When Narcissistic Behavior Is Caused By Something Else

Narcissism has become a label that is easy to apply to anyone exhibiting egotistical or callous behavior. Yet for an individual to be diagnosed with narcissistic personality disorder (NPD), they must be formally evaluated by a professional and fulfill at least five out of the nine hallmarks of the disorder—including a grandiose sense of self-importance, a preoccupation with illusions of success or power, a need for excessive admiration and attention, and a lack of empathy, among others.

However, it is possible to exhibit narcissistic traits and behaviors without having a clinical diagnosis of NPD. Sometimes people are just mean, callous, and cold; such people may display high levels of the personality trait narcissism without necessarily meeting the diagnostic criteria for NPD.

Other times, however, there may be a deeper issue at the heart of someone's seemingly narcissistic traits. Substance use disorders, trauma responses, and low self-worth may, at times, also mimic trait narcissism or even NPD.

Substance Use Disorders

Substance dependence and addiction are legitimate medical conditions recognized by the American Psychiatric Association. The Americans with Disabilities Act classifies addiction as a disability due to the drastic impairments it can cause. These impairments can affect one’s personality during the use period, as well as during the recovery and healing process.

Some individuals with SUD may exhibit signs similar to narcissism due to addiction's impact on neurological functioning. SUD can lead to depressive symptoms, such as withdrawal from family and friends or a refusal to take part in activities, which could give the impression of narcissistic haughtiness and judgment. Other psychological warning signs of SUD that may also appear similar to NPD include increased irritability, angry outbursts, and drastic mood swings. Addiction to certain stimulants, like meth or cocaine, could induce behaviors similar to the ego-centric boisterousness of a narcissist’s extroversion. One has to consider all symptoms and possibilities before assigning an explanation for behavior.

Many studies over the years have helped researchers understand how clinical care can be used to treat substance abuse and addictions. Watkins and colleagues (2022), for example, found that cognitive behavioral therapy can lead to significant reductions in substance use, binge drinking, PTSD, and depressive symptoms.

Patients and their families, however, must be invested in the treatments for them to be effective in both the short and long term. Someone with a true narcissistic personality disorder will likely not accept this care and intervention from friends and family.

PTSD and Traumatic Experiences

While almost everyone is guaranteed to experience pain or possibly even trauma in their lives, no one is guaranteed an easy recovery or healing process. The impact of trauma can cause long-term adverse effects on one’s life and personality traits.

Trauma can invoke negative coping patterns and adaptions that others may not understand, some of which may evolve into post-traumatic stress disorder. PTSD is described as a "disabling psychiatric condition" associated with poor health, loneliness, and difficulty engaging in critical life tasks such as employment (Shepherd-Banigan et al., 2022).

Someone who has undergone serious trauma may develop some narcissistic traits or behaviors as a result, such as an insatiable need for attention and/or compliance due to past abuse or abandonment. Disordered or negative attachment patterns can also trigger the seemingly narcissistic traits of needing constant attention, praise, and positive reinforcement. But unlike true narcissistic personality disorder, narcissistic behaviors that are rooted in trauma are a method of self-preservation that can be reversed and healed.

Some studies have found that trauma-associated narcissistic symptoms (TANS) display a “discrete cluster or psychological symptoms that can closely mimic those of PTSD” (Simon, 2002). A 2022 study found that for some people, their underlying vulnerability to PTSD appeared to be associated with either NPD or narcissistic traits (Montoro et al.). This implies that PTSD and NPD may, in some cases, be related. PTSD can also lead to or co-occur alongside depression, anxiety, and other mood disorders, which can increase the appearance of narcissistic traits and complicate recovery.

Ultimately, it is usually impossible to know exactly where narcissism stems from—whether it be a result of childhood neglect, genetics, or a combination of several factors. When someone displays persistent narcissistic traits and behaviors and has also undergone serious trauma, it can be very difficult to distinguish true NPD from PTSD without the help and guidance of a medical doctor or clinical psychiatrist. Yet the patient's willingness to heal, recover, and devote themselves to an improved life and changed actions may be what ultimately separates true NPD from trauma-associated narcissistic symptoms.

Depression and Low Self-Esteem

At its core, narcissism is a disease of self-esteem. In an attempt to hide a fragile ego and self-hatred, someone high in narcissism hides behind a bombastic exterior and demands devotion from their associates.

Before depression has been accurately identified and diagnosed, it may appear to others as narcissism—often because the depressed individual appears increasingly self-absorbed, irritable, and unable to regulate their own self-esteem and sense of self-worth (Unruh, 2020). They may seek more validation from others and appear less able to focus on the needs of their loved ones. But just because someone is struggling with feelings of worthlessness does not mean they are a narcissist.

Whereas NPD is considered to be a rare disorder, depression is not. Depression is said to affect 10 percent of the general population and as much as 20 percent of clinical populations (Tolentino & Schmidt, 2018). And unlike narcissists, someone who is depressed is more likely to highlight their flaws than boast about their perceived successes and traits (Dada, 2019). True narcissists, by contrast, are generally unable to acknowledge their mistakes or admit carelessness (Leunissen et al., 2017). This is likely due to the narcissist’s lack of empathy and ignorance of the pain they inflict on others.

A narcissist can be suffering from depression but may refuse to seek treatment due to their belief in their own infallibility. When a depressed person experiences episodes of narcissism, some case studies suggest that the true underlying cause of the situation may be the mood disorder itself and not an underlying personality disorder (Saito et al., 2013). Of the recognized mood disorders, narcissistic personality disorder is thought to be most similar to bipolar disorder rather than depression (Dada, 2019; Unruh, 2020).

Depression can be treated and managed with medication and counseling, but the individual has to be willing to engage in treatments. Someone with NPD will rarely believe they need help in the first place; if they feel depressed, they may be more likely to blame it on someone or something else, rather than something within themselves. This distinction of accepting and seeking help is what separates a true narcissist from someone who is struggling with depression.

What Makes a Narcissist?

In the end, the traits of narcissism do not necessarily make a narcissist. Internal factors, such as hormone imbalances or mood disorders, can mimic narcissism but can be treated and improved. External environmental influences, such as experiencing or witnessing trauma, may also cause deep wounds that can be healed with the right attention. Narcissistic personality disorder, however, is a fundamental part of the person's self and is very difficult to treat or change.

People high in narcissism tend to have a "broad incapacity" to self-criticize or accept criticism from others (Funk, 2019). The exaggerated self-confidence and ego of a narcissist rarely allow them to accept their own downfalls; rather, most failures are attributed to and projected onto others (Funk, 2019). This renders many people high in narcissism incapable of exploring counseling and therapy, thus separating them from someone struggling with PTSD, substance abuse, or depressive symptoms.