A neural model of mechanisms of empathy deficits in narcissism.
Open accessAbstract
From a multidimensional perspective, empathy is a process that includes affective sharing and imagining and understanding the emotions of others. The primary brain structures involved in mediating the components of empathy are the anterior insula (AI), the anterior cingulate cortex (ACC), and specific regions of the medial prefrontal cortex (MPFC). The AI and ACC are the main nodes in the salience network (SN), which selects and coordinates the information flow from the intero- and exteroreceptors. AI might play a role as a crucial hub - a dynamic switch between 2 separate networks of cognitive processing: the central executive network (CEN), which is concerned with effective task execution, and the default mode network (DMN), which is involved with self-reflective processes. Given various classifications, a deficit in empathy may be considered a central dysfunctional trait in narcissism. A recent fMRI study suggests that deficit in empathy is due to a dysfunction in the right AI. Based on the acquired data, we propose a theoretical model of imbalanced SN functioning in narcissism in which the dysfunctional AI hub is responsible for constant DMN activation, which, in turn, centers one's attention on the self. This might hinder the ability to affectively share and understand the emotions of others. This review paper on neural mechanisms of empathy deficits in narcissism aims to inspire and direct future research in this area.
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Vulnerable narcissism is characterized by hypersensitivity and dependence on others that reflects a fragile idea of self-worth regulated by strategies like diminishing the importance of connections to others.
“On the contrary, vulnerable narcissism is characterized by hypersensitivity, and dependence on others that reflects a fragile idea of self-worth which is regulated by strategies like diminishing the importance of connections to others (3).”
From The dark side of empathy in narcissistic personality disorder (2023) · cites this paper as [3]
The ‘Empathy and Narcissism’ section associates vulnerable narcissism with low self-esteem, anxiety, and high susceptibility to trauma, which supports the fragile self-worth and hypersensitivity portions of the claim. The passages do not describe dependence on others or diminishing the importance of connections as a strategy for regulating self-worth. Page numbers are not available in our copy. (LLM, conf=0.87)
Experimental — accuracy not yet measuredResearch highlights main obstacles in the bottom-up pathway among narcissists, but the cognitive parts of empathy seem damaged as well.
“Research highlights main obstacles both in the bottom-up pathway among narcissists, but the cognitive parts of empathy seem damaged as well (3, 17, 18).”
From The dark side of empathy in narcissistic personality disorder (2023) · cites this paper as [3]
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Research works printed but not linked: 4
- [3]Davis M Empathy: A Social Psychological Approach Boulder, CO Westview Press 1996
- [6]Batson CD These things called empathy The Social Neuroscience of Empathy Decety J Ickes W Cambridge MIT Press 2009 16 31
- [43]Frith U Frith CD Development and neurophysiology of mentalizing Philos Trans R Soc Lond B Biol Sci 2003 358 459 73 12689373 PMC1693139
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Cited by
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The role of the salience network in cognitive and affective deficits
Schimmelpfennig, J., Topczewski, J., Zajkowski, W. K., & Jankowiak-Siuda, K. (2023) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2023.1133367 · Cited by 347 · see citing works
Self-citationTrends in body mass index and obesity among adults in Finland from 1972 to 1992.
Pietinen, P., Vartiainen, E. A., & Männistö, S. (1996) · PubMed · Cited by 111 · see citing works
Proulx, M. J., Todorov, O. S., Aiken, A. T., & de Sousa, A. A. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.00064 · Cited by 91 · see citing works
When is narcissism associated with low empathy? A meta-analytic review
Urbonaviciute, G., & Hepper, E. G. (2020) · Journal of Research in Personality · doi:10.1016/j.jrp.2020.104036 · Cited by 91 · see citing works
Individualized prediction of trait narcissism from whole‐brain resting‐state functional connectivity
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Can neuroscience help to understand narcissism? A systematic review of an emerging field
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Pavuluri, M. N., & May, A. (2015) · AIMS neuroscience · doi:10.3934/neuroscience.2015.1.18 · Cited by 67 · see citing works
van Mulukom, V., Patterson, R. E., & van Elk, M. (2020) · Psychopharmacology · doi:10.1007/s00213-020-05568-y · Cited by 62 · see citing works
Tamura, A., Oshio, A., Tanaka, K., Masui, K., & Jonason, P. K. (2015) · The Japanese Journal of Personality · doi:10.2132/personality.24.26 · Cited by 53 · see citing works
The dark side of empathy in narcissistic personality disorder
di Giacomo, E., Andreini, E., Lorusso, O., & Clerici, M. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1074558 · Cited by 34 · see citing works
Reduced frontal cortex thickness and cortical volume associated with pathological narcissism
Mao, Y., Sang, N., Wang, Y., Hou, X., Huang, H., Wei, D., Zhang, J., & Qiu, J. (2016) · Neuroscience · doi:10.1016/j.neuroscience.2016.04.025 · Cited by 34 · see citing works
Kumar, J., Iwabuchi, S. J., Vӧllm, B., & Palaniyappan, L. K. (2019) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-019-00989-z · Cited by 23 · see citing works
Jankowiak-Siuda, K., Baron‐Cohen, S., Białaszek, W., Dopierała, A. A. W., Kozłowska, A., & Rymarczyk, K. (2016) · Studia Psychologica · doi:10.21909/sp.2016.01.704 · Cited by 19 · see citing works
Dark-ego-vehicle principle: Narcissism as a predictor of anti-sexual assault activism
Bertrams, A., & Krispenz, A. (2023) · Current Psychology · doi:10.1007/s12144-023-04591-4 · Cited by 17 · see citing works
Jornkokgoud, K., Baggio, T., Bakiaj, R., Wongupparaj, P., Job, R., & Grecucci, A. (2024) · European Journal of Neuroscience · doi:10.1111/ejn.16345 · Cited by 17 · see citing works
Tang, Z., Liu, Y., Zhao, X., Hu, W., Zhang, M., Ren, Y., Wei, Z., & Yang, J. (2024) · Neurobiology of Stress · doi:10.1016/j.ynstr.2024.100682 · Cited by 14 · see citing works
Krispenz, A., & Bertrams, A. (2022) · Current Psychology · doi:10.1007/s12144-023-05451-x · Cited by 12 · see citing works
Trillini, M. O., & Müller‐Vahl, K. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2015.10.030 · Cited by 10 · see citing works
Amoretti, M. C., & Lalumera, E. (2018) · The Journal of Medicine and Philosophy A Forum for Bioethics and Philosophy of Medicine · doi:10.1093/jmp/jhy001 · Cited by 11 · see citing works
Intrinsic and extrinsic emotion regulation strategies in relation to pathological narcissism
Barnett, M. D., Haygood, A. N., & Mollenkopf, K. K. (2021) · Current Psychology · doi:10.1007/s12144-021-01757-w · Cited by 10 · see citing works
Ash, S., Greenwood, D., & Keenan, J. P. (2023) · Brain Sciences · doi:10.3390/brainsci13101499 · Cited by 9 · see citing works
The Role of Tablet-Based Psychological Tasks in Risk Assessment
Ormachea, P. A., Lovins, B. K., Eagleman, D. M., Davenport, S., Jarman, A., & Haarsma, G. (2017) · Criminal Justice and Behavior · doi:10.1177/0093854817714018 · Cited by 9 · see citing works
The Brain That Understands Diversity: A Pilot Study Focusing on the Triple Network
Otsuka, T., Kokubun, K., Okamoto, M., & Yamakawa, Y. (2025) · Brain Sciences · doi:10.3390/brainsci15030233 · Cited by 8 · see citing works
An, Z., Zou, Y., Wu, S., Tong, S., & Peng, K. (2024) · Social and Personality Psychology Compass · doi:10.1111/spc3.70010 · Cited by 9 · see citing works
Benzi, I. M. A., Fontana, A., & Pierro, R. D. (2023) · PubMed Central · doi:10.36131/cnfioritieditore20230301 · Cited by 5 · see citing works
The relevance of neuroscience for the investigation of narcissism: A review of current studies.
Sarno, M. D., Pierro, R. D., & Madeddu, F. (2018) · BOA (University of Milano-Bicocca) · Cited by 5 · see citing works
Biological correlates of antagonism
McDonald, J. B., & Verona, E. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-814627-9.00006-2 · Cited by 5 · see citing works
Schmidt, L., Pfarr, J., Meller, T., Evermann, U., & Nenadić, I. (2023) · Scientific Reports · doi:10.1038/s41598-023-41098-1 · Cited by 5 · see citing works
Implementation and Analysis of Sentimental Analysis on Facial Expression Using HAAR Cascade Methods
Anand, D. (2021) · Türk bilgisayar ve matematik eğitimi dergisi · doi:10.17762/turcomat.v12i2.2308 · Cited by 3 · see citing works
Kastner-Bosek, A., Dajic, I., Mikuš, N., Weidenauer, A., & Willeit, M. (2021) · Journal of Experimental Psychopathology · doi:10.1177/20438087211044362 · Cited by 3 · see citing works
Ormachea, P. A., Davenport, S., Haarsma, G., Jarman, A., Henderson, H., & Eagleman, D. M. (2016) · The AMA Journal of Ethic · doi:10.1001/journalofethics.2016.18.3.stas1-1603 · Cited by 3 · see citing works
The interrelation of emotion regulation, anterior insula structure, and narcissistic traits
Schmidt, L., Dominguez-Ruiz, A., Meller, T., & Nenadić, I. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.05.002 · Cited by 2 · see citing works
Dark Ego Vehicle: Narcissism as a Predictor of Anti-Sexual Assault ActivismPreprint
Bertrams, A., & Krispenz, A. (2022) · doi:10.31234/osf.io/gkab8 · Cited by 2 · see citing works
dos Santos, A. (2022) · Springer eBooks · doi:10.1007/978-3-031-08556-7_1 · Cited by 1 · see citing works
Jornkokgoud, K., Bakiaj, R., Wongupparaj, P., Job, R., & Grecucci, A. (2025) · Psychophysiology · doi:10.1111/psyp.70130 · Cited by 1 · see citing works
Bertrams, A., & Krispenz, A. (2022) · SSRN Electronic Journal · doi:10.2139/ssrn.4195431 · Cited by 1 · see citing works
Major urinary protein 1 acts as a critical molecule in empathy regulationPreprint
Zhao, M., Zhang, K., Song, D. F., Feng, B., Qi, J., Gui, J., Ma, S., Yang, Q., Yang, L., Cui, L., et al. (2023) · Research Square · doi:10.21203/rs.3.rs-2610178/v1 · Cited by 1 · see citing works
Narcissistic Personality Disorder
Akóṣílè, W. (2025) · Springer eBooks · doi:10.1007/978-3-031-40858-8_555-1 · Cited by 1 · see citing works
Ormachea, P. A., Davenport, S., Haarsma, G., Jarman, A., Henderson, H., & Eagleman, D. M. (2016)
The Relationship of Pathological Narcissism to Empathic Functioning
McMaster, A. (2021) · CUNY Academic Works (City University of New York)
Otsuka, T., Kokubun, K., Okamoto, M., & Yamakawa, Y. (2023) · medRxiv · doi:10.1101/2023.06.05.23290953
The Neural Correlates of Narcissism
Ash, S., Joodi, N., & Keenan, J. P. (2024) · Springer eBooks · doi:10.1007/978-3-031-32035-4_157-1
Wasserman, T. H., & Wasserman, L. D. (2024) · Springer eBooks · doi:10.1007/978-3-031-78732-4_10
Wasserman, T. H., & Wasserman, L. D. (2024) · Springer eBooks · doi:10.1007/978-3-031-78732-4_9
Eversole, B. W. (2025) · Springer eBooks · doi:10.1007/978-3-031-73557-8_2
The Neural Correlates of Narcissism
Ash, S., Joodi, N., & Keenan, J. P. (2025) · Springer eBooks · doi:10.1007/978-3-031-73368-0_157
Cognitive empathy and dehumanization co-vary with dark triad traits and agency detection sensitivity
Rudnicki, K., Borowiecki, O., Poels, K., Beersma, B., Peng, W., Sleebos, E., & Backer, C. J. S. D. (2025) · Evolution and Human Behavior · doi:10.1016/j.evolhumbehav.2025.106800
Narcissism Levels and Empathic Capacity in Patients with Attention Deficit Hyperactivity Disorder
Belli, H., Gökçay, H., Köse, H., & Akgül, H. A. (2026) · Salud Mental · doi:10.17711/sm.0185-3325.2026.03
Mielke, E. L., Neukel, C., Roth, C., Bertsch, K., Nüssel, F., & Herpertz, S. C. (2026) · Journal of Neural Transmission · doi:10.1007/s00702-026-03147-7
The manipulation map: How the Dark Triad shapes the brain
Buravlova, A. (2026) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2026.112227
Kwak, S. J., Kim, S., Kim, D. H., & Chang, W. H. (2026) · Brain & Neurorehabilitation · doi:10.12786/bn.2026.19.e8
Minimal Emotional Dysfunctions (MED) in Personality Disorders: A Narrative Review
Christensen, N., & Muschalla, B. (2026) · Journal of Personality Disorders · doi:10.1521/pedi.2026.40.4.374
Social decision-making, morality, and dark personalities
Votinov, M. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-34080-2.00001-9
Reduced social brain coupling to others’ face threats in narcissism
Piispanen, M., Tuominen, J., Wuolio, M. P., Henttonen, P., Harjunen, V. J., Koskinen, E., Krusemark, E. A., Glerean, E., Rinne, P., Sams, M. E., et al. (2026) · Cerebral Cortex · doi:10.1093/cercor/bhag175
- Authors
- Zajkowski, W.
- Affiliations
- Uniwersytet SWPS (PL)
- Corresponding author
- Zajkowski, Wojciech
- ORCID
- Zajkowski, Wojciech
- Venue
- Medical Science Monitor
- Published
- 2013
- Volume
- 19
- Pages
- 934-941
- ISSN
- 1234-1010 (ISSN-L)
- 1643-3750
- PMC
- PMC3829700
- OpenAlex
- W2121705538
- Cited by
- 54
- References
- 103
- Citations by year
- 2026: 7 · 2025: 7 · 2024: 6 · 2023: 9 · 2022: 3 · 2021: 5 · 2020: 2 · 2019: 2 · 2018: 3 · 2017: 1 · 2016: 5 · 2015: 3
- FWCI
- 0.39
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Medical Science Monitor (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Social Sciences › Psychology › Social Psychology › Action Observation and Synchronization
- Keywords
- empathy deficits, narcissism, anterior insula, anterior cingulate cortex, medial prefrontal cortex, salience network, default mode network, frontoparietal network, affective sharing, neural mechanisms of empathy, self-focus
- MeSH terms
- Empathy, Gyrus Cinguli, Humans, Models, Neurological, Narcissism, Nerve Net, Prefrontal Cortex
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