This double blind randomized clinical trial with 84 participants, revealed that mental patients diagnosed with narcissism, and narcissistic celebrities mirror each other’s paranoid, obsessive and histrionic symptomatology, grandiosity, manipulative charm, and inner emptiness. Elite narcissists manifested insidious sadism in the absence of depressive affect, while the narcissistic patients were differentiated by their depressive and masochistic symptomatology. Elite nar-cissists demonstrated advanced empathic skills, contradicting past literature. However, their empathic advantage appeared void of compassion, merely employed as a self-serving tactic to exploit, intimidate and subordinate. Both experimental narcissistic groups evidenced more prevalent psychopathology, yet, higher achievement, efficacy and ambition than their reciprocal control groups, confirming the narcissists’ finesse in concealing psychopathology un-der the brilliance of their pseudo-superiority. The main danger is the affinity between masochism and sadism, bonding low and high functioning narcissistic counterparts to endlessly feed from each-others’ pathology, forming dysfunc-tional interpersonal relationships, cults or disintegrating societies. This sado-masochistic dependency also reflects several countries’ authoritarian trends, where narcissistic constituents’ unyielding loyalty elevates idolized leaders to power, preluding the establishment of toxic tyrannical governments.