Journal of Research in Personality 44 (2010) 453–465

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Journal of Research in Personality

journal homepage: www.elsevier.com/locate/jrp

Narcissism assessment in social–personality research: Does the association

between narcissism and psychological health result from a confound with
self-esteem?
Seth A. Rosenthal *, Jill M. Hooley
Harvard University, Department of Psychology, 33 Kirkland Street, Cambridge, MA 02138, United States

a r t i c l e i n f o a b s t r a c t

Article history: Influential social and personality psychology research indicates that narcissism is related to psychological
Available online 15 May 2010 health. Such inferences are open to question, however, because they nearly all rely on the same self-
report instrument—the Narcissistic Personality Inventory (NPI; Raskin & Hall, 1979, 1981)—to operation-
Keywords: alize and measure narcissism. This is problematic because numerous NPI items do not appear to corre-
Narcissism spond to common definitions or manifestations of narcissism, and may instead be indicative of self-
Self-esteem esteem. Two studies demonstrate that the NPI’s confound with self-esteem accounts for the purported
Psychological health
relationship between narcissism and psychological health. This suggests that inferences about narcissism
Narcissistic personality inventory (NPI)
Narcissistic personality disorder
and psychological health may need to be reinterpreted. Results also highlight the need for measures that
Pathological narcissism correspond more directly to core components of narcissism.
Normal narcissism Ó 2010 Elsevier Inc. All rights reserved.

1. Introduction normative social–personality perspectives on this question, and

Imagine hearing about two people who are both described as
assertive and confident. Both also prefer leadership roles and enjoy
receiving compliments. However, beyond these apparent similari-
ties, the two are quite different from each other. The first is consis-
tently full of bravado to overcompensate for core insecurities,
insatiably in need of other people’s admiration (e.g., Morf & Rho-
dewalt, 2001), and unreasonably pushy, overbearing, and demand-
ing. You probably would not be surprised to hear this person
referred to as a narcissist (e.g., American Psychiatric Association,
2000). In contrast, the second person is ‘‘happier than most, less so-
cially anxious, . . . less depressed, . . . [and] higher [in] self-esteem”
(see W. K. Campbell, 2001, p. 214). Is it possible that this norma-
tively happy and healthy person is a narcissist as well? According
to some perspectives in social and personality psychology research
(e.g., W. K. Campbell, 2001; Miller & Campbell, 2008), the answer
may be ‘‘yes.” In fact, the psychologically healthy characteristics
enumerated above are a partial description of a narcissist from
one social–personality point of view.
The narcissist with these healthy traits lies at the center of a
crucial question about the limits of the theoretical and operational
definitions of narcissism. To what extent should high self-esteem,
and normative traits related to it such as assertiveness and confi-
dence, play a role in defining narcissism? The divergence between
* Corresponding author.
E-mail address: seth@merrimanriver.com (S.A. Rosenthal).
clinical perspectives, which generally emphasize narcissists’ low
or fragile self-esteem (e.g., APA, 2000; Kernberg, 1975; Kohut,
1971, 1977), has made it increasingly difficult to reconcile social–
personality and clinical narcissism research (Cain, Pincus, & Ansell,
2008; Miller & Campbell, 2008; Pincus & Lukowitsky, 2010; Pincus
et al., 2009). Moreover, and most germane to this article, disagree-
ment over whether self-esteem and other normative traits should
be considered narcissistic has created confusion about whether
psychological health is truly a potential characteristic of people
who are narcissistic.
Although it is clear that many social–personality psychologists
include high self-esteem in their conceptions of narcissism
whereas clinical psychologists generally do not (Fossati et al.,
2005; Miller & Campbell, 2008; Pincus & Lukowitsky, 2010; Pincus
et al., 2009), it is unlikely that this reflects fundamental theoretical
differences between the two camps. Instead, we posit that the
inclusion of high self-esteem and other normative characteristics
in social–personality definitions of narcissism results primarily
from the way narcissism is traditionally operationalized. The self-
report scale that is used to measure narcissism in nearly all so-
cial–personality research (Cain et al., 2008; Mullins & Kopelman,
1988; Pincus et al., 2009) is the Narcissistic Personality Inventory
(NPI; Raskin & Hall, 1979, 1981). The NPI contains items that ap-
pear to be confounded with self-esteem, a characteristic that they
may measure at least as effectively as they measure narcissism. As
a result, the NPI’s correlates include not only the negative psycho-
logical states and outcomes that might be shared with typical

0092-6566/$ - see front matter Ó 2010 Elsevier Inc. All rights reserved.
doi:10.1016/j.jrp.2010.05.008
454 S.A. Rosenthal, J.M. Hooley / Journal of Research in Personality 44 (2010) 453–465
clinical definitions of narcissism (e.g., aggression, Bushman &
Baumeister, 1998; reduced romantic commitment, W. K. Campbell
& Foster, 2002; pathological gambling, Lakey, Rose, Campbell, &
Goodie, 2008), but also the positive psychological states that are
more likely to be associated with high self-esteem, such as those
noted in the description of the happy, healthy narcissist in example
two.
Self-esteem is the normative characteristic with which the NPI
appears to share its most robust empirical relationship (see Brown
& Zeigler-Hill, 2004; Cain et al., 2008; Raskin, Novacek, & Hogan,
1991a, 1991b; Rhodewalt & Morf, 1995). One reason to closely
examine the NPI’s positive link with self-esteem, and the possibil-
ity that this link is largely a byproduct of confounded items
contained within the NPI itself, is that there is accumulating
evidence that the connection between the NPI and psychological
health is contingent on the NPI’s relationship with self-esteem. This
is the case, for example, in research by Rose (2002), who reported
that narcissism was related to multiple measures of happiness, and
by Sedikides, Rudich, Gregg, Kumashiro, and Rusbult (2004), who
reported that narcissism was related to numerous indicators of
psychological health, such as lower depression, sadness, anxiety,
and neuroticism, as well as higher levels of personal and couple
well-being. In both sets of studies, the relationship between the
NPI and each of its healthy psychological correlates was fully med-
iated by self-esteem (see also Brown, Budzek, & Tamborski, 2009).
This led Sedikides and colleagues to conclude that self-esteem is
the ‘‘key component of narcissism” (p. 401) through which narcis-
sism predicts positive psychological outcomes (see also Sinha &
Krueger, 1998). In contrast, self-esteem does not appear to mediate
the association between the NPI and the kinds of negative out-
comes more traditionally associated with narcissism. For example,
controlling for self-esteem did not negate the relationship between
the NPI and reduced romantic commitment (W. K. Campbell &
Foster, 2002), pathological gambling (Lakey et al., 2008), or the
greedy exploitation of natural resources (W. K. Campbell, Bush,
Brunell, & Shelton, 2005). Taken together, it appears that a link
between the NPI and psychological health (but not negative
psychological outcomes) depends on a theory of narcissism that
considers high self-esteem to be an inherent narcissistic trait
(e.g., Baumeister, Campbell, Krueger, & Vohs, 2003).
To justify the inclusion of self-esteem and other normative
characteristics within a social–personality theory of narcissism,
some have called for revisiting historic clinical theories that pro-
vide the grounds doing so (see W. K. Campbell, 2001; Miller &
Campbell, 2008). However, such an approach may be problematic
for several reasons. First, it employs post hoc theoretical explana-
tions for findings that might be more parsimoniously explained
through an empirical critique of some of the NPI’s items. Further,
the clinical theories that did include high self-esteem in their def-
inition of narcissism were either too nebulous and overinclusive
(e.g., Freud, 1931/1950) or too multifaceted (e.g., Kohut, 1971,
1977) to be operationalized properly using any single measure
(see Clark & Watson, 1995; Raskin & Terry, 1988).
Perhaps most problematically, these historical clinical theories
are not aligned with the theoretical foundation that was used to
develop the NPI. The NPI was not developed to correspond with
a normative definition of narcissism. Instead, the scale’s authors in-
tended to provide a continuous, non-clinical measure (for use in
normal populations) of the characteristics described by a specific
clinical definition of narcissism, the diagnostic criteria for narcis-
sistic personality disorder (NPD) in the then-current edition of
Diagnostic and Statistical Manual of Mental Disorders (DSM-III,
APA, 1980; see Raskin & Terry, 1988). Accordingly, the NPI’s
authors developed items that they believed ‘‘sampled the domain
of the narcissistic personality” (Raskin & Hall, 1979, p. 590) identi-
fied by the DSM-III criteria. These criteria included a grandiose
sense of self-importance, preoccupation with fantasies of unlim-
ited success, exhibitionism, indifference or rage, and disturbances
in interpersonal relationships such as entitlement, exploitative-
ness, splitting, and lack of empathy. The NPI was based on the
assumption that ‘‘abnormality is continuous with normality, [and
thus] behaviors descriptive of the Narcissistic Personality Disorder
are . . . extreme forms [of these narcissistic traits] which are
manifested to a lesser extent in normal individuals” (Raskin & Hall,
1981, p. 159).
In other words, the scale’s authors intended for the NPI to mea-
sure less extreme levels of characteristics associated with narcis-
sism as described in the DSM-III (see Pincus & Lukowitsky, 2010;
Pincus et al., 2009). They did not intend to expand the definition
of the construct based on normative clinical or social–personality
theories. By referring to historic theories that included high self-es-
teem in their definition of narcissism to justify NPI-based findings
about psychological health, critics (e.g., W. K. Campbell, 2001; Mill-
er & Campbell, 2008) implicitly suggest that the authors of the NPI
got the measurement aspects of narcissism right, but got the the-
ory on which they based their measure wrong. In contrast, we sug-
gest that just the opposite may be the case; the NPI’s authors
appear to have created a scale that is not entirely consistent with
the theory on which it was based. In fact, the NPD section of the
DSM-III states that narcissistic self-esteem is ‘‘often fragile”
(p. 316), rather than that narcissists have high self-esteem.
Using the DSM-III criteria as a theoretical ‘‘conceptual template”
(Raskin & Terry, 1988, p. 892), it is easy to understand how items
ranging from severe manifestations of narcissistic characteristics
(e.g., ‘‘I insist on getting the respect that is due me;” ‘‘I know that
I am good because everybody keeps telling me so”) to more mod-
erate manifestations (e.g., ‘‘I am apt to show off if I get a chance;” ‘‘I
am more capable than other people”) were included in the NPI.
Unfortunately, other NPI items, such as ‘‘I am assertive” and ‘‘I
see myself as a good leader” appear to fall outside of the NPI’s
authors’ own DSM-III-based definition of narcissism. These more
normative characteristics do not appear to lie on a clear continuum
with those enumerated in the DSM-III. Rather, they most likely
measure subjectively different constructs from the diagnostic cri-
teria rather than less severe versions of the same constructs (see
Pincus & Lukowitsky, 2010; Pincus et al., 2009).
A practical problem this causes is that the NPI’s most normative
items are not specific to narcissism—a narcissist might be described
by them (if only superficially), as in the first example presented ear-
lier. But the content of these items also might not be indicative of
narcissism. In other words, the items do not necessarily differenti-
ate well between narcissists and non-narcissists. Even if narcissists
often exhibit these characteristics (see Lynam & Widiger, 2001;
Miller, Gaughan, Pryor, Kamen, & Campbell, 2009; Samuel & Widi-
ger, 2004), knowing that someone possesses these attributes does
not necessarily help one discern how narcissistic that individual
is, or even whether that individual is narcissistic at all. Further, such
items may provide more information about whether a person has
high self-esteem than about whether that person is narcissistic.
And although such normative attributes are not measured by a
majority of the NPI’s items, the internal consistency strategy origi-
nally used to develop the NPI resulted in statistical overrepresenta-
tion of its most normative items in aggregated scores (Emmons,
1984; Kansi, 2003; Raskin & Terry, 1988). As a result, aggregated
NPI scores are poorly proportioned (see Haynes, Richard, & Kubany,
1995), causing them to follow the scale’s most normative items in
correlating with variables indicative of psychological health.
In sum, the conclusion that narcissism is associated with
healthy psychological states and outcomes may depend largely
on the effects of a number of items in the NPI that appear to be
more closely related to self-esteem than to narcissism. To investi-
gate this possibility, in Study 1 we examined whether the NPI’s
 S.A. Rosenthal, J.M. Hooley / Journal of Research in Personality 44 (2010) 453–465
overlap with self-esteem is attributable to a theoretically sound
empirical relationship between the two constructs, or whether,
as we hypothesize, it is the result of the inclusion of specific items
in the NPI that are confounded with self-esteem. In Study 2, we ex-
plored whether these same NPI items account for the types of rela-
tionships between narcissism and psychological health that have
been reported in the social–personality literature.
2. Study 1
2.1. Overview
In Study 1, we used three independent methods—expert ratings,
item response theory (IRT) data, and traditional NPI factors derived
using exploratory factor analysis (EFA)—to delineate which NPI
items did a good job measuring narcissism, and which items func-
tioned relatively poorly at measuring the construct. We then com-
bined the items that most clearly measured narcissism into NPI-N
subscales, whereas the items that appeared to measure some other
characteristic(s) better than they measured narcissism were com-
bined and labeled the NPI-X subscales. We then investigated the
subscales’ relationships to a benchmark measure of DSM-based
narcissism to determine whether the subscales measured narcis-
sism in a manner consistent with the intentions of the NPI’s
authors. We also used a benchmark measure of self-esteem to
investigate whether the NPI-X subscales measured self-esteem
more effectively than they measured DSM-based narcissism.
2.2. Method
2.2.1. Participants
The sample consisted of 232 students between the ages of 17
and 24–129 men and 103 women. The mean age of participants
was 19.5 years (SD = 1.2). This sample is typical of the population
with which NPI-based research is often conducted. Participants
were compensated with research credit or small payments. They
were recruited through a psychology department study pool and
also via posters.
2.2.2. Procedure
Participants provided informed consent and demographic infor-
mation. They then completed the narcissism and self-esteem ques-
tionnaires as part of a larger study. To reduce priming effects, the
narcissism and self-esteem questionnaires were each separated
by several other questionnaires that did not measure either con-
struct. At the end of the study, participants were debriefed and in-
formed about the purpose of the research.
2.2.3. Materials
2.2.3.1. Narcissistic Personality Inventory. The NPI is a forced-choice
measure of narcissism as a dimensional a personality trait. It in-
cludes items ranging in severity from ‘‘I am assertive” to ‘‘I insist
on upon getting the respect that is due me.” Participants completed
the 37-item, 4-factor version of the scale (Emmons, 1987).
2.2.3.2. Personality Questionnaire for the Structured Clinical Interview
for DSM-IV Axis II Personality Disorders. Participants completed the
NPD section of the Personality Questionnaire for the Structured
Clinical Interview for DSM-IV Axis II Personality Disorders (PQ;
First, Gibbon, Spitzer, Williams, & Benjamin, 1997). This allowed
us to test the convergent validity of NPI items against a benchmark
measure directly related to the construct on which the NPI is pur-
portedly based. The PQ is a 119-item yes/no questionnaire. Its
items correspond to the DSM-IV diagnostic criteria for personality
disorders, and are directly linked to the content of the Structured
455
Clinical Interview for DSM-IV Personality Disorders (SCID-II; First
et al., 1997). Participants completed the 17 PQ items that corre-
spond to the nine DSM-IV diagnostic criteria for NPD. Examples in-
clude ‘‘Do people often fail to appreciate your very special talents
or accomplishments?” and ‘‘Do you often expect other people to
do what you ask without question because of who you are?” Re-
sponses were coded according to the number of NPD criteria en-
dorsed (i.e., scores ranged from 0 to 9). For criteria with more
than one associated PQ item, a ‘‘yes” answer to any associated item
was coded as endorsement of the criterion.
The PQ was designed to be a screening instrument for the SCID-
II diagnostic interview (First, Spitzer, Gibbon, & Williams, 1995).
However, agreement between the two assessments is such that
the PQ can serve as a reasonable alternative to the interview (Ekse-
lius, Lindstrom, von Knorring, Bodlund, & Kullgren, 1994). The PQ
has been used previously as a stand-alone research instrument
(e.g., Dowson & Berrios, 1991; Morse, Robins, & Gittes-Fox, 2002).
2.2.3.3. Rosenberg Self-Esteem Scale. The Rosenberg Self-Esteem
Scale (RSE; Rosenberg, 1965) is a widely used measure that as-
sesses participants’ feelings of self-worth. It contains ten items
such as ‘‘On the whole, I am satisfied with myself” rated on a 1
(strongly disagree) to 4 (strongly agree) scale. The RSE has been rec-
ommended for use in research that aims to separate the effects of
narcissism from those of self-esteem (Brown & Zeigler-Hill, 2004).
2.3. Approaches to assessing the narcissistic content of NPI items
2.3.1. Expert ratings
Ratings of the narcissistic content of NPI items were made by 19
clinicians who were also empirical narcissism researchers. Poten-
tial participants met two criteria: they were (a) Ph.D. or M.D. level
clinicians and (b) authors of empirical peer-reviewed narcissism
research articles. Using the PsycINFO database, we identified 32
individuals who met both criteria. We contacted each potential
participant by email and sent a follow up request if there was no
response to the first message. Nineteen participants (16 men and
three women) completed the study. Of these, 15 held Ph.Ds., three
held M.Ds., and one held both degrees.
Experts assessed the content validity of each of the 54 items
from the original version of the NPI (Raskin & Hall, 1979, 1981)
by rating (a) whether it was ‘‘indicative of the construct of narcis-
sism” and (b) whether it suggested ‘‘a clinical or diagnostic level
of narcissism.” This second step was intended, in part, to remind
participants that items did not have to meet a clinical threshold
in order to be considered indicative of the construct. Expert raters
were not directed to make their ratings based on any particular
theoretical or typological orientation. Instead, they were intended
to consider narcissism ‘‘from their own diverse experiences” (see
Lynam & Widiger, 2001, p. 409).
Expert ratings and subscale information for the 37 items in-
cluded in the Emmons (1987) version of the NPI are presented in
Table 1. Of the 37, the mean number of items each rater regarded
as indicative of the construct of narcissism (i.e., hits) was 20.55
(SD = 5.67). From the perspective of the scale, of the 703 total item
ratings made, 390 (55.5%) were hits (SD = 0.16). From the perspec-
tive of items, the mean number of hits per item (out of a possible
19) was 10.54 (SD = 4.16). Overall, 25 of the 37 items were en-
dorsed as indicative of the construct of narcissism by more than
half of the experts. The two items that research has shown to have
the strongest statistical relationship with aggregated NPI scores
(i.e., they have the greatest statistical influence on overall NPI
scores; Raskin & Terry, 1988), ‘‘I would prefer to be a leader” and
‘‘I like to have authority over people” received only two and ten
hits respectively. In contrast, the item that has been shown to have
the weakest relationship with the aggregated NPI (i.e., it has the
456 S.A. Rosenthal, J.M. Hooley / Journal of Research in Personality 44 (2010) 453–465

Table 1
Expert, IRT, and EFA subscale ratings for 37-item NPI, Study 1.

Item Expert hits Expert subscale IRT subscale EFA subscale

20. I insist upon getting the respect that is due me 17 N N N
35. I will never be satisfied until I get all that I deserve 16 N N N
14. I think I am a special person 16 N X N
54. I am an extraordinary person 16 N X N
48. I am going to be a great person 16 N X N
32. Everybody likes to hear my stories 15 N N N
4. Superiority is something you are born with 14 N – N
49. I can make anybody believe anything I want them to 14 N N N
7. I know that I am good because everybody keeps telling me so 14 N N N
18. People can learn a great deal from me 14 N – N
40. I am envious of other people’s good fortunes 13 N – N
46. People always seem to recognize my authority 13 N N X
29. I always know what I am doing 13 N X N
19. I find it easy to manipulate people 12 N N N
53. I am more capable than other people 11 N N N
26. I like to look at my body 11 N N N
28. I am apt to show off if I get a chance 11 N N N
33. I usually dominate any conversation 11 N – N
42. I like to look at myself in the mirror 11 N X N
38. I have a strong desire for power 10 N N N
52. I get upset when people don’t notice how I look when I go out in public 10 N N N
10. I can usually talk my way out of anything 10 N N N
22. I can read people like a book 10 N N N
2. I have a natural talent for influencing people 10 N X X
17. I like having authority over other people 10 N X X
36. I like to be complimented 9 X X N
12. I like to be the center of attention 9 X X X
44. I really like to be the center of attention 9 X X X
50. I am a born leader 9 X N N
21. I like to display my body 9 X N N
27. I have good taste when it comes to beauty 7 X – N
6. I would be willing to describe myself as a strong personality 6 X – X
15. I see myself as a good leader 6 X X X
34. I expect a great deal from other people 5 X N N
47. I would prefer to be a leader 2 X X X
16. I am assertive 1 X X X
5. I would do almost anything on a dare 0 X N N
Mean (SD) 10.54 (4.16)

Note. For expert ratings, N = 19. Expert hits = number of experts who endorsed the item as indicative of narcissism. IRT = item response theory. EFA = exploratory factor
analysis. Item numbers are from the original 54-item NPI. For the Expert subscales, N = more than 50% of raters endorsed item as indicative of narcissism, X = fewer than 50%
of raters endorsed item as indicative of narcissism. For the IRT subscales, N = not identified as a poor item by IRT data, X = identified as a poor item by IRT data, – = IRT data not
available. For the EFA subscales, N = item from the Exploitativeness/Entitlement (E/E), Superiority/Arrogance (S/A), or Self-Absorption/Self-Sufficiency (S/S) subscale, X = item
from the Leadership/Authority (L/A) subscale.

least statistical influence on overall NPI scores; Raskin & Terry,
1988), ‘‘I insist upon getting the respect that is due me,” received
the greatest number of hits (17) from the expert raters.
Overall agreement among the 19 raters was good. The two-way
mixed, absolute agreement, average measures intraclass correla-
tion, which assumes that these specific experts’ ratings will be
used in the aggregate, was .77. The alpha for raters’ internal consis-
tency (with raters treated as variables and NPI items treated as
cases) was .79. No single rater had a significantly detrimental effect
on the alpha coefficient.
Using a liberal 50% endorsement threshold for each item as a
cut-off (see Lawshe, 1975), we classified the 25 NPI items rated
as narcissistic by 10 or more expert raters as Expert-N items, and
the 12 items rated as narcissistic by nine or fewer raters as Ex-
pert-X items.
2.3.2. Item response theory
In the context of the NPI, an IRT analysis can determine whether
each NPI item is likely to be endorsed mainly by individuals who
are higher in the general trait measured by the scale, or is just as
likely to be endorsed by individuals with low levels of the trait.
O’Shea and Gustafson (1999) conducted a three-parameter model
IRT analysis on the 40-item version of the NPI (Raskin & Terry,
1988) with data from 1260 undergraduate participants. The 40-
item NPI shares 31 items in common with the Emmons (1987)
37-item version employed in the current research. O’Shea and Gus-
tafson’s (1999) results indicated that a number of the scale’s items
measured traits toward the lowest severity levels of the NPI’s spec-
trum. As indicated by b parameter scores near or below zero, these
items were likely to be endorsed in the ‘‘narcissistic” direction by
individuals who had near average, or even below average levels
of the general construct measured by the NPI. The data identified
13 items with low b parameter scores. The authors also identified
a 14th item with a high c parameter score, which indicated that it
was excessively likely to be endorsed by individuals who were ex-
tremely low in the trait measured by the scale. Thirteen of the 14
identified items are also contained in the Emmons (1987) 37-item
NPI. Accordingly, we classified those 13 items as IRT-X items. The
other eighteen items shared by both scales (i.e., those with higher
b parameter scores) were classified as IRT-N items. We dropped the
remaining six items for which there were no ratings.
2.3.3. Traditional subscales
Emmons (1984, 1987) derived four NPI subscales using EFA:
Exploitativeness/Entitlement (E/E), Superiority/Arrogance (S/A),
Self-Absorption/Self-Sufficiency (S/S), and Leadership/Authority
(L/A). E/E was the most clinically-relevant subscale; it may mea-
sure the core, maladaptive aspects of narcissism (Dickenson &
 S.A. Rosenthal, J.M. Hooley / Journal of Research in Personality 44 (2010) 453–465 457

Table 2 Table 3
Correlations, descriptive statistics, and reliabilities, Study 1. Regression summaries for NPI-N and NPI-X subscales predicting benchmark narcis-
sism and self-esteem measures, Study 1.
NPI PQ RSE M SD Alpha
Benchmark measures
NPI 14.33 5.83 .80
PQ .34 4.21 2.02 .62 Narcissism (PQ) Self-esteem (RSE)
RSE .36 .21 3.20 0.53 .88
Beta B SEB Beta B SEB
Expert-N .92 .45 .21 8.77 3.85 .69
Expert-X .83 .08 .47 5.56 2.78 .72 Expert-N .58* 0.30 .04 .06 0.01 .01
IRT-N .87 .42 .14 5.09 2.90 .62 Expert-X .23* 0.17 .05 .51* 0.10 .01
IRT-X .86 .11 .55 7.43 3.18 .76
IRT-N .52* 0.36 .05 .22* 0.04 .01
EFA-N .90 .47 .19 9.00 4.09 .70
IRT-X .17* 0.11 .04 .67* 0.11 .01
EFA-X .77 .01 .47 5.32 2.78 .82
EFA-N .57* 0.28 .03 .01 0.00 .01
Note. N = 232. NPI = Narcissistic Personality Inventory. PQ = narcissistic personality EFA-X .23* 0.17 .05 .47* 0.09 .01
disorder section from the Personality Questionnaire for the Structured Clinical
Interview for DSM-IV Axis II Personality Disorders. RSE = Rosenberg Self-Esteem Note. N = 232. NPI = Narcissistic Personality Inventory. PQ = narcissistic personality
Scale. Expert = expert item content ratings. IRT = item response theory. disorder section from the Personality Questionnaire for the Structured Clinical
EFA = exploratory factor analysis. Expert-, IRT-, and EFA-N subscales = subscales Interview for DSM-IV Axis II Personality Disorders. RSE = Rosenberg Self-Esteem
comprised of more clearly narcissistic NPI items. Expert-, IRT-, and EFA-X sub- Scale. Expert = expert item content ratings. IRT = item response theory.
scales = subscales comprised of less clearly narcissistic NPI items. All correlations EFA = exploratory factor analysis. Expert-, IRT-, and EFA-N subscales = subscales
r P .13, p < .05; r P .17, p < .01; r P .22, p < .001. comprised of more clearly narcissistic NPI items. Expert-, IRT-, and EFA-X sub-
scales = subscales comprised of less clearly narcissistic NPI items.
*
p < .001.
Pincus, 2003; P. J. Watson, Grisham, Trotter, & Biderman, 1984). In
contrast, L/A was considered the most adaptive and least clinically-
relevant. The other two subscales, S/A and S/S, fell between E/E and measure of self-esteem as it was to a benchmark measure of nar-
L/A, but are often considered to be adaptive subscales that are clo- cissism. This is also notable as the two benchmark measures were
sely related to L/A (Emmons, 1984, 1987; P. J. Watson & Biderman, negatively correlated with each other in the same data set
1993; P. J. Watson, Little, Sawrie, & Biderman, 1992; P. J. Watson & (r = .21, p < .01).
Morris, 1990).
However, there is also evidence that L/A stands apart from 3.2. Subscales
the two other adaptive subscales, S/A and S/S, as well as from
E/E. L/A exhibits a unique lack of convergence with various other We used three independent methods for dividing the NPI into
measures of narcissism (Shulman & Ferguson, 1988). It is also more two sets of items that were better, or more poorly, aligned with
strongly related to normative characteristics such as assertiveness the construct of narcissism: clinical research experts’ content
(P. J. Watson, McKinney, Hawkins, & Morris, 1988) and extraver- validity ratings, IRT results reflecting internal validity, and tradi-
sion (Emmons, 1984) than are any of the other subscales. Further, tional EFA-derived subscales developed to investigate construct
the L/A subscale is lacking in construct validity on its face (Em- validity. As indicated in Table 1, the three methods produced par-
mons, 1987; Mullins & Kopelman, 1988), because leadership and tially overlapping results. For the 31 items rated by all three meth-
related characteristics do not appear among the DSM-III (or subse- ods, there was three-way agreement on 18 (13 agreed as NPI-N
quent) NPD criteria, but have long been measured as desirable items, five agreed as NPI-X items), and disagreement on the 13
non-narcissistic traits (e.g., Gough, 1969). Thus, the L/A subscale remaining items. Four of the six items for which there were only
essentially ‘‘adds a new dimension” to narcissism (Mullins & Kop- two ratings were agreed as NPI-N items, one as an NPI-X item,
elman, 1988, p. 620), which is generally considered poor practice in and there was disagreement on one.
defining the limits of a construct in order to measure it precisely Although there was notable variation in the composition of the
(Clark & Watson, 1995; Haynes et al., 1995). subscales produced by the three methods for dividing the NPI, the
Because of the potential problems specific to the L/A subscale, pattern of the correlations between the subscales and the bench-
we investigated the consequences of separating L/A from the rest mark scales was nearly identical (see Table 2). In each case, the
of the NPI by labeling the nine L/A items the EFA-X subscale, and NPI-N subscale was significantly correlated with the benchmark
the 28 items from the other three subscales the EFA-N subscale. measure of narcissism (PQ) whereas the NPI-X subscale was uncor-
Thus, the EFA-N subscale retained the items from the adaptive related with the PQ. In contrast, all subscales were significantly
S/A and S/S subscales as well as from the maladaptive E/E subscale. correlated with the self-esteem benchmark measure (RSE). How-
ever, in each pair of subscales, the NPI-X subscale’s correlation with
3. Results the RSE was significantly stronger than was the corresponding NPI-
N subscale’s correlation (ZExpert = 4.40; ZIRT = 7.06; ZEFA = 4.26, all
3.1. Aggregated NPI ps < .001).1 This indicates that the NPI-X subscales share a stronger
relationship with self-esteem than do the NPI-N subscales. More
Descriptive statistics, reliabilities, and correlations for the scales importantly, each NPI-X subscale was also more strongly correlated
and subscales used in Study 1 are reported in Table 2. The aggre- with the RSE than with the PQ (ZExpert = 4.10; ZIRT = 4.82; ZEFA = 4.77,
gated NPI was significantly correlated with both the PQ and the all ps < .001). This indicates that each NPI-X subscale was more
RSE. Further, there was no statistical difference between the mag- strongly related to the benchmark measure of self-esteem than to
nitudes of the two correlation coefficients (rs = .34 and .36 respec- the benchmark measure of narcissism.
tively; Z = 0.22, p = .83; see Meng, Rosenthal, & Rubin, 1992, for the We also investigated whether the NPI-X subscales contributed
method used to compare correlated correlation coefficients variance independent of the NPI-N subscales to predicting the
throughout this article). The same coefficients, corrected for disat- benchmark narcissism measure by simultaneously entering the
tenuation due to less than perfect internal consistency (Spearman, corresponding paired subscales in regressions predicting the PQ.
1904), were also statistically equivalent (disattenuated rs = .48 and
.43 respectively, Z = 0.60, p = .55). In other words, when used as an 1
The correlation between the Expert-N and Expert-X subscales = .53; between the
aggregated scale, the NPI was as closely related to a benchmark IRT-N and IRT-X subscales = .54; and between the EFA-N and EFA-X subscales = .42.
458 S.A. Rosenthal, J.M. Hooley / Journal of Research in Personality 44 (2010) 453–465
The left half of Table 3 illustrates that in each case, the NPI-N sub-
scale predicted PQ scores. In contrast, each NPI-X subscale was
negatively related to the PQ. Although this occurred in the context
of statistical suppressor effects, whereby estimates of the specific
direction and strength of the relationships are unreliable, the sup-
pression did not affect the key conclusion that the NPI-X subscales
were not positively related to the PQ.2
In contrast, as illustrated in the right half of Table 3, when en-
tered simultaneously in a regression, each of the NPI-X subscales
predicted the benchmark self-esteem measure whereas the corre-
sponding NPI-N subscales did not contribute any additional vari-
ance to predicting self-esteem (except in the case of the IRT-
derived subscales, where IRT-N was negatively related to the
RSE). This provides further evidence that the items comprising
the NPI-X subscales are robustly related to self-esteem.
Finally, it is also noteworthy that the potential problems with
the L/A subscale identified by the traditional subscale approach
may have been recognized implicitly in the experts’ ratings. Only
three of L/A’s nine items were rated as indicative of narcissism
by more than half of the experts. The mean number of hits per item
for the 9-item L/A subscale was 7.33 (SD = 3.94), and the mean hit
percentage per item was 38.6% (SD = 0.20). In contrast, the hits per
item for the 11-item S/A subscale was 11.00 (SD = 4.17), hit per-
centage = 57.9% (SD = 0.21); for the 9-item S/S subscale, hits per
item = 12.11 (SD = 3.48), hit percentage = 63.7% (SD = 0.26); and
for the 8-item Exploitativeness/Entitlement subscale (E/E), hits
per item = 11.75 (SD = 3.77), hit percentage = 61.8% (SD = 0.24).
Overall, the average item from the L/A subscale was endorsed as
narcissistic significantly less frequently than was the average item
from the three other subscales, paired-samples t(18) = 4.07,
p < .001.
4. Discussion
Results from Study 1 support the hypothesis that portions of the
NPI do not do a good job of measuring narcissism. Further, these
items appear to be confounded with self-esteem. These conclu-
sions are borne out almost identically whether the NPI is divided
into subscales using judgments of expert clinical researchers, IRT
analyses (O’Shea & Gustafson, 1999), or subscales based on EFAs
conducted by a personality psychologist (Emmons, 1987).
The conclusions derive from two key findings. First, using each
method to divide the NPI, the resulting NPI-X subscale is unrelated
to the benchmark narcissism measure (i.e., the PQ). This suggests
that major portions of the NPI do not meet the scale’s authors’ sta-
ted goal of measuring narcissism that is linked to the DSM diagnos-
tic criteria for NPD (Raskin & Hall, 1979). Second, these less
narcissistic NPI subscales have a significantly stronger relationship
with the benchmark self-esteem measure (i.e., the RSE) than with
the benchmark narcissism measure, suggesting that they measure
self-esteem better than they measure narcissism.
The results of Study 1 also provide some potentially good news
for the validity of inferences based on some of the NPI’s items. In all
cases, the NPI-N subscales were strongly related to the benchmark
narcissism scale. This indicates that many NPI items do meet the
goal of measuring narcissism that overlaps with the DSM descrip-
tion of the trait (see Miller et al., 2009). The NPI-N subscales also
shared positive zero-order relationships with the benchmark self-
esteem scale, suggesting that the NPI’s more narcissistic items
may also be positively related to self-esteem. However, the simul-
2
The statistical suppressor effects do not appear to be the result of multicolinearity
between the NPI-N and NPI-X subscales. Allison (1999) provided the conservative
estimate that a variance inflation factor (VIF) of 2.50 or higher indicates a
multicolinearity problem. In contrast, the VIF in each of the current regression
models was lower than 1.40.
taneous regressions reported in Table 3 indicate that the relation-
ships between the NPI-N subscales and self-esteem are negated by
controlling for the NPI-X subscales, suggesting that this relation-
ship is tenuous and in need of further investigation.
4.1. Limitations
It is important to note that each of the three methods used to
divide the NPI into more and less narcissistic items poses problems
on its own. An expert ratings approach is generally favored for test
items that measure observable outcomes, such as job or school
performance, rather than abstractions such as personality traits
(Lawshe, 1985). Further, a 50% cut point for dividing the scale is
arbitrary, although it is widely used and based on the principle that
items with more than 50% endorsement by a group of experts have
at least ‘‘some degree of content validity” (Lawshe, 1975, p. 567).
Our design for assessing expert ratings also did not account for par-
ticipants’ familiarity with or biases about the NPI, either of which
could have affected their ratings. We also did not ask experts to
choose whether each NPI item measures ‘‘narcissism or self-
esteem,” which would have been more in keeping with the hypoth-
eses of this research. Future research using expert ratings could
benefit by including items from multiple narcissism and self-es-
teem measures, and providing a format in which experts choose
whether each item measures narcissism or self-esteem.
IRT analyses assume that the measure being analyzed is unidi-
mensional. However, the NPI has been shown in numerous studies
to be multidimensional (Corry, Merritt, Mrug, & Pamp, 2008;
Emmons, 1984, 1987; Kubarych, Deary, & Austin, 2004; Raskin &
Terry, 1988). The IRT’s authors (O’Shea & Gustafson, 1999) agree
that the NPI is not fully described by a single factor. On the other
hand, they note that Monte Carlo simulations indicate that IRT
models should produce accurate descriptions of a multidimen-
sional scale if the scale’s first factor accounts for 20% or more of
the overall variance (Reckase, 1979; see also Drasgow & Parsons,
1983). Accordingly, O’Shea and Gustafson (1999) conducted an
EFA with their data. Their analysis produced a first factor that ac-
counted for 43% of the variance in the NPI. This suggests that an
IRT model of their data should produce relatively accurate results.
Also, treating the NPI as if it were undimensional introduces eco-
logical validity to the research (if only unintentionally). Research
using the NPI most often relies on a unidimensional aggregated
score (Miller & Campbell, 2008). Further, the NPI was originally
developed using an internal consistency strategy better suited for
selecting scale items to measure a unidimensional than a multidi-
mensional construct (Raskin & Terry, 1988). Nevertheless, because
of dimensionality concerns, the IRT results should be treated with
caution.
As noted earlier, Emmons’s (1987) traditional NPI subscales
have typically been divided into three adaptive subscales (L/A,
S/S, and S/A), with E/E set aside as the lone maladaptive subscale
(Emmons, 1984, 1987; P. J. Watson et al., 1992). We take a different
approach by combining E/E, S/S, and S/A into a single measure of
narcissism and setting aside L/A as a less appropriate means for
measuring narcissism. We believe that setting L/A, rather than
E/E, aside is more theoretically consistent with the intentions of
the NPI’s authors (Raskin & Hall, 1979, 1981). By removing L/A un-
der the assumption that it is comprised of poorly-conceived items
(i.e., that it does not measure narcissism properly), we retain the
remainder of the NPI as a continuous measure of narcissism. In
contrast, the common practice of separating E/E from the rest of
the NPI while maintaining that both represent valid measures of
narcissism suggests that the NPI is actually made up of two
separate continuous measures of narcissism (E/E being a clinical-
level narcissism measure that is discontinuous from the other
three normal narcissism subscales; e.g., Dickenson & Pincus, 2003;
 S.A. Rosenthal, J.M. Hooley / Journal of Research in Personality 44 (2010) 453–465
P. J. Watson et al., 1984, 1992). We believe that an approach to the
NPI that retains the continuity from more to less severe narcissism,
while removing the items that may not be closely associated with
narcissism at all, is preferable. However, this method for dividing
the NPI has not been tested empirically elsewhere, and should be
considered with that in mind.
It is also important to note that the DSM diagnostic criteria for
NPD have changed since the development of the NPI. This could ac-
count for some of our results (i.e., for the lack of a relationship be-
tween some NPI items and the PQ). However, we believe this is an
unlikely explanation for a number of reasons. First, the crucial
characteristics of grandiosity, entitlement, exploitativeness, need
for admiration, lack of empathy, etc., were retained from the
DSM-III, on which the NPI is based, through the DSM-IV, on which
the PQ is based. Second, the changes in criteria from the inception
of the DSM-III to the DSM-IV should theoretically increase, rather
than decrease, the relationship between the NPI and the PQ. This
is because the DSM criteria that were removed emphasized vulner-
able narcissistic traits (e.g., inferiority, shame, emptiness, splitting;
Cain et al., 2008; Gunderson, Ronningstam, & Smith, 1995). As a re-
sult, the remaining DSM criteria focus nearly exclusively on gran-
diose narcissistic themes (Cain et al., 2008; Miller & Campbell,
2008; Miller, Hoffman, Campbell, & Pilkonis, 2008; Pincus & Luko-
witsky, 2010; Pincus et al., 2009), suggesting that there should be
an increased level of overlap with the NPI. Accordingly, the
changes in the diagnostic criteria for NPD made from the DSM-III
to the DSM-IV are unlikely to be the cause of a lack of correlation
between the NPI-X subscales and the PQ.
Overall, and even with these caveats, the results of Study 1 ap-
pear to support the central hypotheses: (1) that parts of the NPI do
poor job of measuring narcissism and (2) that those poor parts of
the NPI are confounded with and bias the aggregated scale toward
measuring self-esteem.
5. Study 2
5.1. Overview
In Study 2, we investigated the degree to which the overlap be-
tween the NPI-X subscales and self-esteem was responsible for the
relationship between the NPI and self-reports of indicators of psy-
chological health and distress, including optimism, happiness, po-
sitive affect, aggression, anxiety sensitivity, and negative affect. We
predicted that any relationship between the NPI and psychological
health would be fully accounted for by the NPI-X subscales and by
the NPI’s overlap with self-esteem. In contrast, the literature re-
viewed earlier suggests that any connections between the NPI
and psychological distress should be driven directly by the NPI-N
subscales and should be minimally affected by controlling for
self-esteem.
5.2. Method
5.2.1. Participants
A new sample of 141 students between the ages of 18 and
23–40 men and 101 women—was recruited through a psychology
department study pool and also via recruitment posters. The mean
age of participants was 19.6 years (SD = 1.1). This sample is typical
of the population with which NPI-based research is often con-
ducted. Participants were compensated with research credit or
small payments.
5.2.2. Procedure
Participants provided informed consent and demographic infor-
mation, and completed narcissism, self-esteem, and self-report
459
psychological health and distress questionnaires as part of a larger
study. Participants were then debriefed and informed about the
study’s purpose.
5.2.3. Materials
Participants completed the 37-item NPI and the RSE as well as
self-reports of the following psychological health variables (PHVs):
5.2.3.1. Optimism. The Life Orientation Test (Scheier & Carver,
1985) measures dispositional optimism. It consists of eight items
such as ‘‘I always look on the bright side of things” rated on a 1
(strongly disagree) to 5 (strongly agree) scale.
5.2.3.2. Happiness. The Oxford Happiness Questionnaire (Hills & Ar-
gyle, 2002) measures dispositional happiness. It consists of 29
items such as ‘‘I am very happy” rated on a 1 (strongly disagree)
to 6 (strongly agree) scale.
5.2.3.3. Positive and negative affect. The Positive and Negative Affect
Schedule measures positive affect (i.e., ‘‘the extent to which a per-
son feels enthusiastic, active, and alert;” D. Watson, Clark, & Telle-
gen, 1988, p. 1063) and negative affect (i.e., ‘‘subjective distress
and unpleasurable engagement;” p. 1063). Each subscale consists
of ten items which are rated on a 1 (very slightly or not at all) to
5 (extremely) scale. When used to measure dispositional affect,
the Positive Affect and Negative Affect subscales are generally
uncorrelated (Schmukle, Egloff, & Burns, 2002).
5.2.3.4. Aggression. The Aggression Questionnaire (Buss & Perry,
1992) measures dispositional hostility, anger, physical aggression,
and verbal aggression. It consists of 29 items such as ‘‘sometimes I
fly off the handle for no good reason” rated on a 1 (extremely
uncharacteristic of me) to 5 (extremely characteristic of me) scale.
5.2.3.5. Anxiety sensitivity. The Anxiety Sensitivity Index (Reiss, Pet-
erson, Gursky, & McNally, 1986) measures the belief that anxiety
experiences have negative implications and consequences (i.e., it
measures individuals’ fear of anxiety rather than their level of anx-
iety; Taylor, Koch, McNally, & Crockett, 1992). The scale contains
16 items (e.g., ‘‘It scares me when I am nervous”) which are rated
on 1 (very little) to 5 (very much) scale. Anxiety sensitivity is asso-
ciated with behavioral manifestations of anxiety (Maller & Reiss,
1987) and the presence of anxiety disorders, particularly panic dis-
order (McNally, 2002; Olatunji & Wolitzky-Taylor, 2009). It also
shares a robust positive relationship with neuroticism (Norton,
Cox, Hewitt, & McLeod, 1997; Zvolensky et al., 2003).
6. Results
Descriptive statistics for the scales and subscales from Study 2
are reported in Table 4. The first column of Table 5 reports the cor-
relations between the NPI and the self-report PHVs. The aggregated
NPI was positively related to each of the positive PHVs: optimism,
happiness, and positive affect. The aggregated NPI was also posi-
tively related to aggression, but had a marginal negative relation-
ship with the other two negative PHVs: negative affect and
anxiety sensitivity. These are consistent with the relationships be-
tween narcissism and psychological health and distress typically
reported in the types of social–personality studies reviewed earlier.
The second column reports the correlations between the RSE
and the PHVs. The RSE was positively related to the each of the po-
sitive PHVs and negatively related to each of the negative PHVs.
The aggregated NPI and RSE shared the same directional relation-
ship with each of the PHVs except for aggression, with which the
NPI was positively related whereas the RSE was negatively related.
460 S.A. Rosenthal, J.M. Hooley / Journal of Research in Personality 44 (2010) 453–465

Table 4 with the PHVs, the NPI-N subscales’ relationships with the PHVs
Descriptive statistics, Study 2. were generally inconsistent with those relationships. Accordingly,
M SD Alpha it appears that the NPI items that were identified in Study 1 as
NPI 13.54 6.19 .83 poorer indicators of the narcissism construct were largely respon-
Expert-N 7.58 3.72 .72 sible for the aggregated NPI’s relationship with the PHVs. In con-
Expert-X 5.34 2.86 .74 trast, the NPI items that were deemed better indicators of
IRT-N 4.75 2.98 .66 narcissism in Study 1 appear to have little effect on the aggregated
IRT-X 7.13 3.31 .78
EFA-N 8.44 4.33 .75
NPI’s relationship with the PHVs.
EFA-X 5.10 2.82 .83 The right-most column reports partial correlations, which re-
Self-esteem 3.19 0.54 .89 moved the variance associated with the RSE, between the aggre-
Optimism 3.66 0.67 .84 gated NPI and the PHVs. Removing self-esteem’s variance from
Happiness 4.27 0.69 .93
the aggregated NPI negated most of the significant relationships
Positive affect 3.62 0.63 .86
Aggression 2.07 0.49 .89 between the NPI and the PHVs, leaving a only a significant relation-
Anxiety sensitivity 2.22 0.57 .85 ship with aggression and a marginal relationship with positive af-
Negative affect 2.06 0.68 .88 fect, and reversing (i.e., making positive) a marginal relationship
Note. N = 141. NPI = Narcissistic Personality Inventory. Expert = expert item content
with negative affect. Overall, the pattern of partial correlations be-
ratings. IRT = item response theory. EFA = exploratory factor analysis. Expert-, IRT-, tween the aggregated NPI and the PHVs was similar to the pattern
and EFA-N subscales = subscales comprised of more clearly narcissistic NPI items. of zero-order correlations between the NPI-N subscales and the
Expert-, IRT-, and EFA-X subscales = subscales comprised of less clearly narcissistic same PHVs. In contrast, this pattern was strikingly dissimilar from
NPI items.
the pattern of zero-order correlations of the aggregated NPI with
the PHVs.

In each directionally-consistent case, the correlation between the

RSE and the PHV was significantly stronger than the correlation be-
tween the aggregated NPI and the same PHV at the p < .01 signifi-
cance level or greater.
Columns three through five report the correlations between the
NPI-X subscales derived in Study 1 and the PHVs. In each case ex-
cept for aggression, the NPI-X subscales shared the same direc-
tional relationship with the PHV as did both the aggregated NPI
and the RSE. Each of the NPI-X subscales was uncorrelated with
aggression—these relationships essentially ‘‘split the difference”
between the positive relationship of the aggregated NPI with
aggression and the negative relationship of the RSE with aggres-
sion. In every other case, the correlation between the RSE and
the PHV was stronger than the correlation between the NPI-X sub-
scale and the same PHV at the p < .05 level or greater, except for
the RSE’s and NPI-X subscales’ correlations with positive affect,
which were each statistically equivalent.
Columns six through eight report the correlations between the
NPI-N subscales and the PHVs. The NPI-N subscales were signifi-
cantly related to aggression and significantly or marginally related
to positive affect. None of the other relationships between the NPI-
N subscales and the PHVs were significant or marginal. In each
case, the NPI-X subscale was more strongly correlated than its cor-
responding NPI-N subscale with each PHV in the direction that
suggests a relationship between narcissism and psychological
health at the p < .01 level or greater, except in the case of aggres-
sion, with which the NPI-N subscales were more strongly corre-
lated than the NPI-X subscales in the ‘‘unhealthy” direction. In
other words, whereas the NPI-X subscales, the aggregated NPI,
and the RSE generally shared directionally consistent relationships
7. Discussion
Investigating the connection of narcissism to psychological
health using an aggregated NPI score paints a fairly straightfor-
ward picture. High NPI-rated narcissists appear to be more psycho-
logically healthy than non-narcissists (e.g., W. K. Campbell, 2001).
They are optimistic and happy, and are at least marginally lower in
negative affect and fearful reactions to anxiety. In fact, they are
healthy in ways very much like people with high self-esteem
(although less strongly so), except that they report being aggres-
sive whereas their high self-esteem counterparts report the
opposite.
However, a closer examination of why there is a positive rela-
tionship between the aggregated NPI and self-reported psycholog-
ical health reveals a starkly different picture. It is apparent that the
relationship between the NPI and psychological health is nearly
entirely dependent on a small number of NPI items—the same
items that were deemed by multiple methods in Study 1 to be poor
indicators of the narcissism construct. Study 2 further indicates
that the NPI’s relationship with psychological health is largely a re-
sult of its overlap with self-esteem. Removing self-esteem from the
aggregated NPI greatly reduced the scale’s relevance to the PHVs.
This indicates that self-esteem plays a crucial role in guiding the
NPI’s associations with self-reported psychological health.
In contrast, as predicted, the NPI’s association with one less nor-
mative trait—aggression—was largely driven by the NPI items that
were deemed the better indicators of narcissism in Study 1. This
relationship was actually strengthened by removing the effects of

Table 5
Correlations and partial correlations of NPI, self-esteem, and NPI-X and NPI-N subscales with psychological health and distress variables, Study 2.

NPI Self-esteem NPI-X subscales NPI-N subscales Partial correlations

Expert IRT EFA Expert IRT EFA NPI-pr
Optimism .30 .70 .47 .51 .51 .12 .07 .09 .01
Happiness .29 .73 .49 .47 .51 .09 .10 .07 .05
Positive affect .35 .57 .48 .49 .54 .20 .19 .15 .14
Aggression .25 .36 .08 .03 .06 .33 .36 .32 .48
Anxiety sensitivity .14 .43 .28 .27 .27 .02 .02 .03 .05
Negative affect .15 .57 .31 .30 .31 .00 .04 .01 .14

Note. N = 141. NPI = Narcissistic Personality Inventory. Expert = expert item content ratings. IRT = item response theory. EFA = exploratory factor analysis. Expert-, IRT-, and
EFA-X subscales = subscales comprised of less clearly narcissistic NPI items. Expert-, IRT-, and EFA-N subscales = subscales comprised of more clearly narcissistic NPI items.
Partial correlations (pr) remove the variance associated with self-esteem. All correlations r P 14, p < .10; r P .17, p < .05; r P .22, p < .01; r P .28, p < .001.
 S.A. Rosenthal, J.M. Hooley / Journal of Research in Personality 44 (2010) 453–465
self-esteem (see Paulhus, Robins, Trzesniewski, & Tracy, 2004; Tra-
cy, Cheng, Robins, & Trzesniewski, 2009).
Overall, the results of Study 2 indicate that either eliminating a
small number of questionable items from the NPI, or controlling for
the NPI’s overlap with self-esteem, could potentially lead to over-
hauling current findings in some social–personality literature
about the connection of narcissism to psychological health. The
ensuing results would likely indicate that such relationships are
tenuous at best, and should be reconsidered.
8. General discussion
Much of the NPI-based research linking narcissism to psycho-
logical health may need to be reinterpreted. It appears that estab-
lishing a robust connection between narcissism and psychological
health necessitates the following: (1) using only the NPI (including
its most normative items) to measure narcissism, (2) accepting
that the NPI items that are most normative actually measure nar-
cissism, and (3) accepting that the full mediation of the NPI’s con-
nection to psychological health by self-esteem reflects an inherent
overlap of narcissism with high self-esteem rather than a
confound.
Making each of these three choices is problematic. (1) Using
only the NPI to measure narcissism is unwise both because relying
on a single method of measuring any construct is generally consid-
ered problematic (D. T. Campbell & Fiske, 1959), and because, as
our results indicate, aggregating scale items that may measure
more than one construct can lead to making overinclusive infer-
ences (Clark & Watson, 1995). (2) Accepting that the most norma-
tive NPI items measure narcissism is problematic because our
results (as well as much of the accumulated literature) suggest that
these items may bear little resemblance in their content or rela-
tionships with third variables to the DSM-III description of narcis-
sism on which the NPI was purportedly based. Finally, (3)
accepting that the NPI’s overlap with self-esteem reflects a valid,
robust relationship is problematic because many theoretical (e.g.,
Westen, 1990) and empirical (e.g., Brown & Bosson, 2001; Paulhus,
1998, 2001; Paulhus et al., 2004; Tracy et al., 2009) accounts of
narcissism, most empirical work using narcissism measures other
than the NPI (e.g., Soyer, Rovenpor, Kopelman, Mullins, & Watson,
2001), and our regression results, suggest that it does not.
If as a response to these problems, social–personality narcissism
researchers modified their practice of relying on aggregated NPI
scores, omitted questionable NPI items, and/or partialed out self-
esteem as a confound when using the NPI, what we think we know
about the positive side of narcissism could be radically different.
Rather than appearing to be a sign of psychological health, narcis-
sism from a social–personality perspective might align more clo-
sely with clinical perspectives on the trait.
8.1. Multiple definitions of narcissism?
Our results suggest that the NPI is most accurately described as
measuring both less extreme levels of characteristics associated
with clinical narcissism and self-esteem (and confounding the
two into a single score) rather than as measuring a unitary con-
struct of normal narcissism (see Miller & Campbell, 2008; Pincus
& Lukowitsky, 2010; Pincus et al., 2009). However, it is true that,
in contrast with most current clinical conceptions of narcissism,
in narcissism’s early theoretical incarnations, psychoanalysts such
as Freud (1931/1950) and Rank (1911, cited in Pulver, 1970) also
used the term ‘‘narcissism” to describe an eclectic variety of nor-
mative positive feelings and beliefs about the self analogous to
high self-esteem (see W. K. Campbell, 2001; Miller & Campbell,
2008).
461
For instance, Freud (1931/1950) noted that narcissists can exhi-
bit healthy unflappable strength and confidence, and suggested
that any type of psychological investment in the self, whether
pathological or not, fits under the umbrella of narcissism (see Pul-
ver, 1970). Freud’s clinical theory may align best with current so-
cial–personality theories that consider pathological and normal
narcissism to be correlated constructs that are related through ba-
sic core traits (e.g., Miller & Campbell, 2008; Miller et al., 2009). Be-
yond those core traits, however, these types of narcissism have
‘‘substantially different nomological networks” (Miller & Campbell,
2008, p. 470), particularly in their relationship with psychological
health. Kohut (1966) also differentiated normal from pathological
narcissism, indicating that the two have independent developmen-
tal trajectories, where normal narcissism can develop into mature
psychological structures and processes. His view may align best
with current theories that consider pathological and normal nar-
cissism to be largely independent constructs, which may share
some descriptive traits, but are otherwise unrelated (e.g., Cain
et al., 2008; Pincus & Lukowitsky, 2010; Pincus et al., 2009).
Consistent with theories of normal narcissism, the NPI’s opera-
tional definition of narcissism has been described as ‘‘simply recog-
nizing one’s own contribution to positive outcomes without overly
exaggerating one’s accomplishments” (Emmons, 1987, p. 16).
However, as noted by Raskin and Terry (1988), such a broad con-
ception of narcissism runs the risk of rendering the term a vague
and somewhat meaningless way of describing ‘‘all human efforts”
(see Ellis, 1927; Hoffman, 2008). It also makes it difficult, if not
impossible, to differentiate narcissism from definitions of self-es-
teem (Pulver, 1970; Westen, 1990), such as ‘‘the individual . . . is
aware of his virtues . . . [and has] confident anticipation of success”
(Rosenberg, 1965, p. 31).
Moreover, the NPI was not developed to measure historical nor-
mative conceptualizations of narcissism. Therefore, such theories
are not particularly germane to a discussion of NPI-based research.
Instead, the NPI was intended to measure less extreme levels of
narcissism ‘‘as defined by” a specific clinical typology, the DSM-
III criteria for NPD (Raskin & Hall, 1979, p. 590). Thus, it should
not be necessary or desirable to segregate NPI-based research from
clinical narcissism research, as has been suggested elsewhere (Cain
et al., 2008; Pincus & Lukowitsky, 2010; Pincus et al., 2009). Our re-
sults indicate that taking a critical approach to the NPI—by recog-
nizing that it contains poorly-conceived items that appear to be
confounded with self-esteem—may make it easier to understand
how NPI-based research and clinical narcissism research might
yet form a ‘‘cohesive knowledge base” that converges on a unitary
narcissism construct (see Pincus & Lukowitsky, 2010, p. 422).
However, it is also possible that a DSM-based definition of nar-
cissism was too narrow a guide for developing the NPI and/or is too
limited as a benchmark measure against which to test the NPI.
There is more than a century’s worth of theory describing narcis-
sism in ways that reach well beyond the short list of diagnostic cri-
teria included in the versions of the DSM published during the last
30 years (see Morrison, 1986; Ronningstam, 1998; Ronningstam &
Gunderson, 1988). However, essential criteria contained in the
DSM, such as arrogance, grandiosity, entitlement, exploitativeness,
and lack of empathy, are also at the core of the vast majority of
other typologies of narcissism. And in the case of all but the most
normative theories, narcissists’ self-esteem is thought to be either
low, or at best, disordered (Westen, 1990), rather than high. Be-
cause of this, although using the DSM as a research template
may omit some important aspects of narcissism, conclusions
reached in narcissism research using the NPI, or any other mea-
sure, should still stand up to scrutiny through the lens of the DSM’s
criteria.
But where does a focus on less extreme levels of characteristics
associated with clinical narcissism leave the types of healthy,
462 S.A. Rosenthal, J.M. Hooley / Journal of Research in Personality 44 (2010) 453–465
normal narcissism recognized by Freud (1931/1950) and Kohut
(1966), and referenced by social–personality psychologists (e.g.,
W. K. Campbell, 2001; Miller & Campbell, 2008)? Do some or all
of the NPI’s seemingly poorer items measure this other construct?
Without a clear definition of normal narcissism, or strong evidence
that it exists independent of other constructs, this question is dif-
ficult to answer. However, if research on normal narcissism can be
more accurately described as investigations of self-esteem (e.g.,
Rosenberg, 1965), assertiveness (e.g., Rathus, 1973), or leadership
motivations (e.g., Avolio & Locke, 2002; Gough, 1969), etc., it might
be preferable to identify and measure those constructs accordingly,
leaving the narcissism moniker behind.
Miller et al. (2009), take an opposing view. They suggest that a
DSM-based benchmark is inherently limited. Instead, they recom-
mend that the normative characteristics measured by the NPI, such
as assertiveness and extraversion, should be incorporated more
broadly into the operational definition of narcissism. Further, they
point out that such characteristics are already considered by clini-
cians to be important aspects of narcissism (e.g., Lynam & Widiger,
2001; Samuel & Widiger, 2004). However, as noted earlier, such
characteristics exhibit low specificity—they most likely do not dif-
ferentiate well between narcissists and non-narcissists. And thus,
although narcissism may be associated with the presence of these
characteristics, they may be just as prevalent in non-narcissists.
Because of this, they are not good candidates for inclusion in a nar-
cissism scale that aims for discriminant validity in its predictions.
The effects of measuring narcissism based on the NPI’s overin-
clusive definition of the trait were borne out in the descriptive data
of Miller et al. (2009), which indicated that their normal under-
graduate sample had significantly higher NPI scores than did their
clinical outpatient sample (t(95) = 2.59, p < .01). In contrast, as
would be expected, their clinical sample had significantly higher
narcissism scores on clinical (i.e., SCID-II) interviews (First et al.,
1997) than did their undergraduate sample (t(95) = 2.89, p < .01).
The fact that patients who are higher in clinically-defined narcis-
sism can have lower NPI scores than do normal undergraduates
further underscores the likelihood that some of the characteristics
measured by the NPI do not help determine whether an individual
is actually narcissistic.
8.2. Broader implications?
Reevaluating the NPI—assessing whether the scale’s least nar-
cissistic items measure self-esteem better than they measure nar-
cissism—may shed new, albeit speculative, light on a number of
current debates about narcissism and health at a societal level.
For example, there is a dispute about whether a steady increase
in aggregated NPI scores over the past few decades signals a prob-
lematic rise in egotism and self-centeredness among college stu-
dents (see Twenge, Konrath, Foster, Campbell, & Bushman, 2008a,
2008b), or whether NPI subscale data indicate a less worrisome in-
crease in only the least pathological aspects of normal narcissism
(see Trzesniewski, Donnellan, & Robins, 2008). However, if reas-
sessed from the standpoint of the current research, increasing
scores on certain NPI subscales may not reflect an increase in nar-
cissism at all. They may instead be the result principally of in-
creases in self-esteem and other similar characteristics. If this
were the case, the research may reflect a positive, rather than neg-
ative societal change.
Similarly, Foster, Campbell, and Twenge (2003) appeared to
support Lasch’s (1979) assertion that western societies are more
narcissistic than eastern societies by finding that scores on the
aggregated NPI and some NPI subscales were higher in the west
than in the east. However, they also reported that there were no
cultural differences in scores on the most clearly narcissistic NPI
subscales (in this case, the Entitlement and Exploitativeness sub-
scales from the 40-item NPI developed by Raskin & Terry, 1988).
From our perspective, these data may point to a counterintuitive
result—core characteristics of narcissism may be just as prevalent
in the east as in the west. Because of confusion about what the
NPI measures, we suggest caution in making broad assertions
regarding NPI-based findings, including in the two debates refer-
enced here.
8.3. Limitations
Although we focus on the NPI’s overlap with self-esteem, self-
esteem is not the only trait with which the NPI is confounded. Re-
search indicates that the NPI may also fail to discriminate between
narcissism and other normative traits including dominance (Brown
& Zeigler-Hill, 2004) and extraversion (Emmons, 1984), and that L/A
in particular may be confounded with assertiveness (P. J. Watson,
McKinney, et al., 1988). However, our findings suggest that
when the universe is constrained to two self-regard constructs—
narcissism and self-esteem—the problematic NPI items that we
have identified are more closely aligned theoretically and empiri-
cally with self-esteem than with narcissism.
We also recognize that critiquing the empirical overlap of nar-
cissism and self-esteem may oversimplify the relationship be-
tween the two constructs. Most clinical theory suggests that
narcissism and self-esteem are not independent. Instead, there is
thought to be a complex, dynamic relationship between them, with
narcissism functioning as a regulatory system that compensates
for temporary and chronic deficits in self-esteem (e.g., Akhtar &
Thomson, 1982; Kernberg, 1975; Kohut, 1971, 1977; Stolorow,
1975; Westen, 1990). This perspective has gained support in the
research literature as well (e.g., Morf & Rhodewalt, 2001; Raskin
et al., 1991b; Robins, Tracy, & Shaver, 2001; Tracy & Robins,
2003; Tracy et al., 2009). We do not take issue with this view. How-
ever, we contend that in order to understand the relationship be-
tween two constructs, especially closely related ones, it is critical
to measure them in ways that clearly delineate both their core as-
pects and their boundaries (Clark & Watson, 1995; see also Tracy
et al., 2009). Therefore, this article emphasizes the importance of
recognizing the differences between narcissism and self-esteem.
It is also important to note that others may take a more nuanced
approach to defining high self-esteem, particularly as it relates to
narcissism. Some researchers have described the high self-esteem
that is linked robustly with the NPI as qualitatively different from
non-narcissists’ high self-esteem (Tracy et al., 2009). For instance,
narcissists may be described as having accompanying low implicit
self-esteem (Bosson, Brown, Zeigler-Hill, & Swann, 2003; Jordan,
Spencer, Zanna, Hoshino-Brown, & Correll, 2003; Sakellaropoulo
& Baldwin, 2007; Zeigler-Hill, 2006), unstable high self-esteem
(Kernis, 2001, 2003), self-esteem that is highly contingent on posi-
tive social feedback (Morf & Rhodewalt, 2001), or egocentric gran-
diosity that only mimics high self-esteem (Westen, 1990). At other
times, the relationship between narcissism and self-esteem is de-
scribed as we have described it here—as a flaw in the NPI with
self-esteem confounding the results of NPI-based research (Brown
& Bosson, 2001; Paulhus, 1998, 2001; Paulhus et al., 2004). How-
ever, most NPI-based research ignores the overlap and potential
confound of narcissism and self-esteem, or treats it as a meaningful
mediating relationship. Other influential work even balks at mak-
ing a clear distinction between the two constructs (e.g., Baumeister
et al., 2003). This work, in particular, has entered mainstream
thought as the basis for confusing news media reports (e.g., Goode,
2002; Sullivan, 2002).
Finally, we recognize that the conclusions reached in this article
were based on self-report measures and correlational data. The use
of the self-report measure of narcissism (the NPI) was inevitable,
given that it is central to the questions being addressed by this
 S.A. Rosenthal, J.M. Hooley / Journal of Research in Personality 44 (2010) 453–465
research. However, future research of this type would benefit in
particular from the use of both short- and long-term behavioral
measures of psychological health and distress.
8.4. Where do we go from here?
Given the problems with the NPI, how might we obtain a more
interpretable narcissism measure? There may be a number of ways
to retain the NPI by changing how it is used or overhauling it. How-
ever, although dividing the NPI based on expert ratings, IRT analy-
ses, and/or factor analyzed subscales helped provide a clear
illustration of the scale’s problems in the current research, it may
not be the best strategy for its future use. The trouble with this ap-
proach is that the resulting NPI-N subscales generally had unac-
ceptably low internal consistency (see also del Rosario & White,
2005; Emmons, 1987; Kansi, 2003; Raskin & Terry, 1988). For in-
stance, the alphas for the NPI-N subscales in Studies 1 and 2 range
from .62 to .75. Given the number of items in each NPI-N subscale
(18–28), such low reliabilities suggest that these subscales may not
measure coherent constructs.3 Updated factor analyses of the NPI
have improved the subscales’ psychometrics (Corry et al., 2008; Ku-
barych et al., 2004). However, these new subscales are not likely to
correct the broader problems created by the inclusion of poor items
in the scale.
Better options include controlling for self-esteem (as suggested
by Brown & Bosson, 2001; Paulhus, 1998, 2001; Paulhus et al.,
2004) or using a revised version of the NPI. The results of Study
2 indicate that controlling for self-esteem yields results that align
with those produced by the NPI-N subscales. However, it would
clearly be preferable to use a narcissism scale that works properly
on its own without requiring statistical manipulation. Alterna-
tively, Ames, Rose, and Anderson (2006) developed a 16-item ver-
sion of the NPI. They eliminated items that most likely overlapped
with more normative constructs such as assertiveness and self-effi-
cacy. The results of their procedure are reflected in our expert rater
data; their 16 items garnered a higher average hit rate (M = 12.56,
SD = 3.27) than did the full 37-item NPI (M = 10.54, SD = 4.16).
Their scale does, however, share an as-yet unexplored overlap with
self-esteem.
Brown et al. (2009), however, may have provided the best guid-
ance. Their research did not rely on the NPI or any scale that aggre-
gates multiple facets of narcissism into a single score (see Carver,
1989). Instead, they used separate narrowly and precisely defined
scales specific to two core aspects of narcissism: entitlement and
grandiosity (Morey, 1988). By doing this, they ensured that the
constructs they measured corresponded to a priori theories of
narcissism’s facets. Using the Psychological Entitlement Scale
(W. K. Campbell, Bonacci, Shelton, Exline, & Bushman, 2004) and
the Narcissistic Grandiosity Scale (Rosenthal, Hooley, & Steshenko,
in preparation), Brown and colleagues found that whereas
narcissistic entitlement was generally negatively associated with
self-reported psychological health, narcissistic grandiosity was pos-
itively associated with psychological health—a relationship that
was only partially mediated by self-esteem. Further, the authors
demonstrated that it was not possible to replicate this important
distinction using the NPI.
3 Acknowledgments
In contrast, L/A (i.e., the EFA-X subscale) is essentially as internally consistent as is
the full aggregated NPI (see Tables 2 and 4). This in itself is noteworthy and indicative
of the NPI’s problems. If methodically removing more than three-fourths of a scale’s
items (i.e., the EFA-N items) did not decrease the internal consistency of the
remaining items, it strongly challenges the notion that most of the removed items
belong in the scale at all; they may actually detract from the aggregated NPI’s ability
to measure a coherent, unitary construct. Unfortunately, to the extent that the NPI
does measure a unitary construct, the data suggest that the construct is more closely
related to the NPI-X than the NPI-N items.
463
Another alternative, the Pathological Narcissism Inventory (PNI;
Pincus et al., 2009), was developed to measure multiple facets of
pathological narcissism as they range from subclinical to clinical
levels. As a measure that encompasses subclinical levels of patho-
logical narcissistic traits, the PNI actually appears to accomplish
what the authors of the NPI originally intended. The PNI measures
both grandiose (i.e., entitlement rage, exploitativeness, grandiose
fantasy, and self-sacrificing self-enhancement) and vulnerable
(i.e., contingent self-esteem, hiding the self, and devaluing) aspects
of pathological narcissism. Its grandiose subscales (which are the
subscales most relevant to a discussion of the NPI) overlap posi-
tively with the NPI. But unlike the NPI, they are related to psycho-
logical distress (e.g., shame, identity diffusion, interpersonal
distress, suicidality) rather than health. They also generally have
negligible or negative correlations with self-esteem. It will be
important to directly compare the PNI’s Entitlement Rage and
Grandiose Fantasy subscales to the Psychological Entitlement Scale
and the Narcissistic Grandiosity Scale respectively to determine
whether their differing content may provide important incremen-
tal information in defining the full spectrum of core aspects of nar-
cissism. Using these three new narcissism scales together may
provide a complementary and comprehensive assessment of the
range of narcissistic characteristics and problems in normal sam-
ples and could begin to make the NPI obsolete. It may also help
clarify whether there are any specific narcissistic antecedents of
psychological health.
9. Conclusion
Ultimately, the goal of any scale is ‘‘to measure one thing (i.e.,
the target construct)—and only this thing—as precisely as possible”
(Clark & Watson, 1995, p. 315). To the extent that there is no defin-
itive answer to the question of what constitutes narcissism and
what does not (Millon, 1998; Westen, 1990), this goal may be dif-
ficult to achieve. Most psychologists would agree that narcissists
are entitled, exploitative, grandiose, self-absorbed, and so forth.
Unfortunately, some inferences made in social–personality re-
search are driven by the NPI’s relationship with characteristics that
are at best tangential to these domains, such as self-esteem, asser-
tiveness, and leadership motivations. This is evidenced by the fact
that the item ‘‘I am assertive” was considered narcissistic by only
one expert rater in Study 1.
Our concern is that the NPI, and the construct it was developed
to measure (i.e., narcissism), have developed a tail-wags-the-dog
relationship in the social–personality literature. The NPI is cur-
rently the most frequent means for measuring narcissism in psy-
chology research, and an aggregated score is the ‘‘most common
usage” of the NPI (Miller & Campbell, 2008, p. 456). Because of this,
it often appears that narcissism is no longer understood as a latent
personality trait estimated by scores on the NPI. Instead, narcis-
sism has become increasingly redefined as ‘‘that which the aggre-
gated NPI measures.” Extensive use of the NPI has led to a situation
in which social–personality and clinical narcissism research are
increasingly difficult to integrate. It also has created the potential
for reaching questionable conclusions about narcissism, particu-
larly about its relationship to psychological health.
The authors are grateful to Matt Montoya, Diane Purvin, Jenni-
fer Green, and Elsa Ronningstam for their instructive comments.
We also thank Yulia Steshenko, Eleftheria Kyriakopoulos, Andrea
Hsu Roe, and Lindsey Yourman for their help collecting and prepar-
ing data, and 19 anonymous clinical researchers for their time
and expertise. The research and manuscript preparation were
464 S.A. Rosenthal, J.M. Hooley / Journal of Research in Personality 44 (2010) 453–465

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