Can a Narcissist have Anxiety? (A comprehensive guide)

In this brief guide, we will discuss the question “Can a narcissist have anxiety”, and other problems of narcissism like a narcissistic personality disorder, covert narcissism and vulnerable narcissism.

Can a Narcissist have Anxiety?

A Narcissist can have anxiety, and surprisingly, around 40% of people with Narcissistic Personality Disorder may also suffer from anxiety, which a lot of people may find odd given that the primary feature of this condition is thinking too highly of oneself.

The reason behind narcissists having anxiety might be simple, really, which is that a narcissist has extremely low self-esteem and they are constantly trying to create an image of themselves that makes them look good, both to others and to themselves, which is more exhausting and difficult than it sounds.

No matter how much a narcissist would like to pretend otherwise, the fact is that they are not superhuman, and they are not god-like, which means that constantly having to keep up the pretense of this can lead to some very dark places in their minds, and this leaves the true narcissist open to anxiety and depression, as well as an array of different disorders like substance abuse and problems with impulse control leading to risky behaviors.

Research has also found, however, that narcissists may be somewhat lower in the subtype of anxiety called Social Anxiety.

The reason was this is proposed to be the fact that narcissists crave attention and admiration from those around them, which means that they are heavily invested in being around people and getting people to like them, and therefore, they are unlikely to feel anxiety about this situation in particular.

On the other hand, generalized anxiety may be about anything, and can come from anywhere, which means that a narcissist, which his deep-rooted fears and insecurities, is perhaps more vulnerable to anxiety, than someone who is not so insecure.

Relationship between Narcissism and Anxiety

The relationship between narcissism and anxiety has been explored in different contexts, like in the context of mobile use or taking and posting pictures on social media and physical exercise, but the direct link between narcissism and anxiety has surprisingly not been covered, which leaves psychologists to hypothesize and observe, but not state with confidence, What this relationship may be.

A recent research study studied attachment avoidance, which may be thought of as commitment issues or relationship problems, as well as attachment anxiety, and the relationship of these two concepts with narcissism.

In the words of the research paper: “CCA indicated the two linear combinations of variables overlapped significantly and shared about a quarter of their variance in common. The most important variable within the narcissism set was covert narcissism; and within the adult attachment set, both anxiety and avoidance were important, but the former more than the latter. The implications of the present findings are discussed in the context of past and future research on personality, attachment, and the experience of emotions.”

In this context, CCA refers to the statistical analysis used to ascertain the relationship or correlation between the factors, and covert narcissism was simply narcissism that does not show up in the form of grandiosity and an outgoing and self-promoting attitude that people typically associate with narcissism.

According to the study, there was a significant relationship between narcissism, in particular, covert narcissism, and anxiety regarding attachments, which makes sense given how insecure people with these traits are.

In order to understand how anxiety might be related to Narcissism, one needs to also understand what anxiety is, and in this case, we are only focusing on generalized anxiety rather than other subtypes like phobias or social anxiety.

Generalized anxiety disorder is characterized first and foremost by feelings of apprehension and what is known as “free-floating anxiety”, which means that this anxiety just seems to exists, without apparent cause, and without apparent end.

According to the Mayoclinic, the symptoms of Generalized Anxiety include:

  • “Persistent worrying or anxiety about a number of areas that are out of proportion to the impact of the events
  • Overthinking plans and solutions to all possible worst-case outcomes
  • Perceiving situations and events as threatening, even when they aren’t
  • Difficulty handling uncertainty
  • Indecisiveness and fear of making the wrong decision
  • Inability to set aside or let go of a worry
  • Inability to relax, feeling restless, and feeling keyed up or on edge
  • Difficulty concentrating, or the feeling that your mind “goes blank”

“Physical signs and symptoms may include:

  • Fatigue
  • Trouble sleeping
  • Muscle tension or muscle aches
  • Trembling, feeling twitchy
  • Nervousness or being easily startled
  • Sweating
  • Nausea, diarrhea, or irritable bowel syndrome
  • Irritability”

The key things to remember are that the anxiety felt should not be in relation to a specific object or situation, and to should be persistent and coupled with some somatic symptoms as well.

Narcissistic Personality Disorder

A narcissistic personality disorder is one of the rarely diagnosed personality disorders, due to the fact that these people, like those with antisocial personality disorder (sociopathy), tend to be very happy with themselves and their low self-esteem usually exists too far below their conscious level for them to actually notice it.

Someone with a narcissistic personality disorder is very unlikely to seek treatment for the personality disorder, and even if they start suffering from substance abuse, depression, or anxiety, they are more likely to try and tough it out rather than admit weakness and go on with the treatment of some kind.

Someone with narcissitic personality disorder may finally go to a psychologist if they are forced to in some way or if they actually have some sudden insight or feel that they need to be better and that they need help, but this insight, again, is rare.

However, understanding the signs and symptoms of narcissistic personality disorder is still important so they may be recognizable, and these symptoms according to the Amenclinics website, which is run by Daniel Amen, a prominent psychiatrist, are given below:

“Narcissists may appear to have ample amounts of confidence and high self-esteem, but inside, they may feel insecure or inadequate. In spite of their extreme outward confidence, individuals with NPD often have trouble handling anything perceived as criticism or failure. A narcissistic personality disorder is associated with a wide variety of signs and symptoms, including:”

  • “An exaggerated sense of self-importance
  • A need for excessive and constant admiration
  • A lack of empathy
  • Being preoccupied with grandiose fantasies of unlimited success, money, or power
  • A need to be recognized as superior or special
  • A sense of entitlement to special treatment
  • A tendency to exaggerate talents
  • Manipulation or exploitation of others
  • A belief that others are envious of them, while deep down being envious of others
  • An arrogant, haughty, or demanding attitude”

A narcissistic personality disorder is a part of the Cluster B disorders in the Diagnostic and Statistical Manual, which outlines mental and behavioral disorder and is predominantly the classification system used by the American Psychiatric Association.

The Cluster B personalities also include Borderline personality disorder, Antisocial Personality disorder, and Histrionic personality disorder, and this group is characterized by emotionally unstable and massively aberrant behavioral disturbances, as well as significant interpersonal issues.

There are different types of narcissist, including somatic and cerebral narcissists.

Narcissistic Personality Disorder Test

There are two main tests that might be used for identifying and diagnosing Narcissistic personality disorder with confidence, and then to further elaborate on how the person works other and more subjective measures like the Rorschach INk Blot test or Thematic Apperception Test may be used, but first and foremost these are the tests that may be used for diagnosis:

Narcissistic Personality Inventory (NPI): This is a self-report measure, and it measures narcissism across domains based on the classic symptoms that may be found in a narcissitic individual.

This test is also available online, but it is better to take it with a clinician present and in a clinical atmosphere, as self-report measures may sometimes be subject to interference because of environmental reasons.

Millon’s Clinical Multiaxial Inventory (MCMI): MCMI is the favored tool for a lot of clinicians for A lot of problems, not just narcissism.

It gives a good idea of borderline personality disorder and Avoidant personality, and it also informs the clinician about whether there is any depression or other mental health issues like suicidal tendencies.

The best part about MCMI however is the fact that it has scaled that measure lying or trying to look favorable, and these help in the case of patients with personality disorders as they may have the tendency to misrepresent themselves a lot.

Can a Narcissist Change?

Anyone can change if they want to, but in case of personality disorders, especially ones like Narcissistic personality disorder or Antisocial personality, the problem lies in the fact that these people are unlikely to feel remorse, guilt, or shame over their actions and their behavior, and there is an utter and complete lack of insight and judgment, both of which are absolutely necessary for psychotherapy.

Still, in some cases, narcissists can change, if only insight may be fostered in them somehow, and if they come into therapy with even a little bit of willingness, it may be possible to work with them in creating insight and once that happens it may be a smoother process.

Therapy with a narcissist will likely take long regardless of which school of thought the therapist belongs to, as it takes time to work on personality disorders, but most psychologists would agree that eclectic therapy with leanings towards psychoanalytical therapy would likely work best to change a narcissist’s behavior and attitude.

If you’re facing this, it may be a good idea to seek the help of a therapist or other mental health professional. You can find a therapist at BetterHelp who can help you learn how to cope and address it.

Covert Narcissist

A covert narcissist is someone who does not beat their own drum all the time and does not engage in the kind of self-promoting behavior that may be seen in a lot of people, however, at their core these individuals may still be extremely low on self-esteem, and they may still believe that they deserve the absolute best, and may have trouble accepting anything else.

According to Healthline, “Covert narcissism usually involves fewer external signs of “classic” NPD. People still meet the criteria for diagnosis but have traits that aren’t usually associated with narcissism, such as:

  • shyness
  • humility
  • sensitivity to what others think of them”

In many ways, covert narcissism is based on the principle of vulnerable narcissism, which is discussed next.

Vulnerable Narcissist

There are 2 types of narcissism: Grandiose narcissism, which is all bells and whistles and telling everyone how great you are, and Vulnerable Narcissism, which is more about being sensitive to criticism because one believes they don’t even deserve it and being shameful about the smallest mistakes.

On the surface, vulnerable narcissism can look a lot like just plain introversion and neuroticism, but the feelings of shame and guilt they may feel constantly may go far deeper than just that, and these feelings may be rooted in extremely bad self-concept, where they feel that they are not good enough and they need to constantly overachieve so they may feel better.

Vulnerable narcissists are also likely to be very touchy about criticism, and they may often lash out if they are criticized, even if it’s minimal.

The reason for this is not that they feel bad about it, but because they feel that they agree, with makes them feel even worse than they already do.


In this brief guide, we discussed the question “Can a narcissist have anxiety”, and other problems of narcissism like a narcissistic personality disorder, covert narcissism, and vulnerable narcissism. Please feel free to reach out to us with any questions or comments you may have.

Frequently Asked Questions (FAQs): Can a narcissist have anxiety?

What turns a person into a narcissist?

A narcissistic personality disorder may be linked to Environment ― mismatches in parent-child relationships with either excessive adoration or excessive criticism that is poorly attuned to the child’s experience. Genetics ― inherited characteristics.

Can narcissists be self-aware?

Sometimes narcissists can be self-aware, as Kevin Campbell, a psychology professor at the University of Georgia says, “There is some evidence in the literature that people who are narcissistic are self-aware, that’s why some of the self-assessment measures work.”

Does a narcissist fear abandonment?

Yes, a narcissist may have a fear of abandonment, but like all the other traits and symptoms they have, it may be based on the fact that they don’t feel like they are worthy of good things or good relationships.

The narcissist who has a fear of abandonment may use the defense mechanism of Reaction formation and do the exact opposite of abandonment, which may be why they can’t be loyal and keep abandoning their loved ones.


Was this helpful?

Thanks for your feedback!