iii

The Expression of Narcissism among Chinese People in China:

The Development and Preliminary Validation of the Chinese Narcissism Scale

NG, Kin Shing

A Thesis Submitted in Partial Fulfillment

of the Requirements for the Degree of

、 Master of Philosophy

in

Psychology

© The Chinese University of Hong Kong

August 2008

The Chinese University of Hong Kong holds the copyright of this thesis. Any person(s) intending to use a part or whole of the materials in the thesis in a proposed publication must seek copyright release from the Dean of the Graduate School. UNIVERSITY Thesis/Assessment Committee

Professor Fanny M. Cheung (Chair) Professor Freedom Yiu-kin Leung (Thesis Supervisor) Professor Wai Chan (Committee Member) Professor Julian C. L. Lai (External Examiner) iii

Abstract of thesis entitled: The Expression of Narcissism among Chinese People in China: The Development and Preliminary Validation of the Chinese Narcissism Scale Submitted by Ng, Kin Shing for the degree of Master of Philosophy in Psychology at the Chinese University of Hong Kong in June 2008

Narcissism is a well-known personality construct in the Western individualistic society. However, it is unclear whether this personality construct is generalizable to a collectivistic culture like the Chinese which put strong emphasis on collective well-being rather than individual glory. The present study explores the construct of narcissism among the Chinese. Two samples were used for the purpose of this study.

Sample 1 involved 1911 non-psychiatric individuals from both Mainland China (n =

1575) and Hong Kong (n = 336). Sample 2 involved 228 patients with bipolar disorder and 354 patients with depression. Both samples completed the

Cross-cultural (Chinese) Personality Assessment Inventory-2. Sample 2 also completed the Chinese Personality Disorders Inventory. Out of the 541 items of

CPAI-2，we were able to identify 16 personality items closely resembled different aspects of narcissistic personality features as specified in the DSM system. The

16-item scale, tentatively named as the Chinese Narcissism Scale, demonstrated good internal consistency and item-total correlations in both the community and clinical samples. Factor analyses revealed four theoretically meaningful factors: iii

Self-perceived Superiority, Interpersonal Exploitation, Uniqueness and Fantasies of

Greatness. Findings also supported the convergent validity and clinical utility of the

Chinese Narcissism Scale. Implications for future investigation of narcissism in the

Chinese population were discussed. iii

摘要

自戀人格（Narcissism)是西方個人主義社會裏爲人所熟知的人格槪念°然而，

它是否能類推到像中國社會這樣強調集體利益而非個人榮耀的集體主義文化，

仍然是値得懷疑的。本文探討中國人的自戀人格槪念，並應用了兩個樣本作硏

究：樣本一由191 1名非精神病中國人組成，其中1 5 7 5名來自中國內地，

3 3 6名來自香港；樣本二由2 2 8名雙向情感障礙病人（BipolarDisorder)及

3 5 4名抑變症病人（Depression)組成。兩個樣本都完成了《跨文化(中國人）

個性測量表》（CPAI-2)，樣本二亦完成了《個性特徵量表》（CPDI)。從CPAI-2

的5 4 1題題目中’我們發現1 6題跟DSM系統所描述的自戀人格障礙

(Narcissistic Personality Disorder)非常相似°這個量表初步命名爲《中國自戀人

格問卷》，並在雨個樣本中顯示良好的內在信度(internalconsistency)和單項/

總項相關係數(item-totalcorrelation) °因子分析展現四個符合理論的因子，分

別爲“自我優越感”、“利用人際關係”、“獨特性”以及“浮誇的幻想”。

分析亦支持《中國自戀人格問卷》的幅合效度及臨床的可應用性，就硏究所得，

本文提出了有關中國人自戀人格的未來硏究方向。 Iv

ACKNOWLEDGEMENTS

I want to express my deepest gratitude to Professor Freedom Leung, for his unconditional support. I would also like to thank Professor Fanny Cheung and

Professor Wai Chan for their patience and constructive comments in my proposal and thesis defenses. I especially have to thank Professor Fanny Cheung and her laboratory, for allowing me to use the two datasets of the CPAI-2.

This thesis was finished with moum and solitude. V

TABLE OF CONTENTS

Chapter 1 INTRODUCTION Psychoanalytic Theories on Narcissism j Psychometric Studies of Narcissism 3 Problems of the American Scales 7 Exploring the Construct of Narcissism among the Chinese 10 Purposes of the Present Study 12 Chapter 2 METHOD Participants 15 Measures 16 Chapter 3 RESULTS FOR SAMPLE 1 Exploratory Factor Analysis 1 g Confirmatory Factor Analysis 22 Concurrent Validity of the CNS 24 Comparison between Gender, Location and Age-groups 26 Chapter 4 RESULTS FOR SAMPLE 2 Internal Reliability and Item-Total Correlation 28 Cross-validating the Factor Structure in the Clinical Sample 29 Concurrent Validity of the CNS in the Clinical Sample 31 Clinical utility of the CNS 33 Chapter 5 DISSCUSSION Narcissistic Personality Features among Chinese 37 Gender Difference in Narcissism 40 Age Differences in Narcissism 41 Narcissism and Psychosocial Adjustment 42 Clinical Utility of the Narcissism Construct among Chinese 43 Strengths and Limitations of the Present Study 44 Appendix 1 The Nine Diagnostic Criteria ofNPD and Related CPAI-2 50 Items. Appendix 2 Chinese and English versions of the CNS Items 51 References 52 iii

LIST OF TABLES

Table 1. Reliability and Item-total Correlations (Community Sample; N = 985) ....19

Table 2. Exploratory Factor Analysis (N = 985) for Community Sample 20

Table 3. Correlations between CNS and Relevant CPAI-2 Variables

(Community Sample: M = 913，F = 965) 26

Table 4. Comparison of CNS Scores across Gender, Location and Age Groups•.…28

Table 5. Reliability and Item-total Correlations (Clinical Sample; N = 582) 29

Table 6. Summary of Fit Indices for Structural Equation Models 31

Table 7. Correlations between CNS and the Relevant CPAI-2 Variables in the

Clinical Sample (Mood Disorder: M = 282, F = 296) 34

Table 8. Univariate Comparisons across Four Groups and Scheffe Tests 35

Table 9. Correlations between CNS and the 10 Personality Disorders as Assessed by

、 CPDI 36

Table 10. Comparison of CNS between NPD (N = 88) and non-NPD Patients (N =

256) 37

Table 11. Logistic Regression Analysis ofNPD/non-NPD as a Function of CNS

Factors 38 iii

LIST OF FIGURES

Figure 1. Confirmatory Factor Analysis in Normal Sample, Standardized Results

(N =926) 24

Figure 2. Structural Invariance of CNS across Depressed and Bipolar Patients.

(N =582) 32 iii

Chapter 1

INTRODUCTION

Originated from the Greek mythology, narcissism refers to a unique set of

personality features that describes people who exhibit a grandiose sense of self and

an arrogant attitude towards others. Psychoanalytic theories played an important role

in theorizing narcissism as a personality construct (Freud, 1986; Kemberg, 1967;

Kohut, 1977; Reich, 1933).

Psychoanalytic Theories on Narcissism

According to Freud (1914)，primary narcissism is a normal human instinct. By

possessing primary narcissism, children leam to invest their libido in the self and

external objects (e.g. ideal figure), and thus can balance between caring for others

and preserving the self. In contrast, secondary (pathological) narcissism develops

when children fail to balance such investments, typically over focusing on the self

and forming unrealistic ideals. Though not using the term narcissism, Jones (1913)

described a similar pathological personality profile called “God complex". People

with God complex are heavily self-absorbed and demand admiration from others in

order to support their self-esteem. These pioneering works inspired followers to

advance our understanding of narcissism. Among them, Kemberg (1967，1986) and 2

Kohut (1977，1986) are two important theorists in the history of such development.

According to Kemberg (1967)，narcissistic personality structure is formed when one's object relation is bewildered. In normal personality development, individuals leam and admit their dependency on external objects (e.g. parents, friends), as well as to differentiate their actual self from the ideal self. This learning process enables us to accept our own inadequacies and make effort to live up to the standard of the appropriate idealized image. In contrast, narcissists may perceive the actual self as equal to the idealized self and object, and devaluate the importance of external relationships. The confusion between actual and ideal self causes a person to hold grandiose fantasies that he/she is right on everything (because he has already reached the ideal standard); whereas external objects are heavily devaluated and manipulated to become the admirers of the person. Other behavioral features also emerge under such circumstances, including interpersonal aggression, excessive self-absorption, superior sense of uniqueness, and maladaptive interpersonal relationship (e.g. contempt, devaluation, envy).

Kohut (1977，1986) suggested that narcissism is a significant developmental milestone that involves two mechanisms, namely narcissistic idealization of parent imago. The former is responsible for the change from childish sense of grandiosity to mature and realistic ambitions; while the later is related to the 3 transformation from admiring omnipresent ideal figures (e.g. parents) to a mature and realistic ideal standard. Childhood narcissism is supported by caregiver's unconditional love and ideal image that enable the children to follow as model and consolidate into a coherent sense of self. Kohut suggested that frustration is necessary for the self to transform from a subjective omnipotent one to a realistic self-perception. Failure of these processes leads to a depleted self in childhood that would fixate the adult narcissist at the infantile level, displaying characteristics of the omnipotent and invulnerable child.

Though holding different views on the etiology of pathological narcissism,

Kemberg and Kohut collectively captured the wide spectrum of narcissistic personality features. These later became the major reference for the diagnostic criteria of narcissistic personality disorder in the DSM system (Cooper, 1986). From then on, research of narcissism changed from psychoanalytic theorization to development of assessment tools and psychometric research.

Psychometric Studies of Narcissism

An important development in the research on narcissism is the introduction of

Narcissistic Personality Disorder (NPD) in the Diagnostic and Statistical Manual of

Mental Disorders -III (American Psychiatric Association, 1980). The inclusion of

NPD was followed by the development of different assessment tools for narcissistic 4 personality (e.g. O'Brien, 1987; Raskin & Hall, 1979, 1980). According to the latest description in DSM-IV-TR (APA, 2000)，NPD refers to a “pervasive pattern of grandiosity, need for admiration, and lack of empathy that begins by early adulthood and is present in a variety of contexts" (p.714). These personality features often result in significant psychosocial impairment and subjective distress. According to the polythetic rule of the DSM system, anyone meeting five out of the nine diagnostic criteria is regarded as having NPD (refer to Appendix 1 for these diagnostic criteria). Since the inclusion of NPD in the DSM system, many self-report narcissism scales were developed based on these diagnostic criteria.

Narcissistic Personality Inventory (NPI)

The Narcissistic Personality Inventory (Raskin & Hall，1979) is one of the most widely used inventories measuring narcissism in both clinical and non-clinical samples. It was developed based on the diagnostic criteria of NPD in DSM-III (APA,

1980). These criteria include: 1) a grandiose sense of self-importance and uniqueness;

2) preoccupation with fantasies of unlimited success, power, beauty, or ideal love; 3) exhibitionism - requires constant attention and admiration; 4) entitlement - expectations of special favors without reciprocating; and 5) interpersonal exploitativeness. Findings from various studies supported the factorial and content validity of the NPI (Emmons 1981; Raskin, 1980; Raskin & Terry, 1988). Emmons 5

(1984) extracted four factors for the NPI，namely 1) Exploitativeness/ Entitlement, 2)

Leadership/ Authority, 3) Superiority/ Arrogance, and 4) Self-absorption/

Self-admiration. Internal consistency of each factor was satisfactory. Moreover, content validity was supported when comparing NPI with other personality variables.

In the last two decades, NPI has been translated into different languages, such as

Greek and Swedish (Coccosis, Vaslamatzis, Anagnostopoulos & Markidis，1998;

Kansi, 2003)，and the reported 4-factor model was relatively robust across different populations.

O 'Brien Multiphasic Narcissism Inventory (OMNI)

The O'Brien Multiphasic Narcissism Inventory (O'Brien, 1987) was developed to measure different dimensions of pathological narcissism. The first dimension reflects the typical features stated in the DSM-III and NPI (Raskin et al., 1979)，and is thus called the Narcissistic Personality Dimension. In addition, the OMNI also measured two other dimensions described by Miller (1984). The second dimension was termed the Poisonous Pedagogy Dimension, which reflects narcissist's tendency to control others. The third factor was called the Narcissistic Abused Personality, reflecting the need of others' approval for a sense of self-validation (Miller, 1981).

O'Brien (1987) reported that only the Narcissistic Personality Dimension correlated with NPI, suggesting that the Poisonous Pedagogy Dimension and the Narcissistic 6

Abused Personality were two additional dimensions of narcissism. However, the scale was rarely used in later narcissism studies.

Millon Clinical Multiaxial Inventory (MCMI)

The Millon Clinical Multiaxial Inventory (Millon, 1987; Millon, Davis &

Grossman, 2006) includes a Narcissistic scale as one of its standard personality disorder scales. The scale captures major narcissistic features such as inflated self-image, exploitative interpersonal relationship and lack of empathy (Millon,

1981). Several studies reported that the MCMI-Narcissistic scale correlated with other well established narcissism inventories, especially the NPI (Auerbach, 1984;

Prifitera & Ryan, 1984; r equaled .55 and .66 respectively).

Scales from the Minnesota Multiphasic Personality Inventory (MMPI)

Six narcissism scales have been developed from the MMPI. The Narcissistic

Personality Disorder Scale (NPDS; Ashby, Lee & Duke，1979) is a 19-item subscale derived by comparing the MMPI responses of narcissistic patients against control groups. However, this scale did not correlate with the widely supported NPI

(Emmons, 1987; r = .12). It also showed low internal consistency (alpha = .55).

Another 17-item scale developed by Serkownek (Serkownek Narcissism scale, SNS;

1975) also possessed low internal reliability (alpha = .66). Morey, Waugh and

Blashfield (1985) constructed another 31 -item narcissistic personality disorder scale 7

from the MMPI, with supported internal consistency and concurrent validity (Morey

et al.，1985; Wink & Gough，1990). Other scales were also developed by Raskin and

Novacek (1989; Raskin Novacek Narcissism Scale, RNNS) and Wink et al. (1990)，

which will be discussed in details in the following section.

Problems of the American Scales

Most of the MMPI-derived scales did not show satisfactory internal consistency

(alpha ranged from .55 to .66; Rose, 2002). This raised concern whether these

MMPI-derived scales measure a coherent construct of narcissism. In addition, Rose

(2002) failed to find convergent validity for these scales, in some cases even negative correlations were found between several narcissism scales. Rose (2002) found that NPI and RNNS predicted psychological adjustment whereas NPDS and

SNS predicted psychological maladjustment. This finding was in line with past research that different narcissism scales showed opposite predictive validity (e.g.

Hickman, Watson & Morris，1996; Sedikides, Rudich, Gregg & Rusbult，2004) and some narcissism scales did not correlate with each other (Ashby et al., 1979;

Emmons, 1987). The coherency between these scales is therefore questionable.

Using joint factor analysis, Wink (1991) also showed that the aforementioned

MMPI-derived scales failed to converge into a single-factor solution. Instead, a

2-factor solution was found. Wink (1991) explained the results by referring to two 8 subtypes of narcissism, namely the covert and overt subtypes. The covert factor comprised of the scales by Ashby et al. (1979; NPDS), Pepper and Strong (1958), and Serkownek (1975; SNS); whereas the overt factor included narcissism scales by

Morey et al. (1985), Raskin et al. (1989; RNNS) and Wink et al. (1990). In short, overt narcissism refers to one's obvious haughty behavior toward others and self-assurance, whereas covert narcissism is more related to defensive behaviors to protect one's self image. Covert narcissism correlated negatively with psychological well-being (r = -.67) and personal adjustment (r = -0.33), while overt narcissism did not show significant correlations with the same indices (.02 and .12 respectively).

Although the theory of covert/overt narcissism sounds interesting, several problems exist. First, the MMPI-derived scales showed very low internal reliability

(Rose, 2002). Second, the overt narcissism scales were developed based on the

DSM-III criteria ofNPD; whereas in the covert factor, two scales (Pepper et al.,

1958; Serkownek, 1975) were developed from the Masculinity-Femininity scale of the MMPI. The 2-factor solution may reflect the different criteria of item selection, therefore, a methodological artifact. Third, the scales of covert narcissism came either from unpublished manuscripts (Pepper et al., 1958; Serkownek, 1975) or conference paper (Ashby et al., 1979) and did not go through rigorous psychometric verification. Moreover, Wink did not analyze the MMPI-derived scales at the item 9 level. Factor analysis at the item level would allow more detailed factor interpretation from individual item description (c.f. Emmons, 1984).

Mullins and Kopelman (1988) conducted a factor analysis of four narcissism scales at the item level. Factor loadings of .35 or above was the major criterion of factor solution. The scales used in the study included the MMPI scales as well as the well-established NPI (Raskin et al.，1979). Four factors were found, including the

"desire for admiration/attention" (c.f. leadership/authority in NPI, Emmons, 1984),

"sense of inadequacy", "exploitativeness, entitlement and lack of empathy", and

“sensitivity to criticism and defeat". The factor solution is more meaningful than that of Wink (1991) because each factor can be clearly interpreted by considering the content of each loaded item. In addition, each factor resembled the DSM diagnostic criteria of narcissistic personality disorder.

The factor structure of narcissism has also been tested using the nine DSM-IV diagnostic criteria of NPD. Blais，Hilsenroth and Castlebury (1997) found a 3-factor solution of the nine diagnostic criteria, namely Grandiose Fantasies and Behaviors,

Lacks Empathy, and Need for Admiration. Using confirmatory factor analysis,

Fossati et al. (2005) reported a 2-factor model that resembled the covert/overt model of narcissism: the covert factor was loaded by criteria 2{Grandiose Fantasies), 4(Nee for Admiration) and %{Envy)\ the overt factor was loaded by criteria 1 (Sense of 10

Grandiosity), 3{Self Uniqueness), 5{Entitlement), 6(Exploitative), l{Lacks empathy) and 9{Arrogance). Despite the satisfactory fit indices, it was noticed that the covert and overt factors correlated with each other very strongly (r = .11, p< .001). In addition, the model with uncorrelated factors was the worst fitting model. These results did not support the covert/overt theory, because it is believed that covert and overt narcissism are two independent categories.

Exploring the Construct of Narcissism among the Chinese

Most of the previous studies on narcissism were conducted in the United States where individualism is more emphasized than in Eastern collectivistic cultures. It is unclear whether narcissism, a personality construct of the Western individualistic cultures, also exists in the Eastern collectivistic cultures. Under the deep-seated

Confucianism among Chinese societies, which emphasizes humbleness and social harmony, individual glory is often deemphasized or replaced by group success

(Chang, Arkin, Leong, Chan & Leimg，2004). Under this traditional cultural influence, one may expect that Chinese will display lower level of narcissism (i.e., an exaggerated sense of self-importance, contempt of others) than American (Smith,

1990).

However, several social changes in modem China may have led to an inversion of this tradition. As reported by Elegant (2007), the Me generation of China is highly 11

westernized, egoistic and less constrained by Chinese tradition. The majority of this

generation was bom under the one-child policy enforced in 1979. The change of

family structure and parenting styles led to the rise of little emperors in China, who

are often described as self-centering and unsympathetic, resembling some features of narcissistic personality described in the West (Mcloughlin, 2005; Zhang,

Kohnstamm, Cheung & Lau，2001).

Millon (1985) pointed out three important environmental factors in the development of narcissism, namely parental indulgence and overvaluation, learned exploitive behavior and the only-child status. These factors are akin to the upbringing environment of Chinese youngsters bom under the one-child policy in

China. According to Millon (1985), parental indulgence may lead to a distorted sense of self and exploitive interpersonal behaviors among children. More importantly,

"the high frequency with which parental overindulgence and the opportunity to leam exploitive behavior occurs in only children" (Millon, 1985, pp. 77). Preliminary findings from Chinese studies on the effect of the one-child policy suggested increased narcissistic-like features such as self-serving and unsympathetic behaviors among these children (Mcloughlin, 2005; Zhang et al.，2001). It is, therefore, interesting to explore the construct of narcissism in view of the social changes and the rise of the Me generation in modem China. 12

Chinese studies on narcissism are scarce, however, and most of them adopted

the imposed-epic approach (Smith, Bond & Kagitdbasi，2007) that assumed external

validity of imported assessment tools and theories for the Chinese (e.g. Zheng &

Huang, 2005). However, it is note worthy that even American-derived narcissism

scales may face the problems of construct validity and inconsistency in American

samples. Therefore, there is a need to develop an indigenous Chinese narcissism

scale with good psychometric properties which can address the differences in culture

and historical background (Zhang & Xiao，2006)

Purposes of the Present Study

The present study explores the construct of narcissism among the Chinese

population. In the West, two approaches have been used in studying narcissism. In

one approach, researchers adopted the operational definition of NPD in the DSM

system and created items accordingly to measure narcissism (e.g., Raskin et al.，

1979). In another approach, researchers simply extracted items with face validity

from well-established personality inventories (e.g. The MMPI; Morey et al., 1985) to measure narcissism. In this study, we combined both of these approaches in exploring the construct of narcissism among the Chinese. I

Phase 1: Searching for narcissistic features in the CPAI-2

We first followed the operational definition of NPD in the latest DSM-IV-TR 13

(APA, 2000) and searched for narcissistic personality features from the

Cross-cultural (Chinese) Personality Assessment Inventory (CPAI-2; Cheung, Leung,

Song & Zhang，2001) in order to develop an indigenous narcissism scale, tentatively called the Chinese Narcissism Scale (CNS). We chose the CPAI-2 for two reasons.

First, as an indigenously developed instrument, all items of the CPAI-2 were constructed on the basis of sources such as contemporary Chinese novels and studies of Chinese personality in the psychological literature (Cheung et al., 1996). To enhance comprehensibility, Chinese language teachers in junior high schools were asked to review the items to ensure that the language difficulty level was understandable to the general public. All items of the CPAI-2, therefore, represent the emic or culture-specific expressions of different psychological characteristics among the Chinese rather than Western expressions that are translated into Chinese.

Scales constructed based on these items avoid potential methodological problems associated with translated Western scales (Butcher, 2004). Second, the CPAI-2 has been standardized using a rigorous empirical procedure with a large representative sample from multiple regions of China and Hong Kong. This data base represents a highly valuable source of empirical information that no other Chinese assessment inventory has been able to assemble.

Appendix 1 presents the DSM-NPD criteria set and the corresponding CPAI-2 14 items chosen to assess those criteria. Based on face validity, a total of 29 items from the CPAI-2 were selected in the preliminary stage.

Phase 2: Testing the construct validity and clinical utility of the CNS among different

Chinese samples

To test the construct validity and clinical utility of the CNS, the selected items would be first refined using stringent psychometric criteria (factor loading >.40; item-total correlation > .30; internal reliability >.75). Confirmatory factor analyses were conducted to examine the factorial validity of the narcissism construct across different Chinese samples. Different external criterion variables from the CPAI-2 would also be use to verify the concurrent validity of the CNS.

Among the Axis-I clinical problems, major depression and bipolar disorder were found to associate with narcissism (e.g. Anastasopoulos, 2007; Storm,

Ronningstam, Gunderson & Mauricio，1998; Watson, Sawrie, Greene & Arredondo,

2002). As reported in many case studies, narcissists often exhibit manic behaviors

(e.g. grandiose fantasies) as a defense for the fragile self, but it would get reversed

(depressed) when the defense breaks down (Robinson & Fuller，2003). To examine the clinical utility of the CNS, metric equivalence of CNS and score profiles between normal subjects and patients suffering from mood disorders were compared. 15

Chapter 2

METHOD

Participants

Two datasets were used for this study. Sample 1 involved 1911 (M = 913; F =

965; 33 unidentified) non-psychiatric individuals from both Mainland China (n =

1575) and Hong Kong (n = 336). Subjects ranged in age 18 to 70 for the sample (M

=38.00，SD = 12.56). This dataset was collected in 2001 for the validation of the

CPAI-2 (Cheung et al., 2001).

The second dataset involved 1659 (M = 945; F = 714) psychiatric patients in

Mainland China collected from 2004-2006. Their age ranged from 18 to 60，with the mean of 32.55 years old. Among these patients, 559 cases were diagnosed with schizophrenia, 228 with bipolar disorder, 354 with depression, 371 with anxiety disorder and 147 with substance abuse. In this sample, only patients diagnosed with depression and bipolar disorder (N= 582) were selected for this study (Peselow,

Sanfilipo & Fleve，1995). 16

Measures

The Cross-cultural (Chinese) Personality Assessment Inventory-2 (CPAI-2)

The CPAI-2 (Cheung et al., 2001) is a comprehensive personality assessment tool that comprises 29 personality scales, 12 clinical scale and three validity scales with a total of 541 items. Items are present in the “True or False" format. Internal consistency was satisfactory for both Chinese and Hong Kong samples, with

Cronbach's alpha ranging from .47 to .85 (Cheung, Cheung, Zhang, 2004; Cheung,

Cheung, Zhang et al., 2008). Data of the CPAI-2 were available for both sample 1 and sample 2.

The Chinese Personality Disorders Inventory (CPDI)

The CPDI (Leung, 2004) was developed for the assessment of personality disorders on the DSM-IV-TR basis. The diagnostic criteria of each personality disorder were assessed in a yes/no response format. The average Cronbach's alpha for the ten scales was .69，ranging from .58 (histrionic) to .77 (avoidant). The reliability for narcissistic personality disorder scale is .75. Data of the CPDI were available for sample 2 only.

The whole clinical sample was divided into NPD and non-NPD groups according to their scores on the CPDI-NPD scale. Since we rely totally on self-report that may produce high positive rate in clinical context, we set a very stringent cutoff 17 to define the group status. In the whole clinical sample (N = 1611), patients who did not endorsed any of the nine CPDI-NPD items (N= 256) were classified as the non-NPD group. Patients who endorsed at least eight or more CPDI-NPD items

(N=88) were classified as the NPD group. The group statuses would be used for testing the clinical utility of the CNS. 18

Chapter 3

RESULTS FOR SAMPLE 1

Exploratory Factor Analysis

Using SPSS 13.0, sample 1 was first randomly split into two halves. The first half (N = 985) was used for exploratory factor analysis (EFA) whereas the second half (N = 926) was used for confirmatory factor analysis. In exploratory factor analysis, items with factor loadings lower than .40 were discarded (Floyd & Widman，

1995). Secondly, the item-total correlation criterion was set at .30 or above for the reason of consistency within the scale.

Using the principal component analysis and with the above criteria, the original

29 items were reduced to 16 items. These 16 items showed good item-total correlations (ranging from .30 to .44) and internal reliability (Cronbach's alpha = .77; see Table 1 and Appendix 2). Using varimax rotation, the 16 items presented a clear

4-factor structure. The first factor comprised of five items and was tentatively termed

Self-perceived Superiority. The second factor also had five items, named as

Interpersonal Exploitation. The third and fourth factors both consisted of 3 items, namely, Uniqueness and Fantasies of Greatness. The content of each factor is discussed below (see Table 2 and Appendix 2). 19

Table 1. Reliability and Item-total Correlations (Community Sample, N = 985)

Item Code Corrected Item-Total Correlation Cronbach's Alpha if Item Deleted

VI 0.42 0.76

V2 0.30 0.77

V3 0.37 0.76

V4 0.30 0.77

V5 0.36 0.76

V6 0.37 0.76

V7 0.35 0.76

V8 0.44 0.75

V9 0.32 0.76

VIO 0.39 0.76

VII 0.36 0.76

V12 0.32 0.76

V13 0.38 0.76

V14 0.40 0.76

V15 0.44 0.76

V16 0.35 0.76

Cronbach's Alpha = .77

Please refer to Appendix 2 for the content of each item. 20

Table 2. Exploratory Factor Analysis (N = 985) for Community Sample

Item Code 12 3 4

V7 0.72

V13 0.71

V8 0.45

VI0 0.43

V3 0.41

V12 0.64

V9 0.62

VI1 0.62

V15 0.51

V5 0.41

V16 0.80

V14 0.72

V4 0.53

V2 0.74

V6 0.69

VI 0.50

Variance explained 12.40% 12.09% 11.74% 10.96%

Note: Factor loadings lower than .40 are excluded here.

Please refer to Appendix 2 for the content of each item. 21

Factor 1: Self-perceived superiority

This factor resembles several diagnostic criteria of NPD in DSM-IV-TR (APA,

2000)，including grandiosity and need for admiration. This feature was also captured in other narcissism assessment tools {Superiority over Others in the NPI, Emmons,

1984; Raskin et al., 1979; Diagnostic Interview for Narcissism, Gunderson,

Ronningstam & Smith，1991) and theories. As the EFA results showed, this factor explained the largest amount of variance among the four factors (12.4%), indicating the importance of this feature in describing narcissism among Chinese people.

Principal items includes "...I would have outdone many people...", "My abilities are much greater than those ...�� "Ofte’ n others are jealous of my good idea...".

Factor 2: Interpersonal Exploitation

The second factor, interpersonal exploitation, extracted 12.09 percent of variance. Typical items include "...sacrifice the interest of others", "... I will approach someone even if I do not like the person", "... take advantage of others weakness...". It is similar to interpersonal exploitation in the DSM criteria. The item

"I always exaggerate my achievements" is not directly related to interpersonal exploitation and its factor loading is the smallest among the other items. 22

Factor 3: Uniqueness

This factor extracted 11.74 percent of the variance and resembles the description of third criterion in DSM-IV-TR, "believes that he or she is special and unique and can only be understood by ... other special or high status people".

Defining items includes "no one understands me".

Factor 4: Fantasies of Greatness/Need for Admiration

This factor resembles the second criterion of the DSM diagnosis, "is preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love", and explained 10.96 percent of variance. In total, the four factors explain 47.2 ‘ percent of the total variance of the dataset (see Table 2). 23

Confirmatory Factor Analysis

This 4-factor model was tested in the second half of sample 1 (N = 926)，using confirmatory factor analysis (Figure 1). The chi-square was significant (chi-square

(98) = 285.16,/? < .05)，and other goodness-of-fitness indices suggested a reasonable fit of the model (CFI = .90, AGFI = .95, RMSEA = .05). As shown in the model, all the paths were significant, indicating that they were all important in describing narcissism among Chinese people. The replication of the previous factor structure in another community sample suggested that the 4-factor model is stable across different community samples. 24

Figure 1. Confirmatory Factor Analysis in Normal Sample (Standardized Results; N =926)

Chi-square = 285.155, df = 98,/? < .05 . V3 ^.915 CFI = .896, AGFI = .945, RMSEA = .047 ^

Note: * p < .05 .403*, // .400>y^f V7 ^~ .917

^elf-perceivedV/^ .S92*| ~ ^_

/// \ ^ VIO .919 // 二 // ^ V13 ^~~ .922

/ / —883

/ / \ .470. / / \ /s^ V9

Y .396* 、 V15 .921

\ \ V4 \ 〉(^^iquenej^^^^X^ V14 ^.706

\\ / 、 V16 ^~ .730

\ .354* \\ Jf VI .895 \ /^^^asiesoTx ^^ \ r Greatness/ Need __.548* > V2 ^~~ .836 Nqr^dmiratipiK — 、 V6 ^ .778

Please refer to Appendix 2 for the content of each item. 25

Concurrent Validity of the CNS

Tables 4 presents the correlations between CNS and other relevant CPAI-2

personality variables among male and female subjects of the whole community

sample (N = 1911). The correlation pattern provided support to the concurrent

validity of the CNS. For example, CNS correlated positively with Face (male: r

=.48; female: r = .47)，Self-Orientation (male: r = .36; female: r = .44)，Antisocial

Behavior (male: r = .63; female: r = .62)，Paranoia (male: r = .65; female: r = .70)，

Hypomania (male: r = .68; female: r = . 64); and negatively with Harmony (male: r =

-.42; female: r = -.40) and Interpersonal Tolerance (male: r = -.38; female: r = -.38).

Two correlation coefficients worth commenting in Table 3. First, the CNS

showed moderately weak negative correlation with age, implying that older people are less narcissistic then younger people {r = -.22, p < .05). This is in line with previous American studies. In addition, the CNS did not show significant correlation with Extravers ion of the CPAI-2 (r = .03，p = .197)，which contradicts American findings that narcissism is associated with extroversion. These two findings will also be discussed in later section. Table 3. Correlations between CNS and relevant CPAI-2 Variables (Community Sample: M = 913’ F = 965)

1 2 3 4 5 6 7 8 9 10 11 12

1 Emotionality 0.53 0.39 -0.33 0.21 0.50 -0.40 -0.26 0.43 0.31 0.44 0.43

2 Inferiority vs Self-Acceptance • 0.55 0.40 -0.44 0.19 0.67 -0.35 -0.36 0.45 0.40 0.51 0.32

3 Face 0.40 0.37 -0.33 0.14 0.30 -0.16 -0.28 0.29 0.28 0.34 0.32

4 Internal vs External Locus of Control -0.35 -0.44 -0.29 -0.24 -0.34 0.16 0.33 -0.28 -0.24 -0.31 -0.21

5 Self vs. Social Orientation 0.23 0.22 0.10 -0.18 0.24 -0.15 -0.22 0.42 0.33 0.38 0.35

6 Depression 0.52 0.69 0.31 -0.34 0.25 -0.39 -0.32 0.57 0.51 0.63 0.36

7 Harmony -0.47 -0.39 -0.18 0.19 -0.16 -0.47 0.26 -0.49 -0.34 -0.45 -0.37

8 Interpersonal Tolerance -0.35 -0.49 -0.29 0.38 -0.20 -0.37 0.27 -0.32 -0.31 -0.36 -0.16

9 Antisocial Behavior 0.52 0.50 0.29 -0.28 0.30 0.59 -0.55 -0.34 0.65 0.68 0.57

10 Distortion of Reality 0.42 0.53 0.31 -0.28 0.32 0.62 -0.39 -0.34 0.60 0.65 0.55

11 Paranoia 0.47 0.54 0.34 -0.31 0.32 0.65 -0.47 -0.37 0.64 0.68 0.53

12 Hypomania • 0.53 0.42 0.38 -0.25 0.29 0.45 -0.41 -0.23 0.63 0.60 0.58

13 n 0.40 0.40 0.42 -0.43 0.33 0.37 -0.27 -0.42 0.46 0.43 0.54 0.49

14 G 0.37 0.26 0.29 -0.22 0.19 0.31 -0.34 -0.21 0.50 0.34 0.43 0.47

15 O 0.41 0.53 0.27 -0.32 0.33 0.53 -0.39 -0.34 0.53 0.45 0.61 0.38

16 f4 0.32 0.20 0.38 -0.11 0.16 0.19 -0.21 -0.08 0.33 0.31 0.30 0.61

17 Total 0.52 0.48 0.48 -0.39 0.36 0.48 -0.42 -0.38 0.63 0.53 0.65 0.68

Note. All correlations are significant at .001 level.

• overlap with the CNS (Hypomania: 2 items; Inferiority vs Self-Acceptance: 1 items)

Lower diagonal: male output; Upper diagonal: female output.

FhSelf-perceived Superiority F2: Interpersonal Exploitation O: Uniqueness f4: Fantasies of Greatness/ Need for Admiration 27

Comparison between Gender, Location and Age-groups

Table 4 presents the mean differences of the factor and total scores of the CNS across gender and location (Hong Kong and Mainland China). Male participants scored significantly higher than female participants in Factor 2 (Interpersonal Exploitation), Factor 4 (Fantasies of

Greatness/Need for Admiration), and the total score of CNS. Mainland Chinese scored significantly higher in Factor 1 (Self-perceived Superiority), Factor 2 (Interpersonal

Exploitation), Factor 4 (Fantasies of Greatness/Need for Admiration), and the total score of

CNS than their Hong Kong counterparts.

The one-child-policy effect was tested in the mainland participants only (N =1575).

Participants from mainland China aged below 21 (bom after the one-child policy in 1979) scored significantly higher than participants aged equal to or over 21 in terms of the total score and Factor 4 of the CNS. The may support the effect of one-child-policy in development of narcissistic personality. 28

Table 4. Comparison of CNS scores across Gender, Location and Age Groups.

Gender Location Age 21 (Mainland Onlv)

Male Female Mainland HK Age<21 Age>=21

N=913 N = 965 N= 1575 N = 336 N = 60 N = 1423 n 1.60 1.55 1.64* 1.27 1.40* 1.65 f2 1.17* 0.94 1.11* 0.80 1.35 1.10 n 0.72 0.91 0.72 0.70 .92 0.71 f4 1.05* 0.75 .95* 0.64 1.41 0.94

Total 4.53* 3.95 4.42* 3.42 5.13* 4.39

* independent t-tests significant at .05 level

FhSelf-perceived Superiority F2: Interpersonal Exploitation D: Uniqueness f4: Fantasies of Greatness/ Need for Admiration 29

Chapter 4

RESULTS FOR SAMPLE 2

Internal-reliability and Item-total Correlation

Table 5 presents the reliability and item-total correlations of the CNS among the

mood-disordered patients (N = 582). The Cronbach's alpha was .79 and all the item-total correlations were above .30，supporting the validity of the CNS when it was used with the clinical sample.

Table 5. Reliability and Item-total Correlations of the CNS among the Clinical Sample

Item code Corrected Item-Total Correlation Cronbach's Alpha if Item Deleted

VI 0.40 0.78

V2 0.36 0.78

V3 0.33 0.78

V4 0.37 0.78

V5 0.46 0.77

V6 0.44 0.77

V7 0.42 0.78

V8 0.46 0.77

V9 0.31 0.78

VI0 0.43 0.78

VII 0.37 0.78

V12 0.38 0.78

VI3 0.46 0.77

V14 0.30 0.79

VI5 0.33 0.78

V16 0.36 0.78

Cronbach's Alpha = .79

Please refer to Appendix 2 for the content of each item. 30

Cross-validating the Factor Structure in the Clinical Sample

The 4-factor model was cross-validated in the clinical sample of mood-disordered

patients {N= 582; Depression = 354; Bipolar disorders = 228). Sequential model-fitting

technique was used to establish the invariance of the model across the two mood-disordered

groups. First, the two patient groups were fitted to the same model as established in the

community sample. The model showed reasonable fit to the data (/ (196) = 323.22, AGFI

=.904，CFI = .897，RMSEA = .034). After that, the factor loadings were constrained to be

the same across the samples, and the simpler model still fitted the data reasonably well (/

(208) = 339.20，AGFI = .905，CFI = .894，RMSEA =.031; A/ (12) =\5M,p> .05).

Structural invariance was also tested by constraining the factor covariance across the

samples (/ (214) = 350.59, AGFI = .905，CFI = .893，RMSEA = .034; A/ (6) =11.39,p

> .05). Lastly, the factor variances were constrained to be the same across the samples, with

non-significant chi-square change as the evidence of invariant factor variances (/ (218)=

355.22, AGFI = .923，CFI = .898，RMSEA = .031; A/ (4) =4.63, .05). These results

revealed that the 4-factor model can be represented well in both the bipolar and depression

patient groups, with factor loadings and factor correlations being equal across the samples.

The summary of metric equivalence is shown in Table 6. Model summary of the

structural invariant model is presented in Figure 2. 31

Table 6. Summary of fit indices for structural equation models

Model /(df) AGFI CFI RMSEA A/(A df) p-value

Configural Invariance 323.22(196) .90 .897 .034 - -

Factorial Invariance 339.20 (208) .91 .894 .031 15.98 (12) >.05

Structural Invariance 350.59(214) .91 .893 .034 11.39(6) >.05

Factor Variances Constrained 355.22 (218) .923 .898 .031 4.63 (4) >.05 32

Figure 2. Structural Invariance of CNS across Depressed and Bipolar Patients.

Chi-square = 355.22, df = 218,p < .05 . V3 M.913 CFI = .898, AGFI = .923, RMSEA = .031 产

Note: * p < .05 .409* /

/ * V7 ^——.865 / .soiy^l

碎-perceh^^^^Y^ .512; I ^ L_ .859 I ^

/ \ ^ VIO ^ .885 // 二 / ^ V13 .864

/ / ��

// y V5 .851

/ \ .948

(「. ) vu h。9

:[/ ^ V12 卜2

Y .223* VI5 <<.931

\ A ~ V4 —

\\ / 、 V16 M.649

\ .191* I 1 \\ ^ VI ~ .921 M .389*^ \ /^fantasieToTx ^^

\ (^Greatness/ Need ——.626* ^ V2 ^——.780 ^-^cu^Admiratipir

、 V6 —^ .741

Please refer to Appendix 2 for the content of each item. 33

Concurrent Validity of the CNS in the Clinical Sample

Table 7 presents the correlations between CNS and other relevant CPAI-2 variables among mood-disordered patients. The pattern of correlations was similar to that of the community sample. The CNS total score correlated positively with Self-Orientation (male: r

=.49; female: r = .53)，Face (male: r = .41; female: r = .39), Antisocial Behavior (male: r

=.64; female: r = .68)，Distortion of Reality (male: r = .52; female: r = .57), and negatively with Harmony (male: r = -.37; female: r = -.33) and Interpersonal Tolerance (male: r = -.40; female: r = -.42). The CNS also correlated moderately with Inferiority vs. Self-acceptance

(male: r = .39; female: r = .40)，and strongly with Hypomania (2 overlapped items; male: r

=.71; female: r = .71). Table 7. Correlations between CNS and the relevant CPAI-2 Variables in the Clinical Sample (Mood Disorder: M = 282, F = 296)

1 2 3 4 5 6 7 8 9 10 11 12

1 Emotionality 0.50 0.42 -0.38 0.22 0.45 -0.34 -0.25 0.38 0.24 0.35 0.38

2 Inferiority vs Self-Acceptance» 0.49 0.53 -0.51 0.14 0.72 -0.20 -0.45 0.39 0.35 0.52 0.19

3 Face 0.40 0.31 -0.32 0.10 0.42 -0.02 -0.35 0.19 0.15 0.25 0.25

4 Internal vs External Locus of Control -0.25 -0.44 -0.25 -0.25 -0.44 0.02 0.33 -0.38 -0.31 -0.40 -0.27

5 Self vs. Social Orientation 0.20 0.22 0.15 -0.27 0.23 -0.15 -0.17 0.50 0.33 0.41 0.41

6 Depression 0.42 0.72 0.19 -0.46 0.20 -0.17 -0.37 0.38 0.32 0.47 0.08

7 Harmony -0.35 -0.30 -0.04 0.09 -0.08 -0.35 0.13 -0.43 -0.26 -0.38 -0.31

8 Interpersonal Tolerance -0.28 -0.46 -0.30 0.31 -0.19 -0.37 0.35 -0.28 -0.24 -0.38 -0.13

9 Antisocial Behavior 0.37 0.39 0.13 -0.25 0.33 0.45 -0.58 -0.37 0.62 0.69 0.63

10 Distortion of Reality 0.19 0.34 0.08 -0.19 0.24 0.37 -0.45 -0.36 0.68 0.74 0.59

11 Paranoia 0.30 0.49 0.17 -0.32 0.33 0.50 -0.50 -0.40 0.72 0.77 0.54

12 Hypomania * 0.41 0.18 0.27 -0.15 0.42 0.15 -0.26 -0.17 0.54 0.51 0.48

13 fl 0.37 0.25 0.33 -0.38 0.43 0.26 -0.27 -0.45 0.54 0.45 0.54 0.57

14 C 0.31 0.23 0.32 -0.18 0.24 0.16 -0.31 -0.19 0.49 0.41 0.44 0.49

15 B 0.40 0.49 0.20 -0.31 0.45 0.45 -0.39 -0.36 0.52 0.37 0.55 0.36

16 f4 0.33 0.15 0.34 -0.15 0.31 0.09 -0.16 -0.09 0.30 0.27 0.25 0.61

17 total 0.48 0.39 0.41 -0.37 0.49 0.33 -0.37 -0.40 0.64 0.52 0.62 0.71

Note. All the correlations are significant at the .01 level.

• overlap with the CNS (Hypomania: 2 items; Inferiority vs Self-Acceptance: 1 items)

Lower diagonal: male output; Upper diagonal: female output.

Fl :Self-perceived Superiority F2: Interpersonal Exploitation f3: Uniqueness f4: Fantasies of Greatness/ Need for Admiration 35

Clinical Utility of the CNS

Comparison between clinical and community samples

To explore the clinical utility of the CNS, CNS scores across the community

sample (N = 1911) and mood-disordered patients at different mood states, including major depression (N = 351), manic (N = 162) and manic depressed (N = 58) were compared. Results (see Table 8) showed that among the four groups, manic patients scored highest on all the four factors. Interestingly, bipolar disorder patients at the depressive phase were not different from the manic phase patients in terms of

Fantasies of Greatness. In addition, factor 3 (Uniqueness) showed a distinction between the patient and community samples.

Table 8. Univariate Comparisons across Four Groups and Scheffe Tests

Manic Normal Depressed Manic DV One-way ANOVA Depressed (N = 1911) (N = 351) (N= 162) (N=58)

CNS Total F(3,2365) = 53.72* 4.24(3.28)。 5.10(3.35)" 7.66 (3.95)" 5.70 (3.81)"

CNS Factors

Self-perceived Superiority F (3,2365) = 21.36* 1.57(1.41)" 1.75 (1.47)"' 2.51(1.54)" 1.93 (1.63�

Interpersonal Exploitation F (3,2365) = 41.09* 1.06(1.22)" 1.20(1.23)" 2.22(1.49)= 1.43(1.41)"

Uniqueness F (3’ 2365) = 29.76* .71 (.95)" 1.11 (1.06)- 1.26(1.10)- 1.14(1.03)°

Fantasies of Greatness F (3，2365) = 29.70* .90 (.99)" 1.03 (1.04)" 1.68 (1.04� 1.20(1.02)"

P<.05

Superscripts indicated the results of Scheffe Tests, a > b > c — --

36

Correlations with other Personality Disorders

Table 9 shows the correlations between CNS and the scores of the 10

personality disorders as assessed by the CPDI (Leung, 2004). As expected, the

correlation between CNS and cluster B personality disorders were the highest, r

=.71 for narcissistic PD, r = .60 for antisocial PD, r = .58 for borderline PD, and r

=.60 for histrionic PD. CNS also showed moderate correlation with other

personality disorders (e.g. dependent scale: r =52). Lastly, controlling Depression

caused significant drop of correlations between CNS and schizoid personality

disorder (from .45 to .28) and avoidant personality disorder (from .46 to .29). This

excluded the mood effect on the correlation matrix.

Table 9. Correlations between CNS and the 10 Personality Disorders as Assessed by CPDI.

CNS 123456789 10

CNS 0.28 0.49 0.46 0.66 0,53 0.43 0.54 0.29 0.42 0.42

1 Schizoid 0.45 0.34 0.49 0.33 0.23 0.30 0.35 0.40 0.36 0.36

2 Paranoid 0.58 0.47 0.53 0.52 0.47 0.48 0.41 0.43 0.42 0.50

3 Schizotypal 0.56 0.60 0.60 0.51 0.42 0.50 0.50 0.38 0.46 0.44

4 Narcissistic 0.70 0.42 0.57 0.56 0.58 0.47 0.59 0.29 0.47 0.46

5 Histrionic 0.56 0.29 0.50 0.46 0.59 0.51 0.49 0.28 0.49 0.47

6 Borderline 0.58 0.50 0.58 0.62 0.53 0.52 0.52 0.35 0.46 0.40

7 Antisocial 0.61 0.45 0.48 0.58 0.62 0.51 0.59 0.22 0.42 0.36

8 Avoidant 0.46 0.57 0.55 0.52 0.40 0.34 0.56 0.36 0.53 0.43

9 Dependent 0.54 0.51 0.52 0.57 0.53 0.52 0.60 0.50 0.65 0.47

10 Compulsive 0.48 0.43 0.53 0.50 0.49 0.49 0.46 0.41 0.49 0.52

Note: All correlation coefficients are significant at .01 level.

Partial correlations (controlling for depression) were presented in the upper diagonal. 37

Differentiating between NPD and non-NPD groups

The CNS means in the non-NPD group and the NPD group were 2.89 and 10.95 respectively. Independent t-test showed that the difference was significant {p < .05), indicating that the CNS can differentiate between the NPD and non-NPD patients

(see Table 10).

Logistic regression analysis was also conducted to assess the utility of the four

CNS factors (Self-perceived Superiority, Interpersonal Exploitation, Uniqueness,

Fantasies of Greatness) in predicting NPD status (NPD group : CPDI scoring > 7; non-NPD group : CPDI scoring < 2).

A test of the full model with all four predictors against a constant-only model was statistically significant, / (4) = 192.43,/? < .05, indicating that the predictors, as a set, reliability distinguished between NPD and non-NPD patients. The

Table 10. Comparison of CNS between NPD and non-NPD Patients

DV NPD (N = 256) Non-NPD (N= 88) t-test p-value

CNS Total 10.95 (2.84) 2.89 (2.26) 19.6 (83.33) 0.00

Self-perceived Superiority 3.76 (0.93) 0.87(1.09) 18.60 (233) 0.00

Interpersonal Exploitation 2.94(1.38) 0.63(0.87) 12.00 (72.92) 0.00

Uniqueness 2.04(1.07) 0.75(0.92) 9.01 (234) 0.00

Fantasies of Greatness 2.3 (0.79) 0.65 (0.83) 13.50(230) 0.00 38 classification was impressive, with 96.4% of non-NPD and 84.5% of NPD statuses correctly classified based on the predictors. Table 11 shows the statistics of individual predictors. As shown in the Wald tests, factors 1，2 and 4 were significant at predicting NPD status.

Table 11 Logistic Regression Analysis of NPD/ non-NPD as a Function of CNS Factors

Variables B Wald df Sig. Odds Ratio

F1 1.35 17.72 1 .00 3.85

F2 1.10 11.70 1 .00 3.00

F3 .45 1.89 1 .17 1.58

F4 .90 5.40 1 .02 2.46

Constant -7.81 37.56 1 .00 .00

Fl:Self-perceived Superiority F2: Interpersonal Exploitation f3: Uniqueness f4: Fantasies of Greatness/ Need for

Admiration 39

Chapter 5

DISCUSSION

Narcissism is a well-known personality construct in the Western individualistic society. However, it is unclear whether this personality construct is generalizable to a collectivistic culture like the Chinese which put strong emphasis on collective well-being rather than individual glory. The present study explores the construct of narcissism among the Chinese. We first searched for narcissistic personality features in the CPAI-2 (Cheung et al., 2001)，which contains indigenously developed personality items for the Chinese, and attempted to construct a Chinese Narcissism

Scale (CNS). Then, we proceeded to examine the construct validity and clinical utility of the CNS in a community as well as a clinical sample.

Narcissistic Personality Features among Chinese

Although there is no specific measure of narcissism in the CPAI-2 (Cheung et al., 2001)，we were able to find numerous personality items that resemble NPD diagnostic criteria in the DSM-IV-TR (APA, 2000). This discovery indicated that personality features resembling narcissism in Western literature (Kemberg, 1986;

Kohut, 1986) do exist among the Chinese. After rigorous psychometric screening procedures, 16 CPAI-2 items with good face validity in measuring narcissistic 40

personality features and satisfactory internal consistency (alpha = .77 & .79) were

found. Factor analytic procedures revealed that these 16 items clustered together into

four components that resembled the main narcissistic characteristics described in

Western literature. Factor 1 {Self-perceived Superiority) and Factor 2 {Interpersonal

Exploitation) correspond closely to Millon's (1996) two core features of narcissistic

personality disorder. Factor 3 {Uniqueness) and Factor 4 {Fantasies of Greatness)

also resemble important narcissistic features as described in the DSM-IV-TR (APA,

2000) and Diagnostic Interview for Narcissism (DIN; Gunderson, Ronningstam &

Bodkin, 1990).

Close examination of items in the extracted factors revealed some interesting

phenomena in the expression of narcissistic personality features among the Chinese.

First, in Western measures of narcissism such as the NPI (Raskin et al, 1979)，sense

of grandiosity or superiority is often expressed in a direct manner (e.g., “1 see myself

as a great leader", or “I am an extraordinary person"). In the CNS, however, the

sense of superiority (Factor 1) is expressed in a rather indirect way (e.g., "I'm better

than others at most things, but just don't get the opportunity to show it", or "I am just

unlucky, otherwise, I would be way ahead of most people"). Not only could we not

find items to describe certain narcissistic features, we also found certain related

items failed to cluster together as did in American scales. For example, "I often 41 exaggerate my achievements" and "My ability is better than most of other people" were excluded in the exploratory factor analyses, which is contradictory to the typical content of American scales. Hamamura, Heine and Paulhus (2008) suggested that due to different cultural backgrounds, East-Asian individuals may respond to such items in a more ambivalent way whereas Westerners may endorse those features in a direct and straightforward manner. Similarly, Kurman (2008) pointed out that in collectivistic culture, self-enhancement is often expressed in a way that does not contradict the modesty norms. It is possible that among the Chinese, narcissism may be expressed in a relatively subtle and indirect manner.

Secondly, we encountered difficulties in finding appropriate indigenous personality items of the CPAI-2 that describe the Sense of Entitlement. Ronningstam

(2005) indicated that the sense of entitlement reflects the social aspect of narcissism which is characterized by unreasonable expectations of especially favorable treatment from others. In the NPI (Emmons, 1987; Raskin et al, 1979), related items include ‘‘I expect a great deal from other people", “1 will never be satisfied until I get all that I deserve", “I get upset when people don't notice how I look when I go out in public". The lack of similar items in the CPAI-2 may again reflect that in Chinese culture, self-enhancement is expressed in a subtle and indirect manner that does not contradict the modesty norms. 42

Gender Difference in Narcissism

In line with American studies of narcissism, males scored significantly higher than females in the CNS (Akhtar & Thompson，1982; Morey, Waugh & Blashfield，

1985; Tschanz, Morf& Turner，1998; Watson, Grisham, Trotter & Biderman，1984;

Wright, O'Leary & Balkin，1989). Wright et al. (1989) suggested that such difference is due to different socialization each gender encountered, with men more emphasized on self-definition in terms of ability and women on interpersonal connection (e.g. family). When the self-esteem is threatened, women may resolve from interpersonal relationship whereas men may defend themselves by denying failure and self-aggrandization. This situation may be more exaggerated among

Chinese because in traditional Chinese value, boys are always more treasured then girls, and consequently leading to higher proportion of "little male emperors" in the current adult generation (Mcloughlin, 2005).

In addition, most narcissism scales (including the CNS) comprise more features related to ability attributes (e.g. leadership, working performance) rather than physical appearance (e.g. beauty). This may also contribute to the higher score on narcissism for males than for females. Since the relative importance of physical appearance are different between men and women (Chen & Jackson, 2007; Jackson

& Chen，2008), we speculated that the inclusion of such items may alter the gender 43 difference of narcissism. However, in the CPAI-2, we could not find obvious items that describe one's self-absorption toward physical appearance.

In terms of gender differences in narcissism, Tschanz, Morft and Turner (1998) suggested that Exploitiveness/Entitlement of the NPI (Raskin et al, 1979) may carry less weight in measuring narcissism in female sample. One possible explanation is that such social behavior is more unacceptable among females than males, because females are socialized to be socially more sensitive and considerate. This finding suggests that narcissism may express differently in male and female subjects.

Age Differences in Narcissism

It was shown that mainland participants bom after the one-child policy (age under 21) scored higher than those who were bom before the policy. This finding may suggest that single child status is somehow related to elevated narcissism level

in the new Me generation. However, our findings also indicated that age has a small

but significant negative correlation with narcissism, replicating finding in previous

American studies (Ames, Rose & Anderson，2006; Watson et al, 1984). It is possible

that narcissistic personality features may decline with age as individuals mature and

accumulate more life experience (Paris, 2003). Therefore the difference found for

one-child policy may be partly due to the age effect in narcissism. In addition, since

information on single child status and parenting styles were not available in our 44

datasets, any conclusion concerning the effect of single child status is only

speculative and await further empirical confirmation in future studies.

Narcissism and Psychosocial Adjustment

Many previous studies compared narcissism against the five factor model (e.g.

Costa & McCrae，1992). According to the meta-analysis by Saulsman and Page

(2004), narcissism is negatively correlated with Agreeableness, and positively with

Extroversion. In our study, CNS correlated negatively with Harmony and

Interpersonal Tolerance. CNS also showed moderately strong association with Face and Self vs. Social Orientation, suggesting narcissist's concern about their sense of self instead of social relationship.

However, the CNS did not show significant correlation with Extraversion of the

CPAI-2. In Western culture, narcissism is somehow considered as a necessary attribute of leaders, who are often charismatic and good at socializing with people

(Rosenthal & Pittinsky，2006). The current results may suggest that narcissism in

Chinese is not considered as a good attribute in leadership, which may probably be due to its contradiction to the collectivistic cultural norm.

In line with previous research, substantial associations were found between narcissism and mood related scales such as Depression, Hypomania and

Emotionality (Peselow et al., 1995). The current study also found that the levels of 45

narcissism differed by the mood states of bipolar disorder patients (Stormberg,

Ronnignstam, Gunderson & Tohen, 1998). Stormberg et al. (1998) cautioned that

assessment of narcissism may be influenced by mood state, such as inappropriately

diagnosing NPD in bipolar disorder patients. Although the correlation between

Hypomania and the CNS maybe confounded by the overlapping of 1 item, the significant difference between manic and depressed groups still supported the relationship between mood state and narcissism.

Some previous studies showed that NPI was negatively related to depression

(Rose, 2002; Sedikides et al., 2004), suggesting the existence of a healthy form of narcissism. Findings of the present study showed that Chinese narcissism is positively associated with many clinical scales, including depression of the CPAI-2.

Emmons (1984) found that for the NPI, only Interpersonal Exploitation showed association with psychological maladjustment; whereas in the CNS, all four factors were associated with psychological maladjustment. A tentative explanation provided here is that the tolerance of narcissism in collectivistic culture is much lower than that in individualistic culture. As a result, narcissists in Chinese culture may receive more disapproval and experience more emotional distress.

Clinical Utility of the Narcissism Construct among Chinese

Previous studies showed that NPD features were related to many disordered 46 personality features, particularly histrionic personality disorder (Chabrol, Rousseau,

Callahan & Hyler, 2007; Millon, 1985), antisocial and paranoid personality disorders

(Morey et al.，1985). Similar correlations between narcissism and antisocial, paranoid and histrionic personality disorders were also found in our study, suggesting narcissism among the Chinese is also related to multiple disordered personality features. According to Millon (1985), narcissistic and histrionic personality disorders are similar to each other in terms of their need for admiration.

However, histrionic people are more conformed to social norm; whereas narcissistic people, based on their sense of uniqueness, are likely to violate social conventions in order to gain attention and admiration from the public. The negative correlation between the CNS and Harmony supported this argument.

Our findings also show that the CNS was able to differentiate individuals with simulated NPD diagnosis from the non-NPD group. The four CNS factors made satisfactory prediction in the statuses of NPD/ non-NPD groups. The correct percentage of classification is great, 94 % from the four factors. Although all the four factors have odd ratios greater than one, Factor 3 {Uniqueness) did not significantly predict the status. This may be due to the correlation between uniqueness and other factors in the CNS. As seen in the CFA model, uniqueness shared nearly 50% of variance with self-perceived superiority, which may take up all the predictive power 47

of the NPD status. All in all, the overall predictive power of the CNS supported its clinical utility and may be utilized in future clinical studies.

Strengths and Limitations of the present study

Several limitations should be noted in understanding the current results. Firstly, we utilized the CPAI-2 as the source of item pool in constructing the CNS because of its comprehensive content and indigenously developed Chinese items. This method was also used in previous studies (e.g. Ashby et al., 1979; Serkownek, 1975) which extracted items from the MMPI for constructing narcissism scale. This procedure is advantageous in scale development because it avoids problems associated with translation of imported Western scales (Cheung & Cheung，2003). Nevertheless, despite of the comprehensive content of the CPAI-2, we still failed to find certain items for some NPD diagnostic criteria of the DSM. Although the absence of specific items may indicate the cultural effect in conceptualizing personality, we suggest further studies using the CNS may also include original items that depict sense of entitlement and self-perceived physical attractiveness to see if these two features can also be included in Chinese narcissism.

Zimmerman, Pfohl, Stangl and Corenthal (1986) suggested that personality disorders cannot be assessed fully by self-report because of patients' lack of understanding to their own personality. This can be especially problematic for 48 narcissistic patients because of their distorted perception of self ability and social relationship. This argument was supported by Gabriel, Critelli and Ee (1994)，who found significant discrepancy between self-report and objective measures of intelligence and physical appearances among narcissistic individuals. This raises concerns whether self-report questionnaire can adequately measure the adjustment level of narcissists. To reflect the psychosocial adjustment of narcissists, future studies may consider using third rater report of participants' psychosocial functioning.

Thirdly, we did not collect data on participant's childhood family status, such as number of siblings and primary caregivers. According to our original idea, participants bom under one-child policy might receive more attention due to the one-child status and indulgent parental style. Although we found significant difference between participants bom before and under one-child-policy, any conclusion regarding the effect of single child status awaits further direct empirical confirmation in future studies.

Lastly, we found narcissism correlated with both hypomania and depression, and significant difference was found between patients of different mood states (i.e. manic, depressed). Disordered personality is usually defined as an internal structure

(Costello, 1996) that is stable over time. The aforementioned results may challenge 49

whether narcissism is a stable internal structure or a variable that changes along

mood states. Future longitudinal studies may test the test-retest reliability of the CNS

and the exact relationships between narcissism and mood.

Despite the above limitations, there are several strengths in the current study.

First, while previous Chinese narcissism studies (e.g.Zheng & Huang 2005) tended

to assume the validity of Western theories, we adopted the emic approach to study

the uniqueness of narcissism expression in Chinese culture. The metric equivalence

also provided factorial validity that is rarely found in previous narcissism scales.

Second, our sample size is large and representative of both community and clinical

populations when compared to previous Western study. Last but not least, our scale

is internally consistent with a relatively few items than other commonly used

narcissism scales.

Overall, we found narcissism is a meaningflil personality construct among the

Chinese population. Our findings also revealed the clinical utility of this personality

construct in predicting psychosocial maladjustment among the Chinese. Considering the unique social change in China and the appearance of the so-called "Me

Generation", more future studies in this area are worthwhile. 50

Appendix L The 9 Diagnostic Criteria of NPD and Related CPAI-2 Items.

DSM Diagnostic Criteria of NPD Related items from CPAI-2

1. Sense of Grandiosity I often exaggerate my achievements.

My abilities are much greater than those of other people but just never got a chance to

demonstrate them.

If it were not for my bad luck, I would have outdone many people in many aspects.

Social activities would be dull without me because I am very important

I put heavy demand on myself. It will be great if other people comply with my standard too.

I lose face when people do not take my favor

My ability is better than most of other people.

2. Grandiose Fantasies 1 would like to be a hero.

I often dream of becoming a star or a hero living in the limelight.

3. Beliefs of Self Uniqueness I like getting to know important people because it also makes me feel important.

It seems no one understands me.

It seems that no one understands me.

I only socialize with people who share the same beliefs with me.

4. Requires Excessive Admiration It bothers me frequently when people do not take me seriously.

If someone despises me I will definitely look for an opportunity to take revenge.

I get angry when my family members talk about my conduct problems.

I get angry when my family tells me how I should live my life.

When someone offends me, I will always bear that in mind.

5. Sense of Entitlement No specific items were found for this criterion

6. Interpersonal Exploitation As long as it is beneficial to me, I will approach someone even if I do not like the person.

I know how to take advantage of others' weaknesses to further my own goals.

Occasionally I sacrifice the interest of others in order to achieve my own goals.

7. Lacks Empathy My friends think that I am self-centered.

I seldom put myself into others' shoes.

I am not aware of being embarrassing others

8. Envious of Others and I can't deal with anyone getting ahead of me in anyway.

Reciprocal Beliefs Often others are jealous of my good idea just because it did not occur to them first.

I tend to point out shortcomings in those who succeed

9. Arrogant Behaviors and To succeed, I have to put my benefits at top priority.

Attitudes I feel contempt for people who are not well educated or of lower class than me.

Note. The copyright of these items belongs to Prof. F. M. Cheung, Prof. K. Leung, and Dr. J. X. Zhang. 51

Appendix 2. Chinese and English versions of the CNS Items

Code Chinese Version English Version

我喜歡結識—些重要人物’這樣會使我感到自己也很 I like getting to know important people because VI

重要。 it also makes me feel important.

V2 我想當一個英雄人物° I would like to be a hero. 別人得罪了我’我會一直記在心裏。 When someone offends me, I will always bear V3 that in mind.

當家人向我建議我應當怎樣做人時，我便會發怒‘ I get angry when my family tell me how I V4

should live my life.

V5 我經常誇大自己的成就。 丨often exaggerate my achievements.

我常幻想自己成爲大明星、大英雄’受到萬眾矚目“丨often dream of becoming a star or a hero V6 living in the limelight.

我運氣太差’否則，我會在各方面超過許多人“ If it were not for my bad luck, I would have V7

outdone many people in many aspects.

我經常因爲別人不重視我而感到煩惱。 It bothers me frequently when people do not V8 take me seriously.

只要對我有利’即使是我不喜歡的人’我也會接近他° As long as it is beneficial to me, I will approach V9

someone even if I do not like the person.

別人常嫉妒我想出的好主意’因爲他們沒有首先想 Often others are jealous of my good idea just VIO

到 ° because it did not occur to them first.

我知道如何利用別人的弱點來達到自己的目的。 丨know how to take advantage of others' VII

weaknesses to further my own goals.

爲了達到自己的目的’我偶爾也會做幾件損人利己的 Occasionally I sacrifice the interest of others in V12

事 » order to achieve my own goals.

我的能力比別人強很多’只不過總是沒有得到表現的 My abilities are much greater than those of

VI3 機會。 other people but just never got a chance to

demonstrate them.

V14 好像沒有人能理解我。 It seems that no one understands me.

VI5 如果被別人輕視，我一定找機會報復。 If someone despises me I will definitely look

for an opportunity to take revenge.

V16 似乎沒有一個人了解我。 It seems no one understands me. Note. The copyright of these items belongs to Prof. F. M. Cheung, Prof. K. Leung, and Dr. J. X. Zhang. 52

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