Narcissistic dimensions impact depressive symptoms during inpatient psychiatric treatment and depression recurrence following treatment across mental disorders

Dimensional narcissism, as emphasized in International Statistical Classification of Diseases and Related Health Problems in version 11 (ICD-11) and Diagnostic and Statistical Manual of Mental Disorders in version 5 (DSM-5), conceptualize narcissistic traits along a continuum rather than categorical thresholds. Although narcissistic traits have been associated with depressive symptoms and poorer treatment outcomes, their influence on the long-term course of depressive disorders remains insufficiently understood. We examined the impact of dimensional narcissism and its facets admiration and rivalry on depressive symptoms before and after treatment, as well as on depression recurrence one year post-treatment, in an inpatient clinic sample undergoing cognitive behavioral therapy. Dimensional narcissism was assessed using The Narcissistic Admiration and Rivalry Questionnaire - short version (NARQ-S), and depression severity was measured with the Beck Depression Inventory. Depression recurrence was assessed with a clinical interview and confirmed using the Structured Clinical Interview for DSM-4. Linear and binary logistic regression models were calculated. Narcissistic rivalry was associated with higher symptom load before treatment, while narcissistic admiration showed the opposite effect. Neither narcissistic dimension predicted depressive symptom severity following treatment. Narcissistic admiration and rivalry, measured at baseline, did not yield significant effects in predicting depression recurrence, whereas post-treatment scores were significant predictors - narcissistic admiration decreased the likelihood of experiencing at least one depressive episode, while narcissistic rivalry showed the opposite effect. The timing of narcissism assessment is crucial to identify patients at risk of increased depression recurrence and therefore paves the way for individualized treatment strategies and follow-up evaluations, ensuring comprehensively patient-tailored therapy.