Weapon or Armor? Unpacking the Paradox of Narcissism and Self-Reported Mental Health Through a Three-Level Meta-Analysis

Objective: This meta-analysis examined the relationships between different dimensions of narcissism and mental health, with a specific focus on internalizing forms of psychopathology. Method: A systematic search identified 229 empirical studies (N = 185,137; k = 735 effect sizes) from four international databases (Web of Science, PubMed, Scopus, OATD) and two Chinese databases (CNKI, Wanfang Data). Because most studies relied on self-report measures, the findings primarily reflect self-reported associations. Random-effects models were used to estimate overall effects, and moderation analyses tested the roles of demographic, methodological, and construct-related variables. Results: Grandiose narcissism was positively associated with positive mental health (r = 0.19, p < 0.001) and showed no significant association with negative mental health (r = 0.02, p = 0.26). Vulnerable narcissism was negatively associated with positive mental health (r = −0.25, p < 0.001) and positively associated with negative mental health (r = 0.39, p < 0.001). Findings based on the Admiration–Rivalry model and the three-factor model provided additional clarity regarding these associations. Significant moderators included age, measurement instruments, and construct specificity. Conclusions: These results clarify dimension-specific links between narcissism and mental health and provide a more nuanced understanding of narcissism's psychological correlates. Trial Registration: PROSPERO: Registration No. CRD420251016464. © 2025 Wiley Periodicals LLC.