Journal of Personality Assessment

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The Narcissistic Personality Inventory: A Useful

Tool for Assessing Pathological Narcissism?
Evidence From Patients With Narcissistic
Personality Disorder

Aline Vater , Michela Schröder-Abé , Kathrin Ritter , Babette Renneberg ,

Lars Schulze , Jennifer K. Bosson & Stefan Roepke

To cite this article: Aline Vater , Michela Schröder-Abé , Kathrin Ritter , Babette Renneberg ,
Lars Schulze , Jennifer K. Bosson & Stefan Roepke (2013) The Narcissistic Personality
Inventory: A Useful Tool for Assessing Pathological Narcissism? Evidence From Patients With
Narcissistic Personality Disorder, Journal of Personality Assessment, 95:3, 301-308, DOI:
10.1080/00223891.2012.732636

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Published online: 26 Oct 2012.

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Journal of Personality Assessment, 95(3), 301–308, 2013
Copyright C Taylor & Francis Group, LLC
ISSN: 0022-3891 print / 1532-7752 online
DOI: 10.1080/00223891.2012.732636

The Narcissistic Personality Inventory: A Useful Tool for Assessing

Pathological Narcissism? Evidence From Patients With
Narcissistic Personality Disorder
ALINE VATER,1,2 MICHELA SCHRÖDER-ABÉ,3 KATHRIN RITTER,4 BABETTE RENNEBERG,4
LARS SCHULZE,4 JENNIFER K. BOSSON,5 AND STEFAN ROEPKE1,2
1
Cluster of Excellence Languages of Emotion, Freie Universität Berlin, Germany
2
Department of Psychiatry, Charité—Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany
3
Department of Psychology, University of Bamberg, Germany
4
Department of Educational Science and Psychology, Freie Universität Berlin, Germany
5
Department of Psychology, University of South Florida

The Narcissistic Personality Inventory (NPI) has dominated research on narcissism in the field of social and personality psychology. Surprisingly,
it is unclear whether the NPI is useful for identifying pathological narcissism in patients with Narcissistic Personality Disorder (NPD). The goal of
this study was to close this research gap. We used an extreme-group approach by including NPD patients and healthy controls and comparing their
narcissism scores. We further investigated whether explicit self-esteem (assessed with the Rosenberg Self-Esteem Scale) suppressed the relationship
between group membership and NPI narcissism. According to our results, NPD patients do not score higher on the NPI in comparison to healthy
controls. Analysis of indirect effects revealed that differences in NPI scores are suppressed by NPD patients’ low self-esteem. Our results indicate
that the NPI is not a valid indicator of NPD, unless one controls for self-esteem. Implications for future research are discussed.

Narcissism as a construct is as old as psychology itself: Have-
lock Ellis first introduced narcissism as an “autoerotic disorder”
in 1898. Psychoanalytic theorists subsequently contributed to
the popularization of narcissism as a clinical phenomenon (i.e.,
Freud, 1914/1957; Kernberg, 1975; Kohut, 1966). Since then,
scientists and laypersons alike have maintained an enduring in-
terest in narcissism. However, there is still substantial disagree-
ment on the conceptualization and assessment of narcissism
between and within different disciplines. In one common con-
ceptualization, narcissism is defined as a personality trait and
described dimensionally (Foster & Campbell, 2007). Many re-
searchers in social and personality psychology use the terms
normal or subclinical narcissism to refer to nonclinical levels
of narcissistic tendencies (e.g., Miller & Campbell, 2008; Pin-
cus & Lukowitsky, 2010; Zeigler-Hill, Green, Arnau, Sisemore,
& Myers, 2011). In contrast, another conceptualization defines
narcissism as a personality disorder, characterized by “a perva-
sive pattern of grandiosity, need for admiration, and a lack of
empathy” that leads to psychological distress (American Psy-
chiatric Association, 2000). Especially in clinical psychology
and psychiatry, narcissism is primarily treated as a diagnostic
category and assessed with diagnostic interviews. The current
Diagnostic and Statistical Manual of Mental Disorders (4th
ed. [DSM–IV–TR]; American Psychiatric Association, 2000)
emphasizes grandiose aspects of narcissism, but also acknowl-
edges that a “vulnerability in self-esteem makes individuals with
Narcissistic Personality Disorder very sensitive to ‘injury’ from
Received January 15, 2012; Revised July 2, 2012.
Address correspondence to Aline Vater, Cluster of Excellence Languages
of Emotion, Freie Universität Berlin, Habelschwerdter Allee 45 14195, Berlin,
Germany; Email: aline.vater@fu-berlin.de
criticism or defeat.” In the current literature, pathological narcis-
sism is defined as a broad dysfunctional personality trait ranging
from mild to severe expressions. Here, we use the term patho-
logical narcissism to refer to a diagnosis of Narcissistic Person-
ality Disorder (NPD) as defined in the DSM–IV–TR and normal
narcissism to refer to nonclinical levels of narcissistic traits.
In social and personality psychology, the majority of studies
use the Narcissistic Personality Inventory (NPI) to capture nar-
cissism as a personality trait (Cain, Pincus, & Ansell, 2008).
Raskin and Hall (1979) designed the NPI as a measure of sub-
clinical narcissism. Starting with a list of 220 items, these re-
searchers conducted a series of validation studies with students
that resulted in a 40-item final version with seven subscales:
authority, self-sufficiency, superiority, exhibitionism, exploita-
tiveness, vanity, and entitlement (Raskin & Hall, 1979; Raskin
& Terry, 1988). Although the construction of the NPI is based on
the clinical definition of NPD according to the third edition of
the DSM (American Psychiatric Association, 1980), it is still un-
clear whether the NPI captures pathological narcissism. Raskin
and Terry (1988) themselves admitted that the NPI fails to cap-
ture the clinical picture of NPD. They stated that the validation
process of the NPI led to a reduction of important psychological
and behavioral dimensions inherent in pathological narcissism.
Moreover, several researchers state that the NPI primarily
concentrates on the grandiose facets of normal narcissism and
fails to capture the vulnerable qualities inherent to the disorder
(e.g., feelings of shame and insecurity; e.g., Cramer, 2011). For
example, individuals with high scores on the NPI seem to present
a nondistressed, self-confident version of normal narcissism
(Pincus et al., 2009). In contrast, some researchers assume that
the NPI assesses subclinical narcissism that is close to the defini-
tion of NPD according to the DSM–IV–TR (Miller & Campbell,
2008; Paulhus & Williams, 2002; Wallace & Baumeister, 2002).

301
302
This assumption is based on evidence that narcissism assessed
with the NPI is not necessarily advantageous (for a review see
Cain et al., 2008).
In the past decade, several studies used the NPI as a tool
for identifying narcissism within nonclinical samples (Acker-
man et al., 2011; Maxwell, Donnellan, Hopwood, & Ackerman,
2011; Miller & Campbell, 2008; Pryor, Miller, & Gaughan,
2009; Samuel & Widiger, 2008) or clinical samples including
patients with a variety of disorders (Fossati et al., 2009; Pin-
cus et al., 2009; Prifitera & Ryan, 1984; Svindseth, Nøttestad,
Wallin, Roaldset, & Dahl, 2008). For example, Fossati et al.
(2009) found that the NPI total score was a positive predictor
of NPD according to DSM–IV–TR criteria within a sample of
people with various personality disorders. However, no single
study has used the NPI in a sample of patients exclusively di-
agnosed with NPD. We assume that studying clinical patients
with NPD will shed light on the discussion of whether the NPI
is a useful tool for assessing pathological narcissism.
When measuring narcissism with the NPI, researchers
should consider the scale’s positive correlation with measures
of self-esteem. This characteristic might not only obfuscate
the NPI’s relation with other measures, but also suppress the
differences between nonclinical and clinical samples. Several
studies show that the statistical removal of self-esteem increases
the magnitude of associations between NPI narcissism and var-
ious outcome variables (antisocial behavior: Paulhus, Robins,
Trzesniewski, & Tracy, 2004; health: Sedikides, Rudich, Gregg,
Kumashiro, & Rusbult, 2004). Rosenthal and Hooley (2010)
further showed that several NPI items are confounded with
self-esteem and are therefore unsuitable to differentiate between
narcissists and nonnarcissists. As noted earlier, the DSM–IV–TR
includes in its definition of NPD a tendency toward vulnerable
self-esteem that is easily threatened by criticism or defeat.
Moreover, recent research shows that patients with NPD have
lower self-esteem than healthy controls (Vater et al., 2012).
Thus, when judging the utility of the NPI for clinical research,
researchers should consider that self-esteem might act as a
potential suppressor variable. That is, the relatively low self-
esteem of NPD patients could deflate their scores on the NPI.
Clinical psychology and psychiatry provide alternative mea-
sures for assessing narcissism in clinical samples. One of the
most frequently used measures is the Dimensional Assessment
of Personality Pathology–Basic Questionnaire (DAPP–BQ).
The DAPP–BQ was constructed to capture underlying dimen-
sions of personality pathology using a two-stage procedure
(Livesley & Jackson, 2002; Livesley, Jackson, & Schroeder,
1989; Livesley, Jang, & Vernon, 1998). First, the authors gen-
erated a pool of items from several sources including the de-
scription of NPD in the DSM–III, the literature on pathological
personality traits, and input from practicing clinicians. In a sec-
ond stage, these items were summarized to yield several factors,
resulting in the final scale consisting of 18 subscales (e.g., in-
secure attachment, identity problems). Of these subscales, one
assesses pathological narcissism. Individuals who score high
on the DAPP–BQ narcissism subscale exaggerate their achieve-
ments and abilities, crave admiration, are preoccupied with fan-
tasies, possess feelings of entitlement, and exhibit a strong need
for acceptance and approval (cf. Livesley & Jackson, 2002).
Recent studies provide strong support for its validity and relia-
bility (e.g., Bagge & Trull, 2003; Gutiérrez-Zotes et al., 2008;
Kushner, Quilty, Tackett, & Bagby, 2011; Pukrop, Gentil, Stein-
VATER ET AL.
bring, & Steinmeyer, 2001; Pukrop et al., 2009). Moreover, the
DAPP–BQ is a valuable indicator of symptom severity in pa-
tients with personality disorders: Pukrop et al. (2009) provided
evidence that patients with a variety of personality disorders
scored higher on the narcissism subscale than nonclinical con-
trols. The DAPP–BQ might thus be a valid tool for clinical
research with patients with NPD.
AIM OF THIS STUDY
Our first goal was to examine the utility of the NPI for assess-
ing pathological narcissism in NPD patients. In doing so, we
use an extreme-groups approach by comparing the narcissism
scores of patients with NPD with those of nonclinical controls.
As mentioned earlier, several researchers argue that the NPI pri-
marily assesses normal narcissism. However, the NPI predicted
NPD in a sample of clinical patients with various personal-
ity disorders (Fossati et al., 2009). Given that the literature is
equivocal about whether the NPI can validly assess pathologi-
cal narcissism in patients with NPD, we compared NPI scores
among patients with NPD to those among nonclinical controls.
As mentioned, there is evidence that self-esteem suppresses
associations between NPI and other variables (Paulhus et al.,
2004; Sedikides et al., 2004) and that patients with NPD report
lower self-esteem in comparison to nonclinical controls (Vater
et al., 2012). It is thus possible that the NPI can only distin-
guish NPD patients from healthy controls after controlling for
the suppressing effect of self-esteem. To provide evidence that
self-esteem, but not general psychological impairment, func-
tions as a suppressor variable, we also included the Symptom
Checklist–90–Revised (SCL–90–R) and the Beck Depression
Inventory (BDI).
A second goal of this study was to assess the congruence of the
NPI with a measure of narcissism from clinical psychology and
psychiatry, the DAPP–BQ. As the DAPP–BQ is a useful mea-
sure for assessing narcissism in clinical samples with personality
disorders (Pukrop et al., 2009), we hypothesized that patients
with NPD, in comparison to nonclinical controls, would obtain
higher scores on the narcissism subscale of the DAPP–BQ.
A third goal was to explore the overlap between narcissism
self-report measures (the NPI and the DAPP–BQ) and expert
ratings (Structured Clinical Interview for DSM–IV Personality
Disorders [SCID–II] scores). Renneberg, Chambless, Dowdall,
Fauerbach, and Gracely (1992) found little overlap between
the SCID–II interview and a self-report questionnaire for psy-
chopathology (the Millon Clinical Multiaxial Inventory–II; Mil-
lon, 1992). Therefore, we expected self-report measures and ex-
pert ratings to be only weakly correlated. We also examined the
correlation between the NPI and the DAPP–BQ. Recent stud-
ies reported low or medium correlations between the NPI and
other measures of narcissism (Maxwell et al., 2011; Miller &
Campbell, 2008; Samuel & Widiger, 2008), but no study has yet
investigated the correlation between the NPI and the DAPP–BQ.
As both questionnaires assess the same underlying construct, we
expected them to show a moderate association.
METHODS
Participants
We recruited 51 participants with a diagnosis of NPD ac-
cording to the DSM–IV–TR (American Psychiatric Association,
ASSESSING PATHOLOGICAL NARCISSISM
2000; German version: Saß, Wittchen, & Zaudig, 2003) and 44
nonclinical controls. To establish individual diagnoses in pa-
tients, trained psychologists administered the German versions
of the Structured Clinical Interview for DSM–IV Axis I Psy-
chiatric Disorders (SCID–I; First, Spitzer, Gibbon, & Williams,
1996; German version: Wittchen, Zaudig, & Fydrich, 1997)
and the Structured Clinical Interview for DSM–IV Personality
Disorders (SCID–II; First, Gibbon, Spitzer, Williams, & Ben-
jamin, 1997; German version, Fydrich, Renneberg, Schmitz, &
Wittchen, 1997). All diagnoses of NPD were verified with the
patients’ therapists (psychiatrist or psychologist) and the ther-
apists’ supervisor (last author, senior psychiatrist). Interrater
reliability of SCID–II personality disorder diagnoses was as-
sessed with eight patients with a pairwise diagnostic interview
design and three interviewers were blind to personality disorder
diagnoses. Kappa was acceptable, κ = 0.797.
NPD patients were excluded from participation if they had
a history of psychotic disorder, current mania or hypomania,
current substance-induced disorder, or if they were nonnative
speakers. Furthermore, we controlled for mental retardation us-
ing a cognitive screening score for fluid intelligence (IQ > 80
as measured by subscale four of the German intelligence test
Leistungsprüfsystem; Horn, 1983). Comorbid Axis I diagnoses
of NPD patients included major depression (n = 20, 31.2%),
dysthymic disorder (n = 17, 33.3%), panic disorder (n = 2,
3.9%), agoraphobia (n = 2, 3.9%), generalized anxiety disor-
der (n = 3, 5.9%), posttraumatic stress disorder (n = 7, 13.7%),
obsessive–compulsive disorder (n = 2, 3.9%), adjustment disor-
der (n = 10, 19.6%), somatoform disorder (n = 3, 5.9%), alcohol
abuse (n = 11, 21.6%), drug abuse (n = 5, 9.8%), anorexia ner-
vosa (n = 4, 7.8%) and bulimia (n = 7, 13.7%). Comorbid
Axis II diagnoses of NPD patients included avoidant (n = 15,
29.4%), dependent (n = 4, 7.8%), obsessive–compulsive (n =
15, 29.4%), paranoid (n = 19, 37.3%), schizoid (n = 3, 5.9%),
histrionic (n = 7, 13.7%), borderline (n = 27, 52.9%), antisocial
(n = 23, 45.1%), and negativistic (n = 21, 41.2%) personality
disorder. Twenty-nine of the clinical patients were on various
medications (antipsychotics n = 6, 11.8%; and antidepressants,
n = 23, 45.1%).
Participants in the nonclinical control group were screened for
current or lifetime diagnoses for any Axis I or Axis II disorder
with the SCID–I (First et al., 1996; German version: Wittchen
et al., 1997) and SCID–II (First et al., 1997; German version:
Fydrich et al., 1997) questionnaires. We excluded individuals
who met criteria of any present or past Axis I disorder or more
than two criteria for any personality disorders assessed by the
SCID–II.
Procedure
All NPD patients were enrolled in a broad multicen-
ter clinical study on NPD at the Department of Psychiatry,
Charité—Universitätsmedizin Berlin, or at cooperating hospi-
tals and outpatient settings in Germany. During their inpatient
treatment, patients with NPD were consecutively recruited as
participants for this study. Nonclinical participants were re-
cruited through newspaper advertisements. The groups were
matched with respect to years of education, age, and gen-
der. The study was approved by the ethics committee of the
Charité—Universitätsmedizin Berlin. Informed consent to par-
ticipate was obtained from each participant.
303
Measures
Narcissistic Personality Inventory. The NPI consists of 40
items in a forced choice format (Raskin & Terry, 1988; German
version: Schütz, Marcus, & Sellin, 2004). According to our data,
the internal consistency (Cronbach’s alpha) of the scale was α
= .83. The German version of the NPI consists of six subscales
(see Schütz et al., 2004). In the data set used here, internal
consistencies of all NPI subscales were low (average α = .58;
lowest α = .49; highest α = .74), and internal consistencies of
other subscale solutions (four-factor solution by Emmons, 1984;
two- and three-factor solutions by Kubarych, Deary, & Austin,
2004) were also lower than .50. We therefore only calculated
the overall score of the NPI.
The Dimensional Assessment of Personality Pathology.
The DAPP–BQ (Livesley & Jackson, 2002; German version:
Pukrop et al., 2001) is a reliable and valid dimensional measure
of personality pathology (e.g., Pukrop et al., 2001). Due to the
overall length of the questionnaire, we only used the narcissism
subscale, which consists of 16 items. The 5-point response scale
ranges from 1 (very unlike me) to 5 (very like me). In this study,
the internal consistency (Cronbach’s alpha) of the narcissism
scale was α = .92.
Rosenberg Self-Esteem Scale. Self-esteem was measured
using the total score of the Rosenberg Self-Esteem Scale (RSE;
Rosenberg, 1965; German version: Collani & Herzberg, 2003).
This is a 10-item scale that measures people’s feelings of global
self-worth. Responses were made on 4-point scales with end-
points at 1 (strongly disagree) and 4 (strongly agree). The inter-
nal consistency (Cronbach’s alpha) of the scale was α = .92.
Symptom Checklist–90–Revised. The SCL–90–R (Dero-
gatis, 1997; German version: Franke, 2002) was employed to
assess general psychopathological and physical impairments
during the last week. Responses were made on 5-point scales
with endpoints at 0 (not at all) and 4 (very much). The Global
Severity Index (GSI) sum score of the SCL–90–R indicates
psychopathological impairment in general. The internal
consistency (Cronbach’s alpha) of the scale was α = .97.
Beck Depression Inventory. The BDI–I (Beck, Ward,
Mendelson, Mock, & Erbaugh, 1961; German version:
Hautzinger, Bailer, Worall, & Keller, 1995) was employed to
assess severity of depression. Participants responded to 21 items
on 4-point scales that were represented by four different state-
ments. The BDI is a widely used and well-validated self-report
measure for depression and reflects the individual’s experience
of specific symptoms over the past week. The internal consis-
tency (Cronbach’s alpha) of the scale was α = .94.
RESULTS
Descriptive Statistics and Group Differences
Table 1 presents the means and standard deviations of all
measures as well as the t-test results. Compared to the control
group, individuals with NPD had significantly higher scores
on general psychological impairment (indicated by the GSI
of the SCL–90–R), higher depression (BDI), and lower self-
esteem (RSE). Moreover, NPD patients had significantly higher
304 VATER ET AL.

TABLE 1.—Descriptive statistics and t tests of all variables. gression analyses were conducted and indirect effects were ana-
lyzed. Suppression is present when statistically controlling for a
NPD CG t Test
variable (here, self-esteem) increases the magnitude of the rela-
Scale M SD M SD t df p d
tionship between the independent variable (here, group member-
RSE 2.79 0.90 3.87 0.90 –5.99 93 .000 1.20 ship) and the dependent variable (here, narcissism; MacKinnon
SCL–90–R 1.50 0.68 .39 0.51 9.04 91.38 .000 1.84 & Dwyer, 1993; MacKinnon, Krull, & Lockwood, 2000). We
BDI 24.22 11.96 4.97 8.51 9.18 88.28 .000 1.85 entered group membership as the independent variable (with
DAPP–BQ 3.07 0.64 2.46 0.62 3.93 92 .000 0.97 NPD = 0, nonclinical controls = 1), NPI narcissism as the
Narcissism
NPI 13.24 6.67 12.95 6.27 0.21 92 .832 0.04
dependent variable, and self-esteem as a control variable. We
SCID–II 5.70 1.20 0.50 0.82 23.42 89 .000 5.06 present the unstandardized coefficients in Figure 1, as this is
recommended in causal modeling (Preacher & Hayes, 2008).
Note. NPD = narcissistic personality disorder; CG = control group; RSE = Rosen- Bootstrapping with 1,000 bootstrap samples (see Preacher &
berg Self-Esteem Scale; SCL–90–R = Symptom Checklist–90–Revised; BDI = Beck
Depression Inventory; DAPP–BQ = Dimensional Assessment of Personality Pathology; Hayes) was used to assess the indirect effects. Bootstrapping is
NPI = Narcissistic Personality Inventory; SCID–II = Structured Clinical Interview for a nonparametric sampling procedure that generates an empirical
DSM–IV–TR Personality Disorders; d = effect size, Cohen’s d. approximation of the sampling distribution of a statistic from
the available data. Point estimates and 95% confidence intervals
DAPP–BQ scores in comparison to nonclinical control partic- are estimated for the indirect effects. When a confidence interval
ipants. Scores on the NPI did not differ significantly between does not contain zero, the point estimate for that indirect effect
groups (Cohen’s d = .04). is considered significant.
As shown in Figure 1, group membership did not predict
Correlations narcissism as measured with the NPI (c = –.286, p = .832).
We therefore explored whether self-esteem influenced the asso-
Table 2 presents correlations among all variables. We calcu- ciation of group membership and NPI narcissism. First, group
lated correlations separately for both groups to prevent over- or membership predicted self-esteem (a = 1.119, p < .001). Sec-
underestimation of correlations due to group effects. As shown ond, self-esteem predicted NPI narcissism (b = 2.624, p <
in Table 2, the NPI and DAPP–BQ were moderately related .001). Third and most important, when self-esteem was entered
in both groups. Furthermore, both the NPI and the DAPP–BQ into the model, group membership significantly predicted NPI
showed low correlations with SCID–II expert ratings in both narcissism (c’ = –3.220, p = .036), indicating that self-esteem
groups. Importantly, NPI narcissism was associated with higher suppressed the effect of group membership on NPI narcissism.
self-esteem, lower depression, and lower general psychologi- Furthermore, the confidence interval for the indirect pathway
cal impairment, whereas DAPP–BQ narcissism correlated with via self-esteem did not include zero, indicating a significant
higher depression and higher symptom severity. suppression pathway. In contrast, general symptom severity
Using Fisher r-to-z transformation, we investigated whether and depression did not function as suppressors between group
the strength of these correlation coefficients significantly dif- membership and NPI narcissism (see Figure 1). Moreover, self-
fered between NPD patients and nonclinical controls. A signifi- esteem did not influence the association of group membership
cant effect emerged for self-esteem and DAPP–BQ narcissism: and DAPP–BQ narcissism.
The narcissism subscale of the DAPP–BQ was unrelated to
self-esteem within the group of NPD patients, but it was nega-
tively correlated with self-esteem among nonclinical individuals DISCUSSION
(p = .020, z = 2.33). No other correlation coefficients differed
between the two groups (ps > .10). The study reported here is the first to evaluate the utility of the
NPI for research with NPD patients. In summary, patients with a
Suppression Analysis diagnosis of NPD did not score higher on the NPI than nonclin-
ical controls. This occurred because of the suppression effect of
To examine whether self-esteem functions as a suppressor of self-esteem. Given that other variables (i.e., general psychologi-
group membership when predicting NPI narcissism, multiple re- cal impairment and depression) did not influence the association
between group membership and the NPI, the suppression effect
TABLE 2.—Correlations of all variables. we found here is specific to self-esteem. Unlike the NPI, the
DAPP–BQ differentiated between NPD patients and nonclin-
SCL– DAPP–BQ SCID– ical individuals and might thus represent a more appropriate
RSE 90–R BDI Narcissism NPI II
instrument for identifying NPD. Moreover, the DAPP–BQ and
RSE –.459∗∗∗ –.579∗∗∗ –.044 .381∗∗ –.222
the NPI were moderately correlated. However, both of these
SCL–90–R –.732∗∗∗ .616∗∗∗ –.100 –.177 –.002 self-report inventories showed little overlap with expert ratings
BDI –.688∗∗∗ .905∗∗∗ –.082 –.163 –.086 (SCID–II interview). In the following sections, we discuss our
DAPP–BQ –.493∗ .285 .257 .506∗∗∗ .090 results in detail.
Narcissism
NPI .302∗ –.205 –.319∗ .341 .089
SCID–II –.036 .216 .134 .342 .120 Suppression Analysis
Note. Narcissistic personality disorder above diagonal, control group below diagonal.
The finding that low self-esteem suppresses scores on the NPI
RSE = Rosenberg Self-Esteem Scale; SCL–90–R = Symptom Checklist–90–Revised; in patients with NPD has a variety of theoretical and practical
BDI = Beck Depression Inventory; DAPP–BQ = Dimensional Assessment of Personality implications. Of particular importance is the analysis wherein
Pathology; NPI = Narcissistic Personality Inventory; SCID–II = Structured Clinical Inter-
view for DSM–IV–TR Personality Disorders.
NPD patients, in comparison to nonclinical controls, scored
∗
p < .05. ∗∗ p < .01. ∗ ∗ ∗ p < .001. higher on the NPI after controlling for self-esteem. Conversely,
ASSESSING PATHOLOGICAL NARCISSISM 305

c= –.286 (se = 1.340), p = .832

RSE: c’= –3.220 (se = 1.516), p = .036

GSI: c’= 2.715 (se = 1.801), p = .135
BDI: c’= –2.918 (se = 1.341), p = .109

c/c’
Group Narcissism
Membership (NPI)

Self-Esteem (RSE)
a b
Psychological Impairment (GSI)
Beck Depression Inventory (BDI)

RSE: a= 1.119 (se = .177), p < .001 RSE: b = 2.624 (se = .747), p < .001
GSI: a = –101.120 (se = 11.352), p < .000 GSI: b = –.024 (se = .012), p = .050
BDI: a= –.320 (se = –19.490), p < .000 BDI: b = –.223 (se = –1.135), p < .000

FIGURE 1.—Effects of group membership on Narcissistic Personality Inventory (NPI) narcissism with self-esteem (RSE), psychological impairment (GSI), and
depression (BDI) as suppressor variables. Note. Unstandardized coefficients presented. The total effects (weight c) is composed of a direct effect (weight c’) and
the indirect effect (sum of all a an b weights); se = standard deviation; group membership: Narcissistic Personality Disorder = 0, control group = 1.

the DAPP–BQ’s ability to identify NPD was unaffected by the
self-esteem of NPD patients. The fact that the NPI is contami-
nated with self-esteem implies that this measure is not optimal
for detecting NPD. Accordingly, researchers should consider
removing the influence of self-esteem when investigating rela-
tions of NPI narcissism with other variables. Doing so might
enhance the validity of the NPI as a predictor of narcissism in
clinical samples with NPD.
Significant suppressor effects have often been overlooked
in psychological research, although suppressor analyses might
be fruitful when establishing theoretical models of narcissism
(Paulhus et al., 2004). Paulhus et al. (2004) suggested that there
might be a legitimate personality component captured by the
shared variance of narcissism and self-esteem. For instance, it is
plausible that individuals high in NPI narcissism and individu-
als high in self-esteem share positive self-evaluations. However,
Paulhus et al. argued that narcissism and self-esteem are distinct:
Whereas self-esteem reflects realistic self-favorability, NPI nar-
cissism instead reflects unrealistically positive self-evaluations.
Neither one is likely perfectly realistic, though, as both variables
include some discrepancies with reality (Paulhus, Harms, Bruce,
& Lysy, 2003). It thus remains unclear whether the overlap be-
tween narcissism and self-esteem can be isolated or remains an
artifact.
Correlations Between Self-Report Inventories and
Expert Ratings
The NPI was moderately correlated with the DAPP–BQ. This
finding is consistent with studies demonstrating overlap be-
tween the NPI and other narcissism measures (Maxwell et al.,
2011; Miller & Campbell, 2008; Samuel & Widiger, 2008).
In essence, this strengthens the assumption that the NPI and
the DAPP–BQ capture associated but independent facets of the
same underlying construct. Several authors have argued that the
NPI assesses grandiose facets of normal narcissism (Miller &
Campbell; Miller, Price, & Campbell, 2012; Samuel & Widiger).
This conceptualization of narcissism seems to be too narrow, as
feelings of vulnerability are a central component of patholog-
ical narcissism (e.g., Ackerman et al., 2011; Cain et al., 2008;
Maxwell et al., 2011; Miller & Campbell; Miller et al., 2012;
Pincus et al., 2009). Although we can only conjecture at this
point, it might be possible that the narcissism subscale of the
DAPP–BQ captures both grandiose aspects of narcissism (e.g.,
“I am destined for greatness,” “I dream of being looked up to and
admired”) and the vulnerability to self-esteem threats described
in the DSM–IV–TR (e.g., “I get very anxious if I think some-
one does not like me,” “I am only really satisfied when people
acknowledge how good I am”). Future research should investi-
gate the shared and distinct components of different narcissism
measures with respect to grandiosity and vulnerability.
One finding that merits further analysis was the low correla-
tion between self-report inventories (NPI and DAPP–BQ) and
expert ratings (SCID–II) of narcissism. This finding is consistent
with another work showing low overlap between the SCID–II
interview and a self-report questionnaire for psychopathology
(Renneberg et al., 1992). Differences in the conceptualization of
narcissism might account for the low associations between the
SCID–II and both self-report inventories used here. For instance,
the SCID–II interview assesses diagnostic criteria that are not
captured by the NPI or the DAPP–BQ. Consider the finding that
a lack of empathy is characteristic of patients with NPD (Ritter
et al., 2011). Yet, neither the NPI nor the DAPP–BQ assesses
a lack of empathy. Second, the threshold for receiving a diag-
nosis of NPD is quite high in the diagnostic interview, whereas
it might be considerably easier to obtain a high score on the
self-report inventories. Whereas the DAPP–BQ and NPI narcis-
sism scales only assess whether or not grandiose fantasies occur
at all, a patient with NPD only meets criteria for “fantasies” if
his or her fantasies reflect an enduring, inflexible pattern across
a broad range of situations that leads to psychological distress
(e.g., restricted work efficiency). Moreover, the diagnostic cri-
teria must be traced back to early adolescence or the beginning
of adulthood, information that is not assessed in the narcissism
self-report measures used here.
306
Limitations
Several limitations of this study merit attention. A first crit-
ical issue pertains to the selection of patients with NPD, who
exhibited high comorbidity rates in our study. Nevertheless,
the observed comorbidity rates in our study are comparable
to those reported in other studies (Russ, Shedler, Bradley, &
Westen, 2008). We therefore assume that our clinical sample is
representative of patients who seek treatment.
Another potential limitation was our concentration on self-
esteem as a suppressor variable. Other mediators might also be
important, such as the influence of dominance. For instance,
Brown and Zeigler-Hill (2004) found that the association be-
tween self-esteem and narcissism depends on the overlap of each
measure with dominance as a personality trait. The greater the
overlap of the self-esteem measure with dominance, the higher
its association with narcissism. Controlling for dominance led to
a diminished association of self-esteem and the NPI. We there-
fore believe that future studies should focus on untangling the
links between normal and pathological narcissism, self-esteem,
and other personality traits such as dominance.
Another issue that merits critical debate is the low internal
consistencies of all six NPI subscales of the NPI. Due to these
low internal consistencies, we only used the overall sum score in
analyses. Low internal consistencies (e.g., del Rosario & White,
2005) and an unstable factor structure were described in other
studies of the NPI, and a confirmatory analysis (Kubarych et al.,
2004) suggested three rather than seven stable factors (power,
exhibitionism, being a special person). Furthermore, Emmons
(1984) found four NPI factors, and in the German version of
the NPI, six factors were found (Schütz et al., 2004). Given this
inconsistency across studies, the standard practice is to use the
more valid and reliable overall sum score, which is, unfortu-
nately, uneconomical and reduces the complexity of the narcis-
sism construct (Cain et al., 2008). Analyzing specific NPI scales
might have been profitable for this study. Using a large sample
of nonclinical individuals, Maxwell et al. (2011) reported that
the links between self-esteem and narcissism fluctuated across
NPI subscales. Future studies with bigger samples might thus
want to analyze the subscales separately.
Finally, we included only two self-report measures of narcis-
sism. One promising new measure is the Pathological Narcis-
sism Inventory (Pincus et al., 2009). We could not include this
measure, however, as there is currently no German translation
for it. The findings reported here should therefore be replicated
with additional narcissism measures.
Implications for Future Research
This study has several implications for future research on nar-
cissism. We propose that researchers should be more cautious
with planning studies, especially when choosing assessment
devices. Measures should be chosen according to the research
question at hand. If researchers aim to investigate the grandiose
aspects of narcissism, the NPI seems to be an appropriate as-
sessment tool. If researchers wish to investigate vulnerability,
however, other questionnaires (e.g., the narcissism subscale of
the DAPP–BQ or the Pathological Narcissism Inventory; Pin-
cus et al., 2009) might be indicated. As the NPI is contaminated
by self-esteem, and self-esteem is impaired in most patients
with clinical disorders including NPD, the NPI is not useful
VATER ET AL.
for detecting NPD. However, the pattern of correlations of the
NPI with other measures was similar in the NPD group and the
healthy control group. This indicates that results from studies
of healthy individuals using the NPI might provide a better un-
derstanding of NPD, at least when it comes to grandiose facets.
Moreover, we suggest that researchers be explicit about how
they define narcissism (i.e., state whether normal or pathological
narcissism is their focus). This might help facilitate a common
understanding of what normal and pathological narcissism are,
increase empirical knowledge of the narcissism construct, and
provide a rationale for choice of measurement tools (also see
Miller, Maples, & Campbell, 2011).
ACKNOWLEDGMENTS
This research was supported by a doctoral fellowship from
the Cluster of Excellence Languages of Emotion, FU Berlin
(Aline Vater), from Charité—Universitätsmedizin Berlin (to
Kathrin Ritter), and the foundation Sonnenfeld-Stiftung, Berlin
(Kathrin Ritter). We are grateful to the cooperating Departments
of Psychiatry of the following hospitals: Theodor-Wenzel-Werk,
Berlin; Asklepios Clinik North, Hamburg; and the Institute for
Behavioral Therapy (IVB GmbH), Berlin; for their assistance
with patient recruitment. We would also like to thank two un-
known reviewers and the editor for their valuable comments on
the article.
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