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Narcissism is significantly related to overall interpersonal distress. As such, a person with NPD may experience persistent strain on interpersonal relationships, as people with NPD tend to project antagonistic and controlling behaviors and have a hard time empathizing with others. However, a person with the narcissistic characteristic of being overly nurturing also finds hardship in interpersonal relationships because of their strong and intrusive approach to achieving intimacy or status. Therapy for pathological narcissism may prove to be difficult, as significant interpersonal impairments in patients with NPD require creativity and modification in order to adapt to the relational struggle.