Attention-deficit hyperactivity disorder (ADHD) and narcissistic personality disorder (NPD) are two mental health conditions that can share some similar features. They can both lead to problems with impulsivity, relationships, and demonstrating empathy.
Sometimes, it can be difficult to tell whether a person’s symptoms are due to ADHD, NPD, or both. But understanding the underlying motivations for the behaviors can help ensure an accurate diagnosis.
Treatment for co-occurring ADHD and NPD should be designed to reflect both conditions at the same time. This may involve talk therapy and, sometimes, medication.
Research shows people who are diagnosed with attention-deficit hyperactivity disorder (ADHD) as children are at greater risk of developing narcissistic personality disorder (NPD) and other personality disorders later in life. But it’s important to acknowledge that while they often go hand in hand, ADHD and NPD are two very different conditions.
ADHD can cause problems with focus and impulse control, which can sometimes impact relationships and social skills. NPD, however, involves an intense sense of grandiosity and superiority over other people. People with NPD often lack empathy and may appear rude, condescending, or manipulative. These beliefs and behaviors can also impact relationships.
Both ADHD and NPD can cause a person to behave in what appears to be self-serving ways, negatively affecting relationships and interrupting their ability to function in daily life. However, while these conditions can co-occur, they may require different forms of support. Understanding the similarities and differences between ADHD and NPD can help you better understand yourself and your symptoms.
How narcissism and ADHD are connected
We don’t yet have a full understanding of why ADHD and NPD co-occur so frequently. However, research suggests the overlap might be due to a combination of the following risk factors:
Neurobiology: People with ADHD may have differences in the parts of the brain that regulate the ability to see things from another person’s point of view. This is called perspective taking, and it can affect a person’s capacity to demonstrate empathy. Similarly, an inability to empathize is a core feature of NPD. There’s evidence to suggest this could be due to disruptions in various brain systems.
Genetics: Both ADHD and NPD are believed to run in families. This means that if you have a close relative, like a parent or sibling with ADHD or NPD, you might be more likely to develop one of these conditions.
Environment: Experiencing childhood trauma such as abuse or neglect may play a role in the onset of both NPD and ADHD. Children with ADHD who remain in traumatic environments may be more likely to develop a personality disorder.
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Recognizing narcissism vs. ADHD
Receiving an accurate diagnosis is one of the first and most important steps you can take toward managing your health. However, this can be more challenging when you have symptoms that could be the result of multiple conditions.
So, if you think you might have NPD, ADHD, or both, understanding what these disorders have in common and what sets them apart can help you get the care for your needs.
ADHD symptoms can include:
Difficulty staying on task
Trouble paying attention
Disorganization
Restlessness
Frequent or excessive movement in inappropriate settings
Interruptions or excessive talking based on setting
Difficulty with delayed gratification
On the other hand, NPD symptoms can include:
Grandiose sense of self-importance
Fantasizing about amassing success, power, beauty, brilliance, or idealized romantic love
A belief they’re superior to others and they can only be understood by other “superior” people
Chronic envy or a belief that others are envious of them
The exploitation of others for personal gain
A desire for constant affirmation and admiration
A deep sense of entitlement
Rude, arrogant, or haughty attitudes or behaviors
How ADHD and NPD mimic each other
Some symptoms of ADHD and NPD can overlap. These include:
Difficulty demonstrating empathy: Imagine you’re sharing something personal with a friend, and they get up and wander around the room while you’re talking. This could be due to restlessness brought on by ADHD. Or, if they have NPD, it could be due to their belief that your emotional experiences aren’t important.
Problems in interpersonal relationships: Imagine your partner frequently forgets about important details from previous conversations. This could be due to problems with focus brought on by ADHD. Or, if they have NPD, it could be due to their belief that your needs aren’t worthy of their attention.
Impulsivity: Imagine a colleague interrupts you during a meeting. This could be due to difficulty with self-regulation and impulse control brought on by ADHD. Or, if they have NPD, it could be due to their grandiose belief that what they have to say is more brilliant than anything you have to share.
Dig deeper:
When narcissistic personality disorder and ADHD coexist
You can have NPD and ADHD at the same time. However, the relationship between these two conditions is complex and not yet fully understood. While having ADHD doesn’t automatically mean you’ll develop NPD, the vast majority (90%) of people with personality disorders exhibited signs of ADHD as children. Some people with ADHD may also experience comorbidity with vulnerable narcissistic traits, like insecurity, sensitivity to criticism, shame, or defensive behaviors. But, like other co-occurring conditions, we don’t know whether this link is causal or correlational.
How are ADHD and narcissism treated?
If you think you might have ADHD, NPD, or both, working with a mental health professional can help. A therapist can provide an assessment and an accurate diagnosis to ensure you get the right support for your needs.
If you’re living with co-occurring conditions, treatment will usually focus on improving daily functioning, relationships, emotional regulation, and ADHD symptoms. Treatment may include:
Therapy: A therapist may help you build self-awareness, improve communication, and develop healthier coping skills. Approaches like cognitive behavioral therapy (CBT) may help you address unhelpful thought patterns, impulsive behaviors, emotional dysregulation, and interpersonal conflict.
Medication for ADHD: Medication is commonly used to help manage ADHD symptoms like inattentiveness, hyperactivity, and impulsivity. A provider can help you decide whether medication is right for you.
Integrated treatment: If ADHD and NPD occur together, treatment often works best when both conditions are addressed at the same time.
It’s also important to know that many people with NPD don’t recognize their symptoms as problematic. Because of this, some people may enter therapy due to relationship conflict, work problems, or another mental health concern like ADHD.
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Medication can be effective for symptoms of ADHD but not for NPD. A combination of medication and therapy can help reduce interpersonal conflicts.
Ashley Ayala, LMFT
Clinical reviewer
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ADHD and NPD are different mental health conditions that share some key symptoms. Sometimes co-occurring, they can both cause a lack of empathy, impulsivity, and relationship problems.
At Rula, we’re here to help you feel better. Rula makes it easy to find a licensed therapist or psychiatric provider who takes your insurance. That way, you don’t have to choose between great care and a price you can afford.
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Liz Talago
Liz Talago, M.ed. is a mental health professional turned content writer and strategist based in the Detroit metro area. As an independent consultant for mental health organizations, Liz creates meaningful connections between brands and their audiences through strategic storytelling. Liz is known for championing diverse perspectives within the mental health industry and translating bold ideas into inspiring, affirming digital experiences.
In her free time, you can find her hiking with her two German Shepherds, puttering around her dahlia garden, or spending time with her family.
Ashley Ayala, LMFT
Ashley is a Licensed Marriage and Family Therapist who specializes in generational healing and family dynamics. Ashley has worked in schools, clinics, and in private practice. She believes that people’s relationships, including our relationship with ourselves, greatly shape our experiences in life.
Ashley is committed to empowering others to show up authentically and deepen their self understanding. This passion stems from taking a critical lens on her own life story and doing inner healing. One of her favorite quotes is “Be yourself and the right people will love the real you.”
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