Explicit measures of individual narcissism

Most people, at least vaguely, understand the notion of narcissism.  When they visualise a narcissistic individual, they might imagine a person who is arrogant, brash, defensive, or derisive of other people.   Yet, in practice, narcissists exhibit a range of behaviours.  They may, for example,

• depict themselves as victims of injustice,
• crave attention,
• inflate their contributions,
• explode in anger if criticised,
• denigrate other people, and so forth

Despite these variations,

• all narcissistic people are determined, almost compelled, to maintain or to boost their status, rank, standing, or prestige,
• because this urge is so powerful, these individuals want to establish this status as soon as possible,
• consequently, they are not as motivated to gradually acquire the capabilities or achievements they need to boost their status,
• instead, they apply a range of other strategies, such as inflate their skills or denigrate other people, to achieve this goal. 

Although this need to maintain or to boost status is central to narcissism, how this goal manifest varies appreciably.  Therefore, researchers have developed many tools to characterise these various manifestations of narcissism.  This pursuit has uncovered many facets or clusters of narcissistic behaviour.  Many of these facets or clusters, however, can be divided into two key divisions:

• grandiose narcissism—sometimes called overt narcissism,
• vulnerable narcissism—sometimes called covert or hypersensitive narcissism.

Grandiose versus vulnerable narcissism

To boost their status, people who exhibit grandiose narcissism tend to inflate their capabilities or achievements.  For example, they may

• exaggerate their skills or contributions,
• believe they are entitled to special treatment,
• crave attention, admiration, or leadership,
• demonstrate an obsession with their physical appearance or possessions.

In contrast, to maintain or to boost their status, people who exhibit vulnerable narcissism tend to dismiss feedback or information that challenges their perception of themselves.  To illustrate, they may

• disregard the concerns of other people,
• direct rage or contempt towards anyone who criticises their behaviour or character,
• undermine or mock other people subtly,
• portray themselves as victims of injustice, inflating their pain and suffering.

Despite these differences, individuals who report grandiose narcissism and individuals who report vulnerable narcissism do exhibit some behaviours and inclinations in common.  For example, both clusters of individuals tend to

• demonstrate antagonism towards other individuals, manifesting as contempt and distrust coupled with limited compassion or understanding (Crowe et al., 2018),
• demonstrate entitlement, in which they perceive themselves as special and deserving of privileges (Dinić et al., 2021; Krizan & Herlache, 2018).

These two inclinations, antagonism and entitlement, tend to be associated with each other.  Indeed, the inclination of some people to feel entitled and special appears to promote this antagonism and contempt (Edershile & Wright, 2021b).

A typical example

Many researchers have developed scales that measure grandiose narcissism.  To illustrate, Foster et al. (2015) designed and validated the Grandiose Narcissism Scale, comprising 33 items.  These items measure overall grandiose narcissism as well as several subscales:

• authority or the preference to be designated authority, such as “I am a natural born leader” or “I lead rather than follow”,
• self-sufficiency or a preference to complete tasks alone, such as “I do not like to depend on other people to do things”,
• superiority or a feeling they are better than other people, such as “I am more talented than most other people”,
• vanity or an obsession with physical appearance, such as “My looks are important to me”,
• exhibitionism or a need to attract the attention of people, such as “I do things that get people to notice me”,
• entitlement or the sense they deserve special treatment, such as “I expect to be treated better than average”, and
• a willingness to exploit other people, such as “I’m willing to manipulate others to get what I want”. 

As evidence of validity, overall grandiose narcissism, derived from combining these subscales, was positively associated with extraversion, a feeling of agency, and aggression as well as negatively associated with agreeableness and empathy.

The Narcissism Personality Inventory

In essence, the Grandiose Narcissism Scale is a shortened version of a previous instrument, called the Narcissism Personality Inventory, briefly outlined by Raskin and Hall (1979).  Indeed, many, if not most, measures of grandiose narcissism emanated from this seminal Narcissism Personality Inventory or NPI.    Unlike the Grandiose Narcissism Scale, the Narcissism Personality Inventory comprises 223 items.  Each of these items comprise two statements, only one of which epitomises narcissism, such as

• I really like to be the centre of attention
• It makes me uncomfortable to be the centre of attention.

Subsequently, one of the developers of this Narcissism Personality Inventory, Robert Raskin, and another collaborator, Howard Terry, designed a shortened version of this inventory, comprising only 40 pairs of statements (Raskin & Terry, 1988).  This version is called the NPI-40 and also gauges seven facets, such as authority, self-sufficiency, superiority, vanity, exhibitionism, entitlement, and the inclination to exploit people.

Other shortened versions

Other researchers have developed even shorter versions of the Narcissism Personality Inventory. Ames et al. (2006), for example, devised a variant of the Narcissism Personality Inventory that comprises only 16 items.  Unlike other variants, this shorter variant, called the NPI-16, corresponds to only facet or factor.  For each item, participants choose which of two statements describe their character, such as

• “I like to be the centre of attention” versus “I prefer to blend in with the crowd”,
• “I am an extraordinary person” versus “I am much like everybody else”,
• “I always know what I am doing” versus “Sometimes I am not sure of what I am doing”,
• “I like having authority over people” versus “I don’t mind following orders”.

The NPI-16 and NPI-40 generate similar correlations to other measures.  For example,

• they both are positively and moderately associated with openness-to experience, extraversion, and self-esteem
• they both are negatively and moderately associated agreeableness and neuroticism.

A shortened variant with three sub-scales

Gentile et al. (2013) later developed another shortened version, comprising only 13 items, that also generates three subscales.  This version appears to be valid, correlating with the same traits as did the NPI-16 and NPI-40—such as diminished levels of agreeableness, psychopathy, attention seeking, dominance, coldness, and aggression in response to electric shocks.  The three subscales were

• leadership and authority, such as “People always seem to recognise my authority”,
• grandiose exhibitionism, such as “I like to look at my body”, and
• entitlement and inclination to exploit people, such as “I find it easy to manipulate people”.

The first two subscales were significantly associated with traits that epitomise grandiose narcissism.  The third subscale, around entitlement and exploitation, was significantly associated with antagonism—a tendency that is common in both grandiose narcissism and vulnerable narcissism. 

The hypersensitive narcissism scale

To measure vulnerable narcissism, many researchers deploy the hypersensitive narcissism scale (Hendin & Cheek, 1997), developed at Wellesley College in Massuchusetts.  This scale comprises the following 10 items:

• I can become entirely absorbed in thinking about my personal affairs, my health, my cares or my relations to others.
• My feelings are easily hurt by ridicule or by the slighting remarks of others.
• When I enter a room, I often become self-conscious and feel that the eyes of others are upon me.
• I dislike sharing the credit of an achievement with others.
• I dislike being with a group unless I know that I am appreciated by at least one of those present.
• I feel that I am temperamentally different from most people.
• I often interpret the remarks of others in a personal way.
• I easily become wrapped up in my own interests and forget the existence of others.
• I feel that I have enough on my hands without worrying about other people’s troubles.
• I am secretly ‘‘put out’’ when other people come to me with their troubles, asking me for my time and sympathy.

As evidence of discriminant validity, this measure hardly correlates at all with the Narcissistic Personality Inventory—a measure of grandiose narcissism.   Furthermore, as evidence of validity, hypersensitive narcissism is positively associated with neuroticism but inversely associated with extraversion, agreeableness, and openness to experience.ay not acknowledge or even be aware of this tendency.  Consequently, the items did not refer to humility explicitly.  In addition, some of the items depicted characteristics, such as “I feel that I do not deserve more respect than other people”, that people who are not humble would be unwilling to concede, even if they wanted to depict themselves favourably.

Whereas some instruments measure either grandiose or vulnerable narcissism, other instruments measure both of these facets.  One possible example is the Narcissistic Admiration and Rivalry Questionnaire, developed by Back et al. (2013). Specifically, according to Back et al.,

• to boost their status, some individuals apply strategies that attract respect and admiration, such as inflate their achievements, sometimes called self-enhancement,
• in contrast, to maintain their status, other individuals apply strategies that denigrate other people—such as people who criticise their behaviour—sometimes called self-protection.

To represent these two strategies, respectively called narcissistic admiration and narcissistic rivalry, Back et al. developed an instrument that comprises 18 items (for a shorter version, see Leckelt et al., 2018). Narcissistic admiration comprises three distinct facets:

• grandiosity, such as “I deserve to be seen as a great personality”,
• uniqueness, such as “Being a very special person gives me a lot of strength”, and
• charming-ness, such as “I manage to be the centre of attention with my outstanding contributions”.

Similarly, narcissistic rivalry comprises three distinct facets as well, including

• devaluation, such as “Most people are somehow losers”,
• supremacy, such as “I want my rivals to fail”, and
• aggressiveness, such as “I react annoyed if another person is at the centre of events”.

Narcissistic admiration and rivalry were positively associated with each other. To explain this association, one possibility is that narcissistic admiration may precede narcissism rivalry.  Specifically, individuals who exhibit narcissistic admiration may, after they attract some respect, typically by inflating their qualities or contributions, feel this admiration is fragile.  To maintain this status, these individuals may then feel compelled to defend their rank in a competitive, hostile social environment, manifesting as narcissistic rivalry.  

As Back et al. (2013) also revealed, narcissistic admiration and narcissistic rivalry were both associated with the big five personality traits. Specifically, narcissistic admiration was positively associated with extraversion and openness to experience as well as inversely associated with neuroticism.  In contrast, narcissistic rivalry was positively related to neuroticism and inversely related to agreeableness and conscientiousness.  Furthermore, narcissistic admiration and narcissistic rivalry were positively and negatively associated with self-esteem respectively.  Finally, both dimensions were positively associated with a measure of psychopathy but only narcissistic rivalry was positively associated with a measure of Machiavellianism.

A further study, also conducted by Back et al. (2013), explored the association between these narcissistic dimensions and relationships.  Narcissistic rivalry was inversely related to empathy, trust, forgiveness, and gratitude in relationships—as well as a tendency to seek revenge in response to transgressions.  In contrast, narcissistic admiration was not as strongly related to these measures.

Grandiose versus vulnerable narcissism

Originally, both narcissistic admiration and narcissistic rivalry were deemed as facets of grandiose narcissism (Back et al., 2013; for a similar assumption, see Biolik, 2025).  Maples et al. (2025), however, revealed that narcissistic admiration tends to coincide with grandiose narcissism and narcissistic rivalry tends to coincide with vulnerable narcissism. This study administered a series of questionnaires to three samples of participants. These questionnaires included

• the Narcissistic Admiration and Rivalry Questionnaire,
• the Narcissism Grandiosity Scale to assess grandiose narcissism,
• the Hypersensitive Narcissism Scale to assess vulnerable narcissism,
• the Pathological Narcissism Inventory—to gauge more pathological or extreme signs of narcissism,
• other scales including measures of personality, aggression, and self-esteem.

The data were subjected to a series of techniques, including latent profile analysis and structural equation modelling.  In essence, the findings revealed that

• narcissistic admiration tends to coincide with measures of grandiose narcissism, such as the Narcissism Grandiosity Scale, as well as high extraversion and low neuroticism,
• narcissistic rivalry tends to coincide with measures of vulnerable narcissism, such as the Hypersensitive Narcissism Scale as well as high neuroticism, high aggression, and low self-esteem.

One concern with previous models is the degree to which they apply to multiple nations and cultures.  To address this matter, Sivanathan et al. (2021, 2023, 2025) proposed the unified model of narcissism.  This model recognises that several characteristics, such as a sense of entitlement and the ensuing antagonism towards other people, are common to both grandiose and vulnerable narcissism.  However, grandiose and vulnerable narcissism also comprise unique features that are common across cultures.  Specifically, the universal features of grandiose narcissism are

• leadership—a facet that entails a sense of superiority and a tendency to overestimate personal qualities and contributions,
• vanity—or an undue emphasis on physical appearance or other superficial qualities.

In contrast, the universal features of vulnerable narcissism are

• contingent self-esteem—in which individuals seek validation from other people excessively and derive their worth from this validation,
• hiding personal needs, including shame or fear their personal thoughts or feelings may be rejected,
• grandiose fantasy—or a preoccupation with power, achievement, and admiration.

According to Sivanathan et al. (2025), all five facets contribute to a sense of entitlement.  To illustrate

• because of their sense of leadership, narcissistic individuals feel they should be entitled to be granted authority over other people,
• because of their vanity, narcissistic individuals feel they are entitled to receive admiration,
• because their self-esteem is contingent upon validation, narcissistic individuals feel should be entitled to receive praise,
• because they hide personal needs, narcissistic individuals feel they should be admired because of the thoughts or feelings they express,
• because of grandiose fantasy, narcissistic individuals feel they should be respected because of their imagined success or power.

To represent these five facets, Sivanathan et al. (2025) developed a shortened version of their previous unified narcissism scale.  The scale comprises 15 items, 3 items representing contingent self-esteem, leadership, grandiose fantasy, vanity, and hiding personal needs in order.   

• [Contingent self-esteem] When others don’t notice me, I start to feel worthless
• When people don’t notice me, I start to feel bad about myself.
• I spend a lot of time thinking about what other people think of me.
• [Leadership] As a leader, I know what is best for my team.
• If I became a leader, I would be the best.
• I have better leadership skills than other people.
• [Grandiose Fantasy] I want to amount to something in the eyes of the world.
• I often fantasize about being admired and respected.
• I fantasize about being a hero.
• [Vanity] I think I turn heads when I walk down the street.
• I am exceptionally good looking.
• I enjoy taking photos of myself because I look so good.
• [Hiding One’s Needs] It’s hard to show others the weaknesses I feel inside.
• I would feel so ashamed if someone found out all parts of me.
• I become a different person when I am with others for fear of disapproval.

Confirmatory factor analysis validated these sub-scales in four nations: United States, China, Sri Lanka, and Australia.  Grandiose narcissism was lowest in Australia, potentially because Australians tend to be especially resistant to hierarchy.   

Introduction

Some measures and taxonomies of narcissism emanate from the five-factor model of personality. According to the five-factor model of personality, the entire gamut of personality characteristics can be reduced to one of five key traits: extraversion, neuroticism, conscientiousness, agreeableness, and openness to experience.  If this model is accurate, each facet of neuroticism should also correspond to one of these five traits (Miller et al., 2016). 

Overview of the five-factor model

The five traits were initially derived from attempts to categorise the adjectives that are commonly used to describe individuals but later verified and refined using factor analyses, a statistical technique that is conducted to identify sets of correlated dimensions.  Each of these five traits tend to comprise six distinct but underlying facets (Costa & McCrae, 1992):

• To illustrate, individuals who exhibit extraversion are gregarious, assertive, warm, positive, and active, as well as seek excitement.
• The six facets that underpin neuroticism, as defined by Costa and McCrae (1992), relate to the extent to which individuals exhibit anxiety, depression, and hostility as well as feel self-conscious, act impulsively, and experience a sense of vulnerability, unable to accommodate aversive events.
• The six facets that underpin agreeableness are trust in other individuals, straightforward and honest communication, altruistic and cooperative behaviour, compliance rather than defiance, modesty, as well as tender, sympathetic attitudes.
• The six facets that correspond to conscientiousness relate to the degree to which individuals are competent, methodical–preferring order and structure, dutiful, motivated to achieve goals, disciplined, and deliberate or considered.
• Finally, openness to experience relates the extent to which individuals are open to fantasies, aesthetics, feelings, as well as novel actions, ideas, and values (Costa & McCrae, 1992). Open individuals prefer novel, intense, diverse, and complex experiences (McCrae, 1996). In contrast, closed individuals prefer familiar tasks and standardized routines (McCrae, 1996).

Relationship with narcissism

As Miller et al. (2016) revealed, narcissism might represent especially high or low levels of these traits—specifically three of these traits:

• elevated levels of extraversion, such as authoritativeness,
• elevated levels of neuroticism, such as need for admiration, and
• very low levels of agreeableness, such as arrogance.

Therefore, although derived from the five-factor model of personality, these findings indicate that narcissism may comprise three key factors, often called the three-factor model or trifurcated model of narcissism.  After more detailed analyses and research, the definition of these three factors has gradually evolved (Miller et al., 2021; Weiss et al., 2019).  Specifically, these three factors are usually labelled

• agentic narcissism, representing extraverted traits such as assertiveness, leadership, and grandiosity,
• antagonistic narcissism represented limited agreeableness, including deceit, distrust, or limited empathy, and
• neurotic narcissism, manifesting as hypersensitivity and shame, for example.

Agentic narcissism tends to correspond to grandiosity, neurotic narcissism tends to correspond to vulnerability, and antagonistic narcissism tends to correspond to both grandiosity and vulnerability (Miller et al., 2021; Weiss et al., 2019).  This premise, therefore, shows how the five-factor model coalesces with the distinction between grandiose narcissism and vulnerable narcissism.

Introduction

Measures of narcissism are usually long, typically gauging multiple facets.  However, researchers have also developed short measures.  These short measures are not as valid or informative but useful in many circumstances such as when

• researchers or practitioners want to measure levels of narcissism in the same people at many times,
• the participants cannot readily concentrate for more than a few seconds, because of personal deficiencies or challenging circumstances.

A single-item measure

To illustrate a short measure, Konrath et al. (2014) proposed that one item may be sufficient to assess narcissism, at least to a reasonable extent.  Specifically, participants are asked to indicate the extent to which they agree with one statement on a seven-point scale, ranging from not very true of me to very true of me.  The statement is “I am a narcissist.  Note the term narcissist means egotistical, self-focused, and vain”.  Across 11 studies, the researchers discovered that

• responses to this item and responses to the Narcissistic Personality Inventory, one of the longest measures of grandiose narcissism, generated a correlation of .40,
• similarly, responses to this item were positively associated with most of the subscales of this inventory too, such as vanity, exhibitionism, exploitative-ness, authority, superiority, and entitlement. 
• the correlation between responses to this item and a measure of social desirability bias was modest, at r = -23.
• whereas the Narcissistic Personality Inventory was positively associated with irritability and hostility, the single-item measure was also positively associated with shame and fear; accordingly, only the single-item measure appears to coincide with both grandiosity and vulnerability,
• response to this item at one time and responses to this item ten days later generated a correlation of .79, indicating excellent stability over time,
• responses to this item were positively associated with extraversion and inversely associated with agreeableness.

Narcissism at work

Some researchers have developed instruments that assess narcissism as well as other dark traits, including Machiavellianism, psychopathy, and sadism, in particular settings.  For example, Thibault and Kelloway (2020) designed and validated a measure of these traits that is applicable to workplaces.  To gauge narcissism, the instrument comprised the following items:

• My position at work is prestigious.
• I am much more valuable than my coworkers.
• I demand respect at work.
• People always pay attention to me at work.
• Others admire me at work.
• I like being the centre of attention at work.

The instrument also included a measure of

• Machiavellianism, such as “At work, people are only motivated by personal gain”,
• psychopathy, such as “I don’t care if I accidently hurt someone at work.”, and
• sadism, such as “It’s funny to watch people make mistakes at work”.

Thibault and Kelloway (2020) conducted two studies to validate this instrument.  As these studies revealed

• a confirmatory factor analysis validated the four factors,
• all these traits were significantly associated with workplace deviance, such as bullying, incivility, and other counterproductive acts, even after controlling social desirability.

Narcissism seems to be positively associated with affective commitment towards the organisation.  Nevertheless, as the authors underscored, people who are narcissistic may inflate the degree to which they perceive their job as prestigious and significant, increasing the likelihood they may inflate this commitment but still leave if they do not receive the respect they believe they deserve.

The Narcissistic Personality Questionnaire for Children-Revised

Previously, research on the features, consequences, and causes of narcissism was primarily confined to adult participants.  In more recent decades, some research has been extended to children and adolescents.  Accordingly, researchers have developed measures of narcissism that are more applicable to children and adolescents.  Initially, these researchers adapted the Narcissistic Personality Inventory, the most common measure of grandiose narcissism, to suit children and adolescents.  These adapted instruments comprised fewer questions and referred to circumstances that are more applicable to individuals under 18.  Examples of these measures include the

• Narcissistic Personality Inventory-Juvenile Offender (Calhoun et al. 2000),
• Narcissistic Personality Inventory-Children (Barry et al. 2003).

Because of some concerns around the length and factor structure of these instruments, Ang and Yusof (2006) developed the Narcissistic Personality Questionnaire for Children.  To complete this measure, the children indicate the degree to which 18 statements describe their beliefs and behaviours on a 5-point Likert scale.  This instrument comprises four facets:

• six items, such as “I am really a special person”, gauge superiority,
• six items, such as “If I ruled the world, it would be a better place”, gauge exploitative-ness,
• three items, such as “I like it when others brag about the good things I have done”, measure self-absorption, and
• three items, such as “It does not matter if I am the leader or not” (reverse-scored), measure leadership.

Nevertheless, Ang and Raine (2008) raised several concerns about this measure.  First, alpha reliability of self-absorption and leadership are less than 0.7 and thus inadequate.  Second, leadership and, to a lesser extent, self-absorption were deemed to be adaptive in some circumstances and not applicable to the intent of this measure.  Consequently, Ang and Raine (2008) proposed the Narcissistic Personality Questionnaire for Children-Revised—an instrument that is identical to the Narcissistic Personality Questionnaire for Children, except the items that correspond to self-absorption and leadership were deleted.   The six items that measure superiority are

• I always know what I am doing.
• I am going to be a great person.
• I was born a good leader.
• I am really a special person.
• I think my body looks good.
• I think I am a great person.

The six items that measure exploitative-ness are

• If I ruled the world it would be a better place.
• I am good at getting people to do things my way.
• It is easy for me to control other people.  
• I would do almost anything if you dared me.
• I can make people believe anything I want them to.
• When I am supposed to be punished, I can usually talk my way out of it.

This revised variant is usually preferred to the original version.  Specifically, as Ang and Raine (2008) revealed

• the 12 items correspond to two factors that generate adequate alpha reliability—and this factor structure is invariant across age and gender,
• overall narcissism, derived after the two sub-scales are combined, was more strongly related to proactive aggression than reactive aggression.

The Childhood Narcissism Scale

Around the same year the Questionnaire for Children-Revised was released, Thomaes et al. (2008) published the Childhood Narcissism Scale.  This scale comprises only 10 items and one facet.  Specifically, participants specify, on a 4-point rating scale, ranging from not at all true to completely true, the degree to which 10 statements characterise their beliefs and behaviour.  Typical items include

• I think it’s important to stand out.
• Kids like me deserve something extra.
• Without me, our class would be much less fun.
• It often happens that other kids get the compliments that I actually deserve.
• I love showing all the things I can do.

As evidence of validity, scores on this measure of narcissism were positively associated with

• the degree to which self-esteem depends on the validation of other people, called self-esteem contingency, such as “When other kids like me, I feel happier about myself” (Rudolph et al., 2005),
• the extent to which the interpersonal goals of these individuals revolve around dominance, admiration, or agency, such as “…How important is it for you that the others respect and admire you?”, rather than collaboration and belonging, such as “…how important is it for you that real friendship develops between you?” (Ojanen et al., 2005),
• limited levels of empathy, as rated by peers in the classroom to items like “These kids feel bad if they see another kid without a friend to play with” (Strayer & Roberts, 2004), and
• an inclination to seek revenge, as rated by peers.

Researchers have developed, and continue to deploy, a range of instruments to measure narcissism.  These instruments, however, tend to measure subclinical levels of narcissism. That is, these measures have seldom been designed to differentiate clinical or pathological levels of narcissism—levels that may warrant some interventions—from subclinical levels.  That is, to diagnose clinical or pathological narcissism, clinicians need to convene diagnostic interviews or administer the Minnesota Multiphasic Personality Inventory-2 or the Millon Clinical Multiaxial Inventory-III.

To streamline this diagnosis,  Pincus et al. (2009) developed the Pathological Narcissism Inventory.   To generate potential items, the authors garnered insights from a comprehensive analysis of the relevant literature and from therapists who had, over many years, worked with narcissistic patients.  These therapists presented case studies to convey the key features of pathological narcissism.  The final set of 50 items generated seven factors, encompassing both grandiose and vulnerable manifestations of narcissism:

• contingent self-esteem, such as “It’s hard for me to feel good about myself unless I know other people like me”,
• exploitativeness, such as “I can make anyone believe anything I want them to”,
• self-sacrificing self-enhancement, such as “I try to show what I good person I am through my sacrifices” or “I help others to prove I’m a good person”,
• hiding the self, such as “When others get a glimpse of my needs, I feel anxious and ashamed”,
• grandiose fantasy, such as “I often fantasise about being recognised for my accomplishments”,
• devaluing, such as “When others don’t meet my expectations, I feel ashamed about what I wanted” and
• entitlement rage, such as “I get mad when people don’t notice all I do for them”.

Subsequent research, also conducted by Pincus et al. (2009), revealed that pathological narcissism seems to encompass more several manifestations of narcissism that do other tools, such as the Narcissism Personality Inventory.  In addition, pathological narcissism also influenced the behaviour of patients who had received psychotherapy.  If participants reported grandiose narcissism, such as elevated levels of grandiose fantasy or exploitativeness, they were not as inclined to attend hospital programs.  In contrast, if participants reported vulnerable narcissism, such as hiding the self or self-sacrificing self-enhancement, they were more inclined to utilise hospital services, such as the telephone crisis line.