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Abstract of the study:

>Narcissistic personality disorder is characterized by self-absorption, grandiosity, exploitation of others and lack of empathy. People with that disorder may switch from an overt form, mainly with grandiosity, to a covert presentation, with fears, hypersensitivity and dependence from others. Empathy represents a key point in detecting people affected by narcissistic personality disorder because, even if it is described as reduced, it plays a fundamental role in exploitation and manipulation. A systematic search of Literature without any language or time restriction, was performed combining thesaurus and free-search indexing terms related to Narcissistic personality disorder and empathy and produced 531 results. Fifty-two papers that analyzed possible issues in the empathic attitude of people with narcissistic personality disorder were included in this narrative review. Empathy is the capability of understating and feeling others emotions. It is not a unitary construct and can be distinguished in cognitive and affective. It might be channeled into prosocial and antisocial behaviors. A crucial trait identified in narcissistic empathy is affective dissonance that is closely related to rivalry as part of the dark tetrad (narcissism, machiavellianism, psychopathy, and sadism). Subjects affected by narcissistic personality disorder show greater impairment in affective aspects while their cognitive part of empathy appears preserved. Saving at least the cognitive aspects of empathy may contribute to therapeutic improvement of affective aspects.

Discussion:

>People affected by NPD show specific issues in empathy, but those difficulties are limited to its affective part. In fact, the cognitive portion seems preserved and essential for manipulative skill and exploitation of others.
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>Subjects with NPD may experience those problems with affective empathy because they feel others’ emotions as threatening and dangerous and react with detachment to preserve their own personal integrity. In addition to exploitation, a lack of empathic affectivity appears associated with proneness to criminal behaviors, particularly when NPD coexists with antisocial traits, contributing to psychopathy.
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>Furthermore, rivalry seems the key feature among the Dark Triad traits that supports callousness to its extreme pole embodied in “affective dissonance,” with contradictory affects in response to someone else’s feelings.
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>That alarming evidence, in terms of social implications and patient’s wellbeing, is often accompanied by poor therapeutic approaches. NPD patients are often labeled as untreatable, but self-reflection as a first and fundamental approach may represent a key step in facilitating the comprehension of someone else’s feeling and a crucial gateway to treatment.

Limitations:

>Research on narcissistic personality disorder is limited. Patients affected by narcissistic personality disorder are often considered among the most difficult to be treated. The fragility of their ego together with the tendency to impulsivity often obstruct the possibility of access to dynamic psychotherapy, which is considered the best treatment option. The crucial point in the treatment of NPD patients is their will to be treated, which is fundamental in psychotherapy. Such patients often consider treatments as a personal failure and refuse it.
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>Due to their label as untreatable, studies focused on the efficacy of psychotherapy in those patients are few and, consequently, those that analyze empathy and its correlates are even fewer.
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>Furthermore, most of the research is led on western populations, probably due to the rise of this illness in western cultures. This might represent an additional limitation because results cannot be generalized.