I came across this online on accident. Someone else had posted it but it kinda changed so much for me and I wanted to share and see what you guys thought. Knowing the cluster b ended up in the DSM for political reasons shocked me. Here are some quotes from the article:

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“Moral considerations do not appear to play a large role in discussions of the DSM-IV personality disorders...Yet philosophical analysis reveals that the Cluster B personality disorders, in particular, may in fact be moral rather than clinical conditions…Successful treatment in this case is tantamount to a moral conversion.”

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“…DSM classifications are highly vulnerable to political and economic influences and interests, a fact that even sympathetic insiders freely admit. Personality disorders have proven especially vulnerable to these forces. As Lee An Clark states, "it is no secret that the offcial classification of personality dlisorders...embodied in the DSMs represents a compromise among the often competing interests of clinicians, researchers, educators, and statisticians with various training backgrounds and orientations…Others are even more critical, stating that in many ways, the DSM-IV classification of personality disorders is more like a political or philosophical statement than a scientific classification.”

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“It is impossible to imagine a successful "treatment" for the Cluster B disorders that does not involve a moral commitment to therapy. 

The central issue is whether there exists a moral willingness to change together with a sustained readiness to make the moral effort to make and sustain that change. Thus it is impossible to imagine a successful "treatment" or "cure" for those conditions that does not involve some sort of conversion or change in moral character. 

On this basis, it can be argued that these are fundamentally moral conditions and, consequently, that their treatment requires a sort of moral treatment. 

None of this should be taken to imply that Chuster B disorders cannot or do not admit of treatment using other means. Rather, the point is simply that those other treatment interventions can never be sufficient for complete treatment or recovery. 

A full cure requires moral willingness, moral change, and moral effort. Of course, these moral desiderata are not mentioned in most standard psychotherapeutic interventions recommended for the treatment of personality disorders. 

Scientific objectivity does not permit it. 

But the point is that those desiderata are ultimately required for successful treatment and cure.

To see why, consider very briefly the nature of the individual Cluster B disorders.

Antisocial personality disorder is said to involve a "pervasive pattern of disregard for and violation of the rights of others" (APA 1994: 649). 

Narcissistic personality disorder is said to involve a "lack of empathy" (661). 

The moral nature of histrionic personality disorder is more implied than explicit but is clear nonetheless. Here the "excessive attention seeking" and "inappropriate sexually seductive and provocative behavior" referred to is flatly inconsistent with a pattern of empathy and regard for others (657-58). 

Finally, the "inappropriate, intense anger" and instability in interpersonal relationships" cited in the diagnostic criteria for borderline personality disorder again imply clear moral deficits in empathy and regard for others. 

There is therefore no escaping the conclusion that, either by explicit mention or by implication, persons diagnosed with Cluster B personality disorders exhibit morally objectionable and reprehensible behavior toward others.”

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“Clearly, moral shortcomings of some sort appear to be necessary conditions of the DSM Cluster B personality disorders. It follows that unless those moral problems can be overcome or eliminated, successful treatment and cure are impossible.

Someone who is empathic and caring of others cannot logically be said to suffer from antisocial or narcissistic personality disorder in the way these are presently characterized in the DSM. 

Likewise, someone who has reached the point of being morally committed to being more respectful and considerate of others can plausibly be said to be improving and recovering from histrionic personality disorder.

The case of borderline disorder is more difficult, but here as well it is plausible to imagine that a moral commitment to being patient and loving with both others and oneself is an essential ingredient of any serious treatment and cure. 

Note that the same cannot be said of psychotherapeutic interventions for many other sorts of conditions. There are no such moral presuppositions for desensitization behavioral therapy for phobias or even cognitive therapy for depression. 

Willingness, commitment, and effort are of course required for therapy to succeed in these and many other cases. But moral willingness, commitment, and effort of the sort we have been discussing are not required. 

In addition, successful pharmacological interventions to reduce conditions like depression and anxiety for the Cluster B disorders may well help foster positive growth and development, but without a moral commitment to change, those interventions are doomed to remain insufficient and will elude any thorough cure.”

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“…you cannot be fully "cured" of antisocial, borderline, histrionic, or narcissistic personality disorder and regularly intend to be systematically cruel, dishonest, and indifferent to the feelings of others. Successful treatment here requires a moral commitment and character change of a significant sort. 

This invites the question why treatment should be administered by medical professionals. 

The issues go to the heart of the professional status of psychiatry as a medical discipline and the conditions it claims to treat. The situation is also reminiscent of the ideological and professional disputes associated with the eighteenth-century practice of moral treatment.”

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“Strictly speaking, the moral treatment of the Cluster B disorders falls in the province of what psychiatrist David Healy calls the quest for authenticity."

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Edit: added notes (below) that summarize the article

Cluster B pds are best understood as primarily moral/character disorders that manifest through deeply ingrained patterns of how a person treats other people—patterns that involve consistent ethical deficits like exploitation, entitlement, lack of genuine remorse, disregard for others’ rights and feelings, chronic deceit/manipulation, and one-sided empathy demands.

The mainstream psychiatric/psychological framing that treats them as purely (or even primarily) medical/brain-based conditions is:

• intellectually dishonest  

• pragmatically convenient

• protective of institutional legitimacy

• enabling of continued harmful behavior

The diagnostic criteria themselves are saturated with moral language and normative judgments about interpersonal conduct. They are not describing value-neutral physiological malfunctions in the same way as, say, epilepsy or schizophrenia. 

Pretending otherwise requires a level of compartmentalization that becomes increasingly strained the longer one observes real-world outcomes.

Genuine, lasting change in Cluster B presentations requires building morality/character-level ethical re-orientation:

• developing actual (not performative) empathy 

• internalizing accountability for harm caused 

• choosing to prioritize others' welfare and boundaries over self-gratification/entitlement 

• accepting that one's own feelings do not automatically override others' rights.

Very little in the standard “evidence-based,” non-judgmental, validation-heavy therapeutic world reliably produces that kind of transformation. When profound change does occur, it is usually because some combination of the following happened:

• rock-bottom consequences (loss of relationships, legal trouble, ostracism) 

• exposure to clear, consistent moral boundaries (people who refuse to enable or be manipulated) 

• development of genuine guilt/remorse (not just shame about being caught or abandoned)

• voluntary commitment to living by a different set of ethical rules.

The medical model can sometimes manage symptoms or teach surface level coping skills, but it rarely produces the core ethical shift that is required to stop being chronically destructive to others. That shift is MORAL in nature.

The psychological/psychiatric insistence on a primarily medical framing is regarding cluster b is sustained more by professional self-preservation, fear of liability, desire to appear “scientific,” and ideological commitment to destigmatization-at-all-costs than by fidelity to either conceptual clarity or real-world therapeutic outcomes.

Cluster B is moral first, medical second (if at all). Treating it otherwise tends to protect the system and the sufferer more than it protects the people around them.

Asking diagnosed NPDs because I’m trying to understand and don’t want to solely go based off what the internet says.

I hate it when I’m going through my narcissistic episodes, for context I’m BPD but I go through very narcissistic episodes where sure I’ll be charismatic social but I lack social skills to hide the fact that I think I’m better that I think I deserve more than everyone else and it sucks because it’s like two competing parts of my mind where one part can remain logical but it’s very secluded and I feel like that part only comes out at certain times like when I’m doing my engineering work, I hate it so much and whenever I preview and that part of the logical mind comes back typically after a social gathering where I’ve been a total dusche but still come off as charismatic somehow??? I turn back to my normal logical self where I can actually be a normal neurotypical high iq person, it doesn’t help that I’m actually a very good looking (a bit gay looking) high iq person and that doesn’t help me because whenever I become into this dusche bag I gloat none stop and people take a lot more offense because in some parts they do slightly think they are better wether subconsciously or consciously and hate seeing other people succeed and when again I’m succeeding unless they are attracted to me they will hate me and make fun of me to try in bring me down wether I’m in my narcissistic or normal state and that doesn’t help that I’m gloating and bragging and stuff like that and being confident about that which means their hate is compounded 10 fold
If you have any advice outside of seeing therapy because I’ve tried therapy and it never works they give me the same advice I try to implement but never works because the other side of my brain doesn’t want to take it, I don’t know what to do because I’m surrounded by fake people who only like me because of my looks not even my intelligence now a days, and any other person which my logical part of the brain which keeps me from being a depressed person when thinking about things decides to show up it hates those people which I just attract and my other side likes
Edit it doesn’t help I actually like being around narcissists I love it

I was recently diagnosed Narcissism, OCPD, comorbid anxiety with Dysthymia. While the others were true and reasonable I can't understand how they diagnosed me with narcissism. I don't want to villainize people with narcissism, but I don't ask for attention in a social gathering, I have lot of self-esteem issues, I don't talk or act rude to people except my family, I like to isolate myself, I always think from other people's perspective, I like to do stuffs that are morally, ethically and practically right, I want my work to be perfect and talk a lot of time and won't even finish it due to the same self-esteem issues. I don't like to disturb people, so I don't even call them, but I never say no to any requests, I'm even easy to take advantage of. I don't even cut the call first, thinking it would be rude, I pamper all my friends, I don't want to lose them, I appreciate art openly whoever does it. I always put down myself and don't take praises. I get sad at criticisms but I'm self-aware enough to not get angry at people, I just accept I'm bad. I see everyone doing good in their life and I'm stuck self-loathing. I always think about how I'm going to save my family how to contribute to my family. My family even takes loan to donate for the spiritual gatherings to maintain our family's name and pride among the village and relatives, I don't give a shit about it I either give that money to a friend in need or just save for my sister's marriage or give it to an NGO. I'm single and often feel the need for an opposite sex companion to comfort me but I'm decided not to marriage because I know my family and don't want a new person to suffer what I've been put through. I also acknowledge why my family members are like that and their upbringings, I understand their fair share of sacrifice. I never tried to manipulate others for doing works for me. I do everything myself even it hurts me, it's not like I like it, it's the only way I dont disturb others

When I asked for an explanation for this diagnosis my therapist said "Narcissism doesn't only mean the stereotypical traits, there are many other types too. And your narcissism is just the "self-esteem" part. You don't want to be rude, don't want to be perceived to be a villain, don't want to look worse at what you do so you simply avoid doing it, that's what narcissist about you". But I can't find anything narcissist about that, is she lying or is it true. Please help me, it's so confusing, I need to work on myself

I know this is a first-world problem and a lot of people would probably even find it fucking awesome, but it disgusts me. I hate hate hate hate my colleagues. Not all of them. But 9 out of 10. And why? Because they all desperately want contact with me, take every opportunity to come up to me and talk at me and fawn over me, stalk me and constantly harass me because they want to become friends with me. But I don’t want any friends. Well... I do, just not these fucking idiots. You’re all so unbelievably lame, uncool, boring and slow in the head, how the fuuuck do you even dare to talk to me? I’m constantly making it clear to you that I want NOTHING to do with you because I find you absolutely repulsive and disgusting as human beings, and yet you swarm around me like rabid vermin. God, I hate you so much. Leave me the fuck alone, you shitty bargain-bin groupies. And if you’re going to worship me this fucking much, at least do it properly instead of being so intrusive and cringey. God, I hate fan clubs that aren’t made up of cool people. You disgust me so fucking much. Why can’t you just politely ignore me? Why do you constantly have to seek me out and keep bothering me, no matter how many times I reject you? Go talk someone else’s ear off. I fucking despise you, I don’t want you anywhere near me, you’re uncool and fucking boring. Jesus, I wish there were insect repellent for unwanted wannabe fans =0=

This also applies to ourselves.

At the same time, whenever I catch myself starting to feel pride because of my perceived status, I now remind myself, that the reason I do things should be out of LOVE and not STATUS.

pride based on effort and genuine kindness

i hope to cultivate this a day at a time

Hey. I am a diagnosed pwNPD.

Back in 2023, I got a C-PTSD diagnosis, but at the end of 2025 is when I got my NPD diagnosis. My world crumbled

Recently the connection of NPD and shame became interesting

When I search for shame, I get C-PTSD content, and tbh, I do not know if its pop psychology or not.

But at the same time, what if C-PTSD resources are the one for us?

C-PTSD is often associated with BPD. But just like with DBT therapy, NPD also benefits from it - so what if C-PTSD resources are also cool for us?

What do you think? Have you ever digged up such stuff?

Cuando conocí al hombre que creí el amor de mi vida, ese por el cual yo había esperado, pude observarlo y conocerlo pero en ningún momento pensé en que todo era falso. Había estrellas y fuegos artificiales, nos elevabamos mutuamente. Yo no sé si él también tenía el trastorno pero sí tenía muchísimos rasgos. Sí, creo que nos encontramos dos iguales. El quería sexo y validación y yo quería dinero y validación, nos quisimos usar mutuamente.

Más allá de todo, sé que él me amó y a mi modo, yo también a él lo amé mucho. Lo amé porque sentía que eramos dos personas maravillosas que Dios había, por fin, juntado. El me decía que eramos buenas personas, yo lo sentía así. Estábamos perdidos en el mutuo bombardeo de amor, yo diciéndole lo mucho que lo admiraba y él halagando mi belleza y dándome regalos. Para una persona sana quizás esto grita "bandera roja" para mí era lo normal: ¿Cómo podría un hombre conocerme y no ver todo eso en mi, y por ende, adorarme? Esto me hace preguntarme esto: solemos ser ingenuas las personas narcisistas patologicas? Sam Vaknin en un video hablaba mucho de eso

I’m just learning the language, but I guess I’m in a narcissistic collapse. Looking back, I think it’s been happening for like a year, but I just realized the NPD angle last night after looking through this sub.

I had a really good relationship with a sweet, gentle, loving man. He left me last November, said I was a narcissist. I thought he was just being an asshole. But I think he’s right. And for the last year I’ve gone between shame, self blame and self hatred, to anger, blame and devaluing him. I’ve felt so confused.

Looking back now, I’m horrified to see traits and behaviors of narcissism. I loved how he made me feel and what he did for me, but I can’t say I really thought much about who he is as a person, I think? When he would express opinions or desires different than mine, I would get upset because I felt threatened, I would devalue him, mostly in my mind, but sometimes I made comments. I made judgmental comments about his clothes and his work because I didn’t think they were good enough. I thought about him as a reflection of me; what would others think about his looks (he was not conventionally attractive). I worried about his lack of ambition and career because of what it would mean for my financial future as his partner. When we would fight I really struggled to have empathy for him. I wonder if I really had empathy for him in general? I think maybe I only cared about his feelings in so far as how they would impact me. The thing is, I’m a very sensitive, and, I thought, generally empathic person.

He accused me of being selfish, not caring about his feelings or boundaries. It’s true, when he would try to take space I didn’t care at all about his boundaries and continued to cross them in order to get what I wanted, a sense of relief. He said I used him to regulate my own nervous system, and I wasn’t self responsible. He said I would get defensive and had an inability to listen or take personal accountability for my harmful actions. He said he never felt cherished by me. He said that when I’m in social situations I act fake, where I thought I was just being charismatic, and I liked that part of my persona - it feels energetic and engaging and fun (when I have the energy for it, when I don’t, I’m just a depressive Eeyore). He said that I would talk about myself on and on and on, and it was exhausting. I couldn’t handle his frustration when he expressed it, I always made myself the victim. And when he would be hurt by something I did, often I’d accuse him of being too sensitive. God, I’m such an asshole.

I actually never thought that he would leave me. I thought that I was better than him, like I was such a catch and he was dating up and I was dating down. He attempted to break up with me four times, and I just wouldn’t let him. Then I became very insecure that he would leave me, super anxious and clingy. He said my insecurity was too much for anyone to bear. One line he said to me I’ll never forget, “you’re easy to love, but you’re very difficult to live with.” I feel the same about my narcissistic mother.

Now, realizing all the ways I fucked up, I feel so much shame and regret. I had an amazing man, so sweet and open to loving me, he was patient for so long. I thought that I didn’t take him for granted, I knew the whole time that he was good, but now I wonder if it was more like he was good to have around? I liked feeling loved by him, he had such a generous heart. But I guess I never actually made him feel desired fully or safe in the relationship. I feel like such a piece of shit. And I don’t think I can’t forgive myself, cause I really think that was the best opportunity I will have for a loving relationship. It’s been 10 months, and I still obsessed about him every single day. But he has blocked me, I’ve reached out over email ( crossing his boundaries), and he will not engage with me.

Possibly the worst part is that I had no idea I was doing this. I actually thought this was a really healthy relationship and that I was doing a really good job and not being mean. I never called him names, like I might have done when I was younger, I try to listen to his feelings. I tried to be generous, thoughtful, and sweet. That felt natural and nice to me to write him sweet notes and buy him little gifts and tell him that I was grateful for him. I couldn’t handle when he would give me critical feedback about my behavior, but then after I would calm down, I did really want to change to be a better person. But I don’t think I even realized that I was that bad in the first place. I just couldn’t understand the concepts of what he was talking about. That makes me feel really out of control of my mind and kind of hopeless about my ability to be a better person.

I know I’m rambling, if you got this far thank you for taking the time to witness me. Maybe this insanely long self-centered post is a perfect example of me being a narcissist? I have no idea what to think anymore or how to orient myself in the world.

Today i‘m celebrating 3 years sobriety! And as i‘ve been reminiscing about my addiction and also my rehabilitation, i‘ve noticed that i got sober purely out of spite!

Back in 2023 i was a waitress, freshly moved out of my mom‘s and into a completely different city, exploring the world in my early twenties and falling into alcohol addiction.

With addiction oftentimes comes disappointing those around you that care about you and i was doing that to my then-best friend.

When she confronted me about my addiction and told me that she didn‘t want to be in contact with me anymore as she didn‘t want to get disappointed over and over again, i felt an immense amount of shame and anger.

I wouldn‘t let her „win“. I wouldn‘t be the sad loser that she gets to toss out and talk about with her other friends. So i went home, called a rehab clinic and got booked about a month later.

Haven‘t drank since then. So i‘m kind of glad that my social standing was that important to me that i instantly just stopped drinking the moment i feared about getting looked down upon.

Sometimes NPD ain‘t that bad :p

How do you experience emptiness? For me, it feels like a bottomless pit. My mind is a tangle of hot emotions. I graze them without learning why they're so charged. A few times, people have perceived my emptiness. The sun burns away skin and flesh, and all that's left is the scales underneath. It makes me sick to be seen for what I am, so I hide. I've felt empty for most of my life.

Are there any YouTube channels, websites, or books that you use to help with healing (apart from HealNPD)?

Most of the resources I find are either just describing NPD or vilifying it, but I can’t find anything that actually helps with self-regulation and coping 👿

i know that everyone says just take a breath and step back from the trigger, but i don't think this considers how mentally anguishing it feels to be confronted with something that triggers a collapse.

even if i separate myself from the situation i still can't take whats going on in my brain and i end up saying vile and disgusting things online. this is my only coping mechanism thus far, it is a similar feeling to self harm, i have to lash out somewhere and thats where i go to do it.

what has worked for you guys to handle the feelings that come with the trigger? because i feel like the only thing that will help my urges is to not feel these things i do towards my trigger.

thank you for reading and thank you for anyone who comments

See I may be a narcissist but have you considered I am the equivalent to a tiny innocent baby kitten who can do no wrong. When you are mean to me this is who you’re being mean to btw

I also operate solely on cognitive empathy. I know that people have issues and things like that, but deep down in my albeit shallow heart, I don't actually want anything to do with people's feelings. It makes me uncomfortable, and quite frankly, it just fucking kills the mood. Suddenly, conversations aren't going how I want them to go when they get all upset, and topics have to change.

But I just know that acting without enough empathy is a social death trap, because people will peg you as cold, unsympathetic jackass who doesn't care. That being said, in situations where it's required, my mind always goes overdrive, trying to think about what to say/do to prove to people that I'm not a bitch.

Just today, I was closing up at the store I work part-time at with a manager. She's a nice woman, and there have been times where I've been a bit emotionally vulnerable with her because I just went through a hard few months (I was literally crying at work). I respect her as, in those moments, she was nice enough to care when nobody else would.

Anyway, she seems to be in a bit of a rough patch herself, and after a phone call she took with her ex-husband, she had a bit of a breakdown in the back. It's a pitiful situation, but once again, I was annoyed because we were having such a fun talk before she got all upset. It made me uncomfortable as it always does, but I had to do the normal thing to do and console her a bit.

I just really tried to back her up and say that the feelings she had were valid. She's also currently sick, so I told her about some OTC stuff she can take to help while she doesn't have insurance (I'm a nursing student so I would know). I wished her well as we parted ways, but as I'm sitting at home eating dinner, I felt like what I did wasn't quite enough -- especially since she had to deal with all those times I was upset, so now I owe her.

I'm afraid she'll think I wasn't as empathetic as I should be. My other coworkers are like super nice people, so I don't know if I'd measure up to them if they were in my place instead. That in mind, I messaged my other manager (she can see everyone's schedule) and asked if the upset manager would be there tomorrow. She will be, so I'm taking some time from my off day to drop off a one dollar grocery store doughnut for her.

I don't even know if the doughnut will be enough to repay her, but I personally don't like spending money on people that aren't myself, so one doughnut for one dollar it is. I just hope she’ll like the flavor I pick out. Or maybe I'll just get the coolest-looking one instead.

I am posting here only because I found similar questions posted on this subreddit. I have not been to a psychologist and as such do not consider myself a narcissist.

I wish to ask about what you consider to be low empathy. I think I may struggle from it. I say this because whenever somebody wrongs me, which may be something as simple as beating me in a competition, I disregard them completely. I mean I would not care if they were to die the next day. Hell, I actually don't think I would care if anybody but the one person I love would die. Like even people I have known for years, I wouldn't care if they were to just be gone tomorrow. Hopefully I am not the only one who feels like this way

Were there people,before or after diagnosis,that suspected NPD or that something was off? Or did they interpret your behaviours socially,if they even noticed at all? I thought I was being discreet back then,boasting about things that I now realize were pure callouseness and grandiosity. But in the end,I was not.

My female childhood friend of mine just had an oh moment when I told her about my diagnosis. And in just a few seconds,she told me it made sense. She explained that ever since we met at around 7 years old,I was very boastful,entitled,and was agressive or upset if somebody achieved something,or wasn’t praising me. Even up until 13,I made many explicitly boastful comments that were just pure grandiosity. I would also manipulate her into stealing or buying things for me multiple times. I convinced her the ratio between what she gives me and what I give her was entirely fair.

A male secondary school friend of mine,who is diagnosed with ASPD simple said ‘Oh that’s why’. When I asked,he told me a lot of things. Before getting diagnosed with CD at 17,I genuinely believed I was superior to others for being a manipulative,violent thief,I didn’t want to live any other way. Seeing as he had the same diagnosis at the time,he started loosely talking about it at some point,like a passing thought. And I just went on and on about all the terrible things I had done with nothing but pure pride. And I never let that go,and talked about it constantly. He said it felt somewhat weird at the time,but didn’t think much of it. Though,he pointed out that tricks like triggering empathy or guilt,which would normally work on other people,never seemed to work on me. Even when we’d had conflicts and he’d mess me up,I had no problem doubling down lower no matter how many times I had to do it. At some point,though not articulated exactly as I said,he side he realized that I was not an empath and would not respond the same.

Obviously we are wrong to be heirarchal, and each of us have our own heirarchal framework that we made up, so this is not about comparing heirarchies or saying that they are valid, but mostly do you feel anything? I feel extreme desire to get away, incomprehension, and a deep deep sadness, and it almost triggers an existential crises, why it happens, i think it's probably a multilayered reason ranging from it makes me feel the futility of the world, as both this person and I will be dust and bones one day, as well as other things I am probably not yet consciously aware of