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Narcissistic Depression: Signs, Risk Factors & Treatment

Published: July 7, 2022 Updated: November 25, 2022
Published: 07/07/2022 Updated: 11/25/2022
Brooke Schwartz, LCSW
Written by:

Brooke Schwartz

LCSW
Headshot of Trishanna Sookdeo, MD, MPH, FAAFP
Reviewed by:

Trishanna Sookdeo

MD, MPH, FAAFP
  • The Connection Between Narcissism and DepressionConnection
  • Signs of Narcissistic DepressionSigns
  • Can Narcissism Cause Depression?Cause
  • Treatment For Narcissistic DepressionTreatment
  • Final Thoughts" class=
  • Additional ResourcesResources
  • Narcissistic Depression InfographicsInfographics
Brooke Schwartz, LCSW
Written by:

Brooke Schwartz

LCSW
Headshot of Trishanna Sookdeo, MD, MPH, FAAFP
Reviewed by:

Trishanna Sookdeo

MD, MPH, FAAFP

While further research is needed to understand the nature of the relationship between narcissism and depression, several characteristics of narcissism — such as inflated sense of self-importance, need for attention and admiration from others, and a tendency to exaggerate achievements — may make narcissists more prone to experiencing depressive symptoms. Narcissists typically develop depression as a result of how others perceive and treat them vs. how they view themselves.

Find a therapist that can help with depression. BetterHelp has over 20,000 licensed therapists who provide convenient and affordable online therapy. BetterHelp starts at $60 per week. Complete a brief questionnaire and get matched with the right therapist for you.

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The Connection Between Narcissism and 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. 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 quite 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 depressive symptoms, they are hostile towards others (rather than toward themselves), are 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 by others.

Here are six signs of narcissistic depression:

  1. Damage to interpersonal relationships
  2. Hostility toward others (e.g., blaming, making accusations)
  3. Suicidal ideation typically triggered by external events (e.g., perceived rejection)
  4. Hostility toward others (but typically not toward self)
  5. Temporary alleviation of depressive symptoms through social contact
  6. Underlying low self-esteem and low self-worth

Help For Depression

Talk Therapy – Get help from a licensed therapist. Betterhelp offers online therapy starting at $60 per week. Get matched With A Therapist


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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 (narcissistic supply)
  • 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. This can be done through a number of therapies, including cognitive behavioral therapy (CBT), which is a structured therapy that helps people adjust thinking patterns and make behavioral changes. 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 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.

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.

Final Thoughts

Although further research is needed, there is clearly a connection between narcissism and depression, with certain narcissistic traits increasing one’s risk of depressive symptoms. If you’re experiencing narcissistic depression or love someone who may be, seeking professional help with a therapist or psychiatrist can help manage symptoms so you can live a more fulfilling life.

Additional Resources

Education is just the first step on our path to improved mental health and emotional wellness. To help our readers take the next step in their journey, Choosing Therapy has partnered with leaders in mental health and wellness. Choosing Therapy may be compensated for marketing by the companies mentioned below.

Talk Therapy 

Online-Therapy.com – Get support and guidance from a licensed therapist. Online-Therapy.com provides 45 minute weekly video sessions and unlimited text messaging with your therapist for only $64/week. Get Started

Online Psychiatry

Hims / Hers – If you’re living with anxiety or depression, finding the right medication match may make all the difference. Get FDA approved medication prescribed by your dedicated Hims / Hers Healthcare Provider and delivered right to your door. Plans start at $25 per month (first month). Get Started

Learn Anti-Stress & Relaxation Techniques

Mindfulness.com – Change your life by practicing mindfulness. In a few minutes a day, you can start developing mindfulness and meditation skills. Free Trial

Choosing Therapy Directory 

You can search for therapists by specialty,  experience, insurance, or price, and location. Find a therapist today.

Choosing Therapy partners with leading mental health companies and is compensated for marketing by Online-Therapy, Hims / Hers, and Mindfulness.com

For Further Reading

  • National Alliance on Mental Illness (NAMI)
  • Narcissist Abuse Support
  • 21 Best Books on Narcissism & Narcissistic Personality Disorder
  • The Psychology of Narcissism: W. Keith Campbell

Narcissistic Depression Infographics

The Connection Between Narcissism and Depression Signs of Narcissistic Depression Treatment For Narcissistic Depression

3 sources

Choosing Therapy strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.

  • Fjermestad-Noll, J., Ronningstam, E., Bach, B., Rosenbaum, B., & Simonsen, E. (2019). Characterological depression in patients with narcissistic personality disorder. Nordic journal of psychiatry, 73(8), 539-545. https://pubmed.ncbi.nlm.nih.gov/31517547/

  • Anastasopoulos, D., & Tsiantis, J. (1999). Supervision of individual psychoanalytic psychotherapy in institutions: The setting, the dynamics and the learning process. Psychoanalytic Psychotherapy, 13(2), 167-183. https://psycnet.apa.org/record/1999-03009-005

  • Huprich, S. K., & Nelson, S. M. (2014). Malignant self-regard: Accounting for commonalities in vulnerably narcissistic, depressive, self-defeating, and masochistic personality disorders. Comprehensive psychiatry, 55(4), 989-998. https://pubmed.ncbi.nlm.nih.gov/24503574/

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Brooke Schwartz, LCSW
Written by:

Brooke Schwartz

LCSW
Headshot of Trishanna Sookdeo, MD, MPH, FAAFP
Reviewed by:

Trishanna Sookdeo

MD, MPH, FAAFP
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  • Treatment For Narcissistic DepressionTreatment
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  • Additional ResourcesResources
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