Suicidal wishes are not rare in those with narcissistic personality disorder. However, the factors contributing to suicide among narcissistic individuals are not well understood. Paul Links [6] has pointed out that with patients on the narcissistic spectrum, the wish to kill oneself can emerge without the presence of a depressed state. Indeed, suicidal feelings may grow out of a desperate need to regulate self-esteem or protect a pathological self-image of perfection. In addition, an acute narcissistic injury can produce intense shame to the point where suicide seems like the only option. Whereas guilty individuals may feel they are not living up to a standard, shame-prone patients, such as vulnerable narcissists, have the sense of being irreparably defective.
Shame is sometimes defined as a sense of falling short of what one should be. Shame is often at the core of narcissistic individuals, who struggle with an acute sense of having failed in many aspects of their lives. They feel certain that others are thinking badly about them. When “caught” by someone watching them, a sense of painful humiliation may emerge. Seeing and being seen are central to narcissistic patients. They may feel that their secret sense of being “phony” or “fake” is now exposed. Suicide may feel like the only way out, especially after a devastating humiliation.
It is not well recognized, but suicidal behavior is a clinically significant but underestimated cause of mortality in narcissistic personality disorder.
From: Gabbard, G.O. Narcissism and suicide risk. Ann Gen Psychiatry 21, 3 (2022). https://doi.org/10.1186/s12991-022-00380-8