I found this question and answer in Quora and liked it so much, I think it belongs here. The title to this could be “A Healthy Relationship Between an NT and NPD,” although I think anyone can benefit from these insights.
Karen Arluck, Clinical Psychotherapist in private practice
Answered Sep 16, 2017
When I first moved to Austin, TX, I found the most adorable 7 week old puppy who was sitting in a cardboard box. His owner said that he could not afford to keep these “Staffordshire Terrier” puppies, and was looking to get them new homes. After I took home this sweet, adorable, tiny puppy, I looked up this breed only to learn that I had just inadvertently adopted a Pit Bull. I was immediately freaked out, and felt as if I had just taken home a wild Lion cub who would grow up to be some dangerous creature, who was somehow destined to hurt me. I realized that each dog (regardless of their breed), is a unique animal whose personality is greatly affected by it’s upbringing, temperament, my ability to take care of them, and could not be reduced to such a negative and overarching stereotype. 7 Years later, Rocky, is curled up on the floor next to me as I write this answer.
Similarly, each person who has the diagnosis of NPD is a unique person, with their own strengths, weaknesses, and level of emotional functioning. There are some narcissists who would be extremely difficult to have any kind of healthy relationship with, and many who you could, provided that you give some thought to the following criteria as it pertains to this particular person with the diagnosis.
How someone defines “healthy relationship”:
People who suffer from NPD, or have the flavor without meeting the full criteria are likely to struggle in areas affected by their emotional issues (like struggles with object constancy, splitting, emotional empathy etc.), regardless of how wonderful you may be as a friend to them. They usually feel happiest when the focus is on them, their needs and their feelings, and will need a lot of validation and support that they may not be able to adequately reciprocate when you need it. In addition, you may find that they are inadvertently insulting and/or unsupportive and will likely enjoy giving you “advice” and “feedback”, but they will have difficulty tolerating any feedback from you, blame, confrontation, or even gentle assertion that they are wrong in any way. When they feel narcissistically wounded, they may confront you angrily, act passive aggressivily, guilt trip you, or may simply complain about you behind your back.
That being said, they may have other wonderful qualities that can make them very intelligent, interesting, funny, and engaging to spend time with. Emotionally higher functioning narcissists are much easier to have friendships with than someone who is less emotionally high functioning, but it may also be more emotionally taxing than relationships with someone who does not suffer from these issues.
2. Realistic expectations:
One of the issues that makes it so hard for people to maintain relationships with people who suffer from NPD, is how hurtful and disappointing it can be when their narcissistic friend acts out their inner emotional struggles in some way. Usually this is based on a conscious or unconscious hope that their friend would be the emotionally supportive or more self-aware person that they hoped they would be. To have a healthy relationship with a person who suffers from NPD, it is really important to try to maintain realistic expectations that if their friend actually suffers from NPD, it is not a matter of *if* they will act out some of the issues inherent in their disorder towards them, but *when*.
If your friend with NPD acts out in some way, they are unlikely to be able to tolerate any suggestion that they were wrong or hurt you, or to validate your feelings about any of this. This is not a reflection of how much you mean to them, it is a reflection of their struggles, and an important area to manage your expectations of them. On the other hand, they may be very supportive about areas that they do not interpret as a narcissistic injury. Your ability to maintain realistic expectations of this person and their needs, as well as their current emotional limitations, will greatly effect how healthy this relationship feels for you.
3. What is this person’s individual level of functioning:
NPD is a very wide diagnosis, which can encompass everyone from a high functioning and charming person who goes out of their way to help people around them because it makes them feel good about themselves, to someone who regularly steals from and otherwise takes advantage of everyone around them. If this is a higher functioning and more self-aware person with the diagnosis, they may be a better friend than an emotionally lower functioning person or a malignant narcissist, who feels better about themselves by devaluing and emotionally hurting people around them.
4. Personal sensitivities:
Some people may be more sensitive based on their own temperament and past experiences, and may find it too painful to be in a friendship with many of the people who suffer from NPD. A person’s own emotional stability and ability to recognize that a narcissist’s acting out behavior is a reflection of their shortcomings, not of theirs (even if the narcissist tells you its all your fault), can greatly affect how healthy this friendship is for them.
For example: A person has a deep insecurity about not being smart enough, has a narcissistic friend who is always lecturing them about how they “should be doing x”, “should have known x”, or otherwise got something wrong, and then telling them what they should have done differently. This might be too upsetting for many people with this sensitivity to handle in order to have a friendship that would feel healthy for them. Other people would not be as bothered by this particular issue.
5. Other supportive people in your life:
There are plenty of high functioning people with NPD whom I have had as clients or as friends, who I absolutely adore and like very much. However, I think it is important to have other supportive people in your life, so that you are not completely reliant on people with these challenges as your only support systems. It can be helpful to have other people who are more emotionally self-aware and able to be supportive in ways that this person may struggle with.
The point is…
Whether you can have a healthy relationship with someone who has NPD often depends on your definition of “healthy relationship”, this particular person’s strengths and difficulties, your individual sensitivities and tolerance for their issues, and having other supportive people in your life.
The point is, I don’t love all Pit Bulls, but I do adore this one.
Women Who Love Psychopaths
When I was a child, our family would visit with a family we were all close to. They had two kids around our age, a girl and a boy. We three girls, my sister, the girl and I played a game, pretending we were angels and the boy was the devil. 
The book is obviously, not pro-path. But I liked it ok until I came to a part about “evil.” I have made it my business to become an expert on how the world sees psychopaths. The only expert to say anything nice about us is Kevin Dutton, author of The Wisdom of Psychopaths. Nobody else is willing to acknowledge any positive traits such as wisdom. Some would deny our very humanity. Among those folks, the usual species type we are demoted to is that of the 
In this case, a distinction is made between “psychological evil” and “spiritual evil” although the closest they came to explaining that distinction was quoting from the DSM and comparing it to quotes from the Judeo/Christian bible. Apparently “spiritual evil” is any sin listed in Bible while “psychological evil” is manifestation of a disorder from the DSM. She has a whole chapter devoted to explaining how many malfunctions we have in our brains. Not only is the amygdala not communicating properly with the frontal cortex, but practically every part of our brains is at odds with every other part. But, since we are born like that, I wonder why she describes us as “broken.”
To gather her data, Dr. Brown advertised for women who once loved a psychopath to be interviewed. Since she already saw us as evil, I wonder how she worded the ad. 
Reading the book, one would get the impression that all relationships with psychopaths were abusive and the women ended up traumatized, often with PTSD. Perhaps those whose relationships turned out badly wanted something from their lovers that they weren’t ready to offer. Psychopaths are different from NTs. If you really want to be happy, you will enjoy what a lover is instead of fretting about what he is not. Brown speaks at length of the intensity of the love connection, the feeling on the part of the woman that he “knows” her. That knowing is one reason psychopaths are so charming. We are really interested in those we involve ourselves with. Most people don’t have that level of interest.
Brown considers a relationship with a psychopath a very bad thing, no question about that. Yet she speaks at great length about how thrilling such love connections can be. Here are a few examples of the testimony on what sex was like for them:
I can concur that the sex I have had with psychopaths is the best I’ve every known. I wonder how anyone can want out. Of course, he could have changed and lost interest. (Dr. Brown would say his mask slipped.) I wonder, too, why Dr. Brown shares this very delicious feature of a relationship that’s supposedly disastrous. As Taylor Swift sang in Blank Space, “You can tell me when it’s over if the high was worth the pain,” and “It’ll leave you breathless or with a nasty scar.”
When I set out to write about happiness in psychopaths, the title slogan from the 60s came to mind. It seems kind of simple-minded but the first part clearly matches one of the traits of psychopathy that is always listed by professionals: lack of worry or anxiety. When one looks at all the people who develop ulcers, and swallow Benzos like candy, psychopathy looks pretty damned good. We are not worriers. But what about happiness? We know that our emotions in general are less intense than that of NTs.
sad,
I like that answer. I felt nothing when my parents died. At my mother’s death, I was a teenager living at home and going to high school. As such, I had to go to the funeral and I know I was supposed to look sad so I played my role as best as I could. My father came back from the hospital and broke the news to me by saying, “You have no mother.” Then he broke down into sobs. It was easier when he died. I was living apart from the family and my sister made all the funeral arrangements. I’m grateful she was there so I wasn’t expected to do anything. I am very grateful to have been spared all the pain others seem to feel when losing a parent. Even losing a friend. Actually, we had been best friends for years and then drifted apart. I was bored or nostalgic so I tried to contact her again only to learn she had died. I was really surprised. I guess this was a first experience in losing a peer. What’s next for me? Become one of those geezers who pour over the obituaries, looking for friends and acquaintances? But, apart from shock and surprise, I didn’t feel much about her death either.
Perhaps freedom from intense sadness is the way our happiness quotient balances out. I know we have ways of seeking and experiencing ecstatic states. Excitement from taking risks can be great. Kevin Dutton tested a group of students on their degree of psychopathy. The two who scored lowest and the two who scored highest were given the chance to do a bungee jump. The low-scoring students opted out while the two high-scoring ones “jumped” at the opportunity and enjoyed it immensely. I find challenges kind of a necessity for my emotional balance. If I don’t challenge myself regularly, I start to feel really blah. Boredom is terrible for us. The same friend quoted above said, “
I work regularly at avoiding that state of being. I challenge myself with blogging. To me, blogging is an attempt to deepen my own self-knowledge and share it with the world. I also fight boredom with drugs. Since I am no longer young and not able to deal with illegal, recreational drugs the way I did when I was younger, I use drugs that are legal and not as powerful as the ones I once enjoyed (speed and heroin). Actually, I do use one illegal drug, Provigil, which is supposed to be like the “limitless” drug in the movie of that same name. With noortropics, I try to be the best version of myself possible. By being my best, I am able to achieve more with my blogs. 
“Some do and some don’t” really seems to sum it up. The key difference is what an individual psychopath experiences from a particular substance. Cocaine always put my lover to sleep. It made me wide awake and up for a good conversation. I’ve heard some junkies say they hate speed. “It’s just like junk sickness,” they say. But, when I was a junkie, speed made me feel better when I was jonesing for a fix.
It’s generally agreed that good is whatever is desirable and evil whatever is undesirable. Nevertheless, there is a widespread fascination with evil. Just look at the movies. People give lip service to “goodness” but seem to find it boring. They profess horror of “evil” and yet can’t seem to get enough of it as long as they keep a safe distance. Most folks don’t want to do evil, still less do they want to be the victim of evil. But they love to watch it.
Nietzsche offered a double dichotomy of good-evil and good-bad. The latter describes a dichotomy of things that are evil beneficial or harmful to us. Good-bad can also describe the range of abilities. One can be a good baseball player or a bad one, meaning he can’t play for shit. Good-bad is not about morality. The moral division of good and evil is described in Psychology Today as:
‘Good’ means a lack of self-centredness. It means the ability to empathise with other people, to feel compassion for them, and to put their needs before your own. It means, if necessary, sacrificing your own well-being for the sake of others’. It means benevolence, altruism and selflessness, and self-sacrifice towards a greater cause – all qualities which stem from a sense of empathy. It means being able to see beyond the superficial difference of 
It would seem that “goodness” means putting others ahead of oneself. I have a big problem with this as did Nietzsche. But self-sacrifice seems to be the central ideal of Christianity. Christ took on all the sins of the world. He suffered horribly to absolve sinners. In this way, God, by definition the ideal in goodness, was punished so that the unworthy could get a reward they don’t deserve. Western civilization is based on this odd philosophical concept. We are constantly reminded of it. For example, the novel, Harry Potter, which never mentions the word Christ or Christianity and which has been criticized as pagan by some Christians, describes it’s hero, Harry Potter, as “selfless.” As children, we have to exhorted to share our toys, to give away the tastiest morsel of food on our plate and, generally, treat others better than we treated ourselves. Can anyone say “perverted?”
There’s nothing wrong with kindness to others. But this goes a lot further than kindness to others. It constitutes cruelty to ourselves. Even Christ said “Love your neighbor as you would love yourself.” He never said to love your neighbor more than yourself. Christ did exactly that. He sacrificed himself for the sake of the unworthy. A friend of mine said “Christ should be the great example, not the great exception.” If Christ is the great example, humanity is being told to try to be something that is against his very nature.
those we consider better than ourselves while disapproving of those we consider worse. There are limits within which we are expected to stay.
When did evil start to look so alluring? One answer might be: when goodness began to look boring. We can blame this on the puritanical middle classes. It is they who redefined virtue as thrift, prudence, meekness, abstinence, chastity and industriousness. It’s not hard to see why some people should prefer zombies and vampires. Goodness came to seem negative and restrictive.
A big part of the allure of evil is power, the ability to overcome the normal limits of mortality, itself. Anne Rice’s novel, Interview With the Vampire, aroused many people’s fantasies of the wonders of being immortal, powerful and amoral. Junkies actually equated the need for a daily fix with the need of vampires to drink blood. Vampires were predators (as are many junkies). And this brings us to the old Hollywood stand-bye of psychopathy. Psychopaths are considered evil. We are also often charismatic. Hollywood loves us and has given us an aura glamorous power. Most folks who find us fascinating would rather die than admit to being one. But they so enjoy deploring us.
I think in this age of moderation, people are dying for something extreme, something to take them out of the safe and boring cage they live in. That’s probably one of the reasons some of them supported Trump. He is anything but moderate and safe. Hillary Clinton called his followers “deplorable.” But those followers, rather than feel shamed by the term, got t-shirts with the word deplorable on it. We are proud of Western Civilization but most members of that proud civilization are leading lives of “quiet desperation.” And they are dying to escape it.
I have talked about this before, perhaps too many times. But we 
try to hide it. The party line was that everyone has a fair chance in our “democratic” society. All it takes is hard work and talent. If Blacks wind up at the bottom of the economic pecking order, that’s just their fault. We need to teach them how to discipline themselves, stay in school, yada yada. Since Trump has taken office, white supremacy has come out of the closet. Now they scream their opinions loud and clear while the president says there are some really nice people among them. Not that he is white supremacist. Oh, no! Certainly not. But white supremacists can be just as nice as anyone else. At the same time, Trump talks about left-wing dissidents in a very different tone. It’s not all Trump, either. Society is inundated with white supremacy. But we’ve all seen the articles documenting all this. I’m not interested in writing another such article.
My point is that we can (and should) condemn Trump and his administration on the grounds that their politics stink. Do we want a government that only favors those who are already rich? Do we want a government that takes away the already inadequate safety net for the working class? FDR brought about the New Deal which lifted working people from the precarious place in which they had existed until then. Finally, people had some financial security. It was a start. But Ronald Reagan started dismantling the New Deal and his party has continued the work ever since.
Since we have clear grounds upon which to criticize Trump and his party, why bring psychiatry into it? I am a psychopath. I was once a conservative after reading Ayn Rand in my teens. So I know what it feels like. I honestly believed that the rich were mainly the most productive and therefore the worthiest to have the lion’s share of the goodies. I thought government helping the poor was a form of legalized robbery. I was still living with my parents and going to school. Once I graduated and entered the work force myself, it all didn’t look quite so clear-cut. I have read Ayn Rand’s books numerous times because I think they are well-written and interesting. But each time I read them, I saw more and more holes in her logic. My most recent rebuttal of her thinking is 
Lucky’s post starts out with “Since the very beginning of his term, Trump has surrounded himself with people who seem to lack empathy, conscience, or any sense of morality or scruples.” Why should we even care whether these people have “empathy, conscience, or…morality?” Their policies are hurting a lot of people who deserve better. The question is whether we can offer voters a real alternative, whether we can persuade them that they are hurting as a result of Trump’s policies. We need politics in command.
All of the people working for Trump, based on their actions and words, seem to have one of the Cluster B personality disorders, most likely NPD, Antisocial PD (sociopathy), or psychopathy. Many of these people are likely malignant narcissists, like Trump himself. They serve as his flying monkeys and yes-men. There may be one or two non-disordered people left in the administration, who have severe problems with codependency and therefore have some pathological need to be pleasing to Trump, but I think even most of those people have been fired.
Psychiatrists have admonished their fellow professionals not to attempt a diagnosis of anyone they have not examined in person. Unfortunately, many have been unable to live up to the ethics of their own profession and have succumbed to the temptation to play arm-chair psychiatrist. It’s sad when people with the actual credentials stoop to such unprofessional behavior. Why should lay people like Lucky Otter join the game?
There are blogs and web sites devoted to “victims” of psychopaths, sociopaths and narcissists. The above quoted paragraph could easily have been lifted from one of those sites. They typically label those the “victims” complain about (usually their exes) with those same terms with which that paragraph is festooned.
She has talked about this before. 
It’s hard to look at the smirky faces of those who are causing one material harm. The agony of defeat is bitter enough without those who won rubbing our faces in it. But everyone tries his hardest to win. Everyone rejoices in victory. There’s nothing wrong with pursuing one’s self-interest. Since we, the 99%, outnumber the wealthy 1%, all we really have to do is pursue our interest in the political arena and we would have a fine country. The real problem, as I see it, is not a bunch of “sociopaths” in power. The real problem is the mass of fools who vote against their self-interest because they let 
their emotions rule them. Of course the electoral college helped skew the results and allowed a minority to decide the election. The electoral college was set up as a sop to the South. The winner is supposed to take all, not sweeten the defeat of the loser. The South has never really accepted defeat in the Civil War. But, North or South, white supremacy is the wild card that prevented the Union (the winner) from acting rationally. Perhaps there is something to be learned from the smug faces of the Trump-ists. Acting in one’s rational self-interest is not a sin. Let’s win and get our own values in the position of power. And let’s never forget to make the most of our unabashedly joyful victory.
CLUSTER B 