Schizophrenia And Narcissistic Personality Disorder: Is There A Connection?

Narcissism seems to have become an increasingly popular word for describing a wide variety of dysfunctional behaviors, personality types, and relationship styles. Some have even suggested that a narcissistic outlook on life might play a role in the pathology of psychotic disorders. Could there be a similar mental process underlying schizophrenia and narcissism? 

The answer may depend on how narcissism is defined. Older psychological theories of schizophrenia often suggested that this disorder was caused by a “narcissistic” focus on the self and the body rather than the external world. However, modern research suggests that schizophrenia involves an impaired sense of selfhood that may differ a great deal from the grandiose view of personal identity typically observed in narcissistic personality disorder. For further insight into these disorders, consider scheduling a session with a licensed therapist.

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How schizophrenia is defined and diagnosed

Current clinical standards define schizophrenia as a psychotic disorder involving a combination of the following symptoms:

• Delusions (distorted but persistent ideas about reality)
• Hallucinations (sensory perceptions that aren’t real)
• Disorganization (patterns of thought, speech, and behavior that don’t seem to make logical sense)
• Catatonia (lack of volitional movement, resulting in actions like holding a single position for long periods or repetitively mimicking the behavior of others)
• Negative symptoms (diminishment of active mental functions, such as enjoyment, motivation, volition, speech, and emotional response)

Other forms of psychosis can also involve challenges with correctly perceiving and understanding reality. However, these psychotic symptoms tend to be especially prolonged and severe in schizophrenia, and they can occur without being prompted by strong emotional states, substance use, or severe depression. 

Narcissism in psychological theory

Narcissism is often used colloquially and can refer to any kind of excessive or pathological obsession with oneself. The term originates from the mythical Greek figure of Narcissus, who became entranced by his own reflected image in a pool of water. Many people use “narcissism” to broadly apply to anyone who exhibits self-centered or toxic traits, and there is much stigma surrounding this term. However, there is an official diagnosis of narcissistic personality disorder which differs from many people’s perception of “narcissists.”

Current psychological research regards narcissistic traits as an aspect of personality that can vary in strength between individuals. Narcissistic traits generally constitute one element of the so-called Dark Triad, which refers to three personality traits associated with antisocial behavior. People can have some narcissistic traits without having any sort of disorder. However, some people who exhibit narcissistic traits may be diagnosed with narcissistic personality disorder (NPD).

Researchers usually measure narcissistic traits with a psychometric assessment tool called the Narcissistic Personality Inventory (NPI). 

Psychologists often disagree about which features are diagnostic of NPD, but narcissistic personality disorder typically involves an intense concern with one’s own perceived importance and impressiveness. NPD may have two subtypes:

1. Grandiose narcissism, in which the individual perceives and presents themself as powerful, confident, competent, and successful
2. Vulnerable narcissism, in which the person experiences excessive shame or insecurity about being perceived as weak, foolish, or otherwise unworthy of positive regard

While these two aspects of NPD or narcissistic traits don’t usually occur at the same time, they can occur in the same person. For example, someone who exhibits grandiosity may shift into vulnerability in response to a loss of perceived status or respect.

Narcissistic personality disorder

Some people who possess many or strong narcissistic traits may be diagnosed with narcissistic personality disorder (NPD). This condition typically involves a persistent or lifelong pattern of symptoms:

• Exaggerating one’s importance and accomplishments
• Believing oneself to be superior or “special”
• Having an intense desire to be admired by others
• Frequently fantasizing about things like success, fame, beauty, or power
• Feeling entitled to privileges, obedience, and favors
• Displaying arrogant or contemptuous behavior
• Lacking empathy and showing little concern for other people’s needs
• Taking advantage of others for personal gain or aggrandizement

People with narcissistic personality disorder often have a hard time maintaining stable relationships in their personal and professional lives. Their self-interested behavior may cause them to repeatedly experience conflict with those around them. Those with NPD also often experience challenges with self-esteem, despite their seeming arrogance. While there is much stigma surrounding the disorder and many people with NPD are regarded as “bad” people or even abusive, narcissistic personality disorder, like many other mental health challenges, is often deserving of empathy and support.

Pathological narcissism and schizophrenia: The historical connection

During the early years of the psychiatric profession, many mental health professionals believed that psychotic disorders like schizophrenia were related to narcissistic tendencies. Sigmund Freud, the creator of psychotherapy, theorized that psychosis occurred when a patient psychologically regressed to an infantile emotional state of “primary narcissism.”

For decades, many psychoanalysts followed Freud’s lead in regarding schizophrenia as driven in part by a regression to a narcissistic state. However, this understanding of pathological narcissism tends to differ substantially from the use of the term in modern personality psychology. In the past, narcissism generally referred to an excessive focus of attention and desire on the self, rather than an inflated self-image or a desire for the admiration of others

Contemporary research has provided some support for the idea that schizophrenia and psychotic symptoms might be related to an unusually strong self-directed focus. For example, one 2017 research review concluded that high levels of “self-focused processing” could be correlated with a higher risk of psychosis. This might partly explain why people with schizophrenia often experience the delusion that random external events are directed at them or connected to their thoughts. 

The experience of the self in schizophrenia and narcissistic personality disorder

Schizophrenia and narcissism may both involve a tendency to pay more attention to one’s own thoughts and ideas than to reality. However, current evidence suggests that they may differ considerably in the way they affect an individual’s sense of their own identity. 

Clinical research shows that a diminished or disrupted sense of selfhood may be a central feature of schizophrenia. People with this condition often report sensing that they are empty or unreal, as though their thoughts, feelings, and sensations are happening to someone else — or to no one at all. This may impair their ability to relate to others and can result in a sustained lack of interest in pursuing goals, making decisions, or initiating actions.

In contrast, those with pathological narcissism typically have a strong sense of themselves as individuals and social actors. Their sense of self-worth and their understanding of their own identity may be unstable, sometimes shifting rapidly between highly positive and highly negative self-evaluations. Yet they rarely report believing that their experience of life as a distinct individual is disappearing or losing its boundaries, as individuals with schizophrenia often do. 

Can schizophrenia occur in a narcissistic personality?

People may commonly be diagnosed with more than one mental health condition at the same time, a phenomenon known as comorbidity. In theory, a person could have schizophrenia with comorbid narcissistic personality disorder.

However, research suggests that this is fairly rare. A 2016 study found that while approximately 24% of patients with schizophrenia had comorbid personality disorders, only around 0.37% to 1.75% met the criteria for NPD. Schizophrenia is much more likely to occur alongside conditions like schizotypal personality disorder or paranoid personality disorder. These mental illnesses usually have some features in common with schizophrenia, such as delusional or illogical habits of thought. 

Do schizophrenia and NPD have overlapping risk factors?

Most mental health disorders develop due to a combination of genetic and environmental causes. The available evidence suggests that schizophrenia may have a particularly high genetic and neurodevelopmental component, with multiple genes acting as risk factors. 

Some of these genes may be involved in multiple mental health conditions. For example, researchers have found that the genetic risk factors for schizophrenia may overlap with those for the following disorders:

• Autism spectrum disorder (ASD)
• Bipolar disorder (BD)
• Borderline personality disorder (BPD)
• Obsessive-compulsive personality disorder

However, there’s currently little evidence that schizophrenia has genetic mechanisms in common with narcissistic personality disorder. This may change as scientists continue to search for the biological causes of these conditions, but for the moment, they seem to have little in common. 

That said, some of the risk factors for NPD and schizophrenia might be the same. Childhood abuse or trauma may be one notable example. Experiencing severe emotional stress as a child may negatively affect the course of brain development, potentially increasing the chances of developing a variety of psychological disorders. Early traumatic experiences are usually classified as known risk factors for both schizophrenia and NPD.

If you or a loved one are witnessing or experiencing any form of abuse, please know that help is available. You can call the National Domestic Violence Hotline anytime at 1-800-799-SAFE (7233).

Treatment for schizophrenia and narcissism

Both narcissistic personality disorder and schizophrenia can be difficult to treat, and there’s currently no known cure for either one. However, their symptoms can often be effectively managed with the right combination of medication (as prescribed by a doctor or psychiatrist), supportive services, and psychotherapy.

Seeking treatment for a psychotic condition or personality disorder isn’t always easy. The effectiveness of therapy may depend, to a large extent, on the bond between the treatment provider and the client. 

If you’ve been having a hard time finding the right therapist for you, you may want to consider online mental health care. With large pools of providers and the option to request a change at any time, internet therapy platforms can make it easier to find a therapist with whom you connect. 

Online therapy can also offer a level of convenience and flexibility that in-peron formats usually cannot. mental health treatment can often be delivered just as effectively over the web as in person. A 2017 research review found that online therapy usually produced significant, long-lasting improvements in a wide variety of psychological disorders. Please note that individuals with schizophrenia who are experiencing acute psychotic symptoms may need to seek professional support in person.