Narcissism in patients admitted to psychiatric acute wards: its relation to violence, suicidality and other psychopathology
Abstract
Background: The objective was to examine various aspects of narcissism in patients admitted to
acute psychiatric wards and to compare their level of narcissism to that of an age- and gendermatched
sample from the general population (NORM).
Methods: This cross-sectional study interviewed 186 eligible acute psychiatric patients with the
Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF). The patients
filled in the Narcissistic Personality Inventory-21 item version (NPI-21), The Hospital Anxiety and
Depression Scale (HADS) and the Rosenberg Self-Esteem Scale. High and low narcissism was
defined by the median of the total NPI-21 score. An age- and gender-matched control sample from
the general population also scored the NPI-21 (NORM).
Results: Being male, involuntary admitted, having diagnosis of schizophrenia, higher self-esteem,
and severe violence were significantly associated with high narcissism, and so were also low levels
of suicidality, depression, anxiety and GAF scores. Severe violence and high self-esteem were
significantly associated with high narcissism in multivariable analyses. The NPI-21 and its subscales
showed test-retest correlations ≥0.83, while the BPRS and the HADS showed lower correlations,
confirming the trait character of the NPI-21. Depression and suicidality were negatively associated
with the NPI-21 total score and all its subscales, while positive association was observed with
grandiosity. No significant differences were observed between patients and NORM on the NPI-21
total score or any of the NPI subscales.
Conclusion: Narcissism in the psychiatric patients was significantly associated with violence,
suicidality and other symptoms relevant for management and treatment planning. Due to its trait
character, use of the NPI-21 in acute psychiatric patients can give important clinical information.
The similar level of narcissism found in patients and NORM is in need of further examination.