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Narcissism is increasingly conceptualized as a dynamic, multidimensional configuration of the self encompassing both grandiose and vulnerable expressions. Whereas grandiosity reflects self-enhancement, assertiveness, and defensive distancing from self-conscious affect, vulnerability is marked by hypersensitivity, contingent self-esteem, and emotional fragility. Across psychoanalytic, developmental, and interpersonal models, shame, rather than guilt, has long been theorized as the central affective process organizing narcissistic self-regulation, yet empirical findings had not been systematically integrated. This systematic review synthesized 27 empirical studies examining associations among narcissism, shame, and guilt across nonclinical and clinical samples, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. In nonclinical populations, a consistent pattern emerged: Vulnerable narcissism showed moderate-to-strong positive associations with shame, indicating that shame constitutes its core organizing affect. Grandiose narcissism, particularly when assessed with the Narcissistic Personality Inventory, demonstrated small negative associations with shame. When grandiosity was measured with maladaptive instruments (e.g., the Pathological Narcissism Inventory), links with shame were more variable, reflecting a more affect-reactive and clinically proximal form of grandiosity. Clinical studies showed that narcissistic personality disorder showed low shame and guilt proneness but high shame aversion together with elevated implicit state shame suggesting that grandiosity co-occurs with a latent, easily activated vulnerability to shame. Clinical vulnerability was strongly linked to internalized shame, as well as depressive symptoms and suicidal ideation, underscoring shame's central role in emotional collapse and clinical risk. Overall, findings demonstrate that shame, rather than guilt, is the primary affect differentiating and regulating grandiose and vulnerable narcissistic states across the continuum from personality style to disorder.