Suicides in narcissistic personality disorder (NPD) have been associated with suddenness, determination, and high risk for lethal outcome. In addition, major mental illness, which is typically associated with suicidality, may not be present. The aim of this article is to identify and discuss certain conditions and characteristics in pathological narcissism, especially those related to emotion processing, self-esteem regulation, and internal control, which jointly contribute to the specific characteristics of suicides in NPD. Hypervigilance and emotion intolerance can challenge self-esteem, and readily evoke intolerable internal subjective experiences of failure and entrapment, which contribute to sudden and drastic decisions to end life. Glorification of death, dying, and afterlife, can also serve as instigation for initiating suicide. On the other hand thoughts of suicide can also serve an organizing and controlling function in people with NPD and prevent suicidal intents and actions.