Attention-deficit/hyperactivity disorder (ADHD) and narcissistic personality disorder (NPD) are two distinct psychiatric conditions that share some overlapping risk factors and symptoms. People with ADHD are known to be at higher risk for personality disorders, including NPD.1,2 Impulsivity, poor decision making, trouble completing tasks, and staying focused are also common features in both conditions, which can complicate the diagnostic process.3
What Is Attention Deficit/Hyperactivity Disorder (ADHD)?
Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that makes it hard for people to sit still, concentrate, and complete tasks without getting distracted. People with ADHD sometimes also struggle with impulsivity. This can cause them to speak or act without thinking and sometimes leads to poor or irresponsible decision making.3 It’s estimated that over 10% of children and 4.4% of adults are diagnosed with the condition.4 ADHD symptoms may be presented in one of three ways–inattentive, hyperactive/impulsive, or combined presentation type.
Some of the symptoms of ADHD include:3
- Persistent trouble focusing and paying attention
- Making careless mistakes or overlooking details
- Seeming to not listen when spoken to
- Not following instructions or following through on tasks
- Difficulty organizing tasks and activities
- Avoidance of tasks that require sustained attention
- Losing or forgetting things
- Fidgeting or trouble sitting still
- Often being ‘on the go’ or acting as if ‘driven by a motor’
- Talking excessively or interrupting people
What Is Narcissistic Personality Disorder (NPD)?
Narcissistic personality disorder (NPD) is a personality disorder that is characterized by arrogance, impulsivity, defensiveness, and a deep need for external validation. While everyone possesses some traits of narcissism, only about 6% of the population has NPD.6 People with NPD often also struggle with a lack of empathy which can cause interpersonal difficulties. At the extreme, some narcissists use, exploit, or even abuse others to get what they want through manipulation tactics, gaslighting, and narcissistic abuse.3,7
Unofficially, there are certain subtypes of NPD that can change the way the traits and tendencies of narcissism are exhibited. Examples include the overt or ‘grandiose narcissist’, the covert or ‘vulnerable narcissist’ and the most dangerous of all, the ‘malignant narcissist’ (antisocial and narcissistic traits). The particular subtype someone has can change the ways their narcissistic tendencies manifest, but the symptoms used to diagnose NPD are the same.3,7
According to the DSM-5, the symptoms of NPD include:3
- A sense of grandiosity or excessive self-importance
- Recurrent fantasies of being powerful, successful, beautiful, or important
- Beliefs of being special and exceptional (and seeking out people of similar or higher ‘status’ or ‘importance’ as them)
- Excessive need for validation, praise, and admiration from others
- A sense of entitlement or feeling like they deserve special treatment
- Exploiting others for personal gain or selfish reasons
- Unable or unwilling to identify with the needs of others (empathy)
- Being envious of others or believing others are envious of them
- Arrogant or haughty behavior, acting better than others
Overlapping Symptoms of ADHD & NPD
Sometimes, people are diagnosed with both NPD and ADHD. However, it is also possible for these conditions to be confused because of overlapping symptoms and similarities between narcissistic and ADHD tendencies.1,2 For example, someone with ADHD may appear disinterested in a conversation because they’re easily distracted, while someone with NPD may do so because they lack empathy for others.3,5,6,7
Impulsivity is another shared symptom for those with ADHD and NPD, and can be displayed in benign or serious ways. This may look like interrupting people or making risky or harmful decisions. Impulsivity is believed to be linked to poor executive functioning, which is possibly tied to an underdeveloped prefrontal cortex, sometimes seen in individuals with both ADHD and NPD.8,9 In either case, this can interfere with a person’s ability to focus, function, complete tasks, and manage their responsibilities.3
Comorbidity of ADHD & NPD
If you’re wondering whether or not it’s possible to be diagnosed with both ADHD and NPD, it is. In fact, studies have shown that having ADHD as a child or an adult makes someone more susceptible to a range of other mental health conditions, including personality disorders.1 NPD has been specifically linked to an increased risk for cluster B personality disorders, which are characterized by impulsive, dramatic, and attention seeking tendencies.2
Narcissistic, antisocial, and borderline personality disorder (or NPD, ASPD & BPD) are all cluster B personality disorders that have been found to co-occur with adult ADHD. While there is stronger research linking ADHD to BPD and ASPD, it’s still likely that people with ADHD are more likely to develop NPD than the general population. It’s possible that shared risk factors including genetic predispositions, childhood trauma, and strict parenting styles help to explain this high correlation.1,2,10
Similarities & Differences Between ADHD & NPD
Despite the high rates of comorbidity between ADHD and other personality disorders, there’s less research to suggest a strong link between NPD and ADHD.1,2 While it’s certainly possible to have both diagnoses, some of the symptoms of ADHD can be mistaken as signs of NPD. Also, while there are some similarities between both disorders, there are also several important differences between the two, especially in the realm of relationship patterns, empathy, and behavioral patterns.11
Key similarities and differences between ADHD and NPD include:
The symptoms of both ADHD and NPD can overlap considerably, but the two disorders are actually very different. For starters, NPD is a personality disorder that causes abnormalities in the way people think, feel, and behave, and tends to have broader consequences in a person’s life.3,10 ADHD is a neurodevelopmental disorder that is believed to be caused by poor executive functioning and cognitive impairments that tend to mostly affect work, school, and task completion.3
ADHD symptoms can cause people to become easily distracted, forgetful, and off-task, resulting in problems at work, school, and even in daily life. While people with NPD often struggle with these same tasks, these tendencies are linked to other traits like impulsivity, a lack of empathy, entitlement, or an inability to take accountability for actions.3,7 The irresponsible, dismissive, and callous behavior in people with NPD is considered ego-syntonic (reflective of their core personalities), while it’s often unintentional in those with ADHD.3,11
Similarities and differences in symptoms, traits, and behavioral tendencies in ADHD and NPD include:3,5,6,11
|Similarities between ADHD & NPD symptoms||Differences between ADHD & NPD symptoms |
|Impulsivity common in both ADHD & NPD||Poor empathy, more exploitation & abuse in NPD |
|People with both disorders may bore easily||More attention seeking behavior in NPD than ADHD |
|People with both disorders seek thrills/sensations||Poor organization more common in ADHD than NPD |
|Higher rates of drug/alcohol abuse in ADHD & NPD||ADHD impairment more common in work/school |
|Irresponsibility & poor time mgmt in NPD & ADHD||NPD impairment more common in social/emotional |
|Distractibility & poor follow through in NPD & ADHD||Grandiosity & arrogance associated with NPD |
According to research, there are important differences in the causes of NPD and ADHD. For example, researchers have found a strong neurological and cognitive link in ADHD. Some studies suggest that ADHD is mainly caused by problems in the areas of the brain responsible for learning, memory, decision making, and concentration.3,4
NPD, on the other hand, is more closely linked to early childhood trauma, specifically overly neglectful and strict parenting or parental overprotection. Both NPD and ADHD have a genetic link, and having a family member with the disorder makes someone more likely to develop it later on in life.1,2,7,11
ADHD is considered much more treatable than NPD. The most common treatments for child and adult ADHD include a combination of therapy and, when needed, medication to improve focus and concentration. Studies on NPD have not been able to identify successful, research-backed approaches that have shown consistent success in treating NPD. Additionally, individuals with NPD are less likely to seek therapy, and when they do, often discontinue early or are disingenuous in ways that prevent progress.4,6,7
How Are Comorbid ADHD & NPD Treated?
All co-occurring disorders require a multi-tiered approach to ensure that the symptoms and issues associated with each condition are understood. While there are currently no evidence-based treatments for NPD, it’s possible that treating ADHD could help people with both conditions.4,6,12 Many of the medications for ADHD are stimulants that can help to improve cognitive functioning, learning, memory recall, and concentration. This may also reduce impulsivity and improve overall daily functioning for someone with ADHD and NPD.4
Finding a therapist who is experienced in both ADHD and NPD is a good idea, especially for someone who is seeking help for comorbid conditions. Consider seeking the help of a therapist when your symptoms begin to interfere with your quality of life, your relationships, work, or other important areas of life. In most states, there are options to see a therapist online or in an office setting, and most health insurance plans help to cover some of the costs associated with therapy.
Therapists use a variety of different approaches, but the one most effective for ADHD is cognitive behavioral therapy (CBT). This short-term, solution-focused approach helps people change unhelpful thought and behavior patterns contributing to their symptoms, and may also be beneficial for people with NPD.6,12
Therapies for comorbid NPD and ADHD may include:6,7
- Schema therapy: Schema therapy addresses old, irrational, or dysfunctional core beliefs, which have been found to play a role in both ADHD and NPD.2
- Family therapy: Family therapy helps to address communication, relationship issues and conflicts that may be caused or worsened by ADHD or NPD symptoms. In some cases, couples counseling can be beneficial as well.
- Mindfulness-based therapies: Therapies like Acceptance and Commitment Therapy (ACT) or Mindfulness Based Cognitive Therapy (MBCT) may also help to teach emotion regulation, stress reduction, while helping to improve other symptoms of NPD or ADHD
Medication for ADHD is often recommended for adults and children who are impaired by their symptoms, and includes both stimulant and non-stimulant options. Stimulant medications are most commonly prescribed (i.e. Adderall, Ritalin, Vyvanse, etc.) and can help improve energy and focus. However, it is important to note that these also have addictive qualities and should only be taken as prescribed by a doctor.4
Non-stimulant options include drugs like Strattera or other off-label SSRI or SNRI medications, which are commonly used for depression and anxiety. There are no approved medications for the treatment of NPD, but many with the disorder are on medication for another co-occurring disorder.4,6,7
How to Cope With Comorbid ADHD & NPD
It’s recommended for people with comorbid ADHD and NPD to seek help from a professional therapist. It is beneficial to take the time to find a therapist who is experienced, as well as a good personal fit for their needs and preferences. Aside from seeking professional help, there may also be some things people with ADHD and NPD can do on their own to cope and manage their symptoms.
Below are tips for coping with comorbid NPD & ADHD:
- Practice a mindfulness or meditation routine: Mindfulness and meditation are simple exercises to help you focus on the here-and-now, instead of getting distracted by thoughts in your head. Even 15 minutes of mindfulness or using a meditation app can help to curb stress, improve focus, and be more productive.
- Set a routine & schedule: Many people who struggle with ADHD and NPD have a hard time staying organized and managing their time well. This is easier when you have a set routine and schedule that you follow. Using to-do lists, planners, and calendar reminders can help you stick to it.
- Journal and self-reflect: People with ADHD and NPD tend to become so distracted that they rarely take time to self-reflect, spend time alone, and introspect through journaling. These practices are important because they help to build self-awareness, while also providing an outlet for stress and difficult insecurities.
- Minimize external distractions: Minimizing distractions and screen time can be hugely beneficial for those who struggle with concentration and staying on-task. Try decluttering your workspace, turning screens and notifications off, and creating a less distracting workspace when you need to focus and get things done.
- Practice single-tasking: Single-tasking is the practice of devoting your full, undivided attention to a task. This can be very beneficial for your brain, focus, and productivity. Try this by training your attention to the task you’re doing and each time your mind wanders, gently bringing it back to the task at hand.
- Maintain self-compassion & self-care: Self-compassion is the practice of self-kindness, and self-care involves a range of activities that help you meet your physical and emotional needs in healthy ways.
There are some interesting links between ADHD and narcissism, including overlapping symptoms, shared risk factors, and higher rates of comorbidity than seen with other conditions.1,2,3 The only way to determine for sure if you have comorbid NPD and ADHD is to get diagnosed by a licensed mental health or medical clinician. From there, you can explore what treatment options are best for you.