Narcissistic and Psychopathic traits and relational abilities in a Forensic Sample

Maarten Maul

Tilburg University

Name: Maarten Maul Student number: 218500 Supervisor: Carlo Garofalo Second supervisor: Jenny Houtepen Number of words: 4981 Date: August 22th, 2016 and are related constructs that show a number of features, such as derogating others and aggressiveness (DSM-IV, 1994; Hare, 1991) that might lead to problems in relational functioning. This study investigated the relationship between narcissistic and psychopathic traits and relational functioning in a forensic sample (n=138). Self-report questionnaires with different subscales for covert and overt narcissism and primary and secondary psychopathy were used. Relational functioning was measured using scales for social concordance and relational capacities. The results of this study indicated that covert narcissism and secondary psychopathy in particular report difficulties in relational functioning. Limitations of this study and aims for future research are discussed.

In the quest of understanding narcissism, a lot of research focuses on self-esteem in narcissistic personalities (e.g. Horvath & Morf, 2010; Rose, 2001). These articles show that people with narcissism crave for the attention and affirmation of others to maintain their high self-esteem. Unsurprisingly, the concepts of narcissism and self-esteem are mostly moderately to highly correlated (Brown & Zeigler-Hill, 2004). Narcissistic personalities not only have high self-esteem. According to the definition of narcissism in the Diagnostic and Statistical

Manual of Mental Disorders (4th ed. [DSM-IV], American Psychiatric Association, 1994), they also have a sense of entitlement which makes them exploit others and lack for them. Furthermore, they derogate others and have an external attribution for failure. Paulhus

(1998) found that as a result of this behaviour, narcissistic people are disliked by their peers, even if they make a good first impression. In this study, participants met seven times for 20 minutes. After meetings one and seven, group members rated their perceptions of the other group members. Participants with high narcissism and self-deceptive enhancement scores were first seen as agreeable, well-adjusted and competent. However, after the last meeting, they were rated negatively by their peers and gave self-evaluations that were discrepant with peer evaluations.

One can say that narcissists are full of paradoxes. They want to connect with other people because they crave for the affirmation of others. At the same time, they are unable to make that interpersonal connection because of their negative behaviour as described above.

2 They seem self-centred and confident, yet they are very sensitive to how others see them

(Morf & Rhodewalt, 2001). Studies on narcissism and friendships show that narcissists tend to be goal-oriented and strategic if it comes to friendship selection (Foster, Misra & Reidy,

2009; Jonason & Schmitt, 2012). Narcissism was also found to be positively correlated to relational in a peer context in adolescents (Golmaryami & Barry, 2010; Ojanen,

Findley & Fuller, 2012). In another study, Campbell and Foster (2002) found that narcissism was negatively correlated to commitment in romantic relationships. Finally, Keller et al.

(2014) found that narcissism was related to the use of aggression in dyadic relationships.

These findings highlight the negative behaviour narcissistic people can display in relationships and bring up the question if they are able to form and maintain positive relationships in which they have a positive attitude towards others. In studying this question, it is important to make a distinction between two types of narcissists. Research suggests that these two types are covert and overt narcissism (Gabbard, 1989; Wink, 1991; Rose, 2002,

Dickinson & Pincus, 2003). Overt narcissism is described as the grandiose subtype that has a sense of entitlement and demands the attention of others. Covert narcissists tend to be more vulnerable because they are hypersensitive to other’s evaluations (Gabbard, 1989). They are also relatively unhappy and have lower self-esteem than overt narcissists (Rose, 2001). The question in this study is whether there is a difference in these subtypes in relational functioning. Dickinson and Pincus (2003) found that the, what they call vulnerable narcissistic subtype, reports higher interpersonal distress and interpersonal problems than the grandiose subtype. Further research on this issue is required, and one of the aims of the current study is to compare these two subtypes of narcissism to see whether there is a difference in the relation to relational functioning.

A concept that is somewhat similar to narcissism is psychopathy. Both clinical constructs are often observed in forensic populations, and as well as with narcissism, people

3 with psychopathic traits, such as a lack of , a grandiose estimation of self, and a lack of empathy (Hare, 1991) seem to have problems forming and maintaining positive relationships with the people around them. The relation between narcissism and psychopathy is often studied. Some researchers even suggest that psychopathy and narcissism are different names for the same construct (Gustafson & Ritzer, 1995), or that they have at least some features in common, such as aggressiveness and self-promotion (Hart & Hare 1998). Indeed, recent research seems to suggest that they are distinct, although overlapping constructs

(Fossati, Pincus, Borroni, Munteanu & Muffei, 2014; Falkenbach, Howe & Falki, 2013). In their study, Paulhus and Williams (2002) stated that the so called of personality traits, which are narcissism, psychopathy and Machiavellianism, are three separate constructs.

They only shared one common Big Five correlate, which is disagreeableness. According to

Kernberg (1989), a major difference between the two constructs is that psychopaths have an incapacity for concern for others.

In regard to psychopathy and relational functioning, Schmeelk, Sylvers and Lilienfeld

(2008) found that relational aggression correlated significantly with features of psychopathy.

Furthermore, among young adults, psychopathic traits influenced relational aggression in peer and romantic relationships (Czar, Dahlen, Bullock & Nicholson, 2011). The studies mentioned above were conducted with community samples. In a forensic population, Van den

Berg and Oei (2009) stated that it is notoriously difficult for severe psychopathic patients to commit to the patient-therapist relationship. This difficulty is probably caused by certain personality traits, such as a lack of ability to love others, which make it more difficult for psychopathic persons to engage in a reciprocal relationship (Cleckley, 1982).

As with narcissism, theorists made a distinction between two dimensions of psychopathy (Lykken, 1995; Newman, MacCoon, Vaughn & Sadeh, 2005), namely primary and secondary psychopathy. These are the two factors on which Hare (1991) based his

4 psychopathy checklist and Levenson (1995) based his self-report psychopathy scale. The major difference between the two dimensions is that secondary psychopaths experience more fear and anxiety than the typical, classic psychopath, which is referred to as primary psychopathy. However, there is not much research to give insight in relational functioning in the two dimensions of psychopathy. As stated by Kernberg (1989), psychopaths have an incapacity for concern of others. Therefore, one would expect more problems in relational functioning, but it is still unclear if these problems arise in both primary and secondary psychopaths.

The current study focuses on relationship abilities in narcissism and psychopathy in a forensic sample. A self-report questionnaire, the Severity Indices for Personality Problems

(SIPP-SF; Andrea et al., 2007) was used to measure relational abilities. This concept is divided into two constructs, social concordance and relational capacities. Social concordance is the ability to inhibit aggressive responses towards someone else and the ability to cooperate with someone. In the SIPP-SF, by relational capacities the ability to care for someone else and to accept that someone cares for you is meant (Andrea et al., 2007). Together, these two concepts give insight in the ability to form and maintain positive interpersonal relationships.

As mentioned above, plenty of research has been conducted to the relation between narcissism and romantic or friendly relationships. The current study however, focusses on more general relational abilities by using the SIPP-SF.

The aim of the current study is to give more insight in relational functioning in people with narcissistic and psychopathic traits. The research question of this study is therefore:

What is the relationship between narcissistic and psychopathic traits and relationship abilities?

In this study, the different subtypes of narcissism and psychopathy are studied in a way that their relationship with relational capacities and social concordance is tested, correcting for the overlapping relationships with other independent variables. This is important because with

5 this way of analysing only the unique relationships between independent and dependent variables are tested and therefore confusion between overlapping constructs is avoided. In addition, the forensic group of participants is compared to a control group, a community sample, in order to check if there are differences in relational functioning in both groups, and if the relationships between the research variables are similar.

It is important to study this issue because it can provide more insight in people with narcissistic or psychopathic tendencies and especially in the different subtypes of the disorders. Therefore, it can help psychologists to develop more effective treatment programs.

Moreover, an important relationship that, at least forensic patients with narcissistic or psychopathic traits have, is the patient-therapist relation. If we are able to better understand relational functioning in this group of forensic patients, therapist may be able to form more effective relationships with their patients.

It is expected that the forensic group has more problems with both social concordance and relational functioning compared to the control group. It is known that personality problems are prevalent in forensic populations, which can lead to problems in relational functioning (e.g. De Ruiter & Greeven, 2000; Timmerman & Emmelkamp, 2001; Harsch,

Bergk, Steinert, Keller & Jockusch, 2006).

In studies with non-forensic samples, people with high scores on narcissism and psychopathy showed more problems with interpersonal relationships (e.g. Golmaryami &

Barry, 2010; Paulhus, 1998; Schmeelk, Sylvers and Lilienfeld, 2008). Both clinical concepts share certain personality traits, such as aggressiveness and self-promotion (Hart & Hare,

1998), which can influence relational functioning in a bad way. Therefore, participants that score high on narcissism or psychopathy are expected to show difficulties on relational capacities and social concordance.

6 It is expected that covert narcissism would have a strong relation to both social concordance and relational capacities. This hypothesis is based on the findings of Dickinson and Pincus (2003) that, what they call vulnerable narcissists report more interpersonal problems in comparison with grandiose narcissists. Though people with more overt narcissistic traits have more social poise than covert narcissism (Wink & Donahue, 1997), which could lead to better interpersonal relations, they are also known for externalizing behaviour such as arrogance and aggressiveness (Ronningstam, 2009), and therefore it is expected that overt narcissism would have a relation with social concordance in particular.

More difficult is to predict how the two dimensions of psychopathy influence relational abilities, since there has not been much research on this issue. However, logically it would make sense that primary psychopathy is strongly related to relational capacities, because primary psychopaths are considered to have more difficulties to care for other people, which would result in more problems in relational capacities. Secondary psychopaths are generally considered to have more negative emotions and aggression. Therefore, it is expected that secondary psychopathy has a strong relation to social concordance.

Methods

Participants

Participants were 376 Dutch males, from which 238 participants were in the control group. The mean age in this group is 42.7 years (SD=17.47, range 17-79). Most participants in this group were single and had income from gainful employment. Participants in the forensic group all received mental health treatment at forensic outpatient clinic ‘Het Dok’, because of committed aggressive and sexual offenses. The mean age of the participants is

7 45.0 years old (SD=13.07, range 19-70). Most participants were single and had income from gainful employment.

Procedure

Dutch bachelor students Forensic Psychology recruited the participants in the control group. Forensic group participants were recruited by Dutch master students Forensic

Psychology, along with a GZ-psychologist. All participants took part voluntarily and anonymously. Participants signed an informed consent, which they handed in separately from the questionnaires to ensure anonymity. After this, they filled out the short form of the

Severity Indices for Personality Problems (SIPP-SF), the Levenson’s Self-Report

Psychopathy Scale (LSRP) and the Dutch Narcissism Scale (NNS), and demographic questions, such as social status, education level and main source of income. All questionnaires were filled out on paper. Participants of the forensic group filled out the questionnaires at the forensic clinic.

Measures

The SIPP-SF was used to measure relational capacities and social concordance. Social concordance is the ability to accept the identity of someone else, being able to inhibit aggressive impulses towards others and to work together with others. In the SIPP-SF, social concordance is divided into four subscales, namely: Aggression regulation, frustration tolerance, cooperation and respect. With the scale relational capacities, both the ability to care for another person and to accept that other people care for you is being measured. This concept is divided in three subscales: Intimacy, enduring relationships and feeling recognized.

8 Participants filled out the Dutch translation of the SIPP-SF, which consists of a total of 60 statements. An example of a statement for social concordance was: ‘I sometimes find it hard not to become aggressive towards others’. A statement which measures relational capacities was: ‘I have been able to form lasting friendships’. Participants were asked to rate how much they agreed with each statement by using a 4-point scale. All statements were about the last three months. High scores indicate more adaptive, and therefore less pathological, capacities.

The SIPP-SF is based on the SIPP-118, which is the complete version with 118 items. The

SIPP-118 has good test-retest reliability and discriminative validity (Andrea et al., 2007;

Verheul et al., 2008). In this study, Cronbach’s alpha for both relational capacities and social concordance was .84 which means the test has good internal consistency.

To measure narcissistic traits, the Dutch Narcissism Scale (NNS; Ettema & Zondag,

2002) is used. This measure is a multidimensional self-report scale which is based on the theory of the overt and covert subtypes of narcissism. Ettema and Zondag (2002) refer to these subtypes as respectively centrifugal and centripetal narcissism. These names are derived from the underlying interpersonal fascinations, where centrifugal, overt narcissists are overly fascinated with their self which deflects on others. Centripetal, covert narcissists are overly fascinated with the evaluation of others which deflects on their self-image. The NNS includes

35 statements on which participants were asked on a 7-point scale to what extent they agreed with the statement. This scale distinguishes three factors, namely centrifugal narcissism (12 items), centripetal narcissism (11 items) and isolation (9 items). An example of a statement for centrifugal narcissism was: ‘Sometimes I think of how lucky I am with myself’. A statement for centripetal narcissism was: ‘Comments of others can sometimes easily hurt my feelings’. At both scales, a higher score reflects higher levels of narcissism. The subscales centripetal and centrifugal have satisfying validity and reliability rates. The subscale centripetal has a Cronbach’s alpha of .82 and the subscale centrifugal has a Cronbach’s alpha

9 of .71 (Ettema & Zondag, 2002). In the current study, Cronbach’s alpha was .70 for the centrifugal scale and .82 for the centripetal scale.

Psychopathic traits are being measured with the Dutch translation of the Levenson’s

Self-Report Psychopathy Scale (LSRP; Levenson, Kiehl & Fitzpatrick, 1995). The scale is based on the two factor model of primary and secondary psychopathy. Although this scale was originally developed using non-institutionalized samples, it is used in the current study because it is one of the few self-report scales for measuring psychopathy and can be administered time efficient.

The scale includes 26 statements on two factors. The first factor measures the interpersonal and affective aspects of psychopathy (e.g. ‘For me, what’s right is whatever I can get away with’) whereas the second factor measures behaviourally aspects of psychopathy

(e.g. ‘I am often bored’). At each statement, participants could agree on a 4-point scale.

Higher scores on this scale indicate higher levels of psychopathy. According to Miller,

Gaughan and Pryor (2008) the LSRP is a reasonable measure for psychopathy in comparison to alternate measures for psychopathy. Brinkley, Schmitt, Smith and Newman (2001) found that the LSRP is significantly correlated with the psychopathy checklist of Robert Hare (PCL-

R; Hare, 1991), which is an internationally renowned measure for psychopathy. Other research supports the reliability and validity of the LSRP (Lynam, Whiteside & Jones, 1999).

Test-retest reliability is found to be at a high level (r=.83) (Lynam et al., 1999). In this study,

Cronbach’s alpha was .82 for the first factor and .68 for the second factor.

Data-analysis

To check if there is a difference between the clinical forensic group and the community control group multiple t-tests are conducted. In these analysis, the research

10 variables (relational abilities, narcissism, psychopathy and demographics) are dependent variables and ‘group’, forensic or control, is the independent variable.

Descriptive statistics are used in order to test whether there are outliers or missing items in the dataset. The correlation between the SIPP-SF scales social concordance and relational capacities is measured to examine the association between these scales. Also, the correlations between the subscales of the NNS and LRSP are measured to examine the association between narcissism and psychopathy. Finally, correlations between SIPP-SF scales and subscales of the NNS and LRSP are conducted to study the associations between these variables.

In addition to the correlations above, two multiple regression analyses are conducted to test in what way the narcissism dimensions and the psychopathy factors influence social concordance and relational capacities. These multiple regression analyses with both narcissism and psychopathy scales as independent variables are used to investigate the unique relationship between the dependent variable (e.g. relational abilities) and the independent variable (e.g. overt narcissism), controlling for the shared variance among the other independent variables. Also, the Variance Inflation Factor (VIF) is used to check for multicollinearity, because an assumption for the use of multiple regression analyses is that there is no multicollinearity among variables. In the first multiple regression analysis, the

SIPP-SF scale relational capacities is the dependent variable and the independent variables are the two subscales centripetal narcissism and centrifugal narcissism of the NNS, and the two subscales primary psychopathy and secondary psychopathy of the LSRP. The second multiple regression analysis is conducted with the SIPP-SF scale social concordance as the dependent variable. The independent variables are again the four subscales of the NNS and LSRP.

Results

11 Before analysis, 5 participants have been excluded because of too much missing data (more than 10 items missing in the questionnaires).

Table 1:

Descriptive statistics and T-tests

Forensic Control

Variables M SD n M SD n t df Age 44.95 13.07 135 42.71 17.47 235 -1.4 343 Primary psychopathy 31.07 8.63 138 30.70 7.37 238 -.44 374 Secondary psychopathy 21.24 5.37 138 17.91 3.95 238 -6.4*** 224 Overt narcissism 52.86 9.36 138 59.22 7.51 238 6.8*** 239 Covert narcissism 42.17 10.75 138 39.21 10.86 238 -2.6** 374 Relational capacities 32.77 8.34 138 39.52 5.75 238 8.4*** 214 Social concordance 36.81 7.66 138 39.74 5.43 238 3.9*** 218

*p<.05, **p<.01, ***p< .001

Several T-tests have been conducted to look at the differences between the forensic group and the control group. There was no significant difference in age between the two groups (t = -1.3, p = .196). In regard to narcissistic and psychopathic traits, several significant differences between the two groups have been found. The level of covert narcissism scores in the forensic group (M = 42.17, SD = 10.75) is higher than in the control group (M = 39.21, SD

= 10.86, t = -2.6, p = .01). The level of secondary psychopathy scores was also significantly higher in the forensic group (M = 21.24, SD = 5.37, t = -6.9, p = .00) than in the control group

(M = 17.91, SD = 3.95). The forensic group had significant lower scores on overt narcissism

(M = 52.86, SD = 9.36, t = 7.2, p = .00) than the control group (M = 59.22, SD = 7.51). There was no significant difference in primary psychopathy scores (t = -.44, p = .66). It is also found

12 that the forensic group had significant lower scores in social concordance (t = 4.3, p = .00) and relational capacities (t = 9.3, p = .00), meaning they report more problems on these scales.

Table 2:

Pearson correlations

Variables 1 2 3 4 5 6 1. Primary psychopathy _ 2. Secondary psychopathy .569*** _ 3. Overt narcissism -.062 -.084 _ 4. Covert narcissism .221** .439*** .068 _ 5. Social concordance -.566*** -.702*** .052 -.437*** _ 6. Relational capacities -.237** -.503*** .311*** -.445*** .520*** _ *p<.05, **p<.01, ***p< .001

To examine associations between the different scales, correlations have been computed. The results show that primary psychopathy is moderately related to secondary psychopathy (r(136) = .57, p < .001). Primary psychopathy was weakly correlated to covert narcissism (r(136) = .22, p < .01) and had no correlation to overt narcissism (r(136) = -.06, p

> 0.05). Also, a moderate negative correlation between primary psychopathy and social concordance (r(136) = -.57, p < .001) was found. Primary psychopathy and relational capacities had a weak negative correlation (r(136) = -.24, p < .01). Secondary psychopathy was moderately correlated with covert narcissism (r(136) = .44, p < .001) and had no correlation with overt narcissism (r(136) = -.08, p > 0.05). Secondary psychopathy had a strong negative correlation with social concordance (r(136) = -.70, p < .001) and a moderate negative correlation with relational capacities (r(136) = -.50, p < .001).

No correlation was found between overt narcissism and covert narcissism (r(136) =

.07, p > .05). There was also no correlation between overt narcissism and social concordance

(r(136) = .05, p > .05). Overt narcissism was weakly correlated with relational capacities

13 (r(136) = .31, p < .001). Covert narcissism had a moderate negative correlation with both social concordance (r(136) = -.44, p < .001) and relational capacities (r(136) = -.44, p < .001).

Social concordance is moderately correlated to relational capacities (r(136) = .52, p <.001).

To check for collinearity between variables, VIF scores were used. All VIF-scores were below 5, which means no proof for collinearity was found. The highest VIF-score was for secondary psychopathy and relational capacities (VIF = 3.65).

To test whether psychopathic and narcissistic traits have a relationship with social concordance and relational capacities, two multiple regression analyses have been conducted.

Using these multiple regression analyses, in contrast to the bivariate associations examined with correlations, unique relationships between a dependent and independent variable can be studied, controlling for the shared variance among all other independent variables. In the first regression analysis, the SIPP-SF scale Relational capacities was the dependent variable.

Primary and secondary psychopathy and overt and covert narcissism scores were independent variables. The overall model was significant (F= 23.0, p= .000, R2= .39). Also, covert narcissism (-.244, t= -4.22, p= .000) and secondary psychopathy (-.587, t= -4.27, p=

.000) had a negative significant relation with relational capacities. Overt narcissism had a positive relation with relational capacities (2.72, t= 4.54, p= .000), and there was no significant relation for primary psychopathy (t= .83, p= .411).

In the second regression analysis, social concordance was the dependent variable. The independent variables were again the dimensions of psychopathy and narcissism. The overall model was significant (F= 41.8, p= .000, R2= .54) and covert narcissism (-.12, t= -2.63, p=

.010), primary psychopathy (-.23, t= -3.61, p= .000) and secondary psychopathy (= -.69, t= -6.29, p= .000) all had a significant negative relation with social concordance. There was no significant relation between overt narcissism and social concordance (t= .12, p= .902).

14 Discussion

The research question of this study was if psychopathic and narcissistic traits have a relationship with social concordance and relational capacities in a forensic population. To answer this question, the different dimensions of narcissism and psychopathy were studied. T- test results show that people in the forensic group, as expected, report significantly more problems on social concordance and relational capacities than the control group. In line with the hypothesis, the forensic group also reports higher levels of secondary psychopathy and covert narcissism. However, there are significant lower scores of overt narcissism in the forensic group, and there is no significant difference between the two groups in primary psychopathy scores. The fact that the forensic group consists of an outpatient population could explain these results. Namely, the people in this group already received treatment, so that their mental wellbeing would be better than people in a clinical setting, resulting in lower scores of narcissism and psychopathy.

Correlation results show that covert narcissism, primary psychopathy and secondary psychopathy are negatively correlated to both social concordance and relational capacities.

For overt narcissism, there was a positive correlation with relational capacities and no significant correlation with social concordance. Two multiple regression analyses were conducted to study the relationships between narcissistic and psychopathic traits on the one hand and relational abilities on the other, correcting for the overlapping associations with other variables. These results show mostly the same patterns as the correlation results. Covert narcissism indeed has a significant, negative relation to both social concordance and relational capacities. This means that higher scores on covert narcissism relate to more problems on relational functioning. Overt narcissism, on the contrary, has a significant positive relation to relational capacities, and no significant relation to social concordance. The latter result is not

15 according the hypothesis. An explanation for this could lie in the fact that all constructs were measured with self-report questionnaires. It may be that people with high scores on overt narcissism have interpersonal problems, yet they do not see them themselves. As described in the introduction of this article, Paulhus (1998) found that there is a discrepancy between how narcissists think how other people see them, and how other people really see them. This discrepancy could also apply when it comes to reporting relational problems, and people with higher scores of overt narcissism could be more vulnerable for this effect.

Looking at psychopathy, the results of the current study show that primary and secondary psychopathy have a significant, negative relation to social concordance. So both high scores on primary and secondary psychopathy are associated with problems in social concordance. It is known that psychopathic traits cause problems in aggression control (eg.

Heilbrun et al., 1998; Glenn & Raine, 2009), which explains high scores in social concordance. As expected there was a strong negative relation between secondary psychopathy and social concordance. This was expected because people with higher scores on secondary psychopathy tend to have more problems in emotional functioning and aggression control (Porter & Woodworth, 2006). Porter (1996) states that secondary psychopathy is mostly caused by environmental factors, such as negative childhood experiences, that learn certain individuals to “turn off” their emotions, which affects emotional functioning in adulthood. An early study of Widom (1976) shows that secondary psychopaths are, in comparison to primary psychopaths, less able to function efficiently in the Prisoner’s

Dilemma game, where they had to cooperate with other people. Taking this into consideration, it makes sense that secondary psychopathy relates to problems in teamwork and aggression control towards others, which is measured by the social concordance subscale.

As expected, secondary psychopathic traits are also negatively related to relational capacities, meaning that people with more secondary psychopathic traits have more problems

16 with relational capacities. There is no significant relation between primary psychopathic traits and relational capacities. Correlation results do show an association between primary psychopathy and relational capacities, but this relationship is not significant when controlling for the shared variance among other variables. This means that there is no unique relationship found between primary psychopathy and relational capacities. This result is not according to the hypothesis, but could be due to the selection of the forensic participants of this study. As stated above, all participants of this group received an outpatient treatment program, which could result in milder levels of psychopathy.

All this results taken into consideration, we can say that covert narcissistic traits and secondary psychopathic traits indeed influence relational abilities in a negative way. Primary psychopathy also has a significant relation to social concordance, but not to relational capacities, and overt narcissism has no significant relation with social concordance nor with relational capacities. Future research has to study if these relations are also found in forensic populations in a clinical setting and with other research methods.

Namely, a limitation of the current study is that all constructs were measured using self-report questionnaires. Especially for measuring psychopathic and narcissistic traits, this may not be the most accurate way of studying this subject. Psychopaths and narcissists are notorious for lying and deceiving others (DSM-IV, American Psychiatric Association, 1994).

Therefore, it can be naïve to expect them to be open and honest. Nevertheless, this method is simple to administer and easy for participants to participate. Also, anonymity of participants was ensured to maximize the likelihood of honest answers. Still it would be interesting to study this research question with other research methods. For example, interviewing relatives and friends of narcissistic or psychopathic people could give another insight in how relations work and how relational dysfunctions can be solved.

17 Looking at the results of this study, it is apparent that both covert narcissism and secondary psychopathy report the most problems in relational functioning, and that there is a significant correlation between this two constructs. This results support findings of Miller et al (2010) who found a so-called vulnerable dark triad, consisting of vulnerable narcissism, secondary psychopathy and borderline personality disorder. The current study focused more on the differences within psychopathy and narcissism, though it would be interesting and important to study the differences between narcissism and psychopathy more directly. In this way, the differences and similarities between the two constructs will become more clear.

This study has helped to provide more knowledge about narcissism and psychopathy in the forensic population. This knowledge can be used in clinical practice to develop more effective treatment programs. For example, psychologists and social workers can help people with covert narcissistic or secondary psychopathic traits to maintain positive and lasting relationships by providing insight-oriented therapy. In the end this knowledge would lead to a better understanding and treatment of narcissism and psychopathy, which helps not only patients, but also family and the society as a whole.

18 Reference list

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