Narcissism might be the most overused word on the internet, and one of the least understood. On this Men’s Therapy Podcast roundtable, host Marc Azoulay brings together four voices who each see the topic from a different angle: Dr. Mark Ettensohn (clinical psychologist, host of Heal NPD), Dr. David Hawkins (Marriage Recovery Center, author and clinician), Sarah, known online as Cluster B Milkshake (a self-diagnosed narcissist who built a following documenting her own recovery), and therapist Darren F. Magee.
The panel opens by separating pathological narcissism from garden-variety grandiosity, then digs into why the clinical literature and the DSM’s narrow definition often talk past each other. Dr. Hawkins pushes back on the idea that most “narcissistic” men in his practice actually meet criteria for NPD at all, distinguishing narcissism from emotional abuse and immaturity. Sarah offers a rare inside view of what grandiosity and collapse actually feel like day to day, including how it shaped her parenting and relationships. The conversation moves through the empathy myth (having it doesn’t make you good, lacking it doesn’t make you evil), the near-universal presence of developmental trauma in diagnosed cases, and closes with a genuinely hopeful case for why recovery and treatment are possible.
This episode is for anyone who’s ever wondered, “Am I a narcissist?” or “Is my partner a narcissist?” It’s for men trying to make sense of a diagnosis that gets thrown around constantly online but rarely explained accurately. It’s for partners and family members navigating a relationship with someone who may be narcissistic, emotionally abusive, or both. And it’s for clinicians, coaches, and content creators looking for a more nuanced, less sensationalized way to talk about the topic.
Dr. Ettensohn frames pathological narcissism as a disorder of self-esteem instability with two required pieces: an unstable, unrealistic self-image, and at least intermittent grandiosity. Someone who’s simply arrogant or “high on their own horse” isn’t narcissistic in the clinical sense unless that instability is also present. NPD is the personality disorder where this pattern sits at the center of someone’s identity; narcissism as a trait or defense mechanism shows up far more broadly, including in conditions like bipolar disorder and major depression.
It depends entirely on how it’s measured. Diagnosed strictly by the DSM’s grandiosity-only criteria, NPD is one of the least-diagnosed personality disorders. But when researchers include the vulnerable, depleted side of the pattern, it correlates far more strongly with other conditions. Dr. Hawkins notes his own clinical practice sees very few true NPD cases, but plenty of what he calls emotionally immature, self-protective behaviour that gets mislabeled as narcissism.
The panel’s answer: almost always developmental trauma, layered onto whatever temperament someone was born with. Dr. Ettensohn states he’s never diagnosed someone with NPD who didn’t have a significant trauma history, even though trauma isn’t part of his diagnostic checklist. Darren and Marc discuss how early injury combined with parental conditioning, or the total absence of guidance, can lock a child into black-and-white thinking about themselves and the world.
No, and the panel is emphatic about this. Darren bluntly states that having empathy doesn’t make someone good, and lacking it doesn’t make someone evil, pointing out that some of the cruelest people understand exactly what will hurt someone. Dr. Ettensohn describes empathy as state-dependent rather than a fixed trait: everyone experiences low-empathy states during conflict, but people with unstable identities experience them more often because more situations feel threatening to them.
Dr. Hawkins draws a clear line: narcissists tend to mistreat many people across contexts, while emotionally abusive individuals typically direct that behavior at one intimate partner. He notes his practice’s average client age is 55 to 60, often on a second or third marriage, and describes most of these men as “arrested development” rather than clinically narcissistic.
Every panellist says yes. Dr. Hawkins points to DBT’s four pillars (mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness) as core tools, alongside the sense of belonging men find in structured group programs. Dr. Ettensohn rejects the idea that people with NPD have no authentic self, arguing that the distress they feel in treatment is itself proof of an authentic person underneath the defenses, one who needs consistent empathy rather than confrontation to grow.
Dr. Mark Ettensohn hosts Heal NPD on YouTube. Dr. David Hawkins runs the Marriage Recovery Center at marriagerecoverycenter.com. Sarah shares her work as Cluster B Milkshake on YouTube. Darren F. Magee can be found on YouTube and Instagram.
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MTO connects men with licensed practitioners who provide guidance and support for navigating the challenges of modern life. These coaching services are not a substitute for mental health treatment, emergency services, or crisis support.
