Journal of American College Health

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Narcissistic grandiosity and risky health behaviors

in college students

Sulamunn R. M. Coleman, Michael J. Bernstein, Jacob A. Benfield & Joshua M.

Smyth

To cite this article: Sulamunn R. M. Coleman, Michael J. Bernstein, Jacob A. Benfield & Joshua
M. Smyth (2020): Narcissistic grandiosity and risky health behaviors in college students, Journal of
American College Health, DOI: 10.1080/07448481.2020.1762606

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JOURNAL OF AMERICAN COLLEGE HEALTH
https://doi.org/10.1080/07448481.2020.1762606

MAJOR ARTICLE

Narcissistic grandiosity and risky health behaviors in college students

Sulamunn R. M. Coleman, PhDa, Michael J. Bernstein, PhDb, Jacob A. Benfield, PhDb, and Joshua M. Smyth, PhDc
a
Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, Vermont, USA; bDepartment of
Psychological and Social Sciences, The Pennsylvania State University, Abington, Pennsylvania, USA; cDepartment of Biobehavioral Health,
The Pennsylvania State University, University Park, Pennsylvania, USA

ABSTRACT ARTICLE HISTORY

Objectives: This study explored associations between narcissistic grandiosity (including its compo- Received 20 August 2019
nent traits) and reported risky health behaviors in college students. Participants: College male Revised 7 March 2020
and women (N ¼ 122) participated between December 2015 and January 2016. Methods: Accepted 26 April 2020
Participants completed self-report measures of grandiosity, alcohol consumption, number of sex
KEYWORDS
partners, and condom use. Results: Grandiosity was positively associated with alcohol consump- Alcohol; college students;
tion. Gender interacted with grandiose traits, driving associations with reported sexual behaviors. gender differences;
College male high in entitlement/exploitativeness reported more sex partners. Grandiose exhib- grandiosity; narcissism;
itionism was associated with condom use among women but not male, such that college women risky sex
higher in grandiose exhibitionism were more likely to report not using a condom with their most
recent partner. Conclusions: Grandiosity (and grandiose traits) may influence health behavior and/
or the reporting of health behavior in college students, but associations may differ for male
and women.

Narcissism is a complex aspect of personality characterized
in part by “grandiosity”—an overriding need for recognition
and admiration to maintain and enhance an inflated sense
of self.1,2 In a relatively small but growing body of literature
examining associations between narcissism and health,3,4
grandiosity appears to be related, albeit inconsistently, to
risky substance use and sexual behavior.5–9 College students
in particular tend to engage in risky behaviors such as prob-
lematic alcohol consumption, having multiple sex partners
and unprotected sex at high rates.10–13 Nonetheless, engage-
ment in such behaviors may be unevenly distributed
between college male and women.12,13 Therefore, gender dif-
ferences may help explain apparent discrepancies in associa-
tions between grandiosity and risky health behaviors in
college students; however, existing studies have not consist-
ently examined gender as a potential moderator. In this
study, we examine associations between grandiosity (includ-
ing overall grandiosity as well as theoretically distinct traits),
gender, and risky health behaviors in college students,
including alcohol consumption, number of sex partners over
the past 3 months, and condom use with most recent
sex partner.
Grandiosity
Grandiosity is a primary dimension of narcissism that
encompasses related but theoretically distinct traits.
Examples of grandiose traits include “leadership/authority”
(i.e., a preoccupation with success, social status, and drive
for associated recognition and admiration), “grandiose exhi-
bitionism,” (i.e., a tendency to show off and to like being
the center of attention), and “entitlement/exploitativeness,”
(i.e., manipulative tendencies and a general willingness to
take advantage of others to meet entitled expectations).14–16
A 2015 meta-analysis demonstrated that male tended to be
higher than women in grandiosity, particularly in leader-
ship/authority and entitlement/exploitativeness.16 As
research suggests college male and women tend to engage in
risky health behaviors at different rates17–20 it is important
to examine whether grandiosity differentially associates with
health behaviors for male and women to potentially inform
prevention and treatment efforts.
Importantly, measures of grandiosity must be distin-
guished from measures of “narcissistic vulnerability,” the lat-
ter referring to deficits in regulating emotion and behavior
when grandiosity is threatened and which constitutes the
second primary dimension of narcissism.1,2 This distinction
is particularly important for researchers and health profes-
sionals who may be interested in examining whether grandi-
osity and vulnerability differentially influence health
behavior. In the present study, which is a secondary analysis
of data collected as part of a larger study examining associa-
tions between individual differences and social health behav-
iors in college students, the available measure of narcissism
is the Narcissistic Personality Inventory (NPI)-13.15 The
NPI-13 is a widely accepted measure of grandiosity16; thus,
this study focused on conducting a thorough examination of

CONTACT Sulamunn R. M. Coleman sulamunn.coleman@uvm.edu Vermont Center on Behavior and Health, Department of Psychiatry, University of
Vermont, 1 South Prospect Street, Burlington, VT 05401.
ß 2020 Taylor & Francis Group, LLC
2 S. R. M. COLEMAN ET AL.
how grandiosity and specific grandiose traits associate with
reported risky health behaviors among college students.
Risky health behaviors among college students
College is a period of transition from adolescence to adult-
hood that may involve alcohol experimentation for many
students. Such experimentation may include binge drinking
(i.e., consuming four to five or more alcoholic beverages in
a 2-hour window) and heavy alcohol use (i.e., binge drink-
ing on five or more days over a period of one month),21
both of which are widespread among college students.10,22–24
Every year, as many as 600,000 students are involved in
alcohol-related accidents resulting in injury or death.25
Furthermore, individuals who begin consuming alcohol at
an earlier age are at greater risk for developing alcohol
dependence,26 which is known to contribute to serious
health consequences such as liver disease.27 Although some
research has demonstrated that college male may generally
consume more alcohol than college women,13 more recent
evidence suggests the prevalence of heavy alcohol use may
be similar for college male and women (e.g., 12% vs. 11%,
respectively).20 Moreover, research has demonstrated that
compared to college male with major depressive disorder
(MDD; a risk factor for substance use disorders), college
women with MDD engaged in more frequent binge drink-
ing19: this finding may suggest that associations between
grandiosity and alcohol consumption could be moderated
by gender.
College may also constitute a period of sexual explor-
ation. Many students report having multiple sexual partners,
including dating/romantic and casual/non-romantic partners
(i.e., “hookups” without commitment or emotional attach-
ment).28 In one study, roughly 78% of a student sample
reported having at least one casual sexual experience.11 In a
second study, students were just as likely to report engaging
in casual sex since starting college as they were to report
dating.29 In yet another study, 21% of students reported that
their most recent casual sexual experience was during a time
when they were romantically involved with someone else.28
Furthermore, the last decade has seen an increase in the use
of smartphone dating applications, and college students who
use such applications may be more likely to have casual sex-
ual experiences.30 Unfortunately, consistent condom use
among college students may be low (i.e., 29%–50%—well
below what is ideal for preventing health consequences asso-
ciated with unprotected sex),20,31 and college women may
use condoms less consistently than male.17
Given the high rates of alcohol consumption and risky
sexual behaviors among college students, it is important to
underscore that alcohol consumption and risky sexual
behaviors are often correlated.17,32–36 Having multiple sex
partners and irregular or no condom use increase one’s risk
for unintended pregnancy and sexually transmitted infection
(STI),37,38 and college students who have multiple sex part-
ners are at greater risk for perpetrating39 and being a victim
of sexual assault,40 particularly when impaired by alco-
hol.39–42 Thus, it is important to examine whether individual
differences such as grandiosity associate with both alcohol
consumption and risky sexual behaviors.
Grandiosity and risky health behaviors
Two theories, in particular, may help contextualize potential
associations between grandiosity, gender, and risky health
behaviors. These theories include the Dynamic Self-
Regulatory Processing Model of Narcissism43 and
Objectification Theory.44 According to the Dynamic Self-
Regulatory Processing Model, grandiosity is vulnerable to
disconfirmation for both genders, and this vulnerability
results in an ongoing pursuit of validation from others.
However, gender-role socializations may lead to differences
in the behaviors one engages in to obtain such validation.
For example, male more than women may display competi-
tiveness and dominance (e.g., drinking the most alcohol,
having the most sex partners). Gender-role socialization is
also an important factor in Objectification Theory, which
posits that over the course of a woman’s socialization, sexual
parts and/or functions may become regarded as instrumental
and exchangeable for favorable treatment. Men, on the other
hand, are less likely to be socialized to view their relative
attractiveness as exchangeable for favorable treatment. As
such, women who tend to self-objectify may be less likely to
use condoms if it is perceived that the act will garner favor,
and this may be particularly true for women higher in gran-
diosity who are seeking recognition and admiration from
their partners.
Research has demonstrated positive associations between
overall grandiosity and alcohol consumption in college stu-
dents,5,7,9,45 and some evidence suggests specific grandiose
traits may differentially associate with alcohol consumption.
For example, one study demonstrated that “grandiose
fantasy” (which is conceptually similar to “leadership/
authority” in that it involves a preoccupation with fantasies
of unlimited power/success) was negatively related to heavy
episodic drinking.46 On the other hand, “exploitativeness”
was positively related to heavy episodic drinking.
Importantly, the measure of grandiose traits used in this
study was the Pathological Narcissism Inventory,47 which
lacks an assessment of exhibitionism (a critical component
of grandiosity). Thus, a more complete understanding of
how specific grandiose traits associate with alcohol con-
sumption requires an additional assessment of exhibition-
ism, as well as an examination of whether gender acts as
a moderator.
Few studies have examined associations between grandi-
osity (both overall and specific traits) and risky sexual
behaviors in college students. In one study of adolescents
aged 15–18, grandiosity was positively associated with num-
ber of sex partners in girls, but not in boys.6 It remains
unclear whether grandiosity in college students similarly
associates with number of sex partners after accounting for
gender as a moderator. Another study found no correlation
between grandiosity and condom use in college students,5
and associations between specific grandiose traits and con-
dom use were not examined. In a third study, college

students higher in exhibitionism reported more casual sexual
experiences,11 providing some preliminary evidence that spe-
cific grandiose traits may relate to risky sexual behaviors;
however, additional research is needed to examine grandiose
traits in addition to exhibitionism while examining potential
gender effects.
Current study
In this study, we examine associations between overall gran-
diosity, specific grandiose traits (i.e., leadership/authority,
grandiose exhibitionism, and entitlement/exploitativeness),
and self-reported alcohol consumption, number of sex part-
ners over the last 3 months, and condom use with most
recent sex partner in college male and women. We hypothe-
size that overall grandiosity will positively associate with
alcohol consumption and number of sex partners, and nega-
tively associate with condom use (i.e., individuals higher in
grandiosity will be more likely to report not using a con-
dom). Based on evidence that leadership/authority (and con-
ceptually similar traits)46 may be associated with better
functioning,48 we hypothesize that leadership/authority will
negatively associate with alcohol consumption and number
of sex partners, and positively associate with condom use.
By contrast, grandiose exhibitionism and entitlement/exploi-
tativeness have been associated with worse functioning48;
therefore, we hypothesize that grandiose exhibitionism and
entitlement/exploitativeness will positively associate with
alcohol consumption and number of sex partners, and nega-
tively associate with condom use. Finally, given the limited
evidence base, moderation analyses will be conducted in an
exploratory fashion to examine gender effects on associa-
tions between grandiosity and risky health behaviors.
Methods
Participants and procedures
This study was approved by all relevant institutional review
boards, and informed consent was obtained from all partici-
pants prior to data collection. Participants were 130 under-
graduate students at an urban public university recruited
through the university’s psychology subject pool.
Participants completed an online battery of self-report meas-
ures on individual differences, social interactions, and health
behaviors as part of the larger study, and were compensated
with course participation credit which was awarded upon
completion of the study. Because college undergraduates are
typically between the ages of 18 and 24,49 eight participants
were removed from the current analyses because they did
not fall within this age range, and “non-traditional” older
students may differ substantially regarding the enactment of
the health behaviors under investigation.32,50 The final sam-
ple (n ¼ 122; Mage¼19.51, SD ¼ 1.70, 75.2% women) was
racially diverse, with participants identifying as White
(46.3%), Asian (21.5%), Hispanic (15.7%), Black (11.6%), or
“Other” (4.1%). One participant declined to provide racial
and gender identification. Regarding socioeconomic
JOURNAL OF AMERICAN COLLEGE HEALTH 3
characteristics, participants indicated total family incomes of
greater than $100 K (19%), between $40 K and $100 K
(29.8%), between $20 K and $40 K (12.4%), between $10 K
and $20 K (7.4%), and less than $10 K (2.5%), or declined
providing information on family income (29.5%). Most par-
ticipants reported growing up in either suburban commun-
ities (46.3%) or large, metropolitan areas (39.7%), with a
minority reporting small, rural communities (14.1%).
Analyses regarding sexual behaviors were conducted on the
subset of participants who identified as sexually active
(n ¼ 81); this subset had similar sociodemographic charac-
teristics to the full sample.
Measures
Grandiosity
Grandiosity was assessed with the Narcissistic Personality
Inventory-13 (NPI-13).15 The NPI-13 contains 13 forced-
choice items (i.e., a “grandiose” response option vs. a “non-
grandiose” response option) from its 40-item parent meas-
ure, the NPI.14 Participants were instructed to select the
response option that best described them, even if not a per-
fect fit. The NPI-13 also includes three subscales to assess
specific grandiose traits: four items assess “leadership/
authority” (e.g., “I am a born leader” vs. “Leadership is a
quality that takes a long time to develop”), five items assess
“grandiose exhibitionism” (e.g., “I will usually show off if I
get the chance” vs. “I try not to show off”), and four items
assess “entitlement/exploitativeness” (e.g., “I will never be
satisfied until I get all that I deserve” vs. “I take my satisfac-
tions as they come”). Grandiose response options were
summed across subscales to generate an overall grandiosity
score (a ¼ .67) and within subscales to generate scores for
leadership/authority (LA; a ¼ .70), grandiose exhibitionism
(GE; a ¼ .61), and entitlement/exploitativeness (EE; a ¼
.55). Internal consistencies were low to acceptable in the
current sample. However, it has been noted that scales
derived from the NPI may exhibit low internal consistencies
but tend to correlate in theoretically meaningful ways with
criterion variables.48 Importantly, the NPI has been utilized
as a measure of grandiosity in college samples for roughly
40 years.51,52
Alcohol consumption
Alcohol consumption was assessed with the Alcohol Use
Disorders Identification Test-Consumption Questions
(AUDIT-C).53 The AUDIT-C consists of the first 3 con-
sumption items of the AUDIT.54 The three items are: “How
often do you have a drink containing alcohol? (0 [never], 1
[monthly or less], 2 [two to four times a month], 3 [two to
three times per week], or 4 [four or more times a week])”
“How many standard drinks containing alcohol do you have
on a typical day? (0 [1–2], 1 [3–4], 2 [5–6], 3 [7–9], or 4
[>10]),” and “How often do you have six or more drinks on
one occasion? (0 [never], 1 [less than monthly], 2 [monthly],
3 [weekly], or 4 [daily or almost daily]).” Items were
summed such that higher scores indicate greater alcohol
4 S. R. M. COLEMAN ET AL.

Table 1. Descriptive statistics and bivariate correlations.

N Mode Mean SD Skew 1 2 3 4 5 6 7 8 9
1.Grandiosity 122 2 3.57 2.55 .75 .
2.LA 122 0 1.41 1.38 .47 .73 .
3.GE 122 0 1.27 1.31 .89 .67 .18 .
4.EE 122 0 .89 1.10 1.17 .62 .22 .13 .
5.Problematic Alcohol Consumption 122 0 1.83 1.94 1.01 .25 .20 .19 .11 .
6.Number of Sex Partners 81 1 1.06 1.03 4.18 .24 .00 .18 .34 .02 .
7.Number of Sex Partners (log-transformed) 81 0 .69 1.30 1.61 .04 .08 .07 .08 .03 .57 .
8.Number of Sex Partners (categories) 81 1 .98 .63 .63 .13 .08 .14 .21 .00 .87 .80 .
9.Condom Use 81 1 .52 .50 .08 .23 .15 .17 .13 .09 .04 .14 .12 .
Note: p < .05, p < .01, p < .001. LA ¼ Leadership/Authority, GE ¼ Grandiose Exhibitionism, EE ¼ Entitlement/Exploitativeness.

consumption. The AUDIT-C has been shown to perform
better than the AUDIT in college samples.55 In the current
sample, internal consistency for the AUDIT-C was accept-
able (a ¼ .72).
Sexual behavior
Single item measures were used to identify sexually active
participants, assess number of sex partners over the last
three months, and condom use with most recent sex part-
ner. Single items measures such as these have been used to
assess sexual behavior in community56–58 clinical,59 and col-
lege samples5,60 and have shown meaningful associations
with important health-related psychosocial factors and expe-
riences, such as sexual abuse history,56 being exposed to dat-
ing violence,57 and substance use.58,59 In the current study,
sexually active participants were identified using an open-
ended response item: “Please indicate the age at which you
first engaged in sexual intercourse (age in years).”
Participants were excluded from analyses if they indicated
never engaging in sexual activity (e.g., “never,” “N/A,” “I
haven’t had sex”) or responded “0” (i.e., a non-plausible
age). Number of sex partners over the last three months was
assessed with an open-ended response item: “Please indicate
the number of sexual partners you have had during the past
three months.” Finally, condom use with most recent sex
partner was assessed with the item: “Please indicate whether
you used a condom during your most recent instance of
sexual intercourse.” Participants responded to this item by
indicating “Yes” or “No,” coded as “1” and “0,” respectively.
Data analytic strategy
A priori power calculations were conducted in GPower
3.1.61 It was determined that a minimum sample size of 103
participants would be needed to demonstrate significant
effects of grandiose traits, gender, and their interactions on
the outcomes treated as continuous (i.e., alcohol consump-
tion and number of sex partners), and a minimum sample
size of 83 participants would be needed to demonstrate sig-
nificant effects of the independent variables on condom use
(i.e., a dichotomous outcome). All hypothesis tests were con-
ducted in SAS 9.4.62
Variables were checked for normality (see Table 1).
Overall grandiosity, LA, and GE were normally distributed,
and EE and alcohol consumption were positively skewed but
within generally accepted limits (i.e., <2).63 Data were
missing for “number of sex partners” for three of the partic-
ipants, and as in prior research, “number of sex partners”
was highly positively skewed (Skew ¼ 4.18). The “number
of sex partners” variable was transformed in two ways in
order to select a transformation suitable for hypothesis test-
ing: First, “number of sex partners” was log-transformed
(i.e., after adding a small constant of .0001 to preserve val-
ues of “0”), and second, “number of sex partners” was
recoded into four categories consistent with prior research
(i.e., 0 ¼ zero, 1 ¼ one, 2 ¼ two or three, and 3 ¼ four or
more sex partners).64 The log-transformed variable became
negatively skewed (Skew ¼ 1.61) and the categorical vari-
able was less skewed than the log-transformed variable
(Skew ¼ 0.63). As the log-transformed and categorical varia-
bles were highly positively correlated, the main hypothesis
tests focused on the categorical “number of sex partners”
variable. Bivariate correlations were run to test preliminary
associations between all variables.
A series of two-step regressions were conducted to test
the main hypotheses. Grandiosity (or grandiose trait) varia-
bles were entered into the first step, and gender and inter-
action terms were entered into the second step. Linear
regression models were used to test hypotheses regarding
alcohol consumption and number of sex partners. To probe
significant interactions in the linear regression models, over-
all grandiosity and grandiose traits were categorized using a
quartile split and graphed to facilitate describing the charac-
teristics of the sample: this method has been used in prior
studies examining associations between narcissism and
health-related variables.65,66 Logistic regression models were
used to test hypotheses regarding condom use. Odds ratios
(OR) and associated 95% confidence limits (CL) are pre-
sented for significant associations. ORs were computed to
indicate the event of participants’ reporting “not using a
condom” (i.e., the risky behavior) with their most recent
partner. Thus, an OR > “1” indicated that a participant was
more likely to report not using a condom, and a 95% CL
that contained the value “1” was not significant.
Results
Bivariate correlations
Bivariate correlations are presented in Table 1. As expected,
grandiosity and GE correlated positively with alcohol con-
sumption, grandiosity correlated positively with number of
sex partners and negatively with condom use, and EE corre-
lated positively with number of sex partners. Unexpectedly,
 JOURNAL OF AMERICAN COLLEGE HEALTH 5

Table 2. Linear regression models for hypothesis tests regarding associations between grandiosity (overall/traits), gender, and alcohol consumption and number
of sex partners.
Alcohol consumption Number of sex partners (categories)
b 95% confidence limits p b 95% confidence limits p
Model 1
Step 1
Grandiosity 0.19 0.06 0.32 <0.01 0.03 0.02 0.08 0.27
Step 2
Grandiosity 0.17 0.01 0.33 0.04 0.03 0.09 0.03 0.37
Gender 0.25 1.66 1.16 0.73 20.94 21.56 20.33 <0.01
Grandiositygender 0.08 0.22 0.37 0.61 0.23 0.11 0.36 <0.001
Model 2
Step 1
LA 0.23 0.03 0.49 0.08 0.72 0.18 0.03 0.18
GE 0.21 0.06 0.48 0.12 0.06 0.04 0.16 0.27
EE 0.11 0.21 0.43 0.51 0.14 0.01 0.27 0.04
Step 2
LA 0.20 0.11 0.50 0.20 20.10 20.21 2.00 0.05
GE 0.19 0.13 0.50 0.24 0.08 0.02 0.18 0.11
EE 0.07 0.36 0.50 0.76 0.10 0.25 0.06 0.21
Gender 0.53 2.12 1.05 0.51 0.36 1.11 0.38 0.33
LAgender 0.23 0.45 0.91 0.50 0.02 0.33 0.29 0.90
GEgender 0.23 0.49 0.95 0.52 0.12 0.39 0.15 0.38
EEgender 0.04 0.78 0.70 0.92 0.59 0.31 0.88 <0.001
Note: Bolded values indicate significant associations. LA ¼ Leadership/Authority, GE ¼ Grandiose Exhibitionism, EE ¼ Entitlement/Exploitativeness.

LA correlated positively with alcohol consumption, GE was
uncorrelated with numbed of sex partners and condom use,
and EE was uncorrelated with GE, alcohol consumption,
and condom use. Furthermore, among sexually active stu-
dents, alcohol consumption was uncorrelated with number
of sex partners and condom use.
Main hypotheses tests
Hypotheses tests for alcohol consumption and number of
sex partners are presented in Table 2. As hypothesized,
grandiosity was associated with reporting greater alcohol
consumption. Additionally, there was a significant gender by
grandiosity interaction associated with number of sex part-
ners. Compared to male at “high/average” levels of grandios-
ity, women at “high/average” levels of grandiosity reported
having more sex partners over the last three months (Figure
1). By contrast, compared to women at “high” levels of
grandiosity, male at “high” levels of grandiosity reported
having more sex partners over the last three months
(Figure 1).
Regarding individual grandiose traits, as hypothesized,
LA was not associated with alcohol consumption and was
negatively associated with number of sex partners (Table 2).
EE was positively associated with number of sex partners.
The association between EE and number of sex partners was
moderated by gender. Compared to college women at “high”
levels of EE, college male at “high” levels of EE reported
having more sex partners over the last three months
(Figure 2).
Hypotheses tests for condom use are presented in Table
3. As hypothesized, grandiosity was significantly associated
with not using a condom (OR ¼ 1.22, 95% CL ¼
1.01–1.47). Specifically, for every one unit increase in gran-
diosity, college students were 22% more likely to report not
using a condom with their most recent partner. Regarding
specific traits, there was a significant GE by gender inter-
action associated with not using a condom. For college
male, GE was not associated with condom use (OR ¼ 0.39,
95% CL ¼ 0.12–1.24). For college women, every one unit
increase in GE was associated with a 60% increase in the
likelihood of reporting not using a condom with the most
recent partner (OR ¼ 1.60, 95% CL ¼ 1.10–2.41).
Discussion
This study examined associations between narcissistic gran-
diosity, including overall grandiosity and specific grandiose
traits, and reported alcohol use and sexual behaviors in col-
lege students. Results demonstrated positive associations
between overall grandiosity and alcohol consumption and
number of sexual partners, as well as an association between
overall grandiosity and reporting “no condom use.” These
results are consistent with the view that overall grandiosity
may constitute a broad, risk-stratifying aspect of personality
for college students. Thus, college students high in overall
grandiosity may be at increased risk for health consequences
associated with alcohol consumption (e.g., development of
alcohol dependence, accidental injury) and risky sexual
behavior (e.g., unwanted pregnancy, contracting STIs, perpe-
trating or being a victim of sexual assault). Importantly,
these results add to a growing body of literature that sug-
gests grandiosity (and narcissism more generally) may con-
stitute an aspect of personality that affects a variety of
health behaviors and outcomes.3,4
Regarding specific grandiose traits, we found uneven sup-
port for the main hypotheses. As expected, Leadership/
authority (LA), Grandiose Exhibitionism (GE), and
Entitlement/Exploitativeness (EE) exhibited differential and
theoretically meaningful associations with risky health
behaviors. LA was unrelated to alcohol consumption and
condom use and negatively associated with number of sex
6 S. R. M. COLEMAN ET AL.

Figure 1. Interaction between grandiosity and gender on number of sex partners in the last three months in college students. Note: the first quartile was catego-
rized as “Low” (n ¼ 11, 81.8% women), the second as “Low/Average” (n ¼ 25, 76% women), the third as “High/Average” (n ¼ 24, 75% women), and the fourth as
“High” (n ¼ 20; 75% women).

Figure 2. Interaction between entitlement/exploitativeness and gender on number of sex partners in the last three months in college students Note: the first quar-
tile was categorized as “Low” (n ¼ 20, 80% women), the second as “Low/Average” (n ¼ 21, 81% women), the third as “High/Average” (n ¼ 22, 72.7% women), and
the fourth as “High” (n ¼ 17; 70.6% women).

partners. These results generally support the notion that LA
may constitute an adaptive (or less maladaptive) aspect of
grandiosity.48 However, it is important to note that LA also
exhibited a positive zero-order correlation with reported
alcohol consumption. Given that LA is associated with cri-
terion variables such as striving to win at all costs, asserting
dominance, and pursuing social status, one may speculate
that for both college male and women, LA could be quite
maladaptive (e.g., increase risk for acute intoxication/impair-
ment) in contexts where alcohol consumption is linked with
winning and/or asserting dominance (e.g., during drinking
games). Using Ecological Momentary Assessment (EMA) to
examine in-the-moment effects of grandiose traits on drink-
ing behaviors across different social/environmental contexts
may be an interesting avenue for future research to help to
inform campus prevention and intervention efforts.
Gender was found to moderate an association between
entitlement/exploitativeness (EE) and reported number sex
partners, such that at high levels of EE, college male
reported more sex partners over the past three months than
college women. In one study examining how male react to
sexual refusal from women, male higher in grandiosity
exhibited more punitive behavior (i.e., aggression) toward
women who refused to read sexually arousing passages out
loud.67 In line with this study, one could speculate that male
higher in grandiosity in the current study reported more sex
partners because they were more likely to use force or coer-
cion than male lower in grandiosity. If this speculation is
correct, EE may have a dangerous influence on sexual
behavior in college students, potentially contributing to the
incidence of sexual harassment and assault. That said, stud-
ies have shown that compared to women, male may be
more likely to inflate reported number of sex partners.68
Therefore, it is also possible that current results reflect
intentional misrepresentation among college male at higher
levels of EE, particularly given the nature of EE (i.e., a
 JOURNAL OF AMERICAN COLLEGE HEALTH 7

Table 3. Logistic regression models for hypothesis tests regarding associations highly motivated to self-enhance, and may inflate self-
between grandiosity (overall/traits), gender, and condom use.
reports of behaviors perceived to garner recognition and
B 95% confidence limits Wald v2 p
admiration. Because participants completed the question-
Model 1
Step 1
naires anonymously and online, the motivation to intention-
Grandiosity 0.20 0.01 0.38 4.13 0.04 ally misrepresent behaviors may have been reduced.
Step 2 However, future studies would benefit from control meas-
Grandiosity 0.13 0.08 0.35 1.46 0.23
Gender 0.57 0.49 1.63 1.12 0.90 ures on social desirability (e.g., Marlowe-Crowne Social
Grandiositygender 0.16 0.37 0.06 2.04 0.15 Desirability Scale)70 and the use of methods to reduce prob-
Model 2 lems with retrospective reporting bias (e.g., objective data
Step 1
LA 0.18 0.17 0.52 1.02 0.31 where possible; naturalistic methods that utilize intensive
GE 0.22 0.11 0.55 1.68 0.20 sampling to reduce the recall interval).71 Power analyses
EE 0.19 0.25 0.63 0.71 0.40
Step 2
indicated that the current study may have been somewhat
LA 0.08 0.32 0.47 0.14 0.71 underpowered for some statistical tests; thus, future studies
GE 0.47 0.06 0.88 5.14 0.02 on this topic should seek to recruit larger samples, particu-
EE 0.37 0.23 0.96 1.48 0.22
Gender 2.24 0.67 5.14 2.28 0.13 larly with respect to sexually active college students. Finally,
LAgender 0.01 1.19 1.18 0.00 0.99 it was noted in the measures section that low internal con-
GEgender 21.42 22.65 20.19 5.11 0.02 sistencies on subscales derived from the NPI may be accept-
EEgender 0.15 1.28 0.98 0.80 0.80
able because they tend to show meaningful associations with
Note: Bolded values indicate significant associations. LA ¼ Leadership/
Authority, GE ¼ Grandiose Exhibitionism, EE ¼ Entitlement/Exploitativeness. criterion variables.48 GE and EE are considered maladaptive
aspects of grandiosity, and LA may capture (at least in part)
general willingness to use deception/manipulation to obtain potentially adaptive aspects of grandiosity; thus, GE and EE
recognition and admiration). Importantly, both interpreta- should correlate more closely with each other than with LA.
tions are consistent with some theories of gender69 and nar- In the present study, however, EE was uncorrelated with
cissism,2,43,67 and could be examined in future studies using GE. Therefore, it is possible that the NPI-13 did not
measures to help guard against self-report biases (e.g., adequately capture GE or EE. As such, it would be beneficial
Marlowe-Crowne Social Desirability Scale).70 to replicate the present findings in other college samples
As hypothesized, grandiosity was associated with report- using scales with better internal consistency (e.g.,
ing no condom use with most recent sex partner. As such, Psychological Entitlement Scale).72
college students at higher levels of grandiosity may be at
higher risk for irregular or no condom use and, conse-
Conclusions
quently, at higher risk for unwanted pregnancy and STIs.
Regarding specific traits, women (but not male) who were Given the observed associations between grandiosity (overall
higher in GE were more likely to report not using a condom and specific traits), alcohol consumption, and risky sexual
with their most recent partner. Three out of the five items behaviors in college students, this study may help to inform
included in the NPI-13 GE subscale are associated with body prevention and treatment efforts on college campuses. For
image and may indicate a tendency to self-objectify (i.e., “I example, some of the reported associations were moderated
like to show off my body,” “I like to look at my body,” and by gender; thus, it may be important to consider the poten-
“I like to look at myself in the mirror.”). Given these items, tial benefit of tailoring prevention and treatment efforts for
it may be reasonable to suggest that women (more than male and women. Additionally, the behaviors of individuals
male) who are higher in GE tend to self-objectify given gen- high in grandiosity tend to be driven by the need to obtain
der differences in socialization and sexual experiences. This recognition and admiration from others. Thus, it may also
interpretation might help explain why GE was a risk factor be important to develop health and risk messages that chal-
for no condom use in women but not male, and also gener- lenge students’ perceptions of which behaviors will garner
ally aligns with Objectification Theory and associated peer recognition and admiration.73 More generally, the
research65,66 Future research on this topic may benefit from development of strategies to reduce risky health behaviors
using longitudinal study designs with more intensive sam- on college campuses may benefit from the inclusion of
pling schemes (e.g., daily diary) to help delineate gender dif- measures to track associations between grandiosity and
ferences in GE and self-objectification, and examine how health behaviors over time.
potential differences affect the reporting of sexual behaviors
in daily life.
Conflict of interest disclosure
The authors have no conflicts of interest to report. The
Limitations and future directions
authors confirm that the research presented in this article
The current results are cross-sectional which precludes met the ethical guidelines, including adherence to the legal
causal inferencing. In future studies, causal inferencing on requirements, of the United States and received approval
this topic may be improved by using longitudinal methods. from the Institutional Review Board of The Pennsylvania
As discussed above, individuals high in grandiosity are State University.
8 S. R. M. COLEMAN ET AL.
Funding
No funding was used to support this research and/or the
preparation of the manuscript.
ORCID
Joshua M. Smyth http://orcid.org/0000-0002-0904-5390
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