We all have narcissism, but in some cases, the perception of narcissism becomes extreme and pathological. Systematic research has shown that there are three subtypes typical of narcissistic personality disorder: the grandiose/oblivious, the vulnerable/hypervigilant, and the high-functioning subtype. Both biological and psychological factors are at work, but the true cause of pathological narcissism has not been established. The psychotherapy of narcissistic personality disorder (NPD) is complicated and often frustrating because of the difficulty in engaging a person with narcissistic personality disorder in a psychotherapeutic process. Suicide risk is not rare in patients with narcissism, particularly in the context of severe narcissistic injury, where the patient feels shamed and/or vilified. In conclusion, narcissistic patients are difficult to treat, but the risk of suicide makes it imperative for clinicians to stay involved in the treatment and assist the patient in understanding their vulnerabilities.