The Dark Side of Empathy in Narcissistic Personality Disorder
Empathy is usually thought of as something good. It helps people understand each other, care, and respond with kindness. But in Narcissistic Personality Disorder, empathy can work in a more troubling way. A review in Frontiers in Psychiatry explains that people with NPD do not always lack empathy in a simple or total sense. Instead, many appear to retain the cognitive side of empathy, meaning they can often work out what other people are feeling, while struggling with the emotional side, meaning they do not feel genuine concern in the same way. This creates a dangerous imbalance. It means a person may understand someone else’s pain, fear, or insecurity, yet use that knowledge for control, manipulation, rivalry, or self-advantage rather than compassion. For families and carers, this helps explain one of the most confusing parts of narcissism: the person may seem emotionally perceptive, yet still behave in ways that feel cold, exploitative, or cruel. The article explores how this pattern works, why it matters socially, and what it may mean for treatment.
Empathy in narcissism is not simply absent
One of the most important points in this review is that empathy is not a single thing. It has different parts. Cognitive empathy is the ability to understand what another person may be feeling or thinking. Affective empathy is the emotional response that goes with that understanding, such as concern, compassion, or sadness when someone else is suffering.
The review explains that in people with Narcissistic Personality Disorder, these two parts often do not work together properly. Many people with NPD seem to keep some level of cognitive empathy. In other words, they may be quite good at reading emotional signals, noticing weakness, or understanding what matters to other people. But the affective side is often much weaker. They may not feel moved by another person’s pain in a caring or compassionate way.
This matters because it changes how we understand their behaviour. The problem is not always that they are blind to other people. Sometimes they can see others very clearly. The problem is that this awareness may be used for self-serving purposes rather than human connection.
That helps explain why relationships with narcissistic people can feel so unsettling. A partner, parent, friend, or colleague may feel that the narcissistic person knows exactly where it hurts, exactly what they need, or exactly what they fear. Yet instead of responding with care, the person may use that information to dominate, protect themselves, gain admiration, or strike back.
In NPD, the problem may not be a total absence of empathy, but a split between understanding another person’s feelings and genuinely caring about them.
NPD has both grandiose and vulnerable sides
The review also stresses that Narcissistic Personality Disorder does not always look the same. Some people show the more obvious, grandiose side of narcissism. They appear self-important, entitled, dominant, admiration-seeking, and dismissive of others. This is the presentation most people recognise.
But there is also a more vulnerable side. In this form, the person may seem hypersensitive, fearful, ashamed, emotionally dependent, easily humiliated, and overly affected by criticism. These individuals may not look openly arrogant all the time, but their self-esteem is still fragile and heavily dependent on how other people respond to them.
This distinction matters because empathy difficulties may look different in the two forms. A grandiose narcissistic person may seem openly detached and unconcerned by someone else’s feelings. A vulnerable narcissistic person may appear emotionally overwhelmed, so caught up in their own distress that they cannot properly take in another person’s experience.
In both cases, empathy is affected, but not always in the same way. One may dismiss the other person. The other may be so absorbed in fear, shame, or self-consciousness that there is no emotional room left for the other person.
Why empathy can become a tool for manipulation
One of the darkest findings in the review is that preserved cognitive empathy can support exploitation. If someone can accurately read another person’s emotions, insecurities, fears, or longings, that ability can be used in two very different ways. In healthy empathy, it supports kindness, closeness, and good judgment. In narcissistic functioning, it may support manipulation.
For example, a person with NPD may quickly notice that someone feels lonely, guilty, insecure, eager to please, or frightened of rejection. Rather than responding with genuine concern, they may use that knowledge to gain admiration, secure loyalty, avoid accountability, or maintain power. They may say the right words, show interest at the right time, or give selective attention, not because they are emotionally connected, but because they understand what will work.
This helps explain a common experience among people who have lived with narcissistic individuals: the sense that the person can read others very well, but only uses that skill when it benefits them. The empathy is strategic rather than relational.
The review points out that exploitative narcissistic traits are linked with better recognition of certain negative emotions. This may be because vulnerability in others is useful to someone who is looking for advantage, control, or narcissistic supply.
When cognitive empathy remains intact but emotional empathy is weak, understanding another person can become a way of using them rather than caring for them.
Affective empathy is the key area of impairment
The review repeatedly returns to one central idea: the main empathy problem in NPD appears to lie in affective empathy. This is the part that allows a person not only to recognise someone else’s distress, but to feel emotionally touched by it in a caring and socially appropriate way.
Research discussed in the article suggests that many people with NPD can still perform relatively well on tasks that involve reading emotions or taking perspective, especially when it serves their goals. But when it comes to feeling with another person, the system seems more impaired.
Why might this happen? The authors suggest that another person’s emotion may be experienced as threatening rather than simply informative. Seeing pain, fear, need, or vulnerability in someone else may stir up shame, loss of control, weakness, or discomfort in the narcissistic person. Instead of moving toward concern, they may detach, attack, withdraw, or become dismissive in order to protect themselves.
So the problem may not be emotional emptiness in a simple sense. It may be that another person’s feeling becomes too dangerous, too exposing, or too dysregulating to tolerate. In that case, coldness becomes a defence.
The brain may help explain this imbalance
The review also discusses research into the brain systems involved in empathy. Several brain regions are important here, especially the anterior insula, the anterior cingulate cortex, and parts of the medial prefrontal cortex. These regions help people process emotional salience, switch attention, reflect on themselves, and respond to other people’s feelings.
According to the review, people with narcissistic traits may have problems in the pathways involved in affective sharing, the more automatic emotional response to another person’s feelings. At the same time, there may be excessive self-referential processing, meaning the person’s attention quickly shifts back toward themselves.
The review mentions dysfunction in systems linked to threat detection and self-focused mental activity. This may mean that emotional material from other people is more likely to be experienced as personally threatening. Instead of thinking, “This person is hurting,” the system may react more like, “This is uncomfortable, threatening, or destabilising for me.”
That shift matters. It helps explain why some people with NPD may appear sensitive, but not compassionate. Their internal response may be dominated by self-protection rather than emotional resonance.
The narcissistic person may recognise another person’s emotions, but their brain may process those feelings more as a threat to the self than as a call for concern.
Rivalry and “affective dissonance” make empathy darker
A particularly striking idea in the review is the role of rivalry. Narcissism is often grouped with psychopathy and Machiavellianism in what psychologists call the Dark Triad. Within this darker group of traits, rivalry seems especially important in narcissism.
Rivalry means more than competition. It involves antagonism, the need to defeat others, hypersensitivity to status, and harsh reactions when the self feels challenged. In this state, another person’s distress may not lead to sympathy. It may lead to satisfaction, scorn, or emotional contradiction.
The review uses the term “affective dissonance” to describe this. That means the person detects another individual’s emotion, but responds with an opposite or discordant feeling. So instead of concern, they may feel pleasure, contempt, triumph, or relief. This is one of the darkest forms of empathy failure because the emotional information is not missing. It is twisted.
For loved ones, this may be one of the most painful patterns. A person reveals vulnerability and expects comfort, but instead receives criticism, mockery, emotional withdrawal, or a subtle sense that their suffering has somehow strengthened the narcissistic person’s position.
Vulnerable narcissism can also damage empathy
It is tempting to assume that only grandiose narcissism causes these problems, but the review shows that vulnerable narcissism also interferes with empathy. In vulnerable narcissism, the person may be intensely self-conscious, fearful of humiliation, and flooded by personal distress.
In that state, they may not be able to take in someone else’s perspective properly because their own inner pain takes over. Their empathy failure may not look openly cold or superior. Instead, it may look like emotional collapse into the self.
The review notes that vulnerable narcissism has been linked with fear of being laughed at, social withdrawal, and even enjoyment of laughing at others. This combination captures the strange mix of fragility and hostility that can exist in narcissistic pathology. The person feels easily wounded but may also become antagonistic or contemptuous in response.
So again, empathy is blocked, though by a different route. The person is not emotionally available to the other because they are trapped inside shame, fear, self-monitoring, or defensive hostility.
Grandiose narcissism may block empathy through detachment and superiority. Vulnerable narcissism may block it through shame, hypersensitivity, and self-absorption in personal distress.
Antisocial behaviour can grow out of this empathy pattern
The social consequences of this kind of empathy problem can be serious. The review links narcissistic traits with aggression, exploitation, offending behaviour, and other antisocial outcomes, especially when combined with entitlement and poor concern for others.
When a person feels they deserve the best, reacts aggressively to injury, and is not strongly held back by affective empathy, the risk of harmful behaviour increases. The lack of emotional concern becomes a kind of green light. It removes an inner barrier that might otherwise restrain cruelty, manipulation, or revenge.
The review also points out that narcissistic aggression often appears when self-esteem is threatened. In other words, the aggression is not random. It often comes as a response to challenge, humiliation, criticism, or loss of status. In those moments, concern for others drops even further because the person is focused on restoring control, superiority, or dominance.
For families, this is important. It means hurtful behaviour may not just be about anger. It may arise from a deeper mix of entitlement, emotional intolerance, and impaired caring.
Prosocial behaviour in narcissism may still be self-serving
The review does not present narcissistic people as antisocial in every situation. In fact, some may behave in generous, helpful, or socially admirable ways. But here too the motive matters.
Narcissistic prosocial behaviour is often strategic. The person may help when other people are watching, when praise is likely, or when the action supports a positive image of themselves. They may post publicly about causes, appear impressive in social roles, or give support in ways that attract attention. But they are less likely to help quietly, anonymously, or without reward.
This does not mean every helpful act is fake. But it does mean that what looks like empathy or kindness may sometimes be driven by status, admiration, or self-enhancement rather than care. The review refers to narcissistic people as “strategic helpers” in this context.
For people around them, this can be confusing. The person may sometimes look generous and socially engaged, yet still be exploitative or emotionally unresponsive in close relationships. Public kindness and private callousness can exist side by side.
Narcissistic people may sometimes help others, but the help is often directed toward praise, image, or personal advantage rather than simple compassion.
What this means for treatment
Despite the bleak picture, the review does offer some hope. Because cognitive empathy is often at least partly preserved, it may provide a starting point for treatment. The idea is not that people with NPD have no capacity at all. It is that the emotional, affective side needs development and support.
The authors suggest that self-reflection is a crucial first step. Before a person can properly take in someone else’s feelings, they may need help understanding their own internal world. Many people with NPD struggle to face their own emotions honestly. They may not recognise the interpersonal reasons for their distress, or they may defend against painful feelings through grandiosity, blame, withdrawal, or contempt.
If a therapist pushes too quickly for empathy toward others, the patient may experience that as taking the enemy’s side. But if treatment first helps the person reflect on themselves more truthfully, there may be more room for genuine awareness of others later on.
The review also mentions approaches such as Dialectical Behaviour Therapy, which can help patients tolerate strong emotions, identify needs, and respond more appropriately. Perspective-taking exercises may also help, especially because some empathy deficits in narcissism appear to depend partly on motivation rather than pure inability.
In simple terms, if the person can be helped to slow down, regulate emotions, reflect on themselves, and deliberately take another perspective, some empathic improvement may be possible.
Why carers and families need to understand this pattern
For carers, partners, and relatives, this review can be deeply clarifying. It explains why the narcissistic person may sometimes appear emotionally insightful yet still behave in ways that feel cold, punishing, or manipulative. The problem is not always that they cannot read emotion. Sometimes they can. The problem is what happens next.
That does not mean families should become cynical about every apparently kind or perceptive moment. But it does mean they may need to think more carefully about motive, consistency, and real emotional reciprocity. Does the person respond with care only when it benefits them? Do they understand vulnerability but use it in arguments later? Do they seem empathic in public but detached in private?
These questions matter because they help people understand what kind of relating they are actually dealing with. They also help carers set better boundaries. If empathy is selective, strategic, or unstable, then the family member may need to rely more on consistent behaviour than on touching words or momentary insight.
One of the most confusing things about NPD is that the person may understand your feelings well enough to use them, but not well enough to care for them.
Conclusion
This review offers a much more nuanced picture of empathy in Narcissistic Personality Disorder. Rather than simply lacking empathy altogether, people with NPD often show an uneven pattern. The cognitive side, understanding what others feel, may remain relatively intact. The affective side, feeling genuine concern, is more often impaired. That imbalance can turn empathy into something dark: a way of spotting weakness, protecting the self, competing, or manipulating rather than connecting.
The review also shows that this matters not only for close relationships, but for wider society. It influences aggression, exploitation, status-seeking, and even apparently prosocial behaviour. At the same time, the article leaves room for hope. If some empathic capacities are still present, especially the cognitive ones, then treatment may be able to build on them and slowly strengthen affective empathy through self-reflection, emotional regulation, and careful psychotherapy.
For ordinary readers, the key message is this: empathy problems in narcissism are real, but they are not always simple. And understanding that complexity helps explain why narcissistic relationships can feel so emotionally intelligent on the surface, yet so painfully lacking in real care underneath.
Source note
This article is based on the review The dark side of empathy in narcissistic personality disorder by Ester di Giacomo, Elena Andreini, Ottavia Lorusso, and Massimo Clerici, published in Frontiers in Psychiatry.
Read the original article here: https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2023.1074558/full