Narcissistic injury is an injury to self esteem, or self-love. Healthy narcissism means unconditional love of oneself, which enables a coherent and secure sense of self. A narcissistic personality structure forms if the parent's love is conditional - "I love you because you are so special, so gratifying to me" Healthy narcissism forms when the parent loves just as well when the infant is not gratifying. Healthy narcissism does not preclude healthy self-criticism, but this means criticism of the person's actions, not of the person's self. "I don't like what I did, but I love myself just as much anyway."

Since the narcissistically-injured personality lacks a secure sense of self, the narcissistically injured person also lacks a secure sense of the other, and may treat the other as a non-person, not noticing the other's feelings and needs.

Injured narcissism makes a person feel empty and without value. The narcissistically injured person compensates with grandiose fantasies, either of worth (I've won the lottery, discovered a gold mine; I'm king of the world) or of worthlessness (I'm the biggest piece of shit there ever was). Either way these fantasies make it hard for the narcissistically injured person to respect and appreciate another person.

To the extent that the other does not seem real, the narcissistically injured person may injure the other without remorse. Human evil arises from injured narcissism.

We all have injured narcissism. Don't feel too bad if you recognize some of what I say here. What we can do is try to be conscious of our injured narcissism.

Confronting narcissistic injury usually does little to help it. The therapist must understand the injured narcissism, so that the patient feels accepted unconditionally. When the patient was first refused unconditional love, his or her sense of self stopped growing. Unconditional acceptance permits the patient to grow again and heal their narcissistic wound. Again, the narcissist's actions may be challenged, but the narcissist's self must be fully accepted.

Heinz Kohut argued that when transformed, injured narcissism leads to creativity, empathy, humor and an acceptance of mortality.