Yeah, but if you really think about it often they became that way because they were abandoned when they were children. They rarely become patients too because they had learned really young that "needing/asking for help" was unacceptable, and in some cases met with abusive reactions from dysfunctional parents. They come to loathe weakness because it triggers them to feeling unworthy and weak somehow when they were children. Often they will lash out at someone who reminds them of that because that is what they got from their parents whenever they needed comfort and caring, so in a way it is a "learned response" they unknowingly imprinted. People to them are often just "property" too because again, that is how they were treated.

Even if a child is raised with too much praise and handed everything and given everything and constantly told they are "the best or better than everyone else", they can develope a sense of "entitlement" unknowingly and look down on everyone, and just get rid of anyone that doesn't "please and praise them".

If you just think about "empathy", well why would they be able to empathize with someone else when no one ever did it with them? Also, to empathize with another person, it requires a person to be in touch with their own hurts and disappointments, well individuals with NPD don't want to feel these feelings, it's to painful and confusing so they "avoid" situations that require them to do so because they just feel too vulnerable. Often there is a deep resentment and an inner sense of, "No one could possibly understand the depths of me, no one could be that intelligent or capable so why bother, they will just hurt me like the ones I grew up with. No not me I am above going down that path, I have figured out how to do just fine without it".