In recent years, a lot has been said, sometimes carelessly, and without a deep understanding of the subject, about the “victims” of “narcissists.” How to recognise them. How to protect yourself. How to leave a relationship with a narcissistic person without being destroyed by it. On social media, in podcasts, in support groups, in loud and not always well-informed Facebook groups.
It’s a necessary conversation, and for many people it has been liberating, because naming painful relational dynamics helps make sense of them, and stops people from blaming themselves.
But in this narrative, often rightly centred on those who were hurt, there’s a piece that almost never comes up, perhaps because it’s hard to look at, which is the suffering of the person living with a narcissistic personality disorder.
This isn’t meant to balance the blame, or to shift attention away from those who suffered relational harm. It’s meant to help us understand the phenomenon in its entirety, keeping in mind that understanding is not the same as excusing.
A diagnosis, not a label
Narcissistic Personality Disorder (NPD) is a recognized clinical diagnosis found in the major diagnostic manuals (such as the DSM-5 from the American Psychiatric Association and the ICD-11 from the World Health Organisation), not an informal label to slap on an ex-partner, an overbearing boss, or a “toxic” friend.
For a diagnosis of NPD under the DSM-5, there must be a pervasive pattern (meaning consistent over time and across different life contexts, not episodic) that includes at least five of the following nine features:
- a grandiose sense of self-importance;
- a preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love;
- a belief in being “special” and unique, a uniqueness understandable only by other special people;
- a need for excessive admiration;
- a strong sense of entitlement, the expectation of automatic favorable treatment;
- exploiting relationships to achieve one’s own goals;
- a limited capacity to recognize and respond to others’ needs and feelings;
- frequent envy of others, or the belief that others are envious of them;
- arrogant or haughty attitudes and behaviors.
Read from the outside, this list describes a profile that’s difficult to be close to, and indeed, people who enter into a relationship with someone who has these traits often come out hurt. But this list is missing one fundamental symptom, one that’s often invisible even to the person experiencing it.
A disorder, like any other
Like every personality disorder, and every psychological disorder in general, Narcissistic Personality Disorder causes suffering to the person who carries it. This statement may sound counterintuitive, especially to anyone who has lived through a painful relationship with a narcissistic person. And yet it’s consistent with how psychopathology understands personality disorders more broadly: rigid, maladaptive patterns that, by definition, limit a person’s capacity to function well in the world and in relationships, often silently, and almost always unconsciously.
The difference, in the case of pathological narcissism, is that this suffering is particularly hard to see, both from the outside and from the inside. Both for the people who enter into relationships with them and for those who carry narcissistic traits, the underlying suffering is difficult to spot, because it’s hidden beneath the layers described by the diagnostic criteria. Those layers weren’t built on purpose, they are not the result of an evil strategic planning. They were built out of necessity, shaped by the person’s own life experience.
The core of shame
Much of the clinical literature on pathological narcissism identifies, underneath the apparent grandiosity, a deep core of shame. This feeling is a fundamentally relational emotion. It doesn’t arise from an isolated judgment about oneself, but from a perceived rupture in the bond with the other, from the fear of being seen as inadequate, flawed, or unworthy of connection in the eyes of a significant figure.
The suffering caused by shame is born in the intersubjective space between self and other. The underlying thought isn’t so much “I am wrong,” but rather “I am wrong for you, and this threatens our bond.” Within this framework, shame acts as a relational alarm signal, regulating closeness and distance, pushing toward withdrawal or avoidance precisely at the moment when connection would matter most, often creating a vicious cycle of isolation (does that sound familiar?).
Heinz Kohut, one of the leading theorists of self psychology, described shame as a central element in narcissistic psychopathology. In his view, narcissistic needs, legitimate and developmentally normal in childhood, remain unresolved when they aren’t adequately mirrored by empathic caregivers. The person remains, in a sense, “stuck” in a developmental stage where the need for attention and external validation is excessive. To avoid repeatedly experiencing the shame tied to this unmet need, Kohut suggested, the person may respond with rage or withdrawal. Seen through this lens, we can already sense how the relational difficulty has a deep-rooted cause. “Blame” and “guilt” in this light, takes on an entirely different perspective.
Otto Kernberg, from a somewhat different angle, described pathological narcissism as a defensive function against unbearable emotions. This reading converges, despite starting from different theoretical premises, on the same core idea: grandiosity isn’t the problem itself, but a solution (an imperfect and emotionally costly one) to some other profound issue.
Andrew Morrison, author of one of the reference texts on this subject (“Shame, Ideal Self, and Narcissism,” 1983), systematised this insight, showing how shame represents the hidden emotion behind many manifestations of narcissistic pathology.
In other words, the narcissist’s grandiosity doesn’t come from nowhere. If we take into account the ideas of these scholars, it looks like it is an armour, built, often since childhood, to avoid feeling a sense of inadequacy too painful to bear. A sense of “not being enough” so unacceptable and devastating that it has to be denied, rejected, and flipped into its opposite.
What this means in practice
This doesn’t mean that someone with narcissistic personality disorder simply “wants” to be admired, or is simply overdoing their self-esteem. It means, rather, that they’re often unable to tolerate being seen for who they truly are. Which is, a vulnerable human being, as we all are, with their own limits, shortcomings, and imperfect humanity. Grandiosity and the lack of empathy aren’t a choice, but a survival strategy. The only strategy the person has managed to find to survive the unbearable suffering that relationships have created throughout their history.
Constant admiration becomes, within this framework, the only known way to feel safe. And the lack of empathy toward others, the difficulty in truly seeing the other person, is often also a difficulty in truly seeing oneself, flaws and imperfections included.
A necessary clarification
It’s important to be clear on one fundamental point. Understanding the suffering that may lie behind narcissistic personality disorder does not mean excusing harmful behaviour, nor minimising the experience of those who suffered it. The two things aren’t in contradiction. In fact, they need to coexist. After all, it’s within relationships that relational wounds can be healed, including those of the “victims” of narcissists, who often find themselves drawn to this kind of person for reasons that also have to do with their own personal history. But that’s perhaps a topic for another post.
What remains true is that anyone who has suffered relational harm from a person with narcissistic traits or disorder has the right to be heard, believed, and supported in their process of processing it, without the clinical understanding of the disorder becoming an excuse for the behaviour they experienced. Nor does it mean one should try at all costs, within relationships, to “redeem” people with narcissistic personality disorder. It’s right to set appropriate boundaries in relationships and to protect oneself, but understanding what lies beneath can also help do that in the right way, with compassion, both for oneself and for the other person.
At the same time, looking at the suffering behind the symptom isn’t an exercise in excessive indulgence. It is, instead, the first step toward truly understanding the phenomenon. And then, when the person is willing and ready for a path of care, toward being able to help them.
In summary
Narcissistic personality disorder causes suffering to the person who carries it, often without them being fully aware of it. Behind the grandiosity, the clinical literature identifies a deep core of shame, a sense of inadequacy so intolerable that it has to be transformed into its opposite.
Recognising this doesn’t erase the pain of those who have lived through difficult relationships with people with narcissistic personality disorder. But it allows us to look at the phenomenon in its complexity, rather than through a purely moralistic lens, and it’s precisely from this complexity that the path toward care can begin, when possible.
References
- American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5). Washington, DC: APA.
- Kernberg, O. (1975). Borderline Conditions and Pathological Narcissism. New York: Jason Aronson.
- Kohut, H. (1971). The Analysis of the Self. Chicago: University of Chicago Press.
- Kohut, H. (1977). The Restoration of the Self. New York: International Universities Press.
- Morrison, A. P. (1983). Shame, Ideal Self, and Narcissism. Contemporary Psychoanalysis, 19(2), 295–318.
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