PSYCHPsychology2152-7180Scientific Research Publishing10.4236/psych.2014.59124PSYCH-48298ArticlesSOCIAL SCIENCES & HUMANITIESWhat Is Narcissistic Personality Disorder? Lay Theories of NarcissismKirstieWright1AdrianFurnham12*Research Department of Clinical, Educational and Health Psychology, University College London, London, UK1Research Department of Clinical, Educational and Health Psychology, University College London, London, UK 2Norwegian Business School (BI), Olso, Norway* E-mail:a.furnham@ucl.ac.uk(AF);1107201405091120113016 May 201412 June 2014 5 July 2014© Copyright 2014 by authors and Scientific Research Publishing Inc. 2014This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/

There are various studies on mental health literacy which examine lay people’s knowledge and understanding of various mental disorders. Many are interested in beliefs about cause, manifestation and cure as well as the relationship between those beliefs. This study examines lay beliefs regarding the manifestations, aetiology and treatment of Narcissistic Personality Disorder (NPD), and their determinants using a questionnaire divided into three parts. Participants (N = 201) answered 45 attitudinal statements designed for this study regarding NPD. They consisted of 18 manifestation items, 15 aetiology items and 12 treatment items referring to NPD. They also completed the Narcissistic Personality Inventory. Each section of the questionnaire was factor analysed to determine the structure of those beliefs. Factors derived from a principle component analysis of lay beliefs demonstrate poor knowledge of NPD. Factors derived from the manifestations, aetiology and treatment section were modestly and coherently correlated. No demographic factors correlated with all aspects of mental health literacy and lay theories. People are surprisingly misinformed about NPD. They believed that narcissists manifested superficiality and social problems, business abilities and fragility. No distinction was made between biological and psychological causes or genetics and early negative events. Inability to identify NPD may account for many reports of sub-clinical narcissism being associated with leadership derailment.

Narcissism Mental Health Literacy Aetiology Treatment1. IntroductionThe present study concerns lay people’s beliefs about narcissism. It is surprising that despite the prevalence of personality disorders and a rise of narcissism in Western culture (Lasch, 1978) that little research has been car- ried out into lay theories of NPD. This may be due, in part, to difficulties defining NPD. NPD is found in cluster B of the personality disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-R, there have been few empirical studies investigating whether the DSM criteria are useful in defining NPD as the DSM criteria are based on clinical anecdotes rather than empirical studies (Cooper & Ronningstam, 1992). Pincus and Lukowitsky (2010) concluded that relying on DSM-IV criteria may impede the recognition of clinical narciss- ists.@endMarkP#P#P#P#P#P#ing their agreement with the pairs of statements on a likert scale (7 Strongly Agree to 1 Strongly Disagree Statement B). It has been found to have internal, discriminate and predic- tive validity (Ames, Rose, & Anderson, 2006).@endMarkP#P#wang#_2title:ep!!!3. Results3.1. Manifestations

A PCA with varimax rotation was carried out on the 18 behavioural manifestation items. Item 15 was reversed. Upon an initial inspection of the communalities it was discovered that two of the 18 items, Item 9 (The onset of narcissism can occur anytime from early childhood) and Item 17 (Narcissism is not a disorder merely a strong personality) had low communalities (.47 and .48 respectively) and were therefore excluded from the PCA. The communality cut off point was .50. A PCA was then run with the remaining 16 items. The Bartlett’s test of sphe- ricity was significant at χ2 = 971.90, df = 120, p < .001 which together with the size of the Kaiser-Meyer-Olkin measure of sampling adequacy KMO = .84 demonstrated that the remaining 16 manifestation items had suffi- cient common variance for a PCA (Tabachnick & Fidell, 2001). Inspection of the Scree plot (Cattell, 1966) and factor loadings (Comrey & Lee, 1992) were used to identify appropriate components. The PCA revealed three factors that accounted for 58% of the variance.

The first factor contained seven items referring to Superficiality and Social Problems (Eigen value = 3.85, accounting for 24% of the variance). The second factor contained three items referring to Business Abilities (Eigen value = 2.04, accounting for 13% of the variance). The third factor contained three items referring to Fra- gility (Eigen value = 1.75, accounting for 11% of the variance). The factor loadings for each item in each factor are reported in Table 2, along with factor scores calculated by taking the mean response associated with a factor. A high mean indicates strong agreement with a factor and a low mean indicates low agreement. Participants rated that NPD manifests itself in Superficiality and Social Problems more than Fragility and Business Abili- ties. Cronbachs α coefficients were of low to moderate reliability and are also reported in Table 1 (Kline, 1986).

3.2. Aeitiology

A PCA was carried out using the same criteria as the above PCA with the 15 aetiology items. Item 38 was re- versed. The communalities of three items, Item 20 (Delusional beliefs can cause narcissism), Item 24 (People can be predisposed to develop narcissism by having an oversensitive temperament at birth) and Item 27 (Nar- cissism is a defence mechanism and therefore caused by repressed emotions) were low (.44, .34 and .41 re- spectively) and excluded from further analysis. A PCA on the remaining 12 items was carried out and demon- strated the existence of three factors accounting for 56% of the variance. The Bartlett’s test of sphericity was significant at χ2 = 672.50, df = 66, p < .001 which together with size of the Kaiser-Meyer-Olkin measure of sampling adequacy KMO = .77 demonstrated that the 12 remaining aetiology items had sufficient common va- riance for a PCA (Tabachnick & Fidell, 2001). The first factor contained six items referring to Social and Cogni-

Table 1

. The means, standard deviations, factor loadings, Eigen values and alphas of the 16 manifestation items.

Factor and ItemsEigen ValueVariance/Factor LoadingMean (SD)Alpha
1) Superficiality and Social Problems3.85244.44 (.98).60
Narcissists strive for attention..79
Individual’s narcissistic traits can vary across a person’s lifetime..76
Narcissists can handle criticism well..75
Narcissism is Rife in today’s society..69
Having a narcissistic personality can cause problems in many areas of life such as work, relationships and financial matters..69
Narcissists are vain..68
Narcissists are low in Emotional Intelligence..61
2) Business Abilities2.0412.74.02 (1.12).65
Narcissists are visionaries..79
Narcissists are likely to have a high IQ..77
Narcissists make good leaders..71
3) Fragility1.7510.54.15 (1.07).49
Narcissists have a fragile self esteem..74
Narcissists are likely to suffer from other mental disorders..63
Narcissist often set unrealistic goals..56
Non Loading Items
Narcissists are more likely to be men than women.
Narcissists cannot have close healthy relationships.
Narcissists are manipulative.

tive Explanations (Eigen value = 3.15, accounting for 26% of the variance). The second factor contained two items referring to Genetics and Early Negative Events (Eigen value = 1.83, accounting for 15% of the variance). The third factor contained two items referring to Negative Feelings (Eigen value = 1.74, accounting for 15% of the variance). The factor loadings for each item in each factor are reported in Table 2, along with factor scores. Participants rated that the cause of NPD can be explained by Social and Cognitive Explanations more than Neg- ative Feelings and Genetic and Early Negative Events. Cronbachs α coefficients were of low to high reliability (Kline, 1986) and are also reported in Table 2.

3.3. Treatment

PCA was carried out with the same criteria as the above two PCAs with 9 of the 12 treatment items. Three of the items, Item 34 (Narcissism can be successfully treated by Freudian psychoanalysis), Item 36 (Group therapy can effectively treat narcissism) and Item 39 (Although some narcissists behaviour can be treated a person’s personality cannot be dramatically changed) were excluded due to low communalities (.37, .47 and .31 respectively). The PCA carried out on the 9 items demonstrated the existence of two factors accounting for 56% of the variance. The Bartlett’s test of sphericity was significant χ2 = 525.25, df = 36, p < .001 which together with the Kaiser-Meyer-Olkin measure of sampling adequacy KMO = .78 demonstrated that the remaining nine items had sufficient common variance for a PCA (Tabachnick & Fidell, 2001). The first factor consisted of six items referring to Treatability and Less Severe Treatment (Eigen value 3.14, accounting for 35% of the variance).

The second factor consisted of three items referring to Clinical Treatment (Eigen value 1.93, accounting for 22% of the variance). The factor loadings for each item in each factor are reported in Table 3, along with factor scores. Participants rated Treatability and Less Severe Treatment as more effective than Clinical Treatment. Cronbachs α coefficients were of low to moderate reliability and are also reported in Table 3 (Kline, 1986).

Table 2

. The means, standard deviations, factor loadings, Eigen values and alphas of the 12 aetiology items.

Factor and ItemsEigen ValueVariance/Factor LoadingMean (SD)Alpha
1) Social and Cognitive Explanations3.1526.24.18 (1.06).81
Narcissism can be caused by parenting styles such as excessive pampering and extremely high expectations..80
Narcissism can be caused by learning narcissistic behaviours from parents..78
Narcissism can be caused by distorted cognitions..69
Narcissism can be caused by disruptions to the attachment process with the primary caregiver..62
Narcissism can be caused by a lack of opportunity to gain approval from parents..60
Narcissism is caused by society’s approval of boasting about our accomplishments and status..65
2) Genetics and Early Negative Events1.8315.33.56 (1.30).60
Narcissism is hereditary and therefore genetic..83
Narcissism is caused by physical/mental abuse as a child/adolescent..69
3) Negative Feelings1.7414.53.86 (1.26).62
Low self esteem causes narcissistic traits..84
Anxiety causes narcissism..77
Non Loading Items
Narcissism is caused by purely environmental/social factors.
Narcissism is caused by a chemical imbalance in the brain.
Table 3

. The means, standard deviations, factor loadings, Eigen values and alphas of the 9 treatment items.

Factor and ItemsEigen ValueVariance/Factor LoadingMean (SD)Alpha
Treatability and Less Severe Treatment3.1434.894.22 (.73).57
Family therapy can be effective in treating narcissism..78
Narcissism can be improved by environments in which cooperation is necessary..75
Counselling can improve narcissistic behaviour..74
Narcissism can be successfully treated by cognitive behavioural therapy..70
Narcissism cannot be treated..70
Narcissists can improve their behaviour without treatment but by realising the problems that their behaviour causes..64
Clinical Treatment1.9321.493.79 (1.18).63
Narcissism can be effectively treated by medication..83
It is necessary to see a clinical psychologist in order to recover from narcissism..73
Inpatient hospital care can aid the treatment of narcissists..64
3.4. Correlations

Bivariate Pearson correlations were conducted between each of the eight extracted factors, the study of mental illness, personal diagnosis of a mental illness, qualifications, gender age and NPI score to investigate whether participants have a monological belief system regarding NPD and to test the hypothesis that lay beliefs would be affected by the above demographics. As can be seen in Table 4 the factor scores were not all correlated with each other. Superficiality and Social Problems correlated with Social Cognitive Explanations, Genetics and Early Negative Feelings, Treatability and Less Severe Treatment and Clinical Treatment. Business Abilities cor- related with Genetics and Early Negative Events, Negative Feelings and Treatability and Less Severe Treatment. Fragility correlated with Social and Cognitive Explanations, Negative Feelings, Treatability and Less Severe Treatment. Social and Cognitive Explanations correlated with Treatability and Less Severe Treatment and Clinical Treatment. Genetics and Early Negative Events correlated with Clinical Treatment. Negative Feelings correlated with Treatability and Less Severe Treatment.

The study of mental illness correlated with fragility and age. Personal diagnosis of mental illness correlated with Treatability and Less Severe Treatment, Clinical Treatment and Superficiality and Social Problems. Quali- fications correlated with Negative Feelings, Age and NPI Score. Gender correlated with Age and NPI Score. Age correlated with Fragility and Social and Cognitive Explanations and NPI Score. NPI Score correlated with Ge- netics and Early Negative Events, Negative Feelings and Social and Cognitive Explanations. This partly sup- ports the hypothesis that participant’s beliefs would be affected by whether people have studied mental illness, personal experience of mental illness and qualifications, gender, age and NPI Score because some beliefs were associated with these demographics but others were not.

4. Discussion

Regarding manifestations laypeople agreed on statements referring to superficiality and social problems, busi- ness abilities and fragility. Laypeople’s beliefs regarding the aetiology of NPD factored into three components, social and cognitive explanations, negative feelings, and genetics and early negative events. Laypeople do not distinguish between social and cognitive factors suggesting an adoption of social-cognitive explanations by lay- people. No distinction was made between biological and psychological causes or genetics and early negative events. This demonstrates a lack of knowledge of NPD. Psychological explanations of aetiology were rated more positively than genetic explanations (genetic and early negative events) which supports past research

Table 4

. Bivariate Pearson correlations between the eight extracted factor scores, study of mental illness, interest in mental illness, qualification, gender, age and NPI score.

1234567891011121314
1) Superficiality and Social Problems.00.00.26**−.34**−.11.51**−.45**.02−.17*.00−.07.07−.07
2) Business Abilities.01.13.24**.16*.17*.14−.08.02.04.04−.14.03
3) Fragility.26**.04.20**.33**.11.13*−.08.04.10−.19**−.03
4) Social and Cognitive Explanations.00.00.64**.19*.03−.07−.01−.11.17*−.16*
5) Genetics and Early Negative Events.00−.11.54**−.10.07−.02−.02−.07.14*
6) Negative Feelings.20**.13.06−.03.25**−.03. 05−17*
7) Treatability and Less Severe Treatment.00.09−.16**.08−.02.03.02
8) Clinical Treatment.05.14*.01.06−.13−.09
9) Study of Mental Illness.14.05−.11.26**−.03
10) Diagnosed with Mental Illness−.01−.00−.05−.03
11) Qualifications−.08−.16*−.15*
12) Gender−.21**.30**
13) Age.19**
14 NPI Score

*p < .05; **p < .001.

(Furnham, Kirby, & McClelland, 2011; Link, Phelan, Bresnahan, Stueve, & Pescosolido, 1999). Laypeople dis- tinguished clinical treatments from treatability and less severe treatments but not between psychological and biological treatments. Therefore laypeople may think in terms of the severity of treatment rather than making biological or psychological distinctions. This may be useful in everyday life but demonstrates poor knowledge of NPD.

Not all factors correlated with each other, suggesting that laypeople have a multi-logical belief system re- garding NPD, with several different belief structures. This differs from Furnham, Daoud and Swami (2009) who found that laypeople have a monological belief system regarding psychopathy. This suggests that beliefs regard- ing different personality disorders do not all come from the same belief system. Most of the factors had low or moderate alphas and therefore caution should be taken when drawing conclusions from these results. However, the factors, especially when viewed alongside the findings of Furnham, Kirby and McClelland (2011) are useful in guiding our knowledge of laypeople’s beliefs and demonstrating a lack of knowledge of NPD.

A limitation is that the current study’s results could be due to order effects. Participants may have been less likely to correctly identify N2 and N3 than N1 because they thought that there could not be three NPD vignettes or that it was a test of at what severity narcissistic traits becomes a disorder. However this is unlikely because some participants did identify N3 correctly and the vignettes used appear very different which is supported by the content analysis.

All demographics tested except gender correlated with at least one factor. Diagnosis of a mental illness and NPI Score were the most predictive demographics. Personal experience of a disorder may influence beliefs re- garding other disorders. This partly supports Furnham, Kirby and McClelland (2011) who found that personal experience of a mental illness related to lay theories of NPD because the diagnosis of a mental illness was re- lated to three factors but not all factors. The findings also suggest that people’s narcissistic traits influence their beliefs regarding NPD and that we form beliefs regarding personality around our own personality traits. This may make changing people’s beliefs regarding personality disorders hard because some argue that personality cannot be dramatically changed (Costa & McCrae, 1994) and it is therefore necessary to investigate whether this finding can be replicated and whether it applies to other personality disorders, for example whether peoples Schizotypal traits influence their beliefs regarding Schizotypal personality disorder.

Our results partly confirm the hypothesis that the study of mental illness (Furnham, Daoud, & Swami, 2009), personal experience of mental illness (Furnham, Abajian, & McClelland, 2011), qualifications (Lauber, Carlos, & Wolf, 2005), age (Fisher & Goldney, 2003), gender (Wang, Adair, Fick, Lai, Waye, Jorm, & Addington, 2007) and NPI score would relate to participants opinions of the manifestations, aetiology and treatment of NPD, the identification of vignettes and participants likeliness to suggest help. This is because all demographics tested except gender correlated with lay beliefs. Age, NPI score and the study of mental illnesses related to the correct identification of some vignettes. The findings partly support the past research except Wang, Adair, Fick, Lai, Waye, Jorm and Addington (2007). However demographics were more predictive of lay theories than mental health literacy when the past research that the hypothesis was based on investigated demographics relation to mental health literacy, except Furnham, Daoud and Swami (2009). Therefore the current study’s findings do not support previous research in this way.

Overall our results suggest that how “abnormal” people deem certain traits to be is a key factor in identifying and suggesting help for personality disorders and mental illnesses. However, abnormality is not the only factor because differences in abnormality did not always lead to the same pattern of mental health literacy across par- ticipants. Knowledge of the specific disorder tested may also influence people’s mental health literacy, espe- cially regarding peoples likeliness to suggest help ratings because demographics did not influence this. Lay- people may not be willing to suggest help or label someone with a disorder unless they are sure that they have a problem. This is supported by the most frequent reason for a delay in seeking help is a lack of knowledge (Thompson, Hunt, & Issakidis, 2004).

A limitation is that the current sample is not representative of the wider British population due to the method of sampling used. In addition, some of the items may require modification in subsequent research. This study is therefore useful as preliminary research into laypeople’s beliefs regarding NPD but future research should aim to gain a more representative sample.

5. Conclusion

Lay people seem relatively ignorant about the causes, manifestations and treatment of Narcissism. There were few significant correlates of knowledge of NPD which suggests fairly widespread lack of information and data on this disorder.

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