In a study published in the Journal of Psychiatric Research, researchers investigated the prevalence of narcissistic personality traits among adults with attention deficit hyperactivity disorder (ADHD). They found that a notable proportion of ADHD patients exhibited signs of narcissistic personality disorder and that these narcissistic traits were particularly associated with symptoms of hyperactivity and impulsivity, rather than inattention.
ADHD is a prevalent neurodevelopmental condition characterized by persistent patterns of inattention, hyperactivity, and impulsivity. Affecting approximately 2.8% of adults globally, ADHD often leads to significant functional impairments in social, emotional, and professional domains. Symptoms typically manifest in childhood and can persist into adulthood, where they continue to impact daily functioning.
Narcissism, on the other hand, is a complex personality trait that involves an inflated sense of self-importance and a deep need for admiration and validation. Grandiose narcissism is characterized by overt expressions of superiority, dominance, and entitlement. Individuals with grandiose narcissism often display high self-esteem, confidence, and a desire for attention and admiration.
On the other hand, vulnerable narcissism involves a more covert form of narcissism, marked by sensitivity to criticism, feelings of inadequacy, and a constant need for reassurance. Individuals with vulnerable narcissism often experience intense shame, anxiety, and depression, and they may react defensively or withdraw in response to perceived threats to their self-esteem.
Previous studies have highlighted significant associations between ADHD and various personality disorders, including borderline, schizotypal, antisocial, and histrionic personality disorders. Among these, narcissistic personality disorder stands out due to its potential impact on self-esteem regulation and interpersonal functioning. Given that narcissism encompasses both grandiosity and vulnerability, understanding its relationship with ADHD could offer valuable insights into managing these patients more effectively.
Despite existing knowledge on the coexistence of ADHD and personality disorders, few studies have explored the specific connection between ADHD and narcissistic traits. The new study aimed to fill that gap by examining the prevalence of narcissistic pathology in adult ADHD patients and exploring its associations with ADHD symptoms and outcomes.
The study involved 164 adults diagnosed with ADHD, seeking treatment at a specialized unit for adult ADHD and borderline personality disorder. Participants were predominantly female (63.4%) with an average age of 36.5 years. The study included only those who met specific inclusion criteria: being at least 18 years old, having a confirmed diagnosis of ADHD, and providing informed consent for the use of their health data in research.
To assess ADHD, researchers used the ADHD Child Evaluation Plus (ACE+), a semi-structured diagnostic interview that incorporates criteria from both the International Classification of Diseases (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Additionally, participants with symptoms of borderline and narcissistic personality disorders were evaluated using the Structured Clinical Interview for DSM-IV Personality Disorders adapted for DSM-5 (SCID). Narcissistic traits were measured using two self-report tools: the Narcissistic Personality Inventory (NPI) and the Pathological Narcissism Inventory – Brief form (PNI).
The study also collected data on various other psychiatric disorders, including major depressive disorder, bipolar disorder, anxiety disorders, obsessive-compulsive disorder, post-traumatic stress disorder, autism spectrum disorder, and substance use disorders. Participants’ demographic information, such as age, gender, education level, employment status, and marital status, was also recorded.
The study revealed that 9.5% of the ADHD patients had narcissistic personality disorder, a prevalence significantly higher than the general population’s estimate of about 1%. Furthermore, narcissistic traits, as measured by the PNI, showed strong associations with ADHD symptoms related to hyperactivity and impulsivity, but not with inattentive symptoms. Both narcissistic grandiosity and vulnerability were linked to these ADHD dimensions.
Narcissistic traits were also associated with several adverse psychosocial outcomes, including anxiety, depression, impulsiveness, and lower quality of life. Notably, narcissistic vulnerability was particularly connected to emotion dysregulation and a history of hospitalization, suicide attempts, and non-suicidal self-injury. These associations persisted even after adjusting for the presence of borderline personality disorder, suggesting that narcissistic vulnerability has a unique impact on the clinical severity of ADHD.
While this study provides valuable insights, it has some limitations that should be considered. First, the sample was predominantly female, which may not represent the broader population of adults with ADHD. Additionally, the high prevalence of borderline personality disorder in the sample could have influenced the findings, given the overlapping symptoms and comorbidities between these disorders.
Future research should aim to include more diverse and representative samples, with balanced gender distributions and broader assessments of various personality disorders. Longitudinal studies could also help clarify the developmental trajectories and causal relationships between ADHD, narcissistic traits, and associated psychosocial outcomes. Additionally, investigating the neurobiological underpinnings of these associations could provide deeper insights into the shared mechanisms driving these complex interactions.
“However, despite these numerous limitations, we believe that our results may be of interest, especially when considering the scarcity of research conducted on narcissism in ADHD,” the researchers concluded. “Indeed, they provide novel and significant insights on an understudied and potentially important aspect of personality pathology in adult with ADHD and could serve as a basis for future research.”
The study, “Adult ADHD and pathological narcissism: A retrospective-analysis,” was authored by Miguel Duarte, Martin Blay, Roland Hasler, Eleonore Pham, Rosetta Nicastro, Marlène Jan, Martin Debbané, and Nader Perroud.
