Pathological narcissists are extreme in their narcissistic defenses and behavior. They engage in almost a narcissist feast or frenzy, are totally self-absorbed, lack empathy and display indifference or apathy to the emotional needs of others. Pathological narcissists have a highly exaggerated sense of self and are dominated by such primitive defense mechanisms as guilt, shame, envy, control, domination, splitting, projection, projective identification and paranoid anxiety-including many unresolved Oedipal issues. The major defense is in allowing themselves to be dependent: “I’m quitting this treatment, haven’t learned a damn thing and can get more out of reading a book. Nothing has changed.” To this the therapist might reply, “I understand your frustration, and because you are so very bright and educated it has been difficult for me to help you. Of course you can get it out of a book, but every time I offer you something, you’ve already been there, done it, have it all and know it all. So if you can’t take anything in from that, what then can I offer?”