The Truth About the Mental Health of CEOs

Truth about mental health of CEOs
Author: Claudia M. Elsig, MD

One in eight people worldwide lives with a mental disorder.1 The prevalence of mental health conditions is notably higher among CEOs, with 49 percent experiencing issues.2

A quick scratch beneath the surface and it’s not hard to see why. Stress at the top is excessive and unrelenting, and many CEOs are workaholics. A recent survey of 2,400 CEOs found all of them to be suffering from stress.3

Stress is clearly a significant factor, but there’s more to the mental health of CEOs than meets the eye. This blog explains some of the underlying factors that are contributing to poor mental health in our global leaders.

Stress and burnout have accelerated

COVID-19 brought an additional set of pressures to CEOs who had to pivot to manage their businesses under unprecedented and challenging circumstances. Strong leadership was tested to the limit and now burnout amongst Chief Execs is accelerating. The exhaustion of the past two years is setting in.

The International Institute of Management Development (IMD) reports that CEOs have failed to manage their own self-care during the pandemic. “CEOs were simply unprepared for the new levels of VUCA (volatility, uncertainty, complexity and ambiguity) brought on by the pandemic, and the safe reassurance of carefully planned business strategies could not be relied on in such conditions.”4

Marina Go, former Head of Hearst Australia and now a board director of multiple local and international companies explained, “I liken it to the airlines when they say, in case of emergency put on your own oxygen masks first before looking after others. And what we’ve seen with CEOs is in many cases they have not put the mask on themselves.”4

CEOs have been focused on keeping everyone else afloat during difficult times but haven’t been primed to seek help for themselves. Many CEOs don’t even recognize they have a problem until they burn out.

Research by BUPA found that six out of ten executives and board members who suffered mental ill-health during the pandemic resorted to unhealthy coping mechanisms, such as drinking alcohol and gambling, instead of seeking professional help.5

The stigma of mental health

Another key issue preventing CEOs from seeking help is the fact that mental health is still very heavily stigmatized. In higher executive circles, admitting to a mental illness can feel shameful and akin to personal deficiency.

There is great pressure on CEOs to appear ‘superhuman’. Admitting any kind of vulnerability is perceived by many at the top as a weakness. This pressure isn’t just felt in the business, but often also at home within the family. The family’s wealth, status and success are at stake.

The causes of mental health problems in CEOs

Evidence shows that CEOs are more prone to mental health conditions.2 A recent survey of 12,000 people across 11 countries revealed more C-Suite executives have experienced mental health issues compared to their employees.6

So, what are the causes?

CEO pathologies and personalities

Many of the world’s rich and famous entrepreneurs have struggled with a lifetime of mental illness. People who make it to the top of their profession have often done so because of their psychological issues, not despite them.

An example is Reddit Co-founder, Aaron Swartz, who committed suicide in 2013; he had a history of dealing with depression.

Elon Musk has opened up about his mental health, sharing on Twitter his battle with depression. Musk tweeted, “The reality is great highs, terrible lows and unrelenting stress.”7

The late Steve Jobs, who died in 2011 from pancreatic cancer, had (although never formally diagnosed) obsessive-compulsive personality disorder (OCPD). Joshua Kendall, the author of “America’s Obsessives: The Compulsive Energy That Built a Nation” which included a biopic on Jobs, said Jobs was a typical obsessive, and that he suffered ‘on and off’ from anorexia, which was thought to stem from his traumatic experience of being adopted.8

Kendall found a harsh early life to be a common theme in the icons he studied. He noted obsessive behavior to be part of the way up the psychopath continuum and determined, “Sometimes a person rises to the top precisely because he is a tad mad.”8

In 2015, Dr. Michael A. Freeman et al. surveyed 242 entrepreneurs and 93 demographically matched comparison participants.2 They found:

  • Self-reported mental health concerns were present in 72% of entrepreneurs (significantly higher than the comparison group)
  • 49% of entrepreneurs had one or more lifetime mental health conditions
  • 32% of entrepreneurs had two or more lifetime mental health conditions
  • 18% of entrepreneurs had three or more lifetime mental health conditions
  • 23% of entrepreneurs were asymptomatic members of highly symptomatic families

Compared to the control group, the entrepreneurs surveyed were significantly more likely to report:

  • Depression (30%, compared to 15% in the control group)
  • ADHD (29%, compared to 5% in the control group)
  • Substance use conditions (12%, compared to 4% in the control group)
  • Bipolar diagnosis (11%, compared to 1% in the control group)

Personality is a part of the picture. Narcissism is found to be highly prevalent among CEOs. Narcissistic personalities tend to have an inflated sense of self-importance, an excessive need for admiration, a desire for power, a lack of empathy and ease at which they can manipulate others. Narcissism is also often diagnosed with other mental conditions, such as Borderline, Histrionic, or Anti-social personality disorders.

Narcissists are particularly driven to move quickly into positions of leadership. A narcissistic CEO is happy to be in the spotlight, is confident, charming and can “boldly articulate a vision for the company.”9

The pressure to be superhuman

Heading up a business, especially when navigating challenges such as the pandemic, comes with the pressure to ‘keep calm and carry on’. Everyone else in the company is relying on the CEO to provide a steady steer.

Many CEOs ignore the warning signs of mental health issues, such as anxiety, sleeplessness, fatigue and so on. Instead, they turn to unhealthy quick-fix solutions, such as increased alcohol consumption, substance abuse, gambling, and self-medication. They feel that keeping a lid on their own problems is paramount.

Pressure to be a super-achiever often stems from families. In an interview about anxiety for men’s magazine, Esquire, Richard Gelfond, CEO of IMAX, recalls how he was raised: “I was raised in the 1950s, and my father was a very tough, not very communicative guy. The message delivered to us was: tough it out and get through it.” It’s an approach Gelfond, having experienced tough times, now disagrees with.10

CEOs are highly successful at managing people and all aspects of their business, so they believe they should be able to manage and control their own mental health. 

Loneliness, it’s hard to talk

Living up to a ‘superhuman’ image makes it hard for CEOs to lean on others for support. It can be difficult for leaders to find someone they trust to open up to about their vulnerabilities.

‘Leadership loneliness’ is a recognised concept. Research prior to the pandemic found that 30% of executives felt isolated.11 Another survey revealed that as many as half of all CEOs are experiencing feelings of loneliness in their role.12

Examining the interactions between leadership and loneliness, clinical psychologist, Ami Rokach, determined that leaders (educational, state, business, and organizational) endure stress, alienation, loneliness, and emotional turmoil and that this combination can lead to health problems, and negatively affect social and familial relationships.13

The future

The good news is that mental health in business is moving up the agenda and is no longer shut away or ignored. As mental well-being at work becomes more accepted and loses its stigma, an increasing number of CEOs are leading by example and showing a willingness to open up about their mental health and seek help.

A private recovery at CALDA

People in the spotlight, or at the helm of a successful business, can find it difficult to seek help away from the prying eyes of others. CALDA offers a private and personalized journey back to health. In a luxurious and exclusive environment overlooking Lake Zurich, CALDA offers the utmost modern and state-of-the-art medicine in combination with premium hotel service and the highest discretion.

Contact us to discuss your personal requirements.


  1. World Health Organization Fact Sheets. 8Jun2022. Mental Disorders.
  2. Freeman, M.A., Staudenmaier, P.J., Zisser, M.R. et al. 11May2018.The prevalence and co-occurrence of psychiatric conditions among entrepreneurs and their families. Small Bus Econ 53, 323–342 (2019)
  3. Transformative Conversations. 6May2018. The shocking truth about executive mental health.
  4. Wedell-Wedellsborg, M. 7Apr2022. CEOS need to manage their own mental health in times of crisis. The Knowledge Hub of IMD.
  5. BUPA Press Release. 19Nov2020. Business leaders self-medicating to cope with COVID-19 pressure.
  6. Bradbury, L. 7Oct2021. How CEOs and Leaders can Look After Their Own Mental Health. Serenity in Leadership.
  7. Singh, N. 10Oct2018. Entrepreneurs Who Battled Depression For Years. Entrepreneur Asia Pacific.
  8. Lallanilla, M. 16Aug2013. Obsession: The Dark Side of Steve Jobs’ Triumphs. LiveScience.
  9. Bililies, T. Beware The Narcissistic Leader. Chief Executive. [Accessed 19Sep2022]
  10. Parker, S. 30Jul2018. The CEO: “The Anxiety Was Overwhelming” [Interview with Richard Gelfond, CEO of IMAX in Esquire].
  11. Jonsson, N. 03Mar2022. Executive Loneliness and Mental Health. Podcast Crestcom
  12. Saporito, T J. 15Feb2012. It’s Time to Acknowledge CEO Loneliness. Harvard Business Review.
  13. Rokach, A. (2014). Leadership and Loneliness. Semantic Scholar.