Pathological Narcissism and Psychological Distress Among University Students: The Interplay of Family Dynamics, Trauma, and Health-Related Factors

Background/Objectives: The mental health of university students is a global public health priority. While pathological narcissism is increasingly recognized as a source of significant psychological suffering, its developmental and somatic correlates remain insufficiently explored. This study examines the sociodemographic, familial, and health-related correlates of pathological narcissism and its association with global psychological distress. Methods: A cross-sectional study was conducted with 888 university students (M = 21.3 years; 78.5% female) recruited from three faculties—Humanities and Social Sciences, Civil Engineering, and Medicine. Participants completed the Pathological Narcissism Inventory (PNI), Brief Symptom Inventory (BSI), and sociodemographic, familial, and health-related characteristics, including trauma exposure. Multivariable linear regressions and hierarchical regression analyses were conducted. Results: Pathological narcissism was robustly and positively associated with global psychological distress (r = 0.636, p < 0.001). Multivariable regression models identified chronic fatigue as the strongest somatic correlate of narcissistic pathology, consistent with an ego-depletion account of self-regulatory failure. Additional significant correlates included trauma history, insomnia, and prior use of psychological services. Students from the Faculty of Humanities and Social Sciences reported significantly higher narcissism scores than medical students. Poorer perceived family relationship quality was associated with higher narcissism scores. The full models accounted for 14.4% to 16.9% of the variance in narcissistic dimensions. Conclusions: These cross-sectional findings suggest that pathological narcissism is not merely a personality trait but a clinically relevant construct deeply intertwined with psychological distress and somatic exhaustion. The strong association between narcissism and chronic fatigue points to a substantial physiological cost of sustained self-regulatory effort. Findings highlight the need for integrated screening protocols in university counseling services that account for somatic symptoms (fatigue, insomnia), traumatic experiences, and family dynamics, alongside efforts to destigmatize help-seeking, given that fewer than 1% of students turn to faculty for support.