I’m not a psychiatrist, so this is all observational for me, but my father is a narcissist so I can at least tell you what he’s like.
In conversation, or any interaction, if the topic veers into anything that my father can’t relate to or isn’t aware of from his own personal experience, he immediately reframes the topic so it’s about him. This consistently happens in the middle of a conversation, and it usually interrupts someone speaking. The interruption is always unrelated to what the person was actually saying, so after he interrupts you can always see the person he cut off deflate and shrink away from the conversation. Because it’s clear he wasn’t participating in a two-sided conversation, he was just waiting his turn to cut in and take over.
He manages to come across as caring, but that’s only because he knows exactly how to act so he appears that way. But his motivation is only to be praised for his apparent empathy, because if you probe his behavior even a little bit, it’s like a switch is flipped and he goes into a full on angry defensive mode.
For example, a close family member is dying, and he is the only one available to care for them. And he is taking care of them physically, don’t get me wrong, I appreciate that, but whenever another family-member asks for an update on their condition, his framing is always about what he has done and how he has learned what to do in a particular situation, it’s never about the condition of our dying family member.
He takes credit for every idea and new concept he comes across, even if the person who gave him the idea is in the room with him. It sometimes even happens in the same conversation.
Anyway, those are just my personal experiences living with an extremely difficult and selfish father who is incapable of thinking genuinely about other people. I learned a lot about myself and him by reading Adult Children of Emotionally Immature Parents. Worth a read even if you’re not thinking about a parent.
Oh yeah, that last point rings true for my dad too. My family hired a health aid to assist with our relative who he’s helping care for in home hospice, and we fought with him for weeks to defer to the aid’s expertise. He believes, despite the fact that this is literally her career, that he knows better how to take care of someone on their deathbed. Despite not having gone through it before, or having any medical or healthcare experience. He would snap at the aid for showing him how to do something.
We ultimately had to have a heart-to-heart with the aid to apologize for his behavior and to teach her how to use his own narcissism against him so he would do things the right way.