- updated: Jul. 06, 2023
Narcissism, per se, is not bad. Like most mental health conditions, narcissism exists on a spectrum. Self care, grooming and presenting “your best self” are examples of healthy “narcissism.” At the other end of the spectrum, unhealthy narcissism, called Narcissistic Personality Disorder (NPD) is pervasive, debilitating, and socially and personally destructive behavior including belief in one’s superiority, lack of concern for others and interpersonal exploitation for one’s own benefit.
Historically, plenty of narcissists have held powerful positions world-wide, and, currently there’s no shortage of narcissists holding powerful positions as American and world leaders, entertainers, and leaders of industry. None of these people has been formally diagnosed, of course, but when you know the behavioral features of NPD, it’s obvious in these public figures.
According to some estimates, in the US, Narcissistic Personality Disorder (NPD) is diagnosed in about 7.7% of men and 4.8% in women. While some children may seem narcissistic, the behavior may actually be typical for their development age. Actual NPD manifests during the teens or in early adulthood, and generally persists throughout one’s life.
According to the Diagnostic and Statistical Manual of Mental Disorders V (the latest version of the mental disorder “cookbook”) NPD demonstrates a number of these features:
- A grandiose sense of self-importance,
- A preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love,
- A belief that he or she is special and unique and can only be understood by, or should associate with, other special or high-status people or institutions,
- A need for excessive admiration,
- A sense of entitlement,
- Interpersonally exploitive behavior,
- A lack of empathy,
- Envy of others or a belief that others are envious of him or her.
NPD causes problems in many areas of life, such as relationships, work, school or financial affairs. People with NPD may be generally unhappy and disappointed when they’re not given the special favors or admiration they believe they deserve. They may find their relationships unfulfilling, and others may not enjoy being around them. Individuals with NPD are also acutely sensitive to rejection or criticism and may avoid people or situations where there is the possibility of feeling “less than.” When criticized, they may become furious and lash out or withdraw into a shell of sullen hate.
Other behaviors include tremendous attention to achieving and maintaining power or success, and to their appearance. They excessively distort reality to confirm their grandiose feelings about themselves and they routinely take advantage of the people around them, knowingly or unknowingly. Lying and cheating are common.
As you can see, there’s much more to unhealthy narcissism than lack of empathy – the criticism often lodged against partners who are relatively inattentive and unreliable. So then let’s look specifically at empathy.
To understand it scientifically, we have to consider what happens in the brain with respect to empathy. After all, whatever we do, think and feel are generated by the brain.
Deep within each side of the human brain is a tri-part area called the insula or insular cortex. Research has demonstrated that this part of the brain communicates with many other parts of a brain and is critical for awareness of internal sensations and emotion as well as emotion in others. There’s actually a name for deficits in emotional awareness (of our own emotions as well as others). It’s called alexithymia; and the anterior part of the insular cortex is believed to be the source of this condition.
Now, here’s where the brain of a person with NPD comes in. The NPD brain looks and functions somewhat differently than that of a typical (non-NPD) brain. Studies of NPD brains (Magnetic Resonance Imaging, functional Magnetic Resonance Imaging and Diffusion Tensor Imaging) demonstrate reduced connections between the frontal lobe and the striatum, meaning certain cognitive (judgment and decision-making) and reward-registering parts of the brain have weaker circuitry than seen in a typical brain. Since thinking positively about oneself is associated with these areas, it is suggested that the constant need for affirmation from others is a way to compensate for low activity in these areas in a narcissist’s brain. Also, when imaging was used during testing specifically for empathy, narcissistic individuals exhibited smaller and less active insular cortices compared to a typical brain.
So, similar to ADHD, there is a brain-based source for the unwelcome behaviors of a narcissist, including lack of empathy. But, again, ADHD is very responsive to medication and self-regulating strategies, once the individual agrees to a professional assessment and treatment.
Unfortunately, because most narcissists do not believe that they are at fault or responsible for anything untoward that occurs, few seek treatment. Perhaps for that reason, no treatment has been developed the reliably mitigates the condition.