ADHD Vs. Narcissism: Similarities And Differences
Attention-deficit/hyperactivity disorder (ADHD) and narcissistic personality disorder (NPD) are mental health conditions classified in different categories within the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). While updated research may be needed, older studies suggest there could be a connection between ADHD in childhood and personality disorders like NPD in adulthood. The two disorders can share some symptoms, such as emotional dysregulation, impulsivity, and relationship challenges. However, the causes behind these shared symptoms tend to differ. A licensed therapist can offer professional insight and guidance if you believe you may be living with either or both disorders.
What is narcissistic personality disorder?
Narcissistic personality disorder is one of 10 personality disorders described in the DSM-V. It tends to be characterized by grandiose self-perception, a preoccupation with admiration from others, and a lack of empathy.
Narcissism is often assessed on a spectrum, and its severity is typically judged based on how aggressive the individual is and how their behavior impacts daily functioning and relationships.
Symptoms of NPD
There may be several unofficial subtypes of narcissism based on the most prevalent types of symptoms an individual displays. To receive an NPD diagnosis, individuals must display at least five of the following symptoms by early adulthood:
- Extreme arrogance; perceived superiority over others
- Strong sense of self-importance or grandiosity
- A sense of entitlement
- The belief that they are exceptional and deserve special treatment
- A preoccupation with fantasies of being successful, influential, important, or beautiful
- An excessive need for admiration and praise from others
- Envy of others or the perception that others are envious of them
- Lack of empathy
- Exploitation of others for personal gain
What is attention-deficit/hyperactivity disorder (ADHD)?
ADHD is a neurodevelopmental disorder typically characterized by hyperactivity, difficulty paying attention, and impulsive behavior. It’s usually diagnosed during childhood but may persist into adulthood. ADHD can be seen as a spectrum disorder with symptoms ranging from mild to severe.
In general, there are three core types of ADHD categorized by the primary presentation of symptoms. To receive a diagnosis, the symptoms of ADHD must generally have a severe impact on the individual’s academic, social, and/or occupational functioning for more than six months in two or more settings. Individuals under 17 years must display six or more and individuals over 17 must display five or more of the following ADHD symptoms:
Predominantly inattentive presentation
- Is easily sidetracked by external stimuli
- Has a diminished attention span
- Displays poor listening skills
- Avoids starting or completing tasks, such as school or work assignments requiring focus
- Misplaces or loses items needed to complete assignments or tasks
- Makes careless mistakes in assignments or schoolwork due to lack of focus
- Forgets daily activities like assignments, paying bills, and attending appointments
- Has trouble following directions
Predominantly hyperactive/impulsive presentation
- Is overly talkative and interrupts others during conversation
- Has difficulty staying seated at work or school
- Fidgets with hands, feet, or objects
- Is markedly restless
- Has difficulty engaging in quiet activities
- Exhibits impulsive speech and behaviors
Combined presentation
Someone with this type of ADHD usually displays combined symptoms of inattentive and hyperactive/impulsive ADHD types. For example, they may have difficulty focusing and struggle with impulse control.
It can be prudent to mention that people with any type of ADHD may have trouble regulating emotions and display intense, prolonged fixation on an activity or interest (hyperfocus). Difficulty with executive functioning, such as time management and organizational skills, can also be common across ADHD types.
Differences between ADHD and NPD
There tend to be many differences in diagnostic criteria between NPD and ADHD. For instance, NPD isn’t typically diagnosed before 18, while ADHD is usually diagnosed in childhood. The key differences between the two disorders are typically related to the individual’s motivations and intentions behind their behaviors.
For example, “love bombing” can be typical for individuals with NPD who are entering a relationship. People with NPD tend to start out bearing expensive gifts and over-the-top gestures of affection to garner attention and create the illusion that they’re thoughtful or affectionate. Then, as the relationship progresses, they often become emotionally detached and exploit their partner for personal gain. People with ADHD may enter relationships with the same kind of intensity, but it's typically due to hyperfocus and isn’t meant to deceive or manipulate.
People with ADHD might appear detached or distracted when engaged in conversation, but it’s often because they have difficulty focusing and isn’t intentionally meant to manipulate the other person. In contrast, people with NPD may be detached from the conversation because they’re attempting to manipulate the other person by ignoring or stonewalling them.
Similarly, individuals with NPD may be habitually late to meetings because they don’t care (or are trying to give the impression that they’re too important to care). People with ADHD are often late to appointments, but it’s generally because they have difficulty with organization and time management.
People with ADHD tend to be more likely to apologize for unintentionally hurtful behavior, while it can be uncharacteristic for people with NPD to apologize. Instead, they may maintain that everyone else is the problem.
Similarities between ADHD and NPD
Symptoms and behavioral patterns of ADHD and narcissistic personality disorder may be an indication of comorbidity in some cases. That said, here are a few potential similarities between ADHD and NPD:
Impulsivity
In ADHD, impulsivity is usually a core symptom frequently driven by neurological dysregulation that can manifest in many ways. For example, one may struggle to wait for their turn, blurt out answers, or make hasty decisions. With NPD, impulsivity may be driven by a lack of consideration for consequences due to an inflated sense of self-importance.Attention-deficit/hyperactivity disorder (ADHD) and narcissistic personality disorder (NPD) are mental health conditions classified in different categories within the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). While updated research may be needed, older studies suggest there could be a connection between ADHD in childhood and personality disorders like NPD in adulthood. The two disorders can share some symptoms, such as emotional dysregulation, impulsivity, and relationship challenges. However, the causes behind these shared symptoms tend to differ. A licensed therapist can offer professional insight and guidance if you believe you may be living with either or both disorders.
Relationship difficulties
Individuals with ADHD and NPD might have similar interpersonal difficulties, but for different reasons. People with ADHD sometimes have difficulty interpreting social cues or adhering to social norms because of symptoms like forgetfulness, hyperactivity, and impulsive behaviors. People with NPD may struggle with interpersonal relationships due to symptoms like self-centeredness, delusions of superiority, and lack of empathy.
Although lack of empathy isn’t necessarily a trademark characteristic of ADHD, some studies suggest people with ADHD might have difficulty empathizing with others. For example, a 2021 study found that adolescents with ADHD usually showed differences in brain structure from their peers in the region associated with emotional empathy.
Emotional dysregulation
Emotional dysregulation can be a common feature in both ADHD and NPD. In ADHD, individuals may struggle to regulate their emotions due to impulsivity and difficulty focusing. In NPD, emotional dysregulation can stem from fragile self-esteem and a hypersensitivity to criticism. Both disorders can also involve a heightened sensitivity to rejection, though the underlying mechanisms usually differ. In ADHD, rejection sensitivity may be linked to challenges with interpersonal relationships, while in NPD, it may be tied to the fear of not being perceived as perfect or superior.
ADHD vs. narcissism: What are the treatment differences?
Overall, ADHD is often treated with a combination of doctor-prescribed medication, behavioral therapies, and educational support, while NPD is primarily addressed with psychotherapy and, in some cases, cognitive-behavioral interventions.
Stimulant medications are commonly prescribed for ADHD to improve cognitive functioning in areas like focus, attention, and impulse control. However, there is generally no specific medication approved for the treatment of NPD. Medication may be prescribed to address comorbid conditions, such as depression or anxiety, but it may not directly target narcissistic traits.
Behavioral interventions, such as cognitive-behavioral therapy (CBT) and behavior modification techniques, are often the primary approach in helping individuals with ADHD manage their symptoms. These therapies may include skill-building, organization strategies, and reinforcement of positive behaviors. In the case of children with ADHD, involving parents and families in treatment can be crucial. Parental training programs can teach strategies for managing behavior at home.
Treatment for narcissistic personality disorder
For people with NPD, cognitive behavioral therapy and psychoanalytic or psychodynamic therapy tend to be the primary treatment approaches. These methods usually work by exploring the underlying issues behind narcissistic thoughts and behaviors, such as low self-esteem and difficulty with empathy. Once these challenges are identified, the therapist may guide the client to develop healthier ways of relating to others. Group therapy is often a part of NPD treatment, providing individuals with opportunities to interact with others, receive feedback, and work on interpersonal skills.
How to seek treatment
Although psychological treatment is often vital for recovery, some people with ADHD and/or NPD encounter barriers to treatment that prevent them from getting the help they deserve. For example, they may have limited geographical access to mental health professionals, or they may experience discomfort attending in-office sessions due to the stigma that can be associated with mental illness.
When faced with such barriers, many find online therapy to be a valid alternative to traditional treatment. Virtual therapy through platforms like BetterHelp can eliminate geographical limitations, providing patients with a broader pool of experienced therapists from which to choose.
ADHD vs. narcissism: Effectiveness of online therapy
Online therapy is often less expensive than conventional therapy without insurance, and numerous studies indicate that it can be just as effective in treating conditions like ADHD. While not much research yet exists on the efficacy of online therapy for NPD, studies suggest that online therapy tends to produce the same client outcomes as in-person therapy for a variety of mental health disorders.
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