Narcissistic Depression: Signs, Risk Factors & Treatment

What Is Narcissism?

Narcissism is a personality disorder involving severe low self-esteem that masks as extreme self-obsession. It is a challenging personality type for many to deal with, however the narcissist themself typically doesn’t have any issues with having this personality style. Narcissistic people tend to have trouble with their personal and professional relationships as a result of lacking awareness of themselves. They often underestimate the negative impact of their actions or words on other people.

What Is Depression?

Depression is a serious mental health condition in which someone can experience many harsh symptoms such as drastic changes in their sleep, poor emotional regulation, and withdrawal from people and places they once enjoyed. People who struggle with depression often feel a very low mood and have no interest in activities they once enjoyed. Due to lack of motivation, many stop paying bills, cleaning their living space, or taking care of themselves personally.

The Connection Between Narcissism & Depression

Several studies demonstrate a relationship between narcissism and depression. One found that nearly 29% of those with narcissistic personality disorder (NPD) also had a mood disorder, and about 7% of those had major depression.¹ Another study found the prevalence of NPD in those with major depression to be between 0-16%.¹ Further research is needed to fully understand the nature, direction, and strength of the relationship.

Narcissism involves a desire to meet grandiose expectations and receive external attention and validation (i.e., narcissistic supply). Narcissists base their self-worth on such treatment.² When not received, they may experience depressive symptoms like shame and isolation. Further, because narcissism is often the result of attachment disorders and a history of abuse or neglect, narcissists may also be more susceptible to depression.

Despite presenting with confidence and high self-esteem, narcissists tend to have underlying low self-esteem and self-worth — both of which are symptoms of depression — that often go unacknowledged and untreated due to them presenting as the opposite.

Vulnerable Narcissism & Depression

Vulnerable narcissists tend to be most at risk of developing depression. They’re often introverted, sensitive, and prone to experiencing anxiety and shame. They may also struggle to maintain close friendships as they focus heavily on themselves, require attention, and are hyper-sensitive to perceived criticism. Their lack of insight into these patterns may lead them to feel disappointed, underappreciated, ashamed, angry, and lacking in external validation.³

Signs of Narcissistic Depression

Someone may be experiencing narcissistic depression if, in addition to having depression symptoms, they are hostile towards others, destructive interpersonally, and feel a temporary alleviation of symptoms with increased social contact. Whereas someone with non-narcissistic depression may experience suicidality resulting from general hopelessness or low self-worth, those with narcissistic depression tend to experience suicidality in response to external factors, such as perceived criticism or abandonment.

Signs of narcissistic depression can include:

• Damage to interpersonal relationships
• Hostility toward others (e.g., blaming, making accusations)
• Suicidal ideation typically triggered by external events (e.g., perceived rejection)
• Hostility toward others (but typically not toward self)
• Temporary alleviation of depressive symptoms through social contact
• Underlying low self-esteem and low self-worth
• Reactive or situational depression

Narcissistic Injury & Narcissistic Rage

Narcissistic injury refers to a severe emotional pain that a narcissist experiences after being rejected, criticized, or abandoned. This kind of injury is vulnerable, and it exposes the shame and insecurity that they work so hard to conceal. To cope with this challenging injury, they may withdraw, gaslight, or become extremely aggressive toward others.

With that, narcissistic rage may include any combination of screaming, threatening, physically abusing, or being hostile toward others. This rage is disproportionate to the event at hand and is often used to control or manipulate people. You may find yourself doing everything you can to avoid setting off this rage, but triggers can seemingly change overnight, leading you to feel like you have to “keep guessing” what will keep the narcissist happy.

Can Narcissism Cause Depression?

While research has yet to demonstrate that narcissism causes depression, such causation is likely. Narcissists perceive themselves as omnipotent, accomplished, irresistible, immune, and invincible. The function of these beliefs is to mask underlying low self-esteem and insecurity. When narcissists are confronted with criticism, neglect, lack of control, or unmet needs, they may experience narcissistic injury, which is an emotional response to perceived attack or defeat.

Rather than processing the emotional experience, narcissists often project, rage, ice out, or become passive aggressive. These defense mechanisms help them avoid the reality of their trauma and shame (but may in turn contribute to the development of depressive symptoms.)

One explanation for why this may happen is that narcissists rely on the attention and praise of others due to their inability to validate themselves or find internal self-worth. This loss may send a narcissist into a depressive episode, as the accuracy of their view of themselves has been challenged.

Narcissistic traits that may increase the risk of depression include:

• Grandiosity
• Inflated sense of importance (to mask underlying insecurity, shame, and vulnerability)
• Avoidance of experiencing emotions such as shame
• Need for attention and admiration
• Sense of entitlement
• Tendency to exaggerate achievements
• Tendency to demean, intimidate, belittle, or bully others (which may lead the narcissist to be rejected by peers)
• Lack of empathy

Treatment For Narcissistic Depression

Treating both narcissistic and depressive symptoms is critical. It’s worth noting that there is no medication that treats narcissism; however, medications for depression (such as SSRIs) may alleviate depressive symptoms, making it more possible to address narcissistic ones.

Therapy Options for NPD

Finding the right therapist is critical for individuals experiencing narcissistic depression. It’s important to seek a mental health professional who has experience working with narcissism and its interplay with depression. Therapists who specialize in treating NPD can help individuals understand how their narcissistic traits contribute to depressive symptoms and develop strategies to manage both effectively.

Online therapy platforms offer an accessible and convenient way to start treatment. These platforms provide flexibility in scheduling and privacy, which may make it easier for individuals with narcissistic traits to engage in therapy. They also expand access to therapists with specific expertise, allowing individuals to find a professional who understands their unique challenges.

Through therapies like cognitive behavioral therapy (CBT), individuals can address unhelpful thinking patterns, work through depressive symptoms, and develop healthier ways to cope. While medications like SSRIs can alleviate depression, therapy plays a vital role in addressing the underlying traits of narcissism, offering a comprehensive approach to treatment.

Barriers to Treatment for Those With NPD

Therapy and medication are resources that may make life more rewarding and enjoyable for someone with depression and narcissism. However, because narcissists typically don’t notice or care about their narcissistic traits, they don’t often seek treatment for them. They’re more likely to reach out to professionals about depressive symptoms. Still, some narcissists might find it difficult to engage in or follow through with treatment because of perceived insults.

Other Coping Strategies

In addition to therapy and medication, a number of strategies may help a narcissist combat depression. Working on receiving and processing feedback from trusted loved ones may help with depressive symptoms. This may involve changing body posture (e.g., unclenching teeth, relaxing shoulders) to signal to the brain that receiving “negative” or “difficult” feedback isn’t unsafe.

Journaling is another strategy that may help a narcissist combat depression, as this involves reflecting honestly and privately on their emotional experience (which narcissists rarely do, preferring to project instead of confront their emotions.)

Finally, it’s important for narcissists experiencing depression to enact healthy routines, such as ones related to sleep, eating, exercise, and substance use. Staying engaged in a healthy and consistent schedule helps regulate mood, reduce stress, and avoid temptation to isolate or become sedentary.