Understanding Empathy in Narcissistic Personality Disorder

Understanding Empathy in Narcissistic Personality Disorder

Author: Mark Ettensohn, Psy.D. December 19, 2025 Duration: 1:01:53
This video continues the Heal NPD Seminar Series, featuring Dr. Mark Ettensohn with his associates, Deanna Young, Psy.D., and Danté Spencer, M.A. In this session, the group discusses Empathy and Narcissistic Personality Disorder: From Clinical and Empirical Perspectives (2014), examining the long-standing assumption that narcissistic personality disorder is defined by a lack of empathy. Drawing on the article’s review of empirical findings and clinical case material, the conversation explores empathy as a multidimensional and context-dependent capacity rather than a fixed trait. Key themes include the distinction between emotional and cognitive empathy, the variability of empathic functioning across grandiose and vulnerable narcissistic states, and the ways shame, threat, and affective overload can disrupt empathic engagement in intimate relationships. The discussion highlights how empathy may appear intact or even robust in some contexts, while collapsing in situations that feel most emotionally consequential. This video continues the Heal NPD Seminar Series, featuring Dr. Mark Ettensohn with his associates, Deanna Young, Psy.D., and Danté Spencer, M.A. In this session, the group discusses Empathy and Narcissistic Personality Disorder: From Clinical and Empirical Perspectives (2014), examining the long-standing assumption that narcissistic personality disorder is defined by a lack of empathy. Drawing on the article’s review of empirical findings and clinical case material, the conversation explores empathy as a multidimensional and context-dependent capacity rather than a fixed trait. Key themes include the distinction between emotional and cognitive empathy, the variability of empathic functioning across grandiose and vulnerable narcissistic states, and the ways shame, threat, and affective overload can disrupt empathic engagement in intimate relationships. The discussion highlights how empathy may appear intact or even robust in some contexts, while collapsing in situations that feel most emotionally consequential. The seminar also addresses common misunderstandings of neuroimaging findings related to empathy, emphasizing the limits of biological reductionism and the importance of viewing brain-based data as correlates of experience rather than determinants of destiny. Throughout, the group reflects on clinical implications for treatment, including the differentiation between motivation-based and deficit-based empathic disengagement, the role of affect tolerance and reflective capacity, and the relational conditions that support the gradual restoration of empathic availability. This series is intended for clinicians, trainees, and others interested in a nuanced, non-moralizing understanding of narcissistic personality disorder, empathy, and psychological development. To learn more about our work, visit www.HealNPD.org Additional Resources: Newsletter: https://healnpd.substack.com Assessment and therapy inquiries: https://healnpd.org/contact Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life: https://amzn.to/3nG9FgH LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8 Citation for the article discussed: Baskin-Sommers A, Krusemark E, Ronningstam E. Empathy in narcissistic personality disorder: from clinical and empirical perspectives. Personal Disord. 2014 Jul;5(3):323-33. doi: 10.1037/per0000061. Epub 2014 Feb 10. PMID: 24512457; PMCID: PMC4415495. Full text link: https://pmc.ncbi.nlm.nih.gov/articles/PMC4415495/

In Heal NPD, clinical psychologist Mark Ettensohn, Psy.D., offers a nuanced and compassionate exploration of narcissism, moving beyond simplistic labels to examine the underlying psychological structures. This podcast delves into the complexities of narcissistic personality disorder and related traits, providing clarity for those who recognize these patterns in themselves or in their relationships. Dr. Ettensohn draws from his specialized therapeutic practice to discuss the origins of narcissistic adaptations, the impact on interpersonal dynamics, and the realistic pathways toward change and healing. Episodes often break down clinical concepts into accessible language, featuring discussions on empathy, identity, shame, and the challenging process of building healthier self-esteem and relational skills. The tone is educational yet deeply human, aiming to reduce stigma and foster understanding. Whether you are a mental health professional, someone personally affected by NPD, or simply curious about personality psychology, this series provides a rare, expert-guided look into a frequently misunderstood area of human behavior. Tune in for a thoughtful perspective that prioritizes psychological science and the possibility of growth.
Author: Language: English Episodes: 62

Heal NPD
Podcast Episodes
Lisa Taylor-Austin’s Interview with Dr. Ettensohn [not-audio_url] [/not-audio_url]

Duration: 1:12:02
This episode is the audio from an on-camera interview between licensed psychotherapist Lisa Taylor-Austin and Dr. Ettensohn. The video of this interview can be viewed on Lisa's youTube channel here: https://www.youtube.c…
Decoding NPD: The Critical Role of Attachment [not-audio_url] [/not-audio_url]

Duration: 22:41
In this episode, Dr. Ettensohn draws heavily on his own research concerning pathological narcissism and attachment patterns, using attachment theory as a lens to focus explanatory power onto the often confusing dynamics…
5 Common Misconceptions about NPD [not-audio_url] [/not-audio_url]

Duration: 27:27
In this episode, Dr. Ettensohn addresses 5 common misconceptions about pathological narcissism and NPD: 1. NPD is not a mental illness 2. NPD is not treatable 3. Even if NPD is treatable, actual healing is impossible 4.…
Boundaries, Assertiveness, and NPD [not-audio_url] [/not-audio_url]

Duration: 24:47
In this episode, Dr. Ettensohn discusses the important topic of boundaries. He provides a definition of interpersonal boundaries, discusses the reasons why boundaries are important for mental health and healthy relations…
What Causes Narcissistic Rage? [not-audio_url] [/not-audio_url]

Duration: 19:04
In this episode, Dr. Ettensohn explores the possible causes of narcissistic rage, referencing the work of Ernest S. Wolf, a close collaborator with Heinz Kohut and author of the book 'Treating the Self: Elements of Clini…
Do Narcissists ”Know What They’re Doing?” [not-audio_url] [/not-audio_url]

Duration: 14:47
In this episode, Dr. Ettensohn discusses the topic of self-awareness in NPD. Numerous commenters have shared their belief that narcissists "know what they are doing"...that they are fully aware of the harm caused by thei…
Why Narcissists Lack Empathy [not-audio_url] [/not-audio_url]

Duration: 15:21
In this episode, Dr. Ettensohn outline 4 reasons why empathy may be impaired in pathological narcissism and NPD: 1. Lack of self awareness 2. Objectification of the self and others 3. A 'starvation mindset' 4. Avoidant a…
Illness Anxiety and NPD [not-audio_url] [/not-audio_url]

Duration: 10:35
In this episode, Dr. Ettensohn explores the connection between illness anxiety and pathological narcissism. This episode explores how illness anxiety in NPD can be disguised anxiety about loss of self or psychological di…
A Real Definition of Narcissistic Abuse [not-audio_url] [/not-audio_url]

Duration: 10:20
The term ‘narcissistic abuse’ has been, itself, heavily abused. Is has largely been a pop-psychology term that means different things depending on how and where it is used. It is often used to demonize individuals with p…
Why Narcissists Feel Empty Inside [not-audio_url] [/not-audio_url]

Duration: 13:29
In this episode, Dr. Ettensohn discusses the emptiness that individuals with pathological narcissism and NPD often experience using the concept of ‘Self as Object.’ Individuals with pathological narcissism and NPD often…