Narcissistic personality disorder, commonly known as narcissism, is classified by the Diagnostic and Statistical Manual of Mental Disorders IV as a personality disorder defined by extreme selfishness and sense of grandiosity in regards to one’s own talents and desire for admiration. Empathy plays a crucial role in our understanding of narcissism, as difficulty in expressing empathy are typically due to a lack of motivation to be empathetic rather than an inability to be empathetic. As a result, lack of empathy is a symptom of narcissistic personality disorder. A narcissistic individual’s need for admiration and dependence on others for the establishment and maintenance of self-esteem are congruent with emotional dysregulation. While grandiose narcissism is characterized by a sense of entitlement, a disregard for others, and an inflated self-worth, vulnerable narcissism is associated with depression, anxiety, concern about the needs of others, and a deflated sense of self-worth. The essential features of a personality disorder include impairments in personality, concerning both the self and interpersonal factors, and the presence of pathological personality traits.
A significant impairment in identity or self-direction is typically based on the self, while interpersonal impairments are generally associated with functionality of empathy or intimacy. Pathological personality traits, in conjunction with one or both of these impairments, may be expressed as relatively stable over time and are consistent across various circumstances. These characteristics are indicative of a disorder if the impairments and expressions are not understood as normative for an individual’s sociocultural environment or developmental stage (American Psychiatric Association 2013). They are not, however, indicative of a disorder if they are solely attributed to the physiological effects of substance abuse or a general medical condition. Narcissism in particular is defined by significant impairments in personality functioning that manifest themselves first and foremost as impairments in self functioning. In this situation, an individual will excessively reference to others in order to validate self-definitions or regulate self-esteem.
There may be an inflation or deflation of exaggerated self-appraisal, typically vacillating between the extremes; emotional regulation tends to mirror fluctuations in self-esteem (American Psychiatric Association 2013). Individuals who have narcissistic personality disorder may also begin to set goals based on gaining approval from others as a form of self-direction. Their own personal standards are either too high to achieve and perceive the self as exceptional, or they are set too low based on their sense of entitlement. In either extreme, these individuals are often unaware of their motivations in seeking approval. Impairments in interpersonal functioning, such as in the case of empathy, an individual with narcissism has an impaired ability to recognize or identify with the feelings and needs of others (American Psychiatric Association 2013). They are, however, excessively attuned to the reactions of others if they are perceived as being relevant to the self; they may also overestimate or underestimate their effect on others as a response. Intimacy is another common area of interpersonal functioning that is affected, as constructed relationships are largely superficial, existing to serve as regulation for self-esteem.
With the predominance of a need for personal gain, the mutuality associated with typical relationships is constrained by a perpetuating lack of interest in others. The pathological personality traits associated with narcissism are primarily forms of antagonism characterized by grandiosity and attention seeking (American Psychiatric Association 2013). Feelings of entitlement, either overt or covert, and self-centeredness feed into the individual’s firm belief that he or she is better than others, which may lead to condescension. This individual will make excessive attempts to attract attention and remain the focus of others’ attention in order to obtain admiration. Self-esteem and empathy can be correlated with measures of narcissism. Narcissistic personality disorder has facets of both healthy and unhealthy self-functioning, in the sense that there are two form of narcissism: adaptive and maladaptive. Adaptive narcissism tends to precede higher levels of self esteem and more adjusted forms of interpersonal sensitivity, whereas maladaptive narcissism displays the exact opposite pattern (Watson 1992). Given the presence of the Narcissistic Personality Inventory, the most widely used measure of narcissism in social psychological research, narcissism cannot be fully separated into these adaptive and maladaptive components.
It is possible for more maladjusted factors to predict higher levels of beneficial assertiveness, thus negating previously established relationships between characteristics of narcissistic pathology (Watson 1992). “Presumably, adaptive narcissism should correlate directly with self-esteem whereas more dependent and therefore maladjusted forms of narcissism should correlate negatively” (Watson 1992, 437). While the appearance of such relationships requires partial correlations, influences of healthy narcissism has the potential to be obscured by covariance with unhealthy narcissism.
The analysis of these constituents has been better elucidated by the Interpersonal Reactivity Index, which was employed as a multi-dimensional estimate of four aspects of empathy. (IRI, Davis 1983). The Perspective Taking Scale records the cognitive ability of an individual to assume the point of view of another person; this measure largely predicts healthy self-functioning. The Empathic Concern and Fantasy scales both measure emotional empathy, monitoring the capacity to experience sympathy for others and serving as the index for imaginative ability to relate and lose oneself in cinematic and literary fictional characters, respectively (Watson 1992). The Empathetic Concern Scale also appears to be strongly associated with adjustment. The fourth scale, the Personal Distress Scale, encapsulates problematic emotionality in which an affected individual is bothered by “self-oriented feelings of personal anxiety and unease in tense interpersonal settings” (Davis 1983, 114).