CoChat — free account

Abstract

Narcissistic personality disorder (NPD) is associated with an assortment of characteristics that undermine interpersonal functioning. A lack of empathy is often cited as the primary distinguishing feature of NPD. 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. 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. The goal of this practice review is to bridge the gap between our psychobiological understanding of empathy and its clinical manifestations in NPD. We present 3 case studies highlighting the variability in empathic functioning in people with NPD. 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. Because this research is limited, we also present empathy-based findings for related syndromes (borderline and psychopathy). Given the complexity of narcissism and empathy, we propose that multiple relationships can exist between these constructs. 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.

AI snapshot

Written from the paper’s full text.

TL;DR

This practice review argues that empathy in narcissistic personality disorder (NPD) is not simply absent but multidimensional and variable, with deficient emotional empathy and dysfunctional rather than deficient cognitive empathy. It integrates psychobiological, empirical, and case-based clinical perspectives to propose motivational and deficit-based pathways and individualized treatment implications.

Key findings

  • Empathy is divided into emotional and cognitive components; research largely associates NPD with deficient emotional empathy, but dysfunctional rather than deficient cognitive empathy. Patients with NPD did not differ from healthy controls on the Movie for the Assessment of Social Cognition or the Multifaceted Empathy Test, while showing deficits in emotion recognition from facial expressions and in empathic concern/mirroring emotions.
  • Narcissistic individuals tend to overestimate their emotional empathy on self-report, while reporting lower perspective taking on the Interpersonal Reactivity Index, especially willingness to engage in empathic concern.
  • Related syndromes show overlapping patterns: NPD and psychopathy co-occur at approximately 21%, and NPD and BPD comorbidity is estimated at 37%–39% for BPD; psychopathy is linked to deficient emotional empathy with intact cognitive empathy, whereas BPD shows mixed emotional empathy findings and possible cognitive empathy deficits.
  • Three case studies of individuals meeting five or more DSM-5 NPD criteria illustrate variability: grandiose states may involve motivation-based empathic disengagement when empathy conflicts with self-interest, while vulnerable states may involve deficit-based disengagement tied to emotion intolerance and poor affect regulation.

Methods

  • Design: practice review/narrative synthesis bridging psychobiological models of empathy with clinical manifestations in NPD; not a systematic review or new empirical study.
  • Data/sample: summarizes existing empirical literature on empathy and NPD and, given limited work, related syndromes (borderline personality disorder and psychopathy); presents three case studies of individuals who met five or more DSM-5 diagnostic criteria for NPD.
  • Analysis: narrative integration of emotional versus cognitive empathy findings, neural/physiological evidence, self-report data, and clinical case material; no quantitative meta-analysis or primary data analysis.

Limitations

  • The paper states that empirical work on empathy and narcissism is limited, that there is not enough evidence to make definitive conclusions about cognitive empathy in pathological narcissism, and that no existing empirical work delineates fluctuations in grandiose and vulnerable narcissism with relation to empathy.
  • The paper notes that the DSM-5 alternative Section III conceptualization of NPD awaits additional empirical validation, while Section II criteria remain unchanged.
  • Evident from the text: as a narrative review, it lacks a systematic search and quality appraisal; the three case studies are illustrative and cannot establish generalizability or causality, and findings across self-report and experimental measures are mixed.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1037/per0000061

Cites

Statistics

Nothing to recompute.

Claims the paper makes

0 of 119 cited sources checked · 0 supported · 0 flagged

  • Findingreasoning

    Both Mr. H (Case Study #2) and Mr. S (Case Study #1) demonstrated ability to engage empathically under certain circumstances when they felt in charge, capable, and interpersonally valued.

    “Both Mr. H (Case Study #2) and Mr. S (Case Study #1) demonstrated such ability to engage empathically under certain circumstances when they felt in charge, capable, and interpersonally valued.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The case studies (Mr. H, Mr. S, Ms. T) are representative examples of narcissistic empathic functioning and can support general claims about NPD.
  • Premisecitation

    Empathy is multidimensional, involving two distinct emotional and cognitive processes associated with a capacity to respectively understand and respond to others' mental and affective states.

    “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.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Decety & Moriguchi, 2007

      Not checked in the free run.

  • Interpretationnone given

    Growing evidence suggests that the narcissism-empathy relationship is not all or none, but instead is a more complex relationship reflecting fluctuations in empathic functioning within and across narcissistic individuals.

    “growing evidence suggests that the narcissism–empathy relationship is not all or none, but instead is a more complex relationship reflecting fluctuations in empathic functioning within and across narcissistic individuals.”
    Quote in the paperSubstantial claim
  • Premisecitation

    Clinical research efforts using self-report and interview measures have failed to identify lack of empathy as a distinguishing characteristic in patients with NPD.

    “clinical research efforts using self-report and interview measures have failed to identify lack of empathy as a distinguishing characteristic in patients with NPD”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Ronningstam & Gunderson, 1988, 1990

      Not checked in the free run.

    • cites Ronningstam, Gunderson, & Lyons, 1995

      Not checked in the free run.

  • Premisecitation

    The DSM description of empathic dysfunction changed from the inability to recognize how others feel in DSM-III to the unwillingness to recognize or identify with the feelings and needs of others in DSM-IV.

    “the description of empathic dysfunction to change from the inability to recognize how others feel in the DSM–III classification, to the unwillingness to recognize or identify with the feelings and needs of others in DSM–IV”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites APA, 1980

      Not checked in the free run.

    • cites APA, 1994

      Not checked in the free run.

  • May combine two claims. 46
  • Classified as probably not a substantial claim. 34

  • May combine two claims.

    Findingreasoning

    When Mr. H and Mr. S faced situations that were more challenging, such as when their empathic and interpersonal functioning were especially exposed, they reacted with rejection, anger, and resentment (Mr. H), or with avoidance and withdrawal (Mr. S).

    “However, when they faced situations that were more challenging, such as when their empathic and interpersonal functioning were especially exposed, they reacted with rejection, anger, and resentment (Mr. H), or with avoidance and withdrawal (Mr. S).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The case studies (Mr. H, Mr. S, Ms. T) are representative examples of narcissistic empathic functioning and can support general claims about NPD.

  • Classified as probably not a substantial claim.

    Premisecitation

    A lack of empathy is often cited as the primary distinguishing feature of narcissistic personality disorder (NPD).

    “A lack of empathy is often cited as the primary distinguishing feature of NPD.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Adler, 1986

      Not checked in the free run.

    • cites Kernberg, 1983, 1985

      Not checked in the free run.

    • cites Kohut, 1966

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    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.

    “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.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Several factors (e.g., low self-esteem, sense of internal control, self-enhancement, emotion intolerance, self-centeredness) may cooccur and affect the narcissistic individual's empathic capability and functional pattern.

    “several factors (e.g., low self-esteem, sense of internal control, self-enhancement, emotion intolerance, self-centeredness) may cooccur and affect the narcissistic individual’s empathic capability and functional pattern”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Campbell, Reeder, Sedikides, & Elliot, 2000

      Not checked in the free run.

    • cites Fonagy, Gergle, Jurist, & Target, 2002

      Not checked in the free run.

    • cites Ronningstam, 2009

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Empathy involves the ability to monitor oneself and to maintain and regulate self-other awareness.

    “It also involves the ability to monitor oneself and to maintain and regulate self-other awareness”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Funder & Harris, 1986

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Stone (1998) suggested that there could be separable aspects of ability and willingness that affect narcissistic individuals' empathic functioning.

    “Stone (1998), however, further qualified this narcissism–empathy relationship, suggesting that there could be separable aspects of ability and willingness that affect narcissistic individuals’ empathic functioning.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Stone (1998)

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Some narcissistic individuals may have intact empathic ability but choose to disengage from others' pain or distress, while others may have a deficient ability in the recognition of others' feelings.

    “some narcissistic individuals may have intact empathic ability, but choose to disengage from others’ pain or distress, while others may have a deficient ability in the recognition of others’ feelings.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Stone (1998)

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    The literature on empathy and NPD largely associates NPD with deficient emotional empathy and dysfunctional rather than deficient cognitive empathy.

    “we summarize the literature on empathy and NPD, which largely associates this disorder with deficient emotional empathy, and dysfunctional rather than deficient cognitive empathy.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Empathy involves both the affective experience of the other person's actual or inferred emotional state and the recognition and understanding of another's emotional state.

    “Empathy is a multifaceted construct that involves both the affective experience of the other person’s actual or inferred emotional state and the recognition and understanding of another’s emotional state”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Decety & Moriguchi, 2007

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Individuals with psychopathy display difficulties with emotional empathy, but display intact cognitive empathy on experimental tasks.

    “individuals with psychopathy display difficulties with emotional empathy, but display intact cognitive empathy on experimental tasks”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Blair, 2005

      Not checked in the free run.

    • cites Hare, 1993

      Not checked in the free run.

    • cites cf., Brook & Kosson, 2013

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    Emotional empathy includes response to affective displays by others (e.g., facial expressions) and emotionally evocative stimuli (e.g., phrases, stories).

    “Emotional empathy includes response to affective displays by others (e.g., facial expressions) and emotionally evocative stimuli (e.g., phrases, stories).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    This pattern may indicate that narcissistic individuals have a motivation-based impairment in their cognitive empathic functioning in addition to compromised emotional empathy.

    “This pattern may indicate that narcissistic individuals, as suggested above, have a motivation-based impairment in their cognitive empathic functioning in addition to compromised emotional empathy.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Only the false belief and human action stories elicited Theory of Mind reasoning and stimulated greater activity in the superior temporal sulcus, precuneus, and the temporal-parietal junction.

    “only the false belief and human action stories elicited Theory of Mind reasoning and stimulated greater activity in the superior temporal sulcus, precuneus, and the temporal-parietal junction”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Saxe & Kanwisher (2003)

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    There is growing evidence that individuals with pathological narcissism or NPD display significant impairments in emotional empathy, but display little to no impairment in cognitive empathy.

    “there is growing evidence that individuals with pathological narcissism or NPD display significant impairments in emotional empathy, but display little to no impairment in cognitive empathy”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Ritter et al., 2011

      Not checked in the free run.

    • cites Wai & Tiliopoulos, 2012

      Not checked in the free run.

    • cites Watson et al., 1984

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Empathy is a complex process influenced by both biological and environmental factors, and attributed to partially separable neural systems.

    “empathy is a complex process influenced by both biological and environmental factors, and attributed to partially separable neural systems”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Individuals with pathological narcissism may be capable of processing affective information, but don't want to engage in empathic processing so as not to lose control or appear vulnerable.

    “individuals with pathological narcissism may be capable of processing affective information, but don’t want to engage in empathic processing so as not to lose control or appear vulnerable”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Ames & Kammrath, 2004

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisereasoning

    There are two main subdivisions of empathy: emotional and cognitive.

    “there are two main subdivisions of empathy: emotional and cognitive.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Temperament and genetics also influence the development of empathy.

    “Other factors such as temperament and genetics also influence the development of empathy”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Zahn-Waxler et al., 2001

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Both genetic and environmental effects shape empathetic processing.

    “Thus, both genetic and environmental effects shape empathetic processing.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Empathy typically emerges within the second year of life and greatly depends on the nature of human interactions (e.g., caregivers' style, family environment) to support self-other awareness and conscious concern for others.

    “Empathy typically emerges within the second year of life and greatly depends on the nature of human interactions (e.g., caregivers’ style, family environment) to support self-other awareness and conscious concern for others”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Decety & Svetlova, 2012

      Not checked in the free run.

    • cites Svetlova et al., 2010

      Not checked in the free run.

    • cites Vaish et al., 2009

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisenone given

    Cognitive empathy, or Theory of Mind, refers to the understanding and representation of mental states (i.e., belief, desire, and knowledge) that enables an individual to explain and predict others' behavior.

    “Cognitive empathy, or Theory of Mind, refers to the understanding and representation of mental states (i.e., belief, desire, and knowledge) that enables an individual to explain and predict others’ behavior.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisereasoning

    Damage to the insula can impair both the experience of disgust and the recognition of social signals (e.g., facial expression) that convey disgust.

    “damage to the insula, a region crucial in monitoring body state, can impair both the experience of disgust and the recognition of social signals (e.g., facial expression) that convey disgust.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Individuals with NPD display deficits in empathic concern and mirroring emotions when viewing emotionally charged situations.

    “individuals with NPD display deficits in recognition of emotion when viewing facial expressions (Marissen, Deen, & Franken, 2012) and in empathic concern and mirroring emotions when viewing emotionally charged situations”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Ritter et al., 2011

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Psychopathic individuals display overactivation of (pre)frontal regions, which in turn inhibits amygdala reactivity.

    “psychopathic individuals display overactivation of (pre)frontal regions, which in turn, inhibits amygdala reactivity”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Larson et al., 2013

      Not checked in the free run.

    • cites Muller et al., 2003

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Vulnerable narcissism is reflected in patterns of low self-esteem, anger, shame, and suicidality.

    “vulnerable narcissism is reflected in patterns of low self-esteem, anger, shame, and suicidality.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Pincus, 2011

      Not checked in the free run.

    • cites Pincus & Lukowitsky, 2010

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Individuals with NPD may have compromised empathic functioning because of a deficit in emotional empathy and a deliberate attempt to avoid feeling vulnerable.

    “individuals with NPD may have compromised empathic functioning because of a deficit in emotional empathy (e.g., neurobiological evidence) and a deliberate attempt to avoid feeling vulnerable (e.g., self-report data).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationown data

    The three case studies, from individuals who met five or more of the DSM-5 diagnostic criteria for NPD, highlight the multidimensional nature of narcissism and empathy.

    “we present illustrative case studies, from individuals who met five or more of the DSM-5 diagnostic criteria for NPD, that highlight the multidimensional nature of narcissism and empathy.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    For some, empathic functioning may be related primarily to egocentric motivation-based attachment security (grandiose), whereas for others, empathy may reflect unstable attachment and poor affect regulation (vulnerable).

    “for some, empathic functioning may be related primarily to egocentric motivation-based attachment security (grandiose), whereas for others, empathy may reflect unstable attachment and poor affect regulation (vulnerable).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Vulnerable narcissism is associated with anxious/fearful attachment and empathic overarousal.

    “vulnerable narcissism is associated with anxious/fearful attachment and empathic overarousal”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Dickinson & Pincus, 2003

      Not checked in the free run.

    • cites Miller et al., 2010

      Not checked in the free run.

    • cites Meyer & Pilkonis, 2011

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    For narcissistic individuals in leadership positions, empathic deficits can co-occur with psychopathic, power-motivated functioning, leading to illegal actions and conscious exploitation of their position for exclusively personal gains.

    “For narcissistic individuals in leadership positions, these empathic deficits can co-occur with psychopathic, powermotivated functioning, leading to illegal actions and conscious exploitations of their position for exclusively personal gains (Kernberg, 1998; Maccoby, 2003).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Kernberg, 1998

      Not checked in the free run.

    • cites Maccoby, 2003

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Across the three case studies, it is hard to say that any of these individuals are 'lacking empathy' or are even 'unwilling' to engage in empathic processing; yet each of these individuals are classic examples of pathological narcissism.

    “It seems hard to say that any of these individuals are “lacking empathy” or are even “unwilling” to engage in empathic processing; yet, each of these individuals are classic examples of pathological narcissism.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Early developmental experiences influence the primacy of a particular state, but for all cases these early experiences generate coexisting internalized idealization, independence, and self-enhancement, contrasted with experiences of inadequacy, powerlessness, and self-devaluation.

    “early developmental experiences influence the primacy of a particular state, but for all, these early experiences generate coexisting internalized idealization, independence, and self-enhancement, contrasted with experiences of inadequacy, powerlessness, and self-devaluation.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    This review highlights evidence for compromised empathic functioning, but not an inability or absence of empathy, in people with pathological narcissism and NPD.

    “This review highlights evidence for compromised empathic functioning, but not an inability or absence of empathy, in people with pathological narcissism and NPD.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Grandiose narcissism is described as a pattern of arrogant, self-centered, and domineering beliefs and behaviors.

    “Grandiose narcissism is described as a pattern of arrogant, self-centered, and domineering beliefs and behaviors.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Pincus, 2011

      Not checked in the free run.

    • cites Pincus & Lukowitsky, 2010

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Grandiose and vulnerable narcissism can co-occur within each individual and fluctuate across time and context.

    “these two phenotypic expressions, which indeed can co-occur within each individual and fluctuate across time and context”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Pincus, 2011

      Not checked in the free run.

    • cites Pincus & Lukowitsky, 2010

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Mr. H's competence and independence at a young age likely influenced his desire to engage with his staff, but need to retreat when the problems were more personal.

    “Mr. H’s (Case Study #2) competence and independence at a young age likely influenced his desire to engage with his staff, but need to retreat when the problems were more personal.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    In the context of empathy, individuals with BPD appear to be overwhelmed by their own emotions, have difficulty regulating those emotions, and as a result have impairment in inferring the mental state of and being emotionally attuned to another.

    “individuals with BPD appear to be overwhelmed by their own emotions, have difficulty regulating those emotions, and as a result have impairment in inferring the mental state of and being emotionally attuned to another.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    People with NPD in their grandiose state may, like psychopathic individuals, possess the cognitive capacity to utilize empathy but have a motivation-based desire to disengage from empathic processing.

    “People with NPD in their grandiose state may, like psychopathic individuals, possess the cognitive capacity to utilize empathy but have a motivation-based desire to disengage from empathic processing.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    These case studies highlight the importance of recognizing intervening factors that can create a context whereby a narcissistic individual may or may not display empathy.

    “These case studies highlight the importance of recognizing intervening factors that can create a context whereby a narcissistic individual may or may not display empathy.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Although grandiose narcissistic individuals can overtly display an engaging attitude and invite emotional sharing, they may be unable to deeply and genuinely relate and respond to the other person's distress.

    “although grandiose narcissistic individuals can overtly display an engaging attitude and invite emotional sharing, like with Mr. H and Mr. S (Case Studies #1 and #2), they may be unable to deeply and genuinely relate and respond to the other person’s”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Grandiose narcissism is often related to dismissive/secure attachment and these individuals deny interpersonal distress.

    “grandiose narcissism is often related to dismissive/secure attachment and these individuals deny interpersonal distress”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Dickinson & Pincus, 2003

      Not checked in the free run.

    • cites Miller et al., 2010

      Not checked in the free run.

    • cites Meyer & Pilkonis, 2011

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Ms. T's fearful contrast of mother and father influenced her ability to produce great work and be goal-focused, but when directly faced with empathetic challenges and emotion, she became overwhelmed.

    “Ms. T’s fearful contrast of mother and father (Case Study #3), influenced her ability to produce great work and be goal-focused, but when directly faced with empathetic challenges and emotion, she became overwhelmed.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Overall, research suggests a neural deficiency in emotional empathy in narcissistic individuals, despite the tendency for narcissistic individuals to overestimate their own emotional empathic capability.

    “Overall, research suggests a neural deficiency in emotional empathy, despite the tendency for narcissistic individuals to overestimate their own emotional empathic capability.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    It may be that psychopathic individuals rely on cognitive inputs (and potentially Theory of Mind processes) to perceive emotions, but have difficulties processing them, resulting in deficient emotional empathy.

    “it may be that psychopathic individuals rely on cognitive inputs (and potentially Theory of Mind processes) to perceive emotions, but have difficulties processing them, resulting in deficient emotional empathy.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    It may be the case that narcissistic individuals can employ their empathic capability when they feel in control because they possess intact cognitive empathy, but tend to have more difficulty in response to affectively charged situations due to deficiencies in emotional empathy.

    “it may be the case that narcissistic individuals can employ their empathic capability when they feel in control because they possess intact cognitive empathy (Ritter et al., 2011), but tend to have more difficulty in response to affectively charged situations due to deficiencies in emotional empathy.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Ritter et al., 2011

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Mr. S developed a dismissive attachment and an idealized secure attachment with his mother, spurring his compartmentalized ability to engage in empathic processes when he could help strangers, but limited empathic engagement when he had to focus on dealing with his wife's problems.

    “Mr. S in relationship to his father (Case Study #1) developed a dismissive attachment and an idealized secure attachment with his mother, spurring his compartmentalized ability to engage in empathic processes when he could help strangers, but limited empathic engagement when he had to focus on dealing with his wife’s problems.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Narcissistic individuals with deficit-based empathy deficit find it difficult to tolerate their emotions.

    “Narcissistic individuals with this type of empathy deficit find it difficult to tolerate their emotions.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationcitation

    By adjusting the framework of the narcissism-empathy relationship, therapists may be better able to understand narcissistic patients' negative reactions to a therapist's well-intended efforts, and their difficulty accepting therapeutic interventions, as an indication of compromised empathic functioning.

    “By adjusting the framework of the narcissism–empathy relationship, therapists may be better able to understand narcissistic patients’ negative reactions to a therapist’s well-intended efforts (Glasser, 1992; Kohut, 1972), and their difficultly accepting therapeutic interventions, as an indication of compromised empathic functioning.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Glasser, 1992

      Not checked in the free run.

    • cites Kohut, 1972

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    These forms of empathic processing can coexist within an individual and interact in certain situations, with one taking precedence and being more predominant than the other.

    “It is also important to take into account that these forms of empathic processing can coexist within an individual and interact in certain situations (i.e., one can take precedence and be more predominant than the other).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Validation serves to confirm the patients' experience and disarm any defensiveness.

    “Second, validation serves to confirm the patients’ experience and disarm any defensiveness (Schechter, 2007).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Schechter, 2007

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationcitation

    Providing interpretations that serve to increase patients' awareness and insight about fantasies, feelings, and conflicts can be helpful.

    “Lastly, providing interpretations that serve to increase patients’ awareness and insight about fantasies, feelings, and conflicts can be helpful (Wolf, 1993).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Wolf, 1993

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationcitation

    The use of psychoeducation and skills work can be helpful in strengthening the therapeutic alliance, supporting the patient's sense of collaborative agency, and learning to master threatening or overwhelming experiences.

    “In addition to these specific therapeutic styles, the use of psychoeducation (e.g., about the function of emotions) and skills work (e.g., distress tolerance, interpersonal effectiveness, mentalization) can be helpful in strengthening the therapeutic alliance, supporting the patient’s sense of collaborative agency, and learning to master threatening or overwhelming experiences.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Consideration of the states of grandiosity and vulnerability in NPD provides a functional and phenomenological context whereby empathy and other related processes are differentially expressed.

    “Consideration of the states of grandiosity and vulnerability in NPD provides a functional and phenomenological context whereby empathy and other related processes are differentially expressed.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    The choice of strategies depends upon the patient's ability for self-reflection, affect tolerance, and processing of emotions.

    “As mentioned earlier, the choice of strategies depend upon the patient’s ability for self-reflection, affect tolerance, and processing of emotions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning

    The patient's difficulties in processing self-criticism and feelings of shame, rage, and even fear when facing own incapacities and deficits can have a major impact on the therapeutic process and determine both its pace and outcome.

    “The patient’s difficulties in processing self-criticism and feelings of shame, rage, and even fear when facing own incapacities and deficits can have a major impact on the therapeutic process and determine both its pace and outcome.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    Regardless of the specific form of deficient empathic processing in pathological narcissism, narcissism and empathy are closely related and should not be ignored.

    “Regardless of the specific form of deficient empathic processing in pathological narcissism, these two constructs are closely related and should not be ignored.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationcitation

    Balancing validation with careful clarification and confrontation can be a useful part of exploring the patients' ability to take another's perspective and challenge their own, and serves to support the patient's sense of agency and active participation, as well as testing their ability for self-assessment and reflection.

    “Third, balancing validation with careful clarification and confrontation can be a useful part of exploring the patients’ ability to take another’s perspective and challenge their own (i.e., fostering empathic responses and encouraging the development of empathic responses).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Knox, 2011

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Mentalization-Based Therapy skills serve to promote reflective functioning and an increase in understanding one's state of mind, which are processes akin to Theory of Mind.

    “Additionally, Mentalization-Based Therapy skills serve to promote reflective functioning and an increase in understanding one’s state of mind, which are processes akin to Theory of Mind (Bateman & Fonagy, 2012; Ha, Sharp, Ensink, Fonagy, & Cirino, 2013; Higgitt & Fonagy, 1992).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Bateman & Fonagy, 2012

      Not checked in the free run.

    • cites Ha, Sharp, Ensink, Fonagy, & Cirino, 2013

      Not checked in the free run.

    • cites Higgitt & Fonagy, 1992

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Acknowledging empathic fluctuations in terms of motivational disengagement or difficulty regulating an affective experience can encourage therapists to recognize conditions that enable and motivate the patient's empathic engagement in order to encourage more flexible ways of interacting across interpersonal and social contexts.

    “Similarly, acknowledging empathic fluctuations in terms of motivational disengagement or difficulty regulating an affective experience can also encourage therapists to recognize conditions that enable and motivate the patient’s empathic engagement in order to encourage more flexible ways of interacting across interpersonal and social contexts.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Depending on the individual, the narcissism-empathy relationship may take the form of a motivation-based disengagement or a deficit in emotional empathy.

    “As noted above, depending on the individual, the narcissism–empathy relationship may take the form of a motivation-based disengagement or a deficit in emotional empathy.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    Some people may struggle with earlier conflicts or humiliating, threatening experiences that affect their willingness to invest in empathic functioning.

    “Some people may also struggle with earlier conflicts or humiliating, threatening experiences that affect their willingness to invest in empathic functioning.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Change in self-regulatory empathic functioning may depend upon the patient's ability to address broader aspects of self-esteem and vulnerabilities in the context of interpersonal functioning.

    “Change in such self-regulatory empathic functioning may depend upon the patient’s ability to address broader aspects of self-esteem and vulnerabilities in the context of interpersonal functioning.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Vulnerable narcissistic individuals may be overwhelmed by their own emotions, have difficulty regulating those emotions, and as a result have impairment in empathic processes.

    “That is, vulnerable narcissistic individuals may be overwhelmed by their own emotions, have difficulty regulating those emotions, and as a result have impairment in empathic processes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    Distress tolerance skills can help individuals make it through intense emotional reactions, so that empathetic engagement can feel secure.

    “As such, distress tolerance skills can help the individuals to make it through these intense emotional reactions, so that empathetic engagement can feel secure.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    A shift to more proactive therapeutic understanding and interventions can ultimately replace the strong aura of condemnation that has been associated to prior views of narcissistic empathic functioning.

    “A shift to more proactive therapeutic understanding and interventions can ultimately replace the strong aura of condemnation that has been associated to prior views of narcissistic empathic functioning.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Intense shame, envy, and rage can be intolerable for vulnerable narcissistic individuals, especially if accompanied by self-criticism and self-hatred, or by the perception of not measuring up or losing control in interpersonal situations.

    “For example, intense shame, envy, and rage can be intolerable, especially if accompanied by self-criticism and self-hatred, or by the perception of not measuring up or losing control in interpersonal situations.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Acknowledging both motivational and deficit-based components in compromised empathic ability has major implications for treatment of patients with pathological narcissism and NPD.

    “Finally, in addition to impacting clinical conceptualization, acknowledging both motivational and deficit-based components in compromised empathic ability also has major implications for treatment of patients with pathological narcissism and NPD.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Widely divergent views are still present regarding the optimal treatment approach for pathological narcissism and NPD, considering that people with these conditions often are viewed as resistant to treatment or even untreatable.

    “widely divergent views are still present regarding the optimal treatment approach, considering that people with these conditions often are viewed as resistant to treatment or indeed even can be untreatable”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Almond, 2004

      Not checked in the free run.

    • cites Ivey, 1995

      Not checked in the free run.

    • cites Kernberg, 2007

      Not checked in the free run.

68 of 68

  • The paper relies on this without support.

    The case studies (Mr. H, Mr. S, Ms. T) are representative examples of narcissistic empathic functioning and can support general claims about NPD.

    “Both Mr. H (Case Study #2) and Mr. S (Case Study #1) demonstrated such ability to engage empathically under certain circumstances when they felt in charge, capable, and interpersonally valued.”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • NPD is associated with neurophysiological deficits in emotional empathy, together with intact cognitive empathy, and influenced by a complex interaction between motivational, self-regulatory, and interpersonal processes, as well as by emotional dysregulation and intolerance.

    “NPD is associated with neurophysiological deficits in emotional empathy, together with intact cognitive empathy, and influenced by a complex interaction between motivational, self-regulatory, and interpersonal processes (e.g., engagement versus disengagement), as well as by emotional dysregulation and intolerance (49–52).”

    From Narcissistic Personality Disorder: Progress in Understanding and Treatment (2022) · cites this paper as [50]

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

  • High narcissistic people are likely to engage in slacktivism by posting online, despite donating money.

    “Moreover, they are likely to engage in “slacktivism” by posting online, despite donating money (61).”

    From The dark side of empathy in narcissistic personality disorder (2023) · cites this paper as [61]

    In Clinical Implications, Case Study #3 (page unavailable), one patient with pathological narcissism says they donated money to a cancer foundation. The paper does not say that highly narcissistic people are likely to post online or engage in slacktivism, and a single case does not establish that general tendency. (LLM, conf=0.79)

    Experimental — accuracy not yet measured

  • Research indicates a strong overall relationship between narcissism and deficient emotional empathy, and a weak connection with dysfunctional cognitive empathy.

    “Results indicate a strong overall relationship between narcissism and deficient emotional empathy, and a weak connection with dysfunctional cognitive empathy [36].”

    From Symptom severity and mindreading in narcissistic personality disorder. (2018) · cites this paper as [36]

The citation lists haven’t been fetched yet

References 120 · Cited by 137

Research works printed but not linked: 6

  1. American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders 1980 3rd edition Washington, DC American Psychiatric Association
  2. Cooper AM Ronningstam E Further developments of the diagnosis of narcissistic personality disorder Disorders of narcissism: Diagnostic, clinical, and empirical implications 1998 Washington, DC American Psychiatric Press 53 74
  3. Oldham J Brief treatment of narcissistic personality disorder Journal of Personality Disorders 1988 2 88 90
  4. Stone M Ronningstam E Normal narcissism: An etiological and ethological perspective Disorders of narcissism: Diagnostic, clinical and empirical implications 1998 Washington, DC American Psychiatric Press 7 28
  5. Wolf ES Goldberg A The role of interpretation in therapeutic change Progress in self psychology 1993 Hillsdale, NJ Analytic Press 15 30
  6. Young JE Flanagan C Ronningstam E Schema-focused therapy for narcissistic patients Disorders of narcissism: Diagnostic, clinical and empirical implications 1998 Washington, DC American Psychiatric Press 239 268

Authors
Baskin-Sommers, A., Krusemark, E., & Ronningstam, E.
Affiliations
  • Harvard University (US)
  • University of Wisconsin–Madison (US)
ORCID
Venue
Personality Disorders: Theory, Research, and Treatment
Publisher
American Psychological Association (APA)
Published
2014
Volume
5
Issue
3
Pages
323-333
ISSN
  • 1949-2715 (ISSN-L)
  • 1949-2723
DOI
10.1037/per0000061
PMC
PMC4415495
OpenAlex
W2134781345
Semantic Scholar
b6aafee77feead533c14a412257026678a1c69bb
Cited by
137
References
120
Citations by year
2026: 10 · 2025: 15 · 2024: 10 · 2023: 13 · 2022: 19 · 2021: 13 · 2020: 13 · 2019: 5 · 2018: 13 · 2017: 14 · 2016: 3 · 2015: 7 · 2014: 1
FWCI
9.86
Type
journal article
Language
en
Open access
Locations
  • Personality Disorders Theory Research and Treatment (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute on Drug Abuse (T32DA015036)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
  • Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
Keywords
narcissistic personality disorder, empathy, affective empathy, cognitive empathy, interpersonal functioning, borderline personality disorder, psychopathy, narcissism, motivation structure, case studies
MeSH terms
Adult, Empathy, Female, Humans, Male, Personality Disorders

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review