Narcissism as a Consideration When Designing Health and Risk Messages
- Erin M. HillErin M. HillDepartment of Psychology, West Chester University
Narcissism is a personality trait characterized by perceptions of grandiosity, superiority, and the need for attention and admiration. There has been an increase in focus on examining the development of narcissism and how the trait influences a range of social and health behaviors. A key feature of narcissism is that it is characterized by high self-esteem with a simultaneously fragile ego that requires continual monitoring and manipulation. Therefore, much of the behaviors narcissists engage in are linked to the drive to maintain perceptions of superiority and grandiosity. In the area of health and well-being, narcissism has been positively correlated with psychological health, a relationship that may be accounted for by self-esteem. However, there has been less research on the relationship between narcissism and physical health and well-being. There is some evidence that narcissism is linked to a variety of physical appearance-oriented health behaviors (i.e., behaviors that could affect body weight or other aspects of physical appearance, including eating and exercise). Narcissism has also been positively linked to risk-taking behaviors, including use of substances, as well as risks that could significantly impact others, including sexual behaviors and risky driving. The relationship between narcissism and health is therefore complex, with some positive correlates (e.g., physical activity), but also various health risk behaviors.
In considering how narcissism might interact with health messages, communicators have to keep in mind that narcissists seem to have some deficits in judgment and decision-making, such as overconfidence and a narrow focus on rewards associated with behaviors. Their behaviors tend to be driven by managing their own ego and by drawing attention and admiration from others to maintain perceptions of superiority and grandiosity. In turn, health communicators may need to rely on creative strategies that tap into these domains of narcissism in order to effectively modify health behaviors among narcissistic individuals. Further research on the influence of narcissism in healthcare seeking and related preventive behaviors would also help to provide a more detailed understanding for how the trait influences health decisions, information that would be useful for both health researchers and practitioners.
Introduction to Narcissism
Narcissism is a widely studied personality trait that influences various behaviors and social interactions. The trait itself is characterized by perceptions of grandiosity, entitlement, and superiority (Raskin & Terry, 1988). The term narcissism originates from the Greek myth in which Narcissus catches a glimpse of himself in the reflection of a pool of water. In love with his own reflection, Narcissus fails to divert his eyes away from his own image and dies by the pool. In the social-personality psychology literature, narcissism is largely viewed as a personality trait that, by definition, is a stable set of characteristics that influence an individual’s perceptions and behaviors across a variety of situations.
However, narcissism is also a key feature of narcissistic personality disorder (NPD), as detailed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013). NPD is specifically identified as a Cluster B personality disorder, which also includes antisocial, histrionic, and borderline personality disorders. These personality disorders share the common feature that individuals with the disorders tend to be dramatic and highly emotional (American Psychiatric Association, 2013). Indeed, individuals with NPD tend to show consistent patterns of grandiosity, lack of empathy, and need for admiration across a range of contexts. Additionally, individuals with NPD are also sensitive to how they are perceived and the impact on their own self-image.
Despite the overlap between trait narcissism and NPD, the clinical disorder is not common. Based on the previous (DSM-IV), prevalence rates for NPD have ranged from 0 to 6.2% in community samples(American Psychiatric Association, 2013). Furthermore, Campbell, Hoffman, Campbell, and Marchisio (2010) emphasized that the main difference between NPD and trait narcissism is that NPD largely emerges from the psychiatric perspective, while trait narcissism is largely discussed in the context of social-personality psychology. Miller and Campbell (2008) noted that although there are substantial correlations between trait narcissism and prototypical NPD characteristics, individuals with NPD are more likely to be characterized by negative affectivity and distress than individuals elevated on trait (grandiose) narcissism. Given its relative prominence in the social and health psychology literature, trait narcissism is the construct of interest to many researchers and health professionals. Specifically, the trait can be conceptualized as a continuum, with all individuals in a population falling somewhere along the spectrum. In light of the focus of the academic literature, the nonclinical view of narcissism is the primary focus of this article.
Trait narcissism is considered one of three traits that make up what is referred to as the Dark Triad. The Dark Triad are three closely linked personality traits—narcissism, Machiavellianism, and psychopathy (Paulhus & Williams, 2002). Although the traits share some features, including impulsivity and low empathy, each of the traits has its own unique features. Narcissism is characterized by self-admiration and perceptions of superiority, Machiavellianism is characterized by a high level of exploitation and manipulation of others, and psychopathy is largely linked to having little moral concern for one’s actions and insensitivity to others’ feelings. Of the three, narcissism has been judged to be the “brightest” (Rauthmann & Kolar, 2012)—potentially the least harmful to oneself and others in comparison to Machiavellianism and psychopathy. While narcissism is often measured alone (rather than with Machiavellianism and psychopathy) in relation to outcomes, there has been an increase in focus on the Dark Triad as a whole (Book, Visser, & Volk, 2015; Crysel, Crosier, & Webster, 2013; Jonason, Baughman, Carter, & Parker, 2015; Sabouri et al., 2016).
Types of Narcissism
In terms of understanding the relationship between narcissism and health, it is noteworthy that there is considerable debate in the literature about what constitutes narcissism, its dimensions, and the measurement of the trait (Miller, Lynam, & Campbell, 2016; Miller, Lynam, Hyatt, & Campbell, 2017; Miller et al., 2014; Pincus & Lukowitsky, 2010). Much of the research on narcissism focuses on grandiose narcissism, which, in turn, is contrasted with vulnerable narcissism. Grandiose narcissism is characterized by perceptions of superiority and entitlement (Campbell, Brunell, & Finkel, 2006; Morf & Rhodewalt, 2001), while vulnerable narcissism is characterized by insecure grandiosity, defensiveness, and negative affect (Rose, 2002). Furthermore, the types of narcissism are also discussed with reference to the way the trait is expressed—outwardly (overt) or inwardly (covert)—with grandiose narcissism being characterized by external expression of the trait, and vulnerable narcissism primarily experienced internally (Miller et al., 2017; Pincus & Lukowitsky, 2010).
In assessing grandiose narcissism, many studies rely on the Narcissistic Personality Inventory (NPI; Raskin & Terry, 1988), which is a 40-item forced-choice questionnaire. For each item, participants are asked to identify which response is most characteristic of them—or the least objectionable. A sample item from the scale includes two options: “I am no better or worse than most people” or “I think I am a special person,” with the latter choice being characteristic of elevated narcissism. While the NPI has been widely popular, some researchers argue that there has been too much focus on the adaptive form of narcissism, and not enough attention paid to the maladaptive aspects of narcissism (Cain, Pincus, & Ansell, 2008; Pincus & Lukowitsky, 2010). In light of such concerns, Pincus et al. (2009) developed the Pathological Narcissism Inventory (PNI) to assess the more problematic and clinically relevant elements of narcissism. Indeed, narcissism, as measured by the NPI, has been positively correlated with self-esteem, well-being, and psychological health (Rose, 2002; Sedikides, Rudich, Gregg, Kumashiro, & Rusbult, 2004; Zuckerman & O’Loughlin, 2009), while vulnerable narcissism, frequently measured with the Hypersensitive Narcissism Scale (Hendin & Cheek, 1997), as well as pathological narcissism, measured by the PNI, have been associated with reduced self-esteem (Maxwell, Donnellan, Hopwood, & Ackerman, 2011; Rose, 2002). Thus, it is possible that narcissism as measured by the NPI is not actually capturing the more problematic and clinically relevant aspects of the trait.
In examining grandiose narcissism, researchers have also argued that more focus is needed on the various dimensions of the trait. The NPI assesses dimensions that could be classified as adaptive or maladaptive (Konrath & Bonadonna, 2014; Reinhard, Konrath, Lopez, & Cameron, 2012). Adaptive dimensions are measured by the authority, superiority, self-sufficiency, and vanity subscales, while the maladaptive dimensions are measured by entitlement, exploitativeness, and exhibitionism (Konrath & Bonadonna, 2014). Rather than looking at the overall NPI scores in relation to outcomes, some researchers have chosen to focus on the dimensions of overt narcissism and their correlates. Indeed, specific scales assessing various dimensions and forms of narcissism have emerged, including the Narcissistic Grandiosity Scale (Foster, McCain, Hibberts, Brunell, & Johnson, 2015), the Interpersonal Exploitativeness Scale (Brunell et al., 2013), and the Sexual Narcissism Scale (Widman & McNulty, 2010). Although the dimensions of narcissism continue to expand, adding to the complexity of the trait and its correlates, for the purpose of this article, unless otherwise specified, the term narcissism is used to describe grandiose (overt) narcissism. Additionally, the term narcissist is used to describe individuals with an elevated score on the narcissism scale of use, and does not refer to a clinical diagnosis. It is notable that narcissism, as conceptualized in the social psychology literature, is viewed as a continuous (rather than categorical) variable (Foster & Campbell, 2007). That is, there is typically no cut-off score to identify a narcissist, but the term (indicating an elevated narcissism score) is used for brevity and efficiency in discussing the literature.
Models of Narcissism
Various models have been developed in an attempt to explain the characteristics and correlates of trait narcissism. Importantly, Campbell, Hoffman, Campbell, and Marchisio (2010) noted that the most appropriate model used by clinicians and researchers may change depending on the area of examination and the research question. This is an important consideration in health communication, as the model for understanding and applying narcissism may be different depending on the targeted attitude or behavior. Much of the literature is governed by the dynamic self-regulatory model of narcissism (Morf & Rhodewalt, 2001) as well as models that emerged from it: the agency model of narcissism (Campbell et al., 2006) and the unmitigated approach model (Foster & Trimm, 2008). Overall, the models share central features that focus on narcissism as a trait that involves a high degree of monitoring and promotion of self-image, and perceptions of entitlement.
Morf and Rhodewalt’s (2001) self-regulatory processing model of narcissism proposes that narcissism involves interactions between affective and cognitive processes at both the intrapersonal and interpersonal levels. Their model was developed, in part, to demonstrate that narcissism involves continual processing and monitoring of one’s self-image, and is not merely a stable personality trait. Morf and Rhodewalt’s (2001) self-regulatory processing model proposes that narcissism is marked by a high degree of grandiosity and simultaneously fragile self-worth. Thus, the ongoing challenge for narcissists is to continue to build and maintain their desired self. To maintain their image, narcissists both engage in self-enhancement behaviors to demonstrate their superiority and also seek out admiration and attention from others. Thus, Morf and Rhodewalt (2001) emphasized that the narcissist’s self-image is in continual flux, leading to a high degree of vigilance for opportunities to self-promote and to ensure perceptions of admiration. In turn, this high degree of self-regulation affects a variety of interpersonal and self-enhancement behaviors (Campbell, Reeder, Sedikides, & Elliot, 2000; Wallace & Baumeister, 2002).
Building upon the work of Morf and Rhodewalt (2001), Campbell et al. (2006) developed the agency model of narcissism, which later became the extended agency model of narcissism (Campbell & Foster, 2007). In the original agency model, both interpersonal skills (e.g., confidence, charm) and strategies (e.g., self-promotion) are applied to allow the narcissist to maintain elevated levels of self-esteem. In the extended agency model, intrapsychic strategies were also included, with self-perceptions (e.g., of one’s intelligence, attractiveness) also serving to maintain the self-esteem of the narcissist. These domains therefore interact to help maintain elevated levels of self-esteem. For example, perceived attractiveness may fuel interpersonal skills, such as charm in a social encounter. In the agency model, Campbell et al. (2006) proposed that narcissism has some fundamental attributes: narcissists are agentic—they are focused on the self, power, and prestige (rather than on others), they are approach-oriented (rather than avoidance-oriented), they have an inflated view of the self, and they are focused on acquiring self-esteem. Such personal attributes, in turn, fuel the myriad of interpersonal skills and strategies employed to maintain their desired image.
Subsequent research has focused on the approach orientation of narcissism, serving to explain the relationship between narcissism and some risk behaviors (Foster, Reidy, Misra, & Goff, 2011; Foster, Shenesey, & Goff, 2009; Ju, Ji, Lan, & You, 2016). Foster and Brennan (2011) described approach and avoidance motivation as orthogonal dimensions; individuals who are approach-oriented seek out rewards (e.g., engage in gambling for the potential of winning), while individuals who are avoidance-oriented seek to avoid punishment (e.g., engage in studying to avoid failing a test). Foster and Trimm (2008) proposed that the high degree of rewards in Western culture (e.g., parental praise) fuels the promotion of approach orientation among narcissists. That is, over time, narcissists learn to become motivated by rewards and their corresponding benefits (e.g., attention, admiration). Related research supports this model as well; Zajenkowski, Witowska, Maciantowicz, and Malesza (2016) found that narcissism was positively correlated with a hedonistic orientation, the time perspective focused on immediate pleasure/gratification. Overall, this model for understanding narcissism, termed the unmitigated approach model (UAM), is viewed as a subcomponent of the agency model, and has received support in explaining the link between narcissism and risk-taking behaviors (Foster et al., 2009, 2011).
A Brief History of the Examination of Narcissism
The concept of narcissism has its roots in the medical and psychoanalytic fields, and only later emerged as a popular and well-studied construct in the social-personality domain of psychology. The history of the study of narcissism has been well documented; for reviews and in-depth summaries, refer to Levy, Ellison, and Reynoso (2011) and Campbell and Foster (2007). Among the earliest clinicians to discuss the concept was Havelock Ellis, a sexologist-physician who, in the late 19th century, described narcissism as an autoerotic sexual condition, indicating that some patients were “Narcissus-like”—completely focused on self-admiration. In the early 20th century, Otto Rank, a psychoanalyst, commented on the trait, noting that the vanity associated with narcissism was not exclusively sexual and could have an interpersonal component as well (Levy et al., 2011).
Building upon the work of Rank, Freud documented his views on narcissism in 1914, noting that narcissism may be part of normal psychosexual development or may possibly be related to pathology. In line with some of the current perspectives on the relationship between narcissism and self-esteem, Freud noted that narcissism was associated with keeping one’s awareness free from any feelings that could diminish one’s self-worth. Levy et al. (2011) emphasized that it is noteworthy that much of the early discussions of narcissism focused on it as a state variable rather than a personality-oriented trait. Thus, the general understanding of narcissism evolved from examining it as a state to viewing it as a more stable set of characteristics. Following Freud’s discussion of narcissism, other psychoanalysts began to comment on the construct, noting its connection to aggression and an inability to regulate one’s self-esteem, as well as its relationship to borderline personality disorder. Eventually, narcissistic personality disorder was introduced in DSM-III in 1980, and subsequently became subject to investigation from both the clinical perspective and the social-personality perspective (Levy et al., 2011). While trait narcissism and NPD are largely viewed as distinct constructs, research in both domains is complementary and aids in the overall understanding of narcissism and its link to psychosocial functioning, health, and well-being.
Origins of Narcissism
The development of narcissism as a trait or clinical disorder has been of significant interest to both clinicians and researchers. A common view is that parenting has a strong influence on the development of trait narcissism (Brummelman et al., 2015; Huxley & Bizumic, 2017; Thomaes, Brummelman, Reijntjes, & Bushman, 2013). Some of this research has noted that a diathesis-stress model may exist for narcissism, in which certain environmental conditions may activate narcissistic tendencies that are genetically linked (Thomaes et al., 2013). Other research noted that narcissism may result from social learning, shaped in part by reinforcement, conditioning, or modeling (Horton, 2011; Huxley & Bizumic, 2017).
Much of the research on the relationship between parenting and narcissism has focused on individual recollections of parenting practices (Cater, Zeigler-Hill, & Vonk, 2011; Huxley & Bizumic, 2017; Otway & Vignoles, 2006), participant-perceived parental behaviors (Horton, Bleau, & Drwecki, 2006; Horton & Tritch, 2014; Mechanic & Barry, 2015), or parent self-reports (Brummelman et al., 2015). Notably, some research has begun to use more objective observational methods to supplement parental self-reports (Wetzel & Robins, 2016). In terms of understanding the connection between parenting and narcissism, theoretically, continual praise and indulgence related to a child’s mediocre or limited accomplishments could lead to the child developing a sense of entitlement and superiority in relation to others. Indeed, there is some evidence to suggest that parental overvaluation can aid in the development of the trait (Brummelman et al., 2015; Otway & Vignoles, 2006; Segrin, Woszidlo, Givertz, & Montgomery, 2013); however, the findings are mixed (Horton & Tritch, 2014).
In a related vein, other research suggested that perhaps excessive parental warmth contributes to the development of narcissism (Horton et al., 2006; Mechanic & Barry, 2015); however, other research has not supported this claim (Brummelman et al., 2015; Wetzel & Robins, 2016). Huxley and Bizumic (2017) suggested that high levels of invalidation (lack of consideration or acknowledgment of the child’s emotional or internal experience) are predictive of both grandiose and vulnerable narcissism, perhaps linked to the inability to understand one’s own emotions and increased reliance on regulating one’s emotions through external sources (e.g., parental recognition, admiration from others). Further, poor parental monitoring may play a key role in the development of narcissism (Horton et al., 2006; Mechanic & Barry, 2015; Wetzel & Robins, 2016). That is, lack of parental control or inconsistent parenting may lead to a disorganized sense of self or inflated self-importance (Mechanic & Barry, 2015), which, in turn, facilitates the development of narcissism.
Recent research has begun to look more deeply at the facets narcissism; some research suggests that the entitlement/exploitativeness facet of narcissism is linked to low security, high threats of separation, and low parental discipline (Cater et al., 2011). Similarly, in a longitudinal study, Wetzel and Robins (2016) found higher levels of parental hostility at age 12 were associated with elevated levels of entitlement at age 14, suggesting that such parental behaviors could fuel feelings of inadequacy that lead to seeking admiration from others to help compensate for such self-perceptions. Given the complexity of the trait and its various facets, further research is needed to better understand how various parenting practices might influence the development of narcissism. There has been heavy reliance on self-report in research in this area, and therefore longitudinal research that more objectively captures parenting styles and behaviors would be beneficial in understanding the origins of narcissism.
Twenge, Konrath, Foster, Campbell, and Bushman (2008) proposed that narcissism not only is affected by the family environment, but also is likely influenced by broader cultural forces. Twenge and Campbell (2009) suggested that the self-esteem movement could have been a contributor to the rise in rates of narcissism observed in the United States over a 25-year period (Twenge et al., 2008). Indeed, this corresponds with evolution of the focus on narcissism as a clinical trait; there was much focus on self-esteem during the 1970s, and in 1980, narcissistic personality disorder was included in the DSM-III (Levy et al., 2011). The self-esteem movement of the 1970s emphasized elevating and maintaining high levels of self-esteem in children and adolescents. The hope was that high self-esteem would, in turn, serve as protection against the development of delinquency, academic issues, and mental health problems (Twenge & Campbell, 2001). Twenge and Campbell (2009) argued that this focus on inflation of self-esteem was likely a contributor to generations of children growing up in a culture that fosters narcissistic self-views of superiority, grandiosity, and entitlement.
Although the research by Twenge and colleagues (2008) suggested that current generations are more self-focused and narcissistic than previous generations, there has been considerable debate about this claim (Roberts, Edmonds, & Grijalva, 2010; Trzesniewski, Donnellan, & Robins, 2008b). Some of the research directly criticized the methodology in the work by Twenge and colleagues (Trzesniewski et al., 2008b), and other research examining cohort trends in levels of narcissism has documented no increase in the trait (Roberts et al., 2010; Trzesniewski, Donnellan, & Robins, 2008a). Rather, data suggest that the generational differences in narcissism may simply reflect the fact that younger individuals are more likely to have narcissistic characteristics than older age groups (Roberts et al., 2010; Wilson & Sibley, 2011).
The existence of narcissism itself should also be examined in relation to the dimensions of culture. The United States is largely an individualistic culture, and there is evidence to suggest that the societal focus on individualism helps to promote widespread narcissism. Research suggests that individualistic countries are more likely to have higher rates of narcissism (Foster, Campbell, & Twenge, 2003), and that Americans are perceived as highly narcissistic by both Americans and non-Americans (Miller et al., 2015), a finding that could be related to the salience and prominence of narcissism in celebrity culture in America (Young & Pinsky, 2006). Individualistic countries promote the success of individuals, their accomplishments, and personal victories, so the correlation between individualism and narcissism is not surprising. Furthermore, there is research to suggest that self-construals that focus on independence, a key trait associated with individualistic cultures, are positively correlated with narcissism (Konrath, Bushman, & Grove, 2009). The association between individualism and narcissism also fits within the agentic nature of narcissism; power, status, success, and dominance are key elements of the self-image of narcissism (Campbell & Foster, 2007), and, in turn, an individualistic culture rewards and reinforces such elements and characteristics.
Within the social class system in the United States, there also appear to be differences in levels of narcissism. In a series of studies examining the distribution of narcissism across social strata, Piff (2014) reported that social class (measured by income) was associated with greater psychological entitlement and narcissism. The results further suggested that entitlement was a key intermediary variable in the positive relationship between social class and narcissism. That is, it could be that upper-class individuals are more narcissistic due to their elevated perceptions of entitlement. Importantly, Piff (2014) noted that the results of his studies are particularly relevant in the context of income inequality in the United States. Should the income gap continue to widen, it may further fuel low empathy and narcissistic behaviors among those in the higher income brackets. In sum, while narcissism is largely examined in the social-personality psychology literature, broader cultural and societal forces are additional considerations in the development and presence of the trait.
Narcissism, Health, and Well-being
In anticipating how a narcissistic individual may react or respond to a variety of health messages, it is important to understand how narcissism has been related to health outcomes and various health behaviors in previous research. Some research has focused on physical or physiological variables associated with narcissism (see Konrath & Bonadonna, 2014, for a review), but generally the literature is dominated by studies of both overt and covert narcissism as they relate to mental health and well-being (Lapsley & Aalsma, 2006; Ng, Cheung, & Tam, 2014; Rose, 2002; Sedikides et al., 2004). Overt narcissism has been positively correlated with a variety of positive outcomes, including higher life satisfaction and well-being (Ng et al., 2014; Sedikides et al., 2004; Zuckerman & O’Loughlin, 2009), and decreased anxiety, depression, and loneliness (Sedikides et al., 2004; Spano, 2001). However, self-esteem appears to be a key mediating variable in the relationship between overt narcissism and psychological health (Sedikides et al., 2004; Zuckerman & O’Loughlin, 2009). Therefore, the high levels of self-esteem that correspond with elevated narcissism scores help to protect narcissists from psychological health problems.
The relationship between covert narcissism and well-being is not quite as positive as the health correlates of overt narcissism. Research suggests that covert narcissism is positively correlated with stress and decreased life satisfaction (Ng et al., 2014; Rose, 2002), possibly related to low self-esteem (Rose, 2002). Longitudinal research by Edelstein, Newton, and Stewart (2012) has similarly found that covert narcissism may have a long-term negative influence on psychological health, including more depressive symptoms, lower life satisfaction, and decreased overall well-being. Overall, research seems to suggest that covert narcissism influences health and well-being differently than overt narcissism, possibly putting covert narcissists at a higher risk for psychological problems.
In comparison to research examining the relationship between narcissism and mental health, there has been less research on the correlation between physical health status and narcissism. However, a recent study examined the association between the Dark Triad traits and life expectancy, as estimated using the Living to 100 Expectancy Calculator (Jonason et al., 2015). The results identified a positive association between narcissism and calculated life expectancy, a correlation that did not exist for the other Dark Triad components. The authors suggested that it is possible that narcissists benefit from the social nature of the trait, especially in comparison to Machiavellianism and psychopathy. That is, even though narcissists tend to be agentic and self-focused, they still manage to gather and maintain a social network, possibly related to their need for attention and admiration (Campbell & Foster, 2007). In turn, this social network potentially serves them in improving their overall health through stress buffering or promotion of engagement in various health behaviors.
Narcissism and Health Behaviors
Much of the research on narcissism and health behaviors has specifically focused on the relationship between narcissism and risk-taking behaviors. Vazire and Funder (2006), in their review article, suggested that narcissism was positively linked to impulsivity, which in turn influences participation in risk-taking behaviors. In framing the variety of health and social behaviors related to narcissism in a way that may be useful for health communication scholars and practitioners, the following review of the literature is separated into three themes:
physical appearance-oriented health behaviors (e.g., physical activity, eating)
substance use and individual risk behaviors (e.g., drinking, drug use)
other relevant health behaviors (sexual risk-taking and aggression, driving behaviors).
Physical Appearance-Oriented Health Behaviors
Narcissism is significantly associated with concerns about physical appearance (Egan & McCorkindale, 2007). Narcissists tend to engage in behaviors that help to promote or maintain their physical appearance, including health behaviors like healthy eating and exercise. A craving for admiration and attention is a key element of narcissism (Morf & Rhodewalt, 2001), and one of the main ways narcissists receive such attention is through their physical appearance. For example, Vazire, Naumann, Rentfrow, and Gosling (2008) found that narcissists were more likely to wear expensive, flashy clothing. Their research also indicated that narcissists were more likely to have a neat and organized appearance and female narcissists were more likely to wear make-up and show cleavage.
It is notable that a meta-analysis revealed a small but reliable positive correlation between narcissism and objectively assessed attractiveness (Holtzman & Strube, 2010). This meta-analysis revealed that narcissists, indeed, appear to be more objectively attractive than nonnarcissists. As indicated in the research by Vazire et al. (2008), one explanation could be that narcissists simply put more effort into their physical appearance in terms of personal grooming and weight maintenance. Other research has found that narcissism is associated with mate appeal (Dufner, Rauthmann, Czarna, & Denissen, 2013), which was explained by the intermediary variables of physical attractiveness and social boldness. Therefore, the underlying motivation for narcissists’ engagement in health behaviors may be driven by vanity and admiration concerns, but beneficial health outcomes may nonetheless result.
Narcissism has been positively correlated with physical activity in a variety of studies. A positive correlation between narcissism and self-reported physical activity has been reported among gym-active males (Brown & Graham, 2008), residents of New York (Spano, 2001), and among college students (Hill, 2016). Spano (2001) proposed that concern for physical appearance was a likely motivational factor in the association between narcissism and physical activity. It is also possible that the social nature of both narcissism and physical activity helps to explain the correlation between the two variables. Previous research has indeed linked narcissism and extroversion (Holtzman, Vazire, & Mehl, 2010; Paulhus & Williams, 2002), and a meta-analysis by Rhodes and Pfaeffli (2012) showed that extroversion has a significant small-to-moderate impact on physical activity engagement. It is possible that the relationship between narcissism and physical activity is at least partly influenced by high social engagement or high social vitality, a component of hypomania that has been correlated with grandiose narcissism (Siedor, Maples-Keller, Miller, & Keith Campbell, 2016). Additionally, narcissism is positively correlated with competitiveness (Campbell, Bush, Brunell, & Shelton, 2005; Luchner, Houston, Walker, & Houston, 2011), and given that many physical activity endeavors involve sports or games, it could be that the desire to compete influences narcissists’ interest in physical activity.
Not only has narcissism been positively linked to physical activity, but also it has been associated with more problematic forms of exercise, including exercise dependence and exercise addiction. Miller and Mesagno (2014) found a positive correlation between narcissism and exercise dependence among the male participants in their study, and, similarly, Bruno et al. (2014) found that narcissism was associated with high risk for exercise addiction. This research corresponds to the correlation between narcissism and other addictive behaviors (Andreassen, Pallesen, & Griffiths, 2016; MacLaren & Best, 2013; Rose, 2007); therefore, individuals elevated on narcissism may be at high risk for addiction in various forms, including substances as well as exercise.
Eating is a behavior that not only affects overall health and well-being, but, similar to exercise, also affects physical appearance and weight. Much of the research on narcissism and eating has focused on disordered eating patterns. In particular, covert narcissism has been correlated with poor body image and disordered eating behaviors (Dakanalis, Clerici, & Carra, 2016), possibly explained by the low self-esteem and emotion dysregulation linked with this form of narcissism (Maples, Collins, Miller, Fischer, & Seibert, 2011; Rose, 2002; Zhang, Wang, You, Lu, & Luo, 2015). In contrast, overt narcissism has been positively correlated with body esteem and seems to be protective against the development of disordered eating behaviors (Dakanalis et al., 2016). However, Gordon and Dombeck (2010) found that overt narcissism was linked to concerns about appearance and a drive for muscularity. Therefore, while the high level of self-esteem associated with narcissism may be protective in some ways against disordered eating, the strong reliance on attention from others and fixation on physical appearance may lead some narcissists to engage in problematic eating and exercise behaviors.
Beyond the relationship between narcissism and disordered eating, there is some evidence to suggest that narcissism may be beneficial for healthy eating. In a sample of college undergraduates, Hill (2016) found that narcissism was associated with an increased likelihood of reporting always engaging in healthy eating (versus sometimes engaging in healthy eating). It is noteworthy that, in many of the studies on health behavior, the responses were self-reported, thus it is possible that social desirability may affect the results. Nonetheless, should a true correlation exist between narcissism and healthy eating, it would be beneficial to tap into the underlying motivations to determine whether such behaviors are governed by concerns about physical appearance or other factors.
Substance Use and Individual Risk Behaviors
Much attention has been given to the relationship between narcissism and substance use and related risk behaviors. Narcissism is regarded as a trait that is linked to impulsivity (Vazire et al., 2008) as well as sensation seeking (Crysel et al., 2013), which, in turn, potentially contributes to the motivation for substance use and other forms of risk-taking. Similarly, Rose (2007) found that low impulse control was a significant mechanism explaining the association between narcissism and compulsive buying. Rose (2007) emphasized that narcissism is broadly linked to poor self-regulation, which could help explain its association with other addictive behaviors.
Some research on the relationship between narcissism and risk-taking has relied on the Domain-Specific Risk-Taking Scale (DOSPERT; Blais & Weber, 2006), an inventory that assesses risk-taking across ethical, financial, health/safety, recreational, and social domains. Using the DOSPERT inventory, Buelow and Brunell (2014) found that narcissism was predictive of risk-taking in the financial, health, and social domains, but not in the ethical and recreational domains. Similarly, Foster et al. (2009) examined the association between narcissism and risk- taking using the DOSPERT, and found that the positive correlation between the two variables was partially mediated by perceived benefits. That is, a focus on benefits is a main factor that drives narcissists to engage in risk-taking behaviors. Indeed, this result offered support for the approach orientation of narcissism; narcissists are particularly sensitive to the rewards associated with behaviors and seem to be willing to engage in risks to obtain such rewards.
Other studies have linked narcissism to alcohol use and alcohol abuse (Hill, 2016; Luhtanen & Crocker, 2005; MacLaren & Best, 2013). Among college students, narcissism has been linked to both weekday and weekend drinking (Hill, 2016), general alcohol use (MacLaren & Best, 2013), and binge-drinking frequency (Luhtanen & Crocker, 2005). Luhtanen and Crocker (2005) noted that contingencies of self-worth may play an important role in the relationship between narcissism and drinking. Drinking during the college years tends to take place in a highly social context. Thus, narcissists, due to their fragile self-views, are more likely to be driven to engage in behaviors that will continue to elevate their image (Luhtanen & Crocker, 2005).
In addition, narcissism has been linked to other addictive behaviors, including drug use. This relationship has been observed among adolescents (Aalsma, Lapsley, & Flannery, 2006) and college students (MacLaren & Best, 2013). However, research by Hill (2016) found that narcissism was associated with marijuana use, but not overall drug use. Despite some mixed findings, there does seem to be a link between narcissism and drug use, potentially fueled by perceptions of invulnerability (Aalsma et al., 2006) and an approach orientation (MacLaren & Best, 2013) that leads narcissists to seek out stimulation through the use of substances.
While much of the research on narcissism and risk has focused on addictive behaviors, there are other health-risk behaviors that may be of particular relevance to narcissism, including tanning/lack of sun protection. Given narcissists’ focus on physical appearance and limited concern for avoidance of risk (e.g., sunburns/skin damage), Konrath and Bonadonna (2014) suggested that narcissists may be more likely than nonnarcissists to engage in tanning. Additionally, Konrath and Bonadonna (2014) also noted that there is a paucity of research on sleep behaviors in relation to narcissism. Although limited research has been conducted, Sabouri et al. (2016) found that narcissism was the only Dark Triad trait that was not predictive of sleep disturbances. It could also be that unhealthy and healthy narcissism, or overt and covert narcissism, impact sleep in unique ways. Especially given the social orientation of the trait, which may be a motivator to stay up late, as well as the approach orientation, it might be that narcissists sleep fewer hours than nonnarcissists. However, research is needed in this area of study.
Other-Relevant Risk Behaviors
While some behaviors arguably primarily affect the individual (e.g., sunscreen use, smoking), some health behaviors are other-relevant—that is, engaging in the behaviors has the potential to affect the health and well-being of other people. For example, narcissism seems to play a significant role in the engagement in sexual behaviors and sexual violence, as well as risky driving, behaviors that not only impact the individual, but also have an interpersonal element.
Narcissism has been studied in relation to various sexual behaviors—ranging from safe sex behaviors to sexual violence. In the context of sexual behaviors, narcissism has long been identified as a personality variable of relevance. In particular, narcissists tend to be successful at attracting potential mates in the short term; narcissism is linked to mating effort (Egan & McCorkindale, 2007), and narcissists are often perceived as physically attractive and charming (Back, Schmukle, & Egloff, 2010; Dufner et al., 2013). However, in the long run, the problematic nature of the narcissist’s personality shines through and the narcissist tends to become less appealing as a potential mate (Campbell, 2005).
Foster, Shrira, and Campbell (2006) proposed that narcissists are governed by a unique perspective on sexuality. The agentic orientation of narcissism (focused on power, status, and success of self) also influences an individual’s sociosexuality—the contexts and ways in which they prefer to have sex (e.g., within relationships, casual encounters). Because narcissists tend to be agentic rather than communal, their sexual behaviors tend to be self-centered and less focused on intimacy, which is referred to as unrestricted sociosexuality. In their studies, Foster et al. (2006) found that narcissism was associated with unrestricted sociosexuality (characterized by self-focused attitudes and behaviors) and with low relationship commitment. In a related vein, narcissism has also been associated with ludus, a game-playing form of love (Campbell, Foster, & Finkel, 2002) and increased susceptibility to infidelity (Buss & Shackelford, 1997). Thus, the self-centered aspect of narcissism seems to translate into the ways in which narcissists engage in sexual behaviors, which are marked by a lack of care or consideration for others involved.
In terms of engagement in safe sex behaviors, there is some evidence to suggest that narcissists are less likely to engage in safe sex behaviors than nonnarcissists. Narcissism has been linked to sexual sensation seeking and number of sexual partners in the previous year (Konrath, Meier, & Bushman, 2014), an increased incidence of sexually transmitted diseases (Bjekíc, Lecic-Toševski, Vlajinac, & Marinkovíc, 2002), and an increased likelihood of unsafe sex and lower condom use intentions among individuals with HIV (Martin, Benotsch, Perschbacher Lance, & Green, 2013). However, among college students, other research found no relationship between narcissism and risky sexual behaviors (Buelow & Brunell, 2014; Hill, 2016).
There is also mounting evidence to suggest that narcissism is linked to sexual violence and aggression. Early research on the link between narcissism and sexual aggression focused on the narcissistic reactance theory of sexual assault (Baumeister, Catanese, & Wallace, 2002). This model proposes that narcissists are at high risk for sexual aggression because they believe they are entitled to sexual favors. Additionally, Baumeister et al. (2002) proposed that narcissists’ lack of empathy for others and need for admiration related to their sexual dominance further fuel their aggressive tendencies. Supporting this theory, narcissism has been linked to rape myth acceptance and low empathy for rape victims (Bushman, Bonacci, van Dijk, & Baumeister, 2003), hostility directed toward potential sexual partners (Keiller, 2010), perpetration of sexual assault (Mouilso & Calhoun, 2012), and sexual aggression (Mouilso & Calhoun, 2016; Widman & McNulty, 2010).
In addition to sexual behaviors, narcissism is also linked to another other-relevant health behavior—risky and aggressive driving. In early research on the relationship between narcissism and driving behaviors, Schreer (2002) found that dimensions of narcissism were predictive of self-reported aggressive driving. The results varied according to gender, with males elevated on entitlement and females elevated on exhibitionism having the greatest likelihood of reporting aggressive driving. Later research supported the link between narcissism and driving-related risk-taking; narcissism has been correlated with self-reported risky driving (Hill, 2016), anger in reaction to following a slow vehicle (Britt & Garrity, 2006), and aggressive driving (Edwards, Warren, Tubré, Zyphur, & Hoffner-Prillaman, 2013).
There does appear to be a strong interpersonal element in the relationship between narcissism and driving behaviors. As discussed by Wickens, Wiesenthal, and Roseborough (2015), driving is a unique interpersonal situation; a degree of cooperation and consideration is needed when behind the wheel of a car, but driving also allows for some degree of anonymity, thus potentially allowing more aggression to occur than in a typical social situation. To more closely examine the interpersonal element of aggressive driving, some research has examined driver vengeance, defined as infliction of harm on another driver related to a perceived injustice that occurred. Lustman, Wiesenthal, and Flett (2010) reported a positive correlation between narcissism and driver vengeance, as measured with a self-report questionnaire, a finding that was also supported in subsequent research on personality predictors of driver vengeance (Wickens et al., 2015).
In the context of the relationship between narcissism and risky driving behaviors, it is important to note that Lustman et al. (2010) also found that narcissism was positively correlated with perceived driving ability. Therefore, it is likely that multiple factors are at play in the relationship between narcissism and problematic driving behaviors; narcissists may not recognize the potential dangers of their risky driving, but it is also likely that their disregard of, and low empathy for, others fuels some aspects of their aggressive driving. Especially in the context of increased opportunities for distraction while driving (e.g., cell phone use and other technology in the car; Coben & Zhu, 2013), it will be important to further examine the motivations and factors explaining the link between narcissism and the various forms of risky driving behaviors, including aggressive driving, driver vengeance, and general risky driving (e.g., texting while driving). Overall, there is a strong interpersonal element in narcissism, which could influence behaviors that are other-relevant.
Considerations for Health and Risk Message Design and Processing
Although narcissism is a complex trait with various types and dimensions, it is clear that there are elements of the trait that may put an individual at an increased risk for engaging in problematic health behaviors. Thus, looking at the characteristics and behavior patterns associated with narcissism, there are some key considerations for health and risk message design and processing, including narcissists’ judgment and decision-making patterns, as well as their motivation for maintaining their ego and self-image.
Judgment and Decision-Making
Ultimately, health decisions made on a daily basis can have both short-term and long-term influences on one’s overall well-being; each day, one decides what to eat, whether to smoke or drink, and whether to engage in preventive healthcare behaviors. In this context, it is notable that narcissism is a trait associated with significant judgment and decision-making problems. Such judgment impairments not only are potentially problematic for one’s career or financial security (Campbell et al., 2010), but also may have important health implications. Narcissism is linked to overconfidence in a variety of contexts; Narcissists tend to overestimate their academic achievements (Farwell & Wohlwend-Lloyd, 1998) and creativity (Goncalo, Flynn, & Kim, 2010). In gambling tasks, narcissists have been shown to have elevated confidence, which was linked to increased bet acceptance (Campbell, Goodie, & Foster, 2004; Lakey, Rose, Campbell, & Goodie, 2008). In turn, narcissists have been found to lose more than non-narcissists in gambling tasks (Campbell et al., 2004; Lakey et al., 2008). Lakey et al. (2008) proposed that this overconfidence, along with a short-term focus on the reward, influences narcissists’ poor decision-making abilities.
Foster et al. (2011) also found this problematic decision-making pattern in relation to hypothetical stock market investment scenarios. In their study, narcissists were more likely to choose more volatile stocks, and were more likely to lose more money during the study session. However, there have been some conflicting results for the relationship between narcissism and decision-making, with Byrne and Worthy (2013) reporting that narcissists fare better than non-narcissists in ambiguous decision-making situations. Campbell et al. (2010) also noted that narcissists, due to their aggressive risk-taking, may do better in bull markets (markets with rising prices) than bear markets (markets with falling prices). However, overall, results of the gambling and financial decision-making studies are indeed in line with the unmitigated approach motivation framework for understanding narcissism (Foster & Trimm, 2008). Narcissists appear to be strongly motivated by reward (benefits associated with behavior), and they perhaps do not adequately consider the risks relevant in their decision-making.
In a related vein, narcissism has also been positively correlated with perceived invulnerability and optimism. Among adolescents, narcissism has been positively correlated with self-reported invulnerability (Aalsma et al., 2006; Barry, Pickard, & Ansel, 2009), as well as risk behaviors (e.g., fast driving, stealing, fighting; Aalsma et al., 2006). In earlier research, Hickman, Watson, and Morris (1996) found that adaptive dimensions of narcissism were linked to an optimistic orientation, which the authors posited helps to protect narcissists from experiencing psychological distress and mental health problems. Indeed, narcissists are also more likely to be optimistic about their own performance on tasks, and notably do not apply the same optimism to their partners (Farwell & Wohlwend-Lloyd, 1998).
While many of the studies related to the overconfidence and problematic decision-making patterns of narcissists have been applied to business and financial decision-making (Campbell et al., 2010; Chatterjee & Hambrick, 2007; Lakey et al., 2008), it is necessary to consider such perceptions in light of health communication and health promotion. Such optimistic perceptions and behaviors relate broadly to the concept of optimistic bias, which is a person’s overestimation of the likelihood of positive events while simultaneously underestimating the likelihood of negative events. Importantly, optimistic bias does allow individuals to function well in the face of uncertainty, but it is also linked to problematic behaviors in relation to health (Shepperd, Klein, Waters, & Weinstein, 2013). For example, an optimistic bias can lead to downplaying the significance of physical symptoms that should lead to medical care. A delay in healthcare seeking, in turn, could result in a more severe diagnosis than if the individual sought care when the symptoms first appeared (Andersen, Cacioppo, & Roberts, 1995). These key characteristics of narcissism—overconfidence, optimism, and related problematic judgment and decision-making—may have some benefit for psychological well-being, but could significantly influence both short-term and long-term physical health and well-being.
A central feature of trait narcissism is a fragile ego. Although narcissists appear to have high self-esteem and perceptions of superiority, the elevation is unstable, and in turn, susceptible to damage from negative events or critical comments from others (Bushman & Baumeister, 1998). Morf and Rhodewalt (2001) emphasized that many of the interpersonal behaviors of narcissists are marked by a drive to maintain their elevated self-image. This focus on ego maintenance is likely a key feature impacting various health behaviors, including physical activity behaviors, eating, and substance use. Indeed, in their review of the literature, Grijalva and Zhang (2016) found that narcissists were significantly more likely to self-enhance on a variety of agentic characteristics, such as physical attractiveness, intelligence, and task performance.
Within the context of ego maintenance, it is important to note that self-esteem and narcissism, while correlated, are distinct concepts. Narcissism is marked by perceptions of superiority, grandiosity, and entitlement, while self-esteem is marked by a high degree of self-acceptance and self-respect (Brummelman, Thomaes, & Sedikides, 2016; Orth, Robins, Meier, & Conger, 2016). Brummelman et al. (2016) suggested that it is the drive to maintain one’s superiority that motivates many narcissists to engage in self-promoting behaviors. This area of study also relates to the concept of contingencies of self-worth, which are defined as the internal (e.g., moral virtue, family love) and external factors (e.g., physical appearance, outdoing others in competition) upon which individuals base their self-esteem. Luhtanen and Crocker (2005) proposed that narcissists may be particularly reliant on external contingencies of self-worth; however, there has been mixed evidence for the connection between narcissism and externally derived self-esteem (Bosson et al., 2008).
Although the understanding of the relationship between narcissism and self-esteem seems to be evolving (Brummelman et al., 2016), there does appear to be evidence that narcissists are sensitive to ego threat—situations where their positive self-image is at risk (e.g., events involving critical feedback). In their seminal research on the relationship between ego threat and narcissism, Bushman and Baumeister (1998) found an interaction between narcissism and ego threat on aggression. When participants in their study were exposed to an ego threat (insult), high narcissism was predictive of direct aggression toward the individual who stated the insult. The threatened ego framework has been a foundational aspect of explaining the relationship between narcissism and various aggressive behaviors (Lambe, Hamilton-Giachritsis, Garner, & Walker, 2016). In their review, Lambe et al. (2016) acknowledged that narcissism is indeed an important consideration in violence, particularly when the ego or self-image of the narcissist is perceived to be under negative scrutiny.
Ego maintenance is also frequently managed by narcissists in ways that show little regard for others. Correspondingly, narcissism is linked to lowered empathy (Hepper, Hart, & Sedikides, 2014). Therefore, not only are narcissists focused primarily on themselves, but also they may have little consideration for those around them; this has implications not only for their interpersonal relationships, but also for behaviors that can impact others, including sexual behaviors and risky driving. On a positive note, research has shown that the aggression response to ego threat can be attenuated if narcissists believe the individuals who provided negative feedback are similar to them (Konrath, Bushman, & Campbell, 2006) or if narcissists take the victim’s point of view (Hepper et al., 2014). Therefore, it appears that narcissists can have empathy, but in many cases, and perhaps as a default, they choose not to consider another’s perspective.
In reducing narcissists’ overall defensiveness, self-affirmation might also be an important consideration. Self-affirmation involves focusing on one’s self-integrity, values, and strength (e.g., elicited by writing an essay about important personal values; Ferrer, Klein, & Graff, 2017), thus, theoretically shielding the ego from subsequent threats (e.g., criticism from others). Self-affirmation has been shown to reduce defensiveness in the face of threat (Critcher & Dunning, 2015), and has been shown to effectively reduce narcissistic aggression in experimental research (Thomaes, Bushman, Orobio de Castro, Cohen, & Denissen, 2009). Furthermore, self-affirmation has been linked to positive health behaviors and increased acceptance of health-promotion messages (Epton, Harris, Kane, van Koningsbruggen, & Sheeran, 2015); therefore, this area of study may be beneficial for mitigating problematic ego maintenance behaviors and for promoting overall health. However, more research is needed, specifically examining how narcissism and its dimensions might interact with self-affirmation to influence attitudes and behaviors.
Future Directions in the Examination of Narcissism and Health
Narcissism has been receiving increased attention in various areas of psychology. However, it is important that the trait continue to be examined in the context of health as well. Aside from risk-taking and physical activity, there has been limited focus on narcissism in relation to other health behaviors. Notably, there are few studies on the role of narcissism in preventive healthcare behaviors and in relation to health messages. While a variety of personality variables have been linked to healthcare behaviors, including attachment and the big five personality dimensions, narcissism is not typically a focus in this area of study. Especially considering the optimistic perspective that accompanies overt narcissism, the trait may be problematic for healthcare seeking and preventive behaviors (e.g., screening, vaccinations). Further, there is strong evidence to suggest that narcissists are approach-oriented rather than avoidance-oriented. Given that much of preventive healthcare is avoidance-oriented by its nature (e.g., going in for a colonoscopy now to avoid dealing with advanced cancer later on), it could be that narcissists may be less motivated than nonnarcissists to engage in important health behaviors.
In light of the overconfidence and optimistic nature of narcissists, unique health communication strategies may need to be employed. One strong motivator for narcissists is their seeking of attention and admiration from others (Morf & Rhodewalt, 2001), and while this drive could be a factor leading to negative behaviors (e.g., excessive drinking to impress peers), it may also be beneficial for positive health behaviors. Konrath, Ho, and Zarins (2016) found that those who participated only in the video component of the ALS (amyotrophic lateral sclerosis) Ice Bucket Challenge (a social media trend that involved dumping oneself with icewater and donating money to ALS charities) were more likely to be narcissistic than nonparticipants and those who only donated money to ALS charities. Therefore, health campaigns that involve a component of attention or admiration (e.g., “I got my flu vaccine” self-identifiers or online self-promotional tools) to communicate narcissists’ perceived superiority to others may be particularly effective. Similarly, narcissists are also quite competitive (Luchner et al., 2011), and therefore framing health messages in a competitive context (e.g., using a points system for preventive healthcare or other health behaviors in the workplace) is a potential avenue for positive health changes. Although such strategies are not ideal because they are not necessarily grounded in health-oriented concerns, they may be helpful in addressing engagement in broad public health campaigns.
In addition to tapping into the unique facets of narcissism that motivate behavior, it is also noteworthy that there has been some discussion in the literature of narcissism as both a trait and a state variable. This perspective parallels other psychological variables; for example, researchers have long examined anxiety at both the state level (how anxious one feels at that moment) and the trait level (how anxious one typically feels). Some research has examined narcissism at both state and trait levels, noting that is possible that narcissism may fluctuate, depending on factors such as mood or positive/negative events that have occurred during the day (Giacomin & Jordan, 2016a, 2016b). Specifically, the research indicated that state narcissism was elevated when individuals experienced positive outcomes (focused on the self or with others), and that state narcissism was lowered during times of stress. Indeed, this approach to narcissism has been applied to consumer behavior (de Bellis, Sprott, Herrmann, Bierhoff, & Rohmann, 2016). This emerging area of research, then, may be of particular interest in the area of health and well-being; the effectiveness of health campaigns may differ according to individuals’ levels of both state and trait narcissism.
In a related line of research, some studies have examined whether it is possible to reduce narcissistic tendencies. Although there are some positive health outcomes associated with overt narcissism (e.g., self-esteem, physical activity; Hill, 2016; Sedikides et al., 2004), there are significant health risks associated with the trait, including various health-risk behaviors, as well as various negative interpersonal outcomes (Buelow & Brunell, 2014; Campbell & Foster, 2007; Campbell et al., 2004). Therefore, it is a worthwhile line of research to examine whether it is possible to reduce state or trait narcissism and its corresponding negative outcomes. Studies examining reducing state narcissism or the negative effects associated with narcissism (e.g., decreased relationship commitment) have generally focused on the promotion of a communal orientation as an effective intervention (Finkel, Campbell, Buffardi, Kumashiro, & Rusbult, 2009; Giacomin & Jordan, 2014; Jordan, Giacomin, & Kopp, 2014). For example, individuals primed with interdependent self-construals (focusing on similarities and expectations for the future in relation to friends and family) were found to have lower state narcissism scores than individuals primed with independent self-construals (Giacomin & Jordan, 2014). Similarly, communal self-statements (“I am a caring person”) and feelings of empathy have been linked to reduced state narcissism (Giacomin & Jordan, 2014; Jordan et al., 2014). Giacomin and Jordan (2014) emphasized that reducing narcissism may be most beneficial if interventions are designed to evoke empathy and communal attitudes, rather than focusing on decreasing perceptions of grandiosity and superiority.
Finally, narcissism must be viewed as a variable that is impacted significantly by culture. While there have been studies examining cross-cultural differences in narcissism, it is notable that much of the research is conducted in Western countries, and therefore there is limited information on narcissism in other parts the world. Some narcissism research has been emerging from China, for example (Meisel, Ning, Campbell, & Goodie, 2015; Zhang et al., 2015), but further research explicitly exploring the cultural and social influences on the prevalence of the trait would be beneficial. Interdisciplinary research, perhaps integrating sociological, anthropological, and psychological perspectives, would be particularly helpful in addressing this question. Additionally, future studies in Western countries should seek to collect data from a more diverse population. There is evidence to suggest that there are significant socioeconomic differences in narcissism (Piff, 2014), and therefore an effort to use more representative samples (i.e., samples other than college undergraduates) will be important in moving forward to disentangle the relationship between narcissism and various health outcomes.
Discussion of the Literature
Narcissism is a complex trait characterized by continued self-regulation of the ego and perception of the self in the presence of others. There seems to be a consensus among personality scholars that narcissism is marked by a high degree of self-regulation effort directed at maintaining a desired image. This perspective on narcissism as a personality process stems from Morf and Rhodewalt’s (2001) dynamic self-regulatory processing model, and other related models have since emerged, including the agency model (and extended agency model) and the unmitigated approach model. An important note, emphasized by Campbell et al. (2010), is that the model that is most appropriate to one’s research question will vary depending on context. This is particularly important in the consideration of how narcissism relates to overall health and well-being. For example, research seems to support that narcissists engage in a high degree of risk-taking because of the potential rewards involved and the limited value placed on avoiding negative outcomes, consistent with the unmitigated approach model. While this model may be useful in helping to explain the relationship between narcissism and risk-taking, it may not be adequate in explaining the link between narcissism and other health behaviors, such as physical activity or healthcare seeking. This illustrates that the trait is indeed multifaceted, and a singular model may not adequately explain all narcissism correlations.
Narcissists seem to focus on their self-esteem, and therefore may be more motivated to engage in behaviors that elevate or maintain their self-image. However, their egos are fragile, and therefore narcissists may become defensive or aggressive when their ego is threatened. Health messages may need to be framed with this sensitive ego in mind. In light of this, criticism of previous behavior (e.g., not previously wearing sunscreen) would probably be poorly received, while framing health messages with a focus on self-image (e.g., wear sunscreen to maintain healthy looking skin) would likely be more effective. However, this proposition has not been empirically tested; research examining how narcissists may receive various health messages is needed to better understand how the trait interacts with health messages and other health communication strategies.
While this article has primarily focused on overt grandiose narcissism, the most commonly researched form of narcissism in the social-personality psychology literature, the area of study continues to evolve, and it is noteworthy that there is an increase in research focused on the types of narcissism, especially covert narcissism and pathological narcissism, as well as the specific dimensions of narcissism (e.g., grandiosity, entitlement). This movement toward teasing apart narcissism into various forms or subcomponents relates to the complexity of the trait itself. Indeed, some research has indicated that specific subcomponents of narcissism are related to distinct perceptions and health behaviors (Buelow & Brunell, 2014; Schreer, 2002; Swami, Cass, Waseem, & Furham, 2015; Ziegler-Hill, Clark, & Pickard, 2008). Examining the types and various dimensions of the trait in relation to health and well-being outcomes will be necessary to better understand its link to behaviors and decision-making.
Finally, it is important to continue to examine narcissism in relation to cultural values and norms. American society often rewards and promotes the agentic traits associated with narcissism—including power, success, and prestige (Campbell et al., 2006). The narcissist’s focus on the self, in turn, corresponds to limited concern and empathy for others, a problematic orientation in considering the well-being of society as a whole. Health is influenced by individual decisions and behaviors, but is also strongly impacted by social norms, social support, and the communities in which individuals live and work. Therefore, in considering how health messages are received, narcissism must be viewed not only as an individual personality trait, but also as part of a dynamic system that may be influenced by broader social and cultural forces.
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