Shedding light on the efficacy of psychodynamic treatment targeting depression for patients with comorbid narcissistic personality disorder

Objective: Major depressive disorder (MDD) frequently co-occurs with narcissistic personality disorder (NPD). Despite the clinical relevance of this comorbidity, little is known about the efficacy of short-term depression-focused treatments for individuals with comorbid NPD. This study examines whether individuals with comorbid MDD and NPD benefit from treatment and whether NPD diagnostic status changes during therapy. Method: One hundred patients in a randomized controlled trial (RCT) were assessed for NPD (n = 14) using the Structured Interview for DSM-IV. Participants were randomly assigned to supportive therapy or supportive-expressive therapy. Depression severity was measured throughout therapy by the Hamilton Rating Scale for Depression (HRSD). Multilevel models were used to assess treatment efficacy and changes in NPD prevalence. Results: Patients with comorbid MDD and NPD demonstrated significantly greater depressive symptom reduction than those without NPD. However, no significant changes were found in NPD diagnosis status across therapy. Conclusion: These findings challenge the assumptions that NPD is a negative prognostic factor for depression treatment. Rather, they suggest that short-term psychodynamic interventions may effectively reduce depressive symptoms for patients with comorbid NPD, highlighting the need for further research into treatment mechanisms and patient subtypes.