Are Narcissism And Depression Connected?

Medically reviewed by Elizabeth Erban, LMFT, IMH-E
Updated June 17, 2024by BetterHelp Editorial Team
Please be advised, the below article might mention trauma-related topics that include suicide, substance use, or abuse which could be triggering to the reader.
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While narcissism and depression each have several causes and symptoms, questions may be raised about whether the two are connected. Both narcissism and depression can impact an individual's mental and emotional well-being. When taken to extreme levels, narcissistic traits and depression can impede an individual's ability to function in daily life. If you're experiencing narcissistic tendencies and depression simultaneously, you may be interested in learning about the similarities and differences between the two.

Do you struggle to maintain healthy interpersonal relationships?

What is narcissism?

Narcissism and narcissistic personality disorder are two concerns often conflated with each other. Narcissism is a personality trait involving narcissistic tendencies and behaviors with self-serving and non-empathetic tendencies. Narcissistic personality disorder is a personality disorder from the DSM-5 in which people have an inflated sense of self-importance, a need for excessive attention and admiration, troubled relationships, and a lack of empathy for others. 

In some cases, individuals who experience narcissistic tendencies may also experience arrogance, impatience, and a desire to gain the approval of others. Narcissistic behaviors may also manifest in the form of thinking that one is entitled to special treatment, not entitled to others around them. 

Pathological narcissism vs. narcissistic personality disorder (NPD) 

Although sometimes conflated, narcissistic personality disorder and pathological narcissism are different. Narcissistic personality disorder is a clinical diagnosis. It's listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which clinicians use to diagnose and treat patients.

Pathological narcissism is an umbrella concept used in clinical psychological research to capture all the symptoms which may be seen in someone with this type of personality disorder. It contains the symptoms of narcissistic personality disorder and other qualities not captured in that clinical diagnosis. There are two subtypes within pathological narcissism, including grandiose and vulnerable narcissism (sometimes called covert narcissism). 

What is grandiose narcissism? 

Grandiose narcissism is defined primarily by grandiosity. Grandiosity refers to an exaggerated sense of self-importance. There may be overlapping symptoms between grandiose narcissism and narcissistic personality disorder, such as a lack of empathy and exploiting others. 

What is vulnerable narcissism? 

The symptoms of vulnerable narcissism differ from grandiose narcissism and narcissistic personality disorder. For example, those experiencing these tendencies may experience a range of negative feelings not seen in the grandiosity subtype, such as intense shame when criticized or rejected (hypersensitivity).

This feeling of shame may be experienced when they are slighted, embarrassed, or criticized and can result in low self-esteem, in which the person reacts with rage or disdain and spitefully counterattacks. People with vulnerable narcissistic traits may be self-critical and shy. They might also dislike social situations and other people, making it harder to form genuine relationships. 

A person with vulnerable narcissistic tendencies may be introverted, moody, and neurotically averse to criticism. However, they may crave adoration, act arrogantly, have superficial relationships, and take without giving. They may be capable of a specific form of empathy referred to as dysfunctional empathy. 

What is dysfunctional empathy? 

Empathy is often thought of as a purely emotional phenomenon. For example, an empathetic person might see someone crying and feel their distress. However, there are multiple types of empathy, including cognitive empathy, where you can imagine the reasons behind someone's emotions, such as their goals, beliefs, and values. You may see the situation from their perspective without feeling emotional attachment. 

This theory of empathy is called the theory of mind, and it differentiates people with narcissistic tendencies from those with manic ones. According to growing research, those with covert narcissistic tendencies have impaired emotional processing, meaning they possess cognitive but not emotional empathy. They can decipher why someone may feel a certain way, but it may not impact their emotional state. 

Researchers have also found that a dysfunctional form of empathy can be seen in vulnerable narcissism. Some experts believe pathological narcissism should be recognized as a continuum and that individuals with clinical or pathological narcissistic traits may alternate between grandiosity and vulnerability. For this reason, some believe the DSM definition of narcissistic personality disorder should be revised.

Can narcissism be cured or treated?

There is no one precise cure or treatment for narcissism, and it can be challenging to treat. Many people with narcissistic tendencies or an NPD diagnosis may not believe they need treatment. For treatment to work, therapists often believe clients must be willing to improve and better themselves to overcome their symptoms. However, personality disorders can be manageable with treatment, and a few studies on DBT have found it beneficial in treating symptoms of narcissistic personality disorder (NPD). 

What is depression? 

Depression is a mood disorder that causes persistent sadness and loss of interest in previously enjoyed activities. It is experienced by over 280 million adults worldwide. Individuals living with depression often experience mental, emotional, and physical distress. Symptoms can impede their ability to function in day-to-day life and enjoy basic pleasures, such as workplace satisfaction and healthy relationships with others. 


There is a plethora of symptoms associated with depression. In many cases, depressive symptoms include, but are not limited to, the following:

  • Self-loathing 
  • Insomnia or hypersomnia 
  • Appetite changes
  • Relationship conflict
  • Feelings of hopelessness or worthlessness
  • Lack of interest in previously enjoyed activities
  • Difficulty with self-care
  • Anxiety or worry 
  • Weight changes
  • A profound sadness that doesn't go away 
  • Isolation and withdrawal 
  • Suicidal thoughts*

Depression can be long-term and potentially serious. Back pain, headaches, difficulty concentrating, and fatigue are other symptoms of this condition. 


In many cases, treatment for depression includes therapy or medication. Sometimes, a combination of therapy and medication can benefit those experiencing depression. During therapy sessions, clients may work with a specialist who gets to know them and their symptoms. The therapist can use their professional judgment to determine the root of depression and the treatment plan that may be most effective. 

Medication for depression can vary depending on various circumstances. While many people benefit from this form of treatment, medication should only be prescribed by a licensed doctor. Contact a medical doctor for consultation if you're considering starting, changing, or stopping any medication.

Is there a connection between narcissism and depression?

Both narcissism and depression can be clinical mental health issues that may require professional support. However, depression is often easier to treat and recover from. Many people who experience depression are interested in improving themselves and making a change. However, people experiencing narcissistic personality disorder may struggle to see a reason to change.

However, there is a connection between NPD and depression. The American Journal of Psychiatry states that vulnerable narcissism significantly overlaps with anxiety and depression symptoms. According to researchers at Harvard Medical School, major depressive disorder is the most common comorbid disorder for patients diagnosed with pathological narcissism or NPD.

These findings regarding depressive feelings and co-occurring depression in psychiatric outpatients with clinical narcissism mainly apply to those who present the vulnerable narcissism subtype. The comorbid conditions associated with grandiose narcissism include antisocial personality disorder and substance use disorders. Below are some of the other commonalities between pathological narcissism and depression symptoms.

Profound distress 

Profound distress can be another symptom common between those with depressive disorders and those diagnosed with NPD. Low self-esteem is a symptom of depression and narcissism. The difference is that narcissistic behaviors may be a front to mask the low self-esteem an individual experiences. Not all people with NPD or narcissistic traits may experience low self-esteem, but it can be a common factor. 

While low self-esteem may be more apparent in cases of depression, people with narcissistic tendencies may use overconfidence or grandiosity to avoid their feelings about themselves. They might showcase an excessive need for admiration, the compulsion to feel superior to others, and feelings of entitlement. Someone with high self-esteem and self-worth might not feel the need to seek out validation from others habitually, which is where narcissistic traits and self-love differ. 

Damage to interpersonal relationships

Another connection between narcissism and depression exists in the form of damage to interpersonal relationships. In many cases of depression, individuals may isolate themselves, withdraw from activities they love, and behave in manners that are concerning to those around them. These behaviors might cause distancing in relationships or conflict. 

NPD is also associated with conflict in personal relationships in a different manner. These individuals often use lying, bullying, and cheating to get what they want. They might also believe that rules are for others and that they can do whatever they want. After witnessing this behavior, others might choose to leave a relationship with someone with narcissistic traits. Instead of apologizing or looking inward, the person with narcissistic tendencies may blame others or their environment. 


One of the most common depressive symptoms is difficulty feeling positive emotions. Those in a depressive state may report being unable to feel motivation, consummatory pleasure (enjoyment), or anticipatory pleasure (excitement). This state is referred to by professionals as anhedonia.

A study from 2018 found a positive association between pathological narcissism and anhedonia, providing one more commonality between depression symptoms and symptoms of narcissism. In another study from 2020, researchers found a link between pathological narcissism and depression when it came to unprocessed emotions. The unprocessed emotions of someone with covert narcissistic traits may play a "mediating role," giving rise to intrusive negative feelings, potentially leading to depression. 

Substance use disorders 

Clinical depression and pathological narcissism are often comorbid with various substance use disorders, including alcohol use disorder. A 2019 study of college students found that those who tended to devalue others and hold a sense of self-entitlement were more likely to experience this mental health condition. 

Do you struggle to maintain healthy interpersonal relationships?

Counseling options for depression and NPD  

When experiencing symptoms of NPD, a depressive disorder, or both at once, seeking professional counsel and guidance may be beneficial. If you're feeling shameful or struggling to find a counselor within your budget or location, you can also try to find an online therapist. Through a platform like BetterHelp, you can meet with a licensed therapist from home through phone, video, or chat sessions with your provider. 

Research has looked at the effectiveness of online therapy. One study found that online therapy for depression, panic disorder, social anxiety disorder, and generalized anxiety disorder is as effective as face-to-face therapy. Another study found that online therapy is a practical alternative to face-to-face treatment for cluster B personality disorders like NPD and borderline personality disorder (BPD). 

You can partake in online therapy without commuting to an office and saving money on gas or parking. With an internet connection and personal device, you can meet with your therapist anywhere in the world. For many, being able to see a provider from home can bring a sense of discreetness and safety.

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Depressive disorders and narcissism can have some symptoms in common. However, before self-diagnosing, consider reaching out to a therapist for guidance. Mental health conditions can often be treatable or manageable with professional support if you are willing to put in the work to make changes. You can contact a therapist at any time in your area or online to get started.
Depression is treatable, and you're not alone
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