Stimulants Reduce Narcissistic Personality Traits, Increase Empathy In ADHD Adults:

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Stimulants Reduce Narcissistic Personality Traits, Increase Empathy In ADHD Adults: Study

ADHD RESEARCH
Stimulants Increase Empathy

The small study also found that stimulant medication reduced narcissistic personality traits in adults with ADHD. | Read more »

Stimulant medication may improve deficits in empathy, as well as narcissistic personality traits, in adults with ADHD, according to new research.

February 11, 2025.     Objective

The purpose of this study was to investigate changes in narcissistic personality traits and empathy deficits in adults with attention-deficit hyperactivity disorder (ADHD) after pharmacotherapy, focusing on psychostimulant treatment. Understanding these comorbidities is crucial for optimizing treatment and improving therapeutic outcomes.

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.

The 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.