February 11, 2025
Narcissistic personality traits are curbed, and empathy improved, by the use of stimulant medication in adults who have ADHD, according to a small study published in Alpha Psychiatry.1 The study is the first to explore the impact of ADHD medication on narcissistic personality traits and empathy in adult patients with ADHD, building on past research that established a high prevalence of narcissistic personality disorder (NPD) in this population.
The study involved 75 participants (54% male, 46% female). Of those, 44% received extended-release methylphenidate, 50% received short-acting methylphenidate, and 6% received atomoxetine for three months. Levels of ADHD symptoms, empathy, and pathological narcissism — both grandiose and vulnerable/covert subtypes — were assessed before and after three months of treatment. Researchers found significant changes in three areas among patients taking stimulant medication: reductions in narcissistic traits, increases in empathy levels, and improvements in ADHD symptoms.
Pathological narcissism is marked by impairment in self-esteem regulation; intense shame, anger, or envy leads individuals to employ maladaptive strategies to restore self-esteem in situations where it is perceived as threatened.2 The subtype of grandiose narcissism is marked by exhibitionism, aggression, and self-assurance; the subtype of vulnerable narcissism is marked by distrustfulness, fear of rejection, introversion, and negative emotionality.
Deficits in empathy are central to narcissism and can lead to myriad challenges over the lifespan including problems with communication and interpersonal relationships. While previous research, including a systematic review published in 2021, found that treatment with methylphenidate increased empathy in children with ADHD, research focusing on adults had been scarce.3, 4 As such, the study helps to fill in a gap in the research landscape.
Narcissistic Personality Traits Linked to Hyperactivity and Impulsivity
This research comes just months after another small study, published in Journal of Psychiatric Research, explored the link between pathological narcissism and ADHD by gathering data on a group of 164 adults with ADHD.5 The study’s findings confirmed previous research that demonstrated a significantly increased prevalence of narcissistic traits among adults with ADHD; it found that narcissistic personality disorder (NPD) occurs in 25% of adults with ADHD6 compared to 6% of all adults.7
The Journal of Psychiatric Research article offered further insight into the link between ADHD and narcissism, revealing that narcissistic traits tied to both grandiose and vulnerable subtypes were associated with symptoms of hyperactivity and impulsivity, but not with inattention.
In addition, narcissistic traits in ADHD adults were linked to higher levels of anxiety and depression. Traits of vulnerable narcissism, specifically, were associated with more significant emotion dysregulation and a history of hospitalization, suicide attempts, and non-suicidal self-injury, even after adjusting for the presence of borderline personality disorder. The study’s findings “suggest that narcissistic vulnerability has a unique impact on the clinical severity of ADHD,” write the study’s authors.
Narcissistic Personality Traits Lower Adherence to ADHD Treatment
Multiple studies have demonstrated that people with ADHD and comorbid personality disorders, including NPD, have lower adherence rates to ADHD treatment than do people with ADHD alone, making treatment for these individuals both variable and challenging.8, 9
“An omission in the consideration of [narcissistic] traits may be the reason for inadequate improvement in areas [of ADHD] such as social interaction, social functioning, and interpretation of events. This, in turn, may lead to sub-optimal treatment of ADHD,” write the authors of the Alpha Psychiatry study. “New approaches are needed to mitigate comorbid personality traits in order to enhance treatment adherence and response rates.”
Limitations of both studies include the small sample size, lack of longitudinal follow-up, and potential confounding factors. The authors of both studies call for further research.
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1Takım U, Belli H, Gökçay H, Köse H, Arslan Akgül H, Çakır A. Examination of Changes in Levels of Empathy and Narcissistic Pathology After Treatment of Adult with Attention-Deficit/Hyperactivity Disorder. Alpha Psychiatry. 2024 Sep 1;25(5):598-603. doi: 10.5152/alphapsychiatry.2024.241630. PMID: 39553487; PMCID: PMC11562234.
2Duarte M, Blay M, Hasler R, Pham E, Nicastro R, Jan M, Debbané M, Perroud N. Adult ADHD and pathological narcissism: A retrospective-analysis. J Psychiatr Res. 2024 Jun;174:245-253. doi: 10.1016/j.jpsychires.2024.04.032. Epub 2024 Apr 21. PMID: 38670059.
3Fantozzi, P., Sesso, G., Muratori, P., Milone, A., & Masi, G. (2021). Biological Bases of Empathy and Social Cognition in Patients with Attention-Deficit/Hyperactivity Disorder: A Focus on Treatment with Psychostimulants. Brain Sciences, 11(11), 1399. https://doi.org/10.3390/brainsci11111399
4Groen, Y., den Heijer, A.E., Fuermaier, A.B.M. et al. Reduced emotional empathy in adults with subclinical ADHD: evidence from the empathy and systemizing quotient. ADHD Atten Def Hyp Disord 10, 141–150 (2018). https://doi.org/10.1007/s12402-017-0236-7
5Duarte M, Blay M, Hasler R, Pham E, Nicastro R, Jan M, Debbané M, Perroud N. Adult ADHD and pathological narcissism: A retrospective-analysis. J Psychiatr Res. 2024 Jun;174:245-253. doi: 10.1016/j.jpsychires.2024.04.032. Epub 2024 Apr 21. PMID: 38670059.
6Bernardi S, Faraone SV, Cortese S, Kerridge BT, Pallanti S, Wang S, Blanco C. The lifetime impact of attention deficit hyperactivity disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Psychol Med. 2012 Apr;42(4):875-87. doi: 10.1017/S003329171100153X. Epub 2011 Aug 16. PMID: 21846424; PMCID: PMC3383088.
7Stinson FS, Dawson DA, Goldstein RB, Chou SP, Huang B, Smith SM, Ruan WJ, Pulay AJ, Saha TD, Pickering RP, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. 2008 Jul;69(7):1033-45. doi: 10.4088/jcp.v69n0701. PMID: 18557663; PMCID: PMC2669224.
8Gift TE, Reimherr FW, Marchant BK, Steans TA, Wender PH. Personality disorder in adult attention-deficit/hyperactivity disorder: attrition and change during long-term treatment. J Nerv Ment Dis. 2016;204(5):355 363. ( 10.1097/NMD.0000000000000470) [DOI]
9Robison RJ, Reimherr FW, Gale PD, et al. Personality disorders in ADHD Part 2: The effect of symptoms of personality disorder on response to treatment with oros methylphenidate in adults with ADHD. Ann Clin Psychiatry. 2010;22(2):94 102. [PubMed]
Updated on February 20, 2025