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Cited by 32Personality Disorders and PsychopathologyPersonality Traits and PsychologySuicide and Self-Harm Studies

Narcissism and suicide risk

Open access
Gabbard, Glen O.·2022·Annals of General Psychiatry
DOI 10.1186/s12991-022-00380-8PMC PMC8783517
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Abstract

We all have narcissism, but in some cases, the perception of narcissism becomes extreme and pathological. Systematic research has shown that there are three subtypes typical of narcissistic personality disorder: the grandiose/oblivious, the vulnerable/hypervigilant, and the high-functioning subtype. Both biological and psychological factors are at work, but the true cause of pathological narcissism has not been established. The psychotherapy of narcissistic personality disorder (NPD) is complicated and often frustrating because of the difficulty in engaging a person with narcissistic personality disorder in a psychotherapeutic process. Suicide risk is not rare in patients with narcissism, particularly in the context of severe narcissistic injury, where the patient feels shamed and/or vilified. In conclusion, narcissistic patients are difficult to treat, but the risk of suicide makes it imperative for clinicians to stay involved in the treatment and assist the patient in understanding their vulnerabilities.

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  • Impulsivity and maladaptive coping mechanisms may contribute to sudden emotional shifts in narcissistic individuals.

    “Additionally, impulsivity and maladaptive coping mechanisms may contribute to sudden emotional shifts, reinforcing the need to help patients develop more adaptive emotion regulation skills (69).”

    From Psychoanalytically informed MDMA-assisted therapy for pathological narcissism: a novel theoretical approach (2025) · cites this paper as [69]

    The Background describes a grandiose narcissist becoming vulnerable when shamed or criticized, and the Conclusions acknowledge that impulsive suicidal behavior is possible. Neither passage says that impulsivity or maladaptive coping mechanisms cause sudden emotional shifts; the Conclusions also distinguish NPD from the impulsivity typical of borderline personality disorder. Page numbers are unavailable in our copy. (LLM, conf=0.79)

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  • Shame is a primary driver of suicidality in narcissistic patients.

    “Shame is a primary driver of suicidality in narcissistic patients, making it essential to approach this emotion carefully (69).”

    From Psychoanalytically informed MDMA-assisted therapy for pathological narcissism: a novel theoretical approach (2025) · cites this paper as [69]

    The “Suicide risk in narcissistic individuals” section says intense shame after a narcissistic injury can make suicide seem like the only option, and it discusses treatment considerations for patients feeling shame. But it also says the factors contributing to suicide are not well understood; it does not establish shame as the primary driver. (LLM, conf=0.86)

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  • Suicide risk in narcissistic individuals can fluctuate dramatically, often in response to perceived failures, rejection, or humiliation.

    “Gabbard (69) highlights that suicide risk in narcissistic individuals can fluctuate dramatically, often in response to perceived failures, rejection, or humiliation.”

    From Psychoanalytically informed MDMA-assisted therapy for pathological narcissism: a novel theoretical approach (2025) · cites this paper as [69]

    In “Suicide risk in narcissistic individuals” (page not provided), Gabbard says acute narcissistic injury can produce intense shame and that suicide may seem like the only way out after a devastating humiliation. The section also discusses feelings of failure, but it does not specifically describe dramatic fluctuations in suicide risk or identify rejection as a trigger. (LLM, conf=0.85)

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  • The therapeutic alliance is a key protective factor against suicidality in narcissistic individuals, helping regulate affect, reduce impulsivity, and provide corrective emotional experiences that mitigate feelings of abandonment or humiliation.

    “The therapeutic alliance is a key protective factor against suicidality in narcissistic individuals, which can help regulate affect, reduce impulsivity, and provide corrective emotional experiences that mitigate feelings of abandonment or humiliation (69).”

    From Psychoanalytically informed MDMA-assisted therapy for pathological narcissism: a novel theoretical approach (2025) · cites this paper as [69]

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

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  • As MDMA's effects wane, patients may become vulnerable to intense emotions such as narcissistic rage, shame, and anguish, potentially triggering suicidal impulses, even in the absence of chronic suicidality.

    “As MDMA’s effects wane, patients may become vulnerable to intense emotions such as narcissistic rage, shame, and anguish, potentially triggering suicidal impulses, even in the absence of chronic suicidality (69, 183, 184).”

    From Psychoanalytically informed MDMA-assisted therapy for pathological narcissism: a novel theoretical approach (2025) · cites this paper as [69]

    The “Suicide risk in narcissistic individuals” section says an acute narcissistic injury can produce intense shame and suicidal feelings, even without a depressed state. It does not discuss MDMA’s effects waning or establish that this risk occurs in patients without chronic suicidality. (LLM, conf=0.88)

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Authors
Gabbard, G. O.
Affiliations
Baylor College of Medicine (US)
Corresponding author
Gabbard, Glen O.
Venue
Annals of General Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2022-01-22
Volume
21
Issue
1
Pages
3-3
ISSN
1744-859X (ISSN-L)
DOI
10.1186/s12991-022-00380-8
PMC
PMC8783517
OpenAlex
W4206966008
Cited by
32
References
8
Citations by year
2026: 7 · 2025: 9 · 2024: 8 · 2023: 5 · 2022: 3
FWCI
5.71
Type
journal article
Language
en
Open access
Licence
Locations
  • Annals of General Psychiatry (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
Keywords
narcissistic personality disorder, pathological narcissism, suicide risk, grandiose narcissism, vulnerable narcissism, narcissistic injury, shame, psychotherapy engagement

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