"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.
Given the complexity of narcissism and empathy...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’ behaviour and motivational structure.
Clinical research efforts using self-report and interview measures have failed to identify a lack of empathy as a distinguishing characteristic in patients with NPD.
This accumulation of evidence spurred 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 (Diagnostic and Statistical Manual of the American Psychiatric Association).
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.
For NPD, the following conceptualization of empathic functioning was suggested: “Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimate of own effects on others.
Although the experimental research on empathy and narcissism is limited, generally, it indicates a stronger deficit in emotional rather than cognitive empathy. Research using self-report questionnaires that measure components of empathy, reports that...individuals high on narcissism report lower levels of perspective taking on the Interpersonal Reactivity Index, particularly in response to questions that assess willingness to engage in empathic concern. Conversely, narcissistic individuals tend to overestimate their capacity for 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. That is, 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. Combined with their inability to respond to other’s emotions, this may leave narcissistic individuals at a loss for how to connect with others and manage interpersonal interactions.
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. Such disengagement is likely to co-occur with grandiose strivings that stem from idealized or enhanced experiences, internal grandiose fantasies, or a need to promote self-serving interpersonal behaviour. In such situations, empathic engagement with other people’s problems can be counterintuitive to the narcissistic individual’s needs for self-centred avoidance or enhancement."

Arielle Baskin-Sommers, Department of Psychiatry, Harvard Medical School, McLean Hospital. Elizabeth Krusemark, Department of Psychology, University of Wisconsin-Madison. Elsa Ronningstam, Department of Psychiatry, Harvard Medical School, McLean Hospital. Tweet