Key Points

• Recent research finds that pathological narcissism, both grandiose and vulnerable, increases one’s risk of depression.
• Impaired emotional processing appeared to lead to a particularly high risk of depression in vulnerable narcissists.
• It could be especially challenging for vulnerable narcissists to seek help.
• However, vulnerable narcissists could benefit from developing resilience, overcoming negative self-image, and coming to terms with shame.

In proportion, narcissism is healthy, bolstering secure attachment with a positive self-image, adaptive responses to embarrassment, a sense of pride and gratitude toward oneself for self-efficacy, and a balanced interest in one’s appearance, accomplishments, and social standing.

In excess, narcissism becomes pathological, creating a situation where it isn’t possible to get along with others. Extreme needs to be liked and admired coupled with an inability to see one’s flaws clearly, either denying or exaggerating them (or both), makes it difficult to own it and move forward constructively. Rather than accepting shame as a normal, even useful emotion (e.g. for social learning), shame becomes warped, proof of one’s utter reprehensibility to a near-delusional extent.

Narcissism and Depression

As reported by researchers Kealy, Laverdière, and Pincus (2020), pathological narcissism increases the risk of depression. How this happens is not known. It has been hypothesized that difficulty dealing with emotions may be at the root of the problem.

Narcissism has two related but distinct dimensions: grandiose and vulnerable. Grandiose narcissism covers the arrogant personality often referred to by crass epithets, characterized by an inflated ego, the tendency to exploit others, and a sense of being genuinely superior. Such grandiosity appears to be innate and authentic.

Vulnerable narcissism, on the other hand, often arises out of childhood adversity, trauma, and neglect, evoking empathy and caregiving from others—for a time. Vulnerable narcissists understand the idea of empathy but expect it from others without seeing the give-and-take, leading to victimhood and disappointment. Those around them often end up feeling burned-out, bitter, and finally just done.

The authors discuss different theories connecting narcissism and depression. Narcissistic individuals may not effectively process feelings about themselves personally and regarding social situations. Negative feelings get stuck, building up over time.

Wanting to hide their flaws, they maintain a front with others while inside growing more distant and depressed. Depressive states interfere with feeling in control and throw off behavior in social and work settings, further driving the cycle.

What’s Going On?

Given the lack of research looking at links among narcissism, emotions, and depression, Kealy and colleagues designed a preliminary study of 99 outpatients being treated at publicly funded mental health clinics in Vancouver, Canada. They recruited a “convenience sample” of patients in the order they started treatment, good for a pilot study but less robust than follow-up studies would be. The participants were 70 percent White females, around 36 years old on average.

Measures included: the Pathological Narcissism Inventory, covering grandiosity and vulnerability; the Emotional Processing Scale, looking at five factors of 1) emotional suppression, 2) unprocessed feelings, 3) poorly regulated emotions, 4) avoidance of feelings, and 5) reduced (“impoverished”) emotions; and the Patient Health Questionnaire, which assesses core depression symptoms, including an additional question about the negative impact on social functioning.

Findings

Overall, grandiosity and vulnerability were related, but distinct. Both were also correlated with an increased risk of depression. There were several interconnections: vulnerability with emotion suppression and unprocessed emotions; depression with unprocessed emotions; poorly regulated emotion with grandiosity, vulnerability, and depression; and impoverished emotional experience with grandiosity, vulnerability, and depression.

They used these basic correlations to find the best statistical model. The model showed impaired emotional processing increased the risk of depression only for vulnerable narcissism. Failing to process emotions was the only significant emotional processing factor mediating the relationship between vulnerability and depression.

Furthermore, vulnerable narcissism correlated with social impairment via unprocessed emotions, as well as from the depressive symptoms themselves. Grandiose narcissism was correlated with depression risk, but not through emotional processing.

Relevance

These results suggest that people with vulnerable narcissistic traits become more easily depressed because they don’t work through their feelings properly. The authors highlight that narcissistic vulnerability, with heightened sensitivity to negatives, amplifies and sustains unpleasant mental states. Preoccupation with oneself diverts resources that could otherwise be used to drive adaptive responses.

Grandiose narcissism is related to depression, but not because of how emotions are processed. Especially in more severe cases, pathological grandiosity leads to personal and professional failure, isolation and loneliness, and lack of accomplishment. These outcomes may trigger depression independent of how emotions are managed.

With greater narcissistic vulnerability comes increased pessimism, a weakened sense of self-control, greater shame and isolation, and ineffective help-seeking. People with vulnerable narcissism often reject help to prevent feeling needy or dependent, which makes them feel more vulnerable and shameful. This typically drives people away by burning out their empathy and making them feel unappreciated. In the absence of understanding the repeating pattern, this in turn may trigger acute disappointment, anger, and indignation at perceived abandonment. It is on top of everything else a confusing experience due to lack of insight and over-reliance on blame and self-hatred to make sense of things.

Moving Away from Vulnerable Narcissism

People suffering from vulnerable narcissism have a difficult but not impossible task. Understanding the distortions which come from failure to process emotions, however painful, is necessary in order to recognize what isn’t working and replace it with adaptive strategies and habits. Pain itself is not necessarily useful but often goes with the territory, until one gets past the masochistic habits and learns greater self-acceptance, gratitude, and forgiveness, or at least is heading in that direction. Managing emotional pain in healthy ways is key. Self-compassion is a powerful tool here.

It is important to address underlying developmental trauma, depression, anxiety, and related psychiatric illness, along with learning to interrupt repetitive negative thinking and institute positive reappraisal. It is a tough problem to gain any traction with, because the depressive view feels more real, and more valid, than any optimistic perspective. In fact, hope is often met with mistrust and arrogance, and those offering hope are seen as incompetent, even adversarial, or worse.

Fostering resilience, taking a leap of faith to believe in oneself if possible, overcoming negative self-image to reach out for and accept help, adopting a posttraumatic growth approach, coming to terms with shame, and ultimately building a sense of security and agency, is a different way of life.

For those with strong vulnerable narcissism, facing shame and risking rejection and failure is a big ask. Although a challenging path, for many it is a better opportunity than standing still. As we move on in life, it becomes harder to put off facing ourselves. Time wanes, we grow wiser and less able to ignore what is important, and the demands of family and work allow us to draw on our resources in previously unseen ways. In short, learn to make good use of your emotions, and yourself

Originally published in Psychology Today on February 9, 2020

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