So why are some narcissists sadistic and others not? In my clinical experience, I have found that sadistic narcissists were more seriously neglected or emotionally abused in childhood than other narcissists. Many narcissists are difficult to get along with, have a grandiose sense of self, and won’t take accountability for their actions, but they don’t have a driving need to punish others. I have found that the sadistic narcissist has lower self-esteem than the non-sadistic narcissist, even though neither truly has high self-esteem. The most important point to understand is that the drive to punish or upset others on a regular basis typically stems from an individual having been on the receiving end of confusing, mind-twisting behavior from a parent early in life.