![]() ![]() Subjects affected by narcissistic personality disorder show greater impairment in affective aspects while their cognitive part of empathy appears preserved. 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). It might be channeled into prosocial and antisocial behaviors. It is not a unitary construct and can be distinguished in cognitive and affective. Empathy is the capability of understating and feeling others emotions. Fifty-two papers that analyzed possible issues in the empathic attitude of people with narcissistic personality disorder were included in this narrative review. 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. ![]() 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. People with that disorder may switch from an overt form, mainly with grandiosity, to a covert presentation, with fears, hypersensitivity and dependence from others. Narcissistic personality disorder is characterized by self-absorption, grandiosity, exploitation of others and lack of empathy. 2School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.1Department of Mental Health and Addiction, Health Care Trust–IRCCS San Gerardo Monza, Monza, Italy.Ester di Giacomo 1,2* Elena Andreini 1,2 Ottavia Lorusso 1,2 Massimo Clerici 1,2 ![]()
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