Article

TRAUMA, VIOLENCE, & ABUSE

1-22
The Role of Narcissism in Aggression ª The Author(s) 2016
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and Violence: A Systematic Review DOI: 10.1177/1524838016650190
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Sinead Lambe1, Catherine Hamilton-Giachritsis1, Emily Garner1,

and Julian Walker2

Abstract
It has long been hypothesized that feelings of inferiority or low self-esteem lead individuals to aggress against those they view as
being threatening. However, recent studies suggest that it is not just the level of self-esteem but stability that is relevant to
understanding this process. As such, researchers have looked to related constructs, such as narcissism, in trying to understand
aggressive behaviors. Narcissism is characterized by a dissociation between an unconscious sense of inadequacy and a conscious
feeling of superiority. A large number of studies examining the relationship between narcissism and violence have recently been
published within both clinical and student populations. This review aimed to systematically collate the findings of such studies and
integrate them within current theories of violence. Electronic literature databases such as Web of Science, MEDLINE, PsychINFO,
EMBASE, Cochrane databases, and LexisNexis (legal database) were searched to identify studies examining the relationship
between narcissism and violence. Twenty articles were included in this review, describing 25 separate samples. Findings suggest
that narcissism is relevant in understanding aggression and violence. This was consistent across both clinical and nonclinical
populations and therefore does not appear to be an artifact of studying either very violent or student samples. Evidence from
student samples strongly supported the association between narcissism and aggression following an ego threat, while studies using
clinical samples did not examine the effect of an ego threat. These findings may have an impact on how we understand, predict, and
reduce violence.

Keywords
narcissism, violence, aggression, ego threat

Key Points of the Research ratios (ORs) ranged from 1.21 to 11.46, suggesting that
narcissism is associated with between a 1.2- and 11.5-
 Both cognitive and psychodynamic models of violence fold increase in violence. Narcissism was a greater pre-
have placed importance on self-esteem. They suggest dictor of more severe violence, and this may have
that implicit low self-esteem, hidden by a veneer of
accounted for the range of ORs, the 1.2-fold increase
explicit confidence as is the case in narcissism, leaves
relating to mild or moderate forms of violence, and
individuals vulnerable to external events that threaten or
studies examining more severe violence (e.g., homicide)
undermine this positive veneer (i.e., ego threats), which
reporting higher ORs.
lead to the activation of negative self-beliefs. Violence is
 Similarly, narcissism was predictive of aggression in
used as a means of protecting against these feelings of
nonclinical student samples. The relationship between
shame by restoring a sense of pride and self-esteem.
narcissism and aggression was most consistently found
 In recent years, a number of studies have examined the following an ego threat. This is in line with psychologi-
relationship between narcissism, ego threat, and vio-
cal models of violence.
lence in forensic, psychiatric, and nonclinical samples.
In addition, a number of narrative reviews have argued
about the importance of narcissism in understanding
violence (Baumeister, Bushman, & Campbell, 2000; 1
Department of Psychology, University of Bath, Bath, United Kingdom
Salmivalli, 2001; Walker & Knauer, 2011). Therefore, 2
Pathfinder Personality Disorder Service, Avon & Wiltshire Mental Health
a review that systematically collates and integrates the Partnership NHS Trust, Bristol, United Kingdom
findings of these studies into current theories of violence
Corresponding Author:
is timely. Sinead Lambe, Department of Psychology, University of Bath, Claverton Down
 This review found narcissism to be a significant predic- Road, Bath, BA2 7AY, United Kingdom.
tor of violence in clinical and forensic samples. Odds Email: [email protected]

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2 TRAUMA, VIOLENCE, & ABUSE

According to Howells and Hollin (1989, p. 4), ‘‘aggression psychoanalytical theory of violence presented by Gilligan
refers to the intention to hurt or gain advantage over people (1996) suggests that violence is a means to an end; it is used
without necessarily involving physical injury; [whilst] violence to attain justice by punishing those whom they feel have pun-
involves the use of strong physical force against another per- ished them, unjustly. Gilligan argued that a personally mean-
son, sometimes impelled by aggressive motivation.’’ Violence ingful insult results in an overwhelming sense of shame. The
has been a long-standing feature of society. In 1996, the World violent person is unable to cope with this shame due to a lack of
Health Organization (WHO) declared violence a major public self-esteem or a healthy sense of pride. Therefore, high self-
health issue with the intention of attracting ‘‘greater attention esteem or pride is seen as a defense against humiliation or
and draw in resources for violence prevention and to stimulate shame, without which violence becomes a way of restoring a
action at local, national, and international levels’’ (Krug, sense of esteem or pride. Similarly, Beck’s (1999) work with
Mercy, Dahlberg, & Zwi, 2002, p. 32). Since then progress has couples led him to suggest that anger arises when the perpe-
been made in decreasing violence both globally and in the trator feels diminished or offended, believes that the offense
United Kingdom, however, it is far from eradicated. In 2012, was unjustified and intentional, and views the offensive act or
there were 1.9 million incidences of violence recorded in the comment as a characteristic of that person, therefore conclud-
United Kingdom (Office for National Statistics, 2014), and ing that the person is deserving of punishment. The more recent
these are known to have high social and financial costs. For cognitive model of violence proposed by Walker and Bright
example, figures released by Trust for London (2011) esti- (2009b) views violence as an attempt to protect against further
mated that domestic violence, which accounts for approxi- injury (humiliation) and the perceived lowering of self-worth
mately one quarter of violence, costs England £5.5.billion in and pride. It proposed that, due to early experiences, individu-
2011. This included costs incurred by police, civil justice, als develop core beliefs about being vulnerable and weak. To
housing, refuge, and health-care services. defend against and hide these beliefs from others, conditional
assumptions develop which manifest as a veneer of confidence
and arrogance (i.e., I must never let others see me vulnerable).
Psychological Models of Violence Social situations that generate embarrassment, or the threat of
The most popular model for understanding violence is Nova- embarrassment, activate these negative core beliefs making the
co’s (1976) cognitive behavioral theory of anger. Novaco sug- individual believe that someone has made them look foolish
gests that anger is triggered by an environmental event, which and that this perpetrator is deserving of punishment.
results in physiological arousal and a number of information-
processing biases including attentional and attribution biases.
However, whether this ‘‘anger response’’ progresses to vio-
Self-Esteem and Violence
lence depends upon the disinhibition of internal control. This In line with these theories, it has been a long-standing view in
disinhibition can come about through a range of factors, includ- psychology that feelings of inferiority or low self-esteem predis-
ing person-specific factors such as high levels of physiological pose people to aggressive or violent behavior (Horney, 1950).
arousal, perception of a low possibility of punishment, and the Although empirical evidence does support this perspective,
use of drugs or alcohol. As such, anger management programs many authors have argued that it is in fact high self-esteem that
typically involve increasing self-awareness of anger, triggers, results in violence. Most notable of these is Baumeister, Smart,
and related behavior coping strategies combined with relaxa- and Boden (1996) who argued that violence results from a very
tion training (Fernandez, 2013). Studies have shown that anger positive view of the self that is threatened. A recent systematic
management can be effective in reducing anger and aggression review that sought to clarify this issue examined 19 studies, 12 of
(DiGiuseppe & Tafrate, 2003). However, studies are often car- which found low self-esteem to be related to violence, 5 found
ried out with nonclinical populations (e.g., students) and rely no relationship, 1 found high self-esteem related to violence, and
on self-report measures (Walker & Bright, 2009a), while 1 reported a curvilinear relationship in which both high and low
research with serious offenders is limited (Beck & Fernandez, self-esteem were related to violence (Walker & Bright, 2009b).
1998; Schamborg & Tully, 2015; Walker & Bright, 2009a). These findings highlight the complexity of understanding the
Furthermore, there is a debate about the theoretical validity relationship between self-esteem and violence.
of anger management programs. Mills and Kroner (2006) Self-esteem is far more multidimensional and dynamic than
found no relationship between anger and violence or recidi- the term suggests, and traditional measures do not reflect this
vism. Similarly, other studies have found that anger does not complexity. Self-esteem measures rely on the assumption that
differ between violent and nonviolent groups (Archer, 2004; they reflect the person’s true acceptance of himself or herself.
Loza & Loza-Fanous, 1999). Regardless of the link between However, self-esteem questionnaires are extremely sensitive to
anger and violence, focusing on the experience of anger alone socially desirable responding, various forms of response biases,
neglects to consider the factors that leave some individuals and related psychological defenses (Johnson, 1997). Thus,
more vulnerable to anger and/or violence-provoking stimuli those scoring high on self-esteem are likely to be a heteroge-
than others. neous group. A high self-reported self-esteem may reflect a
In contrast, some theories have placed humiliation at genuine acceptance of oneself, a desire to give others a picture
the center of understanding violence. For example, the of himself or herself as very good, or it may reflect a sense of

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Lambe et al. 3

high self-esteem that defends against underlying self-doubts or aggression/violence? (b) Is the relationship between narcissism
an unconscious lower self-esteem. It is the later ‘‘subgroup’’ and aggression/violence greater in the presence of an ego
that is thought to be of increased risk of increased aggression threat? (c) Is the relationship between narcissism and aggres-
and violence (Thomaes & Bushman, 2011). sion/violence consistent across clinical and nonclinical
As such, authors have argued that it is not just level of self- populations?
esteem but stability that is relevant. Self-esteem stability refers Before continuing, it would be helpful to clarify a number
to the magnitude of short-term fluctuations that people experi- of semantic and conceptual issues. The terms violence and
ence in their contextually based, immediate feelings of self- aggression are used somewhat interchangeably in the research
worth (Kernis, Cornell, Sun, Berry, & Harlow, 1993, p. 1090). literature and as such will be examined in combination in this
Thus, unstable self-esteem reflects fragile, vulnerable feelings review. However, strictly speaking, laboratory procedures
of immediate self-worth that are influenced by self-relevant measure aggression but not violence insofar as the latter is
events that either are externally provided (e.g., interpersonal limited to acts that cause serious harm to victims (Bushman
rejection) or are self-generated (reflecting on one’s dating pro- et al., 2009). As such, studies using clinical samples are typi-
wess). Kernis, Cornell, Sun, Berry, and Harlow (1993) and cally examining violence (e.g., domestic violence), whereas
Kernis, Grannemann, and Barclay (1989) conducted several experimental studies (e.g., application of noise blast) are typi-
studies regarding this issue, and the findings generally suggest cally examining aggression.
that people with high but unstable self-esteem report the highest In addition, narcissism is a complex construct and is thought
tendencies to experience anger and hostility, whereas people to comprise a number of subcomponents. Component analysis
with high and stable self-esteem report the lowest. This supports on the Narcissistic Personality Inventory (NPI) generated seven
the idea that it is not just the level of self-esteem (high vs. low) subscales: authority, superiority, exhibitionism, entitlement,
but also stability (stable vs. unstable) that relates to aggression. vanity, exploitativeness, and self-sufficiency (Raskin & Terry,
Thus, researchers have looked to newer constructs that capture 1988). A number of studies have looked at the effect of one
both of these elements such as narcissism. A number of studies of more subscales (e.g., entitlement) on violence (Konrath,
have focused on narcissism (e.g., Baumeister, Bushman, & Bushman, & Campbell, 2006). An exploration of these sub-
Campbell, 2000; Bushman & Baumeister, 1998) because it cap- components was beyond the scope of this review, and thus the
tures a self-view that is highly favorable (high self-esteem) and, aim of this study was to explore the construct of narcissism as a
at the same time, vulnerable to ego threat (unstable). whole.

Narcissism and Violence Method

A central feature of narcissism is a dissociation between an Search Strategy
unconscious sense of inadequacy and a conscious feeling of Electronic literature databases, Web of Science, MEDLINE,
superiority (Kernberg, 1975), more recently thought of in terms PsychINFO, EMBASE Cochrane databases, and LexisNexis
of low implicit self-esteem and high explicit self-esteem (legal database), were searched to detect relevant studies. No
(Tafarodi & Ho, 2006). Self-enhancement and grandiosity are restrictions were put in place with regard to publication year.
therefore seen as strategies to regulate internal feelings of The following combination of key words was entered in the
inadequacy by countering them with feelings of superiority, topic/subject search fields of the databases to identify eligible
thereby allowing a person to maintain a sense of pride and publications: Narcissism (MeSH term/Narciss*/ego*/egotism/
self-esteem. Robins, Tracy, and Shaver (2001) suggested that egolistic/egotomania/‘‘high self-esteem’’/‘‘inflated self-
narcissists, more than other individuals, are motivated to seek esteem’’ AND violence (MeSH term)/Aggression (MeSH
out situations in which they can feel pride and avoid situations term)/aggress*/conflict/attack/coerc*/cruel*/bully*/‘‘agonistic
where they might experience humiliations or shame. Bushman behavior’’. These search terms were generated through discus-
et al. (2009) examined the relationship between both self- sion with an experienced researcher in this field (J.W.) and
esteem and narcissism on violence. They found no independent were subjected to thesaurus mapping in both Medline and Psy-
effect for high self-esteem alone, but high self-esteem com- chINFO. Reference sections of included studies and the narra-
bined with high narcissism was related to aggression in the tive reviews were screened to detect additional studies. Finally,
presence of an insult. Hence, it may be that narcissism is central Google Scholar was consulted to check publications that cited
to understanding the relationship between self-esteem and vio- selected studies. The last search was performed in February
lence and aggression. This literature review focuses on the role 2015.
of narcissism as a potential mediator between self-esteem, ego
threat, and violence and aggression.
Selection of Literature
References were imported into endnote, and duplications were
Aim of Systematic Literature Review removed. Titles and abstracts were then reviewed to determine
The aim of this study was to examine the following questions: the selection for full-text reading. Full texts of selected articles
(a) Is there a significant relationship between narcissism and were studied to decide upon eligibility for inclusion. The PECO

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4 TRAUMA, VIOLENCE, & ABUSE

framework used in this review defining the population, expo- Due to the variation in methodology, the NOS was adapted.
sure, comparison, and outcome of interest was as follows: Quality was assessed according to the following criteria:
(1) selection of the study groups (i.e., representativeness of the
 P: Adults aged 18 years or over cases, selection of controls and definition of controls for case–
 E: Narcissism control studies, valid measure of the exposure to primary risk
 C: Statistical examination of the relationship factor), (2) comparability of the groups (i.e., confounding fac-
 O: Aggression and/or violence tors adequately controlled for), and (3) outcome (i.e., valid
assessment of outcome, adequate description of statistical anal-
ysis). If the study fulfilled a criterion, one point was given; and
Inclusion criteria. Studies were included if they (1) were primary
if not, it was awarded zero. A total quality score was then
studies examining the relationship between narcissism and
generated by summing the number of criteria met by each study
aggression or violence in those over the age of 18, (2) reported
out of a possible 10 (see Appendix B).
statistical findings between study variables, (3) were written in
English, and (4) were published in peer-reviewed journals.
There were no restrictions with regard to publication year, but Results
all of the included studies had been published in the last Study Selection
25 years.
The initial search yielded 4,029 articles. Based on title and
Exclusion criteria. Papers were excluded if participants were less abstract, 173 articles were selected for full-text assessment.
than 18 years old; the violence was sexually motivated (e.g., Careful reading of these papers highlighted that there was a
rape, sexual aggression) or politically motivated (e.g., war, sufficient number of studies using objective measures of vio-
terrorism). In addition, studies were excluded if they reported lence or aggression for a systematic review and evidence synth-
only on the subscales of measures of narcissism rather than esis. Therefore, all studies that used subjective reports of
overall score. Single-case studies, reviews, books, commen- violence and aggression such as Buss–Perry Aggression Ques-
taries, unpublished dissertations, and papers written in lan- tionnaire (Buss & Perry, 1992) were excluded, as previous
guages other than English were excluded. studies have shown that self-report aggression questionnaires
are susceptible to socially desirable responding particularly
among those presenting as high in self-esteem (Baumeister,
Interrater Reliability Campbell, Krueger, & Vohs, 2003; Thomaes & Bushman,
Fifteen percent of the titles and abstracts were selected ran- 2011), which is the target sample of this review.
domly using a random-number generator. Two members of the Examination of the reference lists of these articles and those
research team individually assessed each of the papers for elig- of previous narrative reviews revealed one additional article. A
ibility for inclusion. An a priori procedure was followed to search of Google Scholar to check articles that cited included
resolve any interrater discrepancies; in the case of a disagree- studies did not produce any additional relevant articles. Hence,
ment regarding the inclusion of a certain study, both reviewers 20 articles were included in the review. These articles
were asked to reassess the paper for inclusion. If the reassess- described 25 separate samples (Appendix A). The included
ment still led to a disagreement between the reviewers, an studies were conducted on 25 unique samples. Twenty studies
independent third party was also asked to assess the paper in were conducted in different jurisdictions within the United
question, and the decision would be based on the majority States with the remaining studies performed in Canada (3),
decision. Interrater agreement was good with a Cohen’s Norway (1), and the United Kingdom (1).
k ¼ .80, 95% confidence interval [0.413, 1.00]. All extracted
data were checked for accuracy by a member of the research Description of the Selected Studies
team. Disagreements were discussed and corrected with refer-
ence to the original text where appropriate. Design of studies. The designs of included studies were quite
varied. Studies were divided into those examining the relation-
ship between narcissism and aggression or violence (Tables 1
Quality of the Papers and 2) and those examining the relationship between narcis-
Quality measures for systematic reviews of observational stud- sism and aggression in the presence of an ego threat (Tables 3
ies are less well established than in those of randomized con- and 4). Thirteen studies examined the relationship between
trolled trials; a number of measures have been developed, but narcissism and aggression, seven observational studies, and six
none have been fully validated. The Cochrane Collaborative cross sectional. Of the 12 studies examining the effect of an ego
Review Group recommends the Newcastle–Ottawa Scale threat, 10 used an experimental paradigm where participants
(NOS; Wells et al., 2000) for assessing the quality of nonran- were randomized to ego threat condition or no ego threat. Two
domized studies in meta-analyses, as it is comprehensive and were observational studies. All studies that used clinical sam-
has been partly validated (Higgins & Green, 2009). The meth- ples used either an observational or a cross-sectional design,
odologies of studies included in this review were varied and whereas the majority of studies using student samples used an
included cohort, cross-sectional, and experimental designs. experimental design.

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 Table 1. Narcissism and Aggression in Clinical Samples.

Authors Sample Design Measure Findings

Beasley and Target roup: perpetrators Cross-sectional comparison of N: NPI; MCMI (1) Significant difference between DV group
Stoltenberg of DV (n ¼ 49) perpetrators of domestic A/V: physical violence defined as assaults on the and NDV on MCMI narcissism subscale,
(1992), United Control group: nonviolent violence and nonviolent partner’s body confirmed by arrest history F(1, 71) ¼ 10.57, p < .001; DV (M ¼ 72.2,
States but distressed control group or evidence by victim SD ¼ 23.22); NDV (M ¼ 56.73, SD ¼ 19.72)
relationships (NDV; (2) No significant difference between groups
n ¼ 35) on the NPI; DV (M ¼ 17.02, SD ¼ 7.78);
100% male NDV (M ¼ 16.08, SD ¼ 6.94);
Mean age: 34 MANCOVA
Ethnicity: 86% Caucasian
Cale and Lilienfeld Prison inmates Observational study looking at N: NPI (1) Narcissism was significantly related to
(2006), United n ¼ 98 predictors of incidences of A/V: behavior ratings from prison record and aggression (R2 ¼ .14, p < .05)
States 100% male violence informant ratings from prison officers and Multiple regression
Mean age (SD): 23.7 (7.7) counsellors
Ethnicity: 64% African
American; 28%
European; 7% other
Coid (2002), United Prison inmates Observational study looking at N: SCID-II (1) Narcissism predicted violence against
Kingdom n ¼ 81 predictors of incidences of A/V: physical violence toward inmates and inmates (adjusted odds ratio [OR] ¼ 2.84;
100% male violence prison staff rated through review of CI ¼ [1.08, 7.47]; p ¼ .034)
Mean age (SD): 34 (7.58) prisoners’ unit file and discussion with (2) Narcissism predicted violence against staff
Ethnicity: nr prison staff (adjusted odds ratio ¼ 2.84; CI [1.08, 7.42];
p ¼ .031)
Logistic regression
Goldberg et al. Psychiatric inpatients Cross-sectional observational N: NPI (1) No significant difference in Narcissism
(2007), United n ¼ 76 study, participants were split A/V: both physical and nonphysical aggression between aggressive group (16.85) and
States Aggressive group, n ¼ 20 based on ROAS score of 5 against others using ROAS (Sorgi, Ratey, nonaggressive group (M ¼ 14.36)
Nonaggressive group, Knoedler, Markert, & Reichman, 1991) MANCOVA
n ¼ 56 based on chart notes

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26% female
Mean age (SD): 38.6 (11.38)
Ethnicity: nr
Svindseth, Nottestad, Psychiatric Inpatient Cross-sectional study. N: NPI-21 (1) There was a significant correlation between
Wallin, Roaldset, n ¼ 186 Participants divided into high A/V: physical violence observed on the wards aggression and NPI (r ¼ .32; p < .01)
and Dahl (2008), High narcissism group, and low narcissism group and documentation in the medical records Semipartial correlation
Norway n ¼ 98 (2) In the presence of high narcissism (low
Low narcissism group, narcissism ¼ ref); no violence (ref) (OR ¼ 1);
n ¼ 88 mild/moderate violence (OR ¼ 1.21; 95% CI
41% female [0.51, 2.87]; p ¼ .67); severe violence
Mean age (SD): 37.3 (13.4) (OR ¼ 11.46; 95%; CI [2.02, 65.60]; p ¼ .006)
Ethnicity: nr Multivariate logistic regression
(continued)

5
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Table 1. (continued)

Authors Sample Design Measure Findings

Warren et al. (2002), Inmates in maximum Cross-sectional study N: SCID-II (1) NPD significantly predicted current
United States security prison retrospectively looking at A/V: physical aggression defined as incarceration for any violent crime, including
Target group, n ¼ 132 with predictors of incarceration incarceration for a violent offense homicide (B ¼ 1.0 + 0.33, p < .01,
Cluster B PD for violent crime OR ¼ 7.57)
Control group, n ¼ 128 (2) NPD significantly predicted current
without Cluster B PD. incarceration for any violent crime,
100% female excluding homicide (B ¼ 0.80 + 0.26,
Median age ¼ 32 p < .01, OR ¼ 4.92)
Ethnicity: 66% minority, Logistic regression
34% nonminority
Wiehe (2003), Target group: abusive Cross-sectional study N: HSNS (1) abusive parents (AP) exceeded the foster
United States parents (n ¼ 52) comparing abusive and A/V: Physical and nonphysical aggression parents (FP) on measure of narcissism; AP
Control group: foster nonabusive parents defined by investigation for child physical or (M ¼ 30.21; SD ¼ 7.49), FP (M ¼ 22.71;
parents (n ¼ 101) emotional abuse by child protective service SD ¼ 5.24); t ¼ 6.45, p < .05
76% females agencies ANOVA
Age: nr (2) Narcissism was a significant predictor of
Ethnicity: 49% White, 45% aggression (R2 ¼ .28; F ¼ 18.80; b ¼ –.46)
African American, 3% Regression
Hispanic, and 3% other

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Note. The statistical tests are given in bold. NPI ¼ Narcissism Personality Inventory; N ¼ narcissism; A/V ¼ aggression/violence; ROAS ¼ Retrospective Overt Aggression Scale; MCMI ¼ Millon Clinical Multiaxial
Inventory; DSM ¼ Diagnostic and Statistical Manual of Mental Disorders; SCID-II ¼ Structured Clinical Interview for DSM-III for Axis II personality disorder; DV ¼ Domestic violence; NDV ¼ Non-domestic
violence; HSNS ¼ Hypersensitivity Narcissism Scale; MANCOVA ¼ multivariate analysis of covariance; CI ¼ confidence interval; ANOVA ¼ analysis of variance; PD ¼ personality disorder; nr ¼ variable not
measured/reported.
 Table 2. Narcissism and Aggression in Student Samples.

Authors Sample Design Measure Findings

Lobbestael, UG students Observational study where N: HSNS; NPI (1) Narcissism as measured by the NPI
Baumeister, n ¼ 100 participants took part in A/V: physical aggression defined as the was related to aggression (B ¼ 0.244;
Fiebig, and Eckel 100 % male competitive task and then filled in frequency of noise blasts t ¼ 2.49; p ¼ .014)
(2014), United Mean age (SD): narcissism measures administered to fake participant (2) Narcissism as measured by the
States 19.47 (2.16). during a competitive computer task HSNS was not significantly related
Ethnicity: 73% Caucasian, 12% to aggression (B ¼ 0.098; t ¼ .967;
Hispanic, 7% Asian, 6% African p ¼ .336)
American, and 2% Arab Multiple regression
Maples et al. UG students Observational study where N: SCID-II (1) There was a significant correlation
(2010), Study 1, n ¼ 108 participants filled in narcissism A/V: physical aggression defined as between DSM-IV NPD and
United States 45% female measures and then took part in intensity, duration, and frequency of aggression; r ¼ .22; p < .05
Mean age (SD): 19.16 (1.30) competitive task shocks delivered Bivariate correlation
Ethnicity: 80% Caucasian
Maples et al. UG students Observational study where N: SCID-II (1) Aggression was not significantly
(2010), Study 2, n ¼ 134 participants filled in narcissism A/V: physical aggression defined as correlated with DSM-IV NPD
United States 43% female measures and then took part in intensity, duration, and frequency of (r ¼ .15; p > .05)
Mean age (SD): 19.31 (1.67) competitive task shocks delivered Bivariate correlation
Ethnicity: 81.3% Caucasian
McIntyre et al. UG students Observational study where N: NPI (1) High narcissism was not significantly
(2007), United n ¼ 176 participants filled in narcissism A/V: nonphysical aggression defined by related to aggression: narcissism:
States 43 % female measures and then took part in whether or not the player made an low, B ¼ 0, exp(B) ¼ 1, p ¼ referent;
Mean age: 22 simulated war game unprovoked attack during simulated medium, B(SE) ¼ 0.21(0.66),
Ethnicity: 60% White, 20% Asian or war game exp(B) ¼ 1.24; p ¼ .745; high,
Asian American, 11% Black, 3% B(SE) ¼ 0.74 (0.67), exp(B) ¼ 2.09,
Hispanic, 1% Native American, p ¼ .271; very high, B(SE) ¼ 0.86
and 5% other

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(0.64), exp(B) ¼ 2.37, p ¼ .174
(2) In males only, narcissism predicted
greater odds of attacking:
narcissism: low, B ¼ 0, exp(B) ¼ 1;
p ¼ referent; medium, B(SE) ¼ 1.66
(1.03), exp(B) ¼ 5.23, p ¼ .107; high,
B(SE) ¼ 2.77 (1.07), exp(B) ¼ 15.92,
p ¼ .010; very high, B(SE) ¼ 2.46
(1.15), exp(B) ¼ 11.70, p ¼ .032)
Logistic regression
(continued)

7
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Table 2. (continued)

Authors Sample Design Measure Findings

Reidy, Foster, and UG students Observational study where N: NPI (1) A significant relationship between
Zeichner n ¼ 137 after exclusions—original n ¼ participants filled in narcissism A/V: physical aggression defined as narcissism and aggression, B ¼ 0.39,
(2010),United 159, and following demographics measures and then took part in intensity, duration, and frequency of SE ¼ 0.21, exp(B) ¼ 1.48, indicated
States relate to this full sample. competitive task shocks delivered that for every one SD increase in
100% males narcissism, the odds of being an
Mean age (SD): 19.2 (1.4) unprovoked aggressor increased by
Ethnicity: 82.5% Caucasian, 7.3% Asian, 48%
4.4% Black/African American, 1.5% Logistic regression
Hispanic/Latino, 0.7% American
Indian, and 3.6% other
Terrell, Hill, and UG students Observational study where N: NPI (1) A significant main effect for
Nagoshi (2008), n ¼ 150; participants filled in narcissism A/V: physical aggression defined as the narcissism, F(2, 126) ¼ 4.37,
United States 52% female measures and then took part in frequency of noise blasts p ¼ .015, n2p ¼ .065, where
Mean age (SD): 19.27 (2.47). competitive task with fake administered to fake participant participants higher in narcissism
Ethnicity: 73% Caucasian, 11% Latino/ participant during a competitive computer task were more likely to deliver noise
Hispanic, 7% Asian, 3% African blasts than individuals low in
American, 3% Native American, and narcissism
3% other ANOVAS
(2) For males, there was a significant
correlation between narcissism and
aggression (r ¼ .261; p < .05)

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(3) For females, relationship between
aggression and narcissism was not
significant (r ¼ .086; p < .05)
Correlation
Note. The statistical tests are given in bold. NPI ¼ Narcissism Personality Inventory; N ¼ narcissism; A/V ¼ aggression/violence; HSNS¼ Hypersensitivity Narcissism Scale; DSM ¼ Diagnostic and Statistical Manual
of Mental Disorders; SCID-II ¼ Structured Clinical Interview for DSM-III for Axis II personality disorder; UG ¼ undergraduate.
 Table 3. Narcissism and Direct Aggression in the Presence of an Ego Threat.

Authors Sample Design Measure Findings

Barry, Chaplin, and UG psychology students Experimental study randomized to N: NPI Significant main effect for narcissism
Grafeman (2006), n ¼ 120 receive positive or negative A/V: Nonphysical aggression defined as (b ¼ .27, p < .01) with higher narcissism
United States 50% females feedback (ego threat) from false how much they hinder fake participant in related to increased aggression after
Age: nr participant Fishing simulation task (Gifford & feedback.
Ethnicity: 79% Caucasian Gifford, 2000) Significant interaction between feedback
and narcissism (b ¼ .21; p < .05), with
negative feedback predicting an increase
in aggression among participants high on
narcissism
Significant three-way narcissism by
feedback by sex interaction for
predicting changes in aggression,
F(7, 112) ¼ 5.33, p < .001, R2 change ¼
.04. After positive feedback, high
narcissism was associated with slight
increases in aggression for males but not
for females. Following negative feedback,
males with high narcissism showed high
increases in aggression, whereas females
with narcissism demonstrated only slight
increases in aggression
Multiple regression
Bushman and UG psychology students Experimental study randomized to N: NPI Significant main effect of narcissism on
Baumeister (1998), n ¼ 260 receive positive or negative A/V: physical aggression defined as the aggression, F(l, 245) ¼ 13.92, p < .05,
Study 1, United 50% female feedback (ego threat) from false intensity and duration of a noise blast b ¼ 0.06, SE ¼ 0.02, r ¼ .27.
States Age: nr participant administered to fake participant during A significant interaction between
Ethnicity: nr competitive reaction time task narcissism and ego threat, F(l, 245) ¼

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5.04, p < .05, b ¼ 0.08, SE ¼ 0.03,
indicating that high narcissism and an ego
threat resulted in high aggression.
The relationship between narcissism and
aggression was stronger when the
evaluation was negative, F(l, 245) ¼
20.36, p < .05, b ¼ 0.11, SE ¼ 0.02,
r ¼ .37, than when it was positive,
F(l, 245) ¼ 4.59, p < .05, b ¼ 0.05,
SE ¼ 0.02, r ¼ .18, but both were
significant.
Multiple regression
(continued)

9
 Table 3. (continued)

10
Authors Sample Design Measure Findings

Bushman and UG psychology students Experimental study randomized to N: NPI Narcissism was positively related to
Baumeister (1998), n ¼ 140a receive positive or negative A/V: physical aggression defined as the aggression when the evaluation was
Study 2, United 50% female feedback (ego threat) intensity and duration of a noise blast negative, F(l, 254) ¼ 9.62, p < .05,
States Age: nr administered during competitive b ¼ 0.09, SE ¼ 0.04, r ¼ .25, but it was
Ethnicity: nr reaction time task unrelated to aggression when the
evaluation was positive, F(l, 254) ¼ 0.34,
p >.05, b ¼ 0.02, SE ¼ 0.02, r ¼ .10,
respectively
Multiple regression
Bushman et al. (2009), UG psychology students Observational study: All received N: NPI The main effect of narcissism was not
Study 2, United n ¼ 132; negative feedback (ego threat) A/V: physical aggression defined as the significant, b ¼ 0.040, t(128) ¼ 1.86,
States 50% females intensity and duration of a noise blast p < .07
Age: nr administered during competitive In the presence of negative feedback, there
Ethnicity: nr reaction time task was a significant relationship between
narcissism and aggression (r ¼ .25)
Multiple regression
Jones and Paulhus n ¼ 82 Experimental study randomized to N: NPI The main effect of narcissism was not
(2010), Canada 60% Females receive positive or negative A/V: physical aggression: the intensity and significant (b ¼ .16, t ¼ 1.32, p ¼ .19)
Mean age: 20.4 feedback (ego threat) duration of a noise blast administered to There was a significant interaction between
Ethnicity: nr fake participant during competitive narcissism and feedback whereby
reaction time task negative feedback evoked greater
aggression among those high in
narcissism (b ¼ 2.23, t ¼ 2.32, p ¼ .02)
Multiple regression
Kirkpatrick, Waugh, n ¼ 88 Experimental study randomized to N: NPI Main effect of narcissism was not significant
Valencia, and 55% women receive positive or negative A/V: physical aggression defined by the (b ¼ .09, p > .10)
Webster (2002), Age: nr feedback (ego threat) amount of hot sauce put on the false The interaction between narcissism and
Study 1, United Ethnicity: nr participants food feedback was not significant (b ¼ .13;
States p > .05).
When self-esteem was controlled for,

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narcissism was a negative predictor of
aggression (b ¼ .24, p < .05)
Multiple regression
Kirkpatrick et al. n ¼ 75 Experimental study randomized to N: NPI Main effect for narcissism was a significant,
(2002), Study 2, 53% women receive positive or negative A/V: physical aggression defined by the positive predictor of aggression (b ¼ .27,
United States Age: nr feedback (ego threat) amount of hot sauce put on the false p < .05)
Ethnicity: nr participants food The interaction between narcissism and
feedback was not significant (b ¼ .15,
p < .10).
When self-esteem was controlled for,
narcissism was not significant predictor
of aggression in the equation (b ¼ .23,
p > .10)
Multiple regression
(continued)
 Table 3. (continued)

Authors Sample Design Measure Findings

Twenge and Campbell n ¼ 31 Observational study: All received a N: NPI When rejected, narcissism was significantly
(2003), Study 3, 48% women Mean age: 18.9 social rejection (ego threat) by fake A/V: physical aggression defined as the related to aggression (b ¼ 0.12; b ¼ .51;
United States Ethnicity: 74% White and participant intensity and duration of a noise blast t ¼ 2.97; p < .01)
26% racial minority administered during competitive task Multiple regression
Vaillancourt (2013), UG students Experimental study randomized to N: NPI In the negative feedback group, there was a
Study 1, Canada n ¼ 176 receive positive or negative A/V: nonphysical aggression score given to significant correlation between
55% female; feedback (ego threat) from false false university staff member on the narcissism and aggression (r ¼ .26;
Mean age (SD): 18.78 (1.80) member of university staff students’ evaluations of teaching form p < .01)
Ethnicity: 44.3% In the positive feedback group, there was
Caucasian, 21% Asian, not a significant relationship between
and 15.3%, South Asian narcissism and aggression (r ¼ .09;
p > .05)
Correlation
Vaillancourt (2013), UG students Experimental study randomized to N: NPI The narcissism was not significantly related
Study 2, Canada n ¼ 160 receive positive or negative A/V: nonphysical aggression score given to to aggression following negative
50% female feedback (ego threat) from false false university staff member on the feedback (r ¼ .07, p > .05) or positive
Mean age (SD): 19.16 (3.18) member of university staff students’ evaluations of teaching form feedback (r ¼ .00, p > .05)
Ethnicity: 50% Caucasian, Correlation

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20.3% South Asian, and
15.2% Asian

Note. The statistical tests are given in boldface. NPI¼ Narcissism Personality Inventory; N ¼ narcissism; A/V ¼ aggression/violence; nr ¼ variable not measured/reported; UG ¼ undergraduate.

11
 12
Table 4. Narcissism and Displaced Aggression Following an Ego Threat.

Authors Sample Design Measure Findings

Bushman and UG students Experimental study randomized to receive N: NPI Narcissism was not related to displaced aggression
Baumeister n ¼ 140a positive or negative feedback (ego threat) A/V: physical aggression defined as the when feedback was positive, F(l, 254) ¼ 0.99,
(1998), Study 2, 50% female from false participant intensity and duration of a noise blast p > .05, b ¼ 0.02, SE ¼ 0.02, r ¼ .14), or negative,
United States Age: nr administered, during competitive task F(l, 254) ¼ 0.61, p > .05, b ¼ 0.02, SE ¼ 0.03,
Ethnicity: nr r ¼ .10
Multiple regression
Martinez, Zeichner, n ¼ 92 Experimental study randomized to receive N: NPI Significant main effect of narcissism on aggression
Reidy, and Miller Gender: 100% negative feedback, positive feedback, or A/V: physical aggression defined as the (b ¼ .26, b ¼ 0.45, p < .01) even when self-
(2008), United male delayed feedback from the researcher mean intensity and duration of electric esteem was controlled for.
States Mean age (SD): shocks during competitive task The effect of narcissism was stronger in the delayed
19.5 (2.01) feedback condition than in the negative feedback
Ethnicity: 87% condition (b ¼ 0.82, p  .05) or in the positive
Caucasian condition (b ¼ 1.40, p  .01)
Stepwise regression
Twenge and n ¼ 61 Experimental paradigm: Participants were N: NPI Significant main effect of narcissism (b ¼ 0.06;
Campbell (2003), Gender: 49% randomized to experience rejection or A/V: physical aggression defined as the b ¼ .21; t ¼ 1.65; p < .05)
Study 4, United female acceptance by fake participants intensity and duration of a noise blast Significant interaction between narcissism and
States Mean age: 18.4 administered, during competitive task feedback (b ¼ 0.46; b ¼ .28; t ¼ 2.43; p < .01).
Ethnicity: 82% The relationship between narcissism and
White and aggression was stronger for those who received
18% racial an ego threat, r(37) ¼ .42, p < .01, than those

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minority who did not, r(20) ¼ .17; p > .05)
Narcissism remained significant even after self-
esteem was controlled for.
Multiple regression
Note. The statistical tests are given in boldface. NPI ¼ Narcissism Personality Inventory; N ¼ narcissism, A/V ¼ aggression/violence; nr ¼ variable not measured/reported; UG ¼ undergraduate.
a
Total N for study was 280 but n ¼ 140 for the displaced aggression condition and n ¼140 in the direct aggression condition (displayed in Table 3).
Lambe et al. 13

Nature of the sample. Participants were individuals over the age Four studies looked at nonphysical aggression; two studies
of 18 years. Eighteen studies used university students, and of used scores or evaluations given to a false participant as a
these, 11 provided course credit in exchange for participation, measure of aggression and two defined aggression as hindering
while 3 recruited from introductory psychology classes (Barry, an opponent’s performance during a competitive game.
Chaplin, & Grafeman, 2006; Maples et al., 2010), 2 recruited
from an undergraduate volunteer pool (McIntyre et al., 2007; Provoked aggression (ego threat). Twelve studies looked at the
Reidy, Foster, & Zeichner, 2010), 1 recruited through adver- effect of an ego threat on the relationship between narcissism
tisements (Lobbestael, Baumeister, Fiebig, & Eckel, 2014), and and violence. Ten studies used a negative evaluation on a piece
1 did not specify (Bushman et al., 2009). Five studies were of work as an ego threat, and two studies by the same authors
carried out with a forensic population, and two were carried used social rejection by peers.
out with a psychiatric population. None of the studies examin- There was a distinction between whether studies examined
ing the effect of ego threat were carried out with a clinical direct aggression or displaced aggression. Direct aggression
population. refers to aggression toward the individual who administered
the ego threat, while displaced aggression refers to aggression
Measurement of narcissism. The most commonly used measure directed toward someone who was not responsible for the ego
of narcissism was the NPI (Raskin & Hall, 1979). The 40-item threat. Ten studies looked at direct aggression, and two looked
version of this measure was used by 22 of the included studies. at displaced aggression. One study randomized participants to
The NPI is based on Diagnostic and Statistical Manual of either a direct aggression or a displaced aggression condition
Mental Disorders (DSM) criteria for narcissistic personality (Bushman et al., 2009). For the purpose of the analysis, the
disorder (NPD; Raskin & Terry, 1988) and has been validated results of this study were split between the table section for
using clinical samples (Prifitera & Ryan, 1984) and nonclinical direct aggression and the table section for displaced aggression
samples (Raskin & Terry, 1988). One study used a 21-item (see Tables 3 and 4, respectively).
version of the NPI, which they adapted for the purpose of this
study (Svindseth, Nottestad, Wallin, Roaldset, & Dahl, 2008).
However, to the best of our knowledge, there are no data vali-
Evidence From Clinical Samples
dating this shorter version. Three studies used the Structured Narcissism and aggression. Six of the seven studies that used a
Clinical Interview for DSM-III (SCID-II) for Axis II person- clinical sample found a significant relationship between narcis-
ality disorder diagnoses (Coid, 2002; Maples et al., 2010). One sism and violence (Beasley & Stoltenberg, 1992; Cale &
study used the Millon Clinical Multiaxial Inventory-II (MCMI- Lilienfeld, 2006; Coid, 2002; Svindseth, et al., 2008; Warren
II; Millon, 1985). The MCMI-II, like the NPI, was designed to et al., 2002; Wiehe, 2003). Three of these studies reported ORs.
assess characteristics consistent with the DSM-III-R criteria. In Coid (2002) found that those high in narcissism were over
contrast, the NPI measures narcissism, as it occurs in a healthy 2.5 times more likely (OR ¼ 2.84) to be violent toward inmates
population. Two studies used the Hypersensitivity Narcissism and prison staff than those low in narcissism. Svindseth, Not-
Scale (HSNS; Hendin & Cheek, 1997), which focuses more on testad, Wallin, Roaldset, and Dahl (2008) found that those high
symptoms of vulnerability and hypersensitivity, indicative of in narcissism were only 20% more likely to be mildly/moder-
the concept of narcissism as found in psychoanalytic literature ately violent (OR ¼ 1.21) but 11.5 times more likely to be
(Kernberg, 1975; Perry & Perry, 1996) as opposed to the severely violent (OR ¼ 11.46). Warren et al. (2002) found that
NPI and SCID-II, which focus more on boisterous, self- those with NPD were nearly 5 times more likely to have been
aggrandizing, vain, and interpersonally exploitative behavior convicted for a violent crime excluding homicide (OR ¼ 4.92)
(Hendin & Cheek, 1997; Wink, 1991). but were 7.5 times more likely to have been convicted of a
violent crime including homicide (OR ¼ 7.57). Thus, the find-
Aggression and violence. As outlined above, this review used ings of both Svindseth et al. (2008) and Warren et al. (2002)
Howells and Hollin’s (1989, p. 4) definition of aggression and suggest that there is a stronger relationship between narcissism
violence which states that ‘‘aggression refers to the intention to and more severe forms of violence.
hurt or gain advantage over people without necessarily involv- Only one study did not find a significant relationship (Gold-
ing physical injury; violence involves the use of strong physical berg et al., 2007). They found no difference in narcissism
force against another person, sometimes impelled by aggres- between the aggressive group and nonaggressive group of psy-
sive motivation.’’ Of the 25 studies included, 21 looked at chiatric inpatients. However, the aggressive group had only 20
physical aggression; of these, 8 studies defined aggression as participants, which is the smallest sample size of any of the
the intensity and frequency of noise blasts administered to an clinical studies and may therefore have been underpowered.
opponent, 7 studies used real-world incidences of violence Beasley and Stoltenberg (1992) found a significant difference
(e.g., violent crime conviction, incidences of violence against between perpetrators of domestic violence and controls on the
staff), 4 studies defined aggression as the intensity and fre- MCMI-II measure of narcissism but not on the NPI. There is no
quency of electric shock administered to an opponent, and obvious explanation for this inconsistency across measures.
2 studies defined aggression as the amount of hot sauce allo- Both the NPI and the MCMI-II are based on the DSM-III
cated to an opponent’s food. criteria. However, the NPI was designed to measure narcissism

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14 TRAUMA, VIOLENCE, & ABUSE

in the general population, whereas the MCMI-II measures increased aggression following negative feedback or insult
pathological narcissism indicative of NPD. Thus, perhaps (Barry et al., 2006; Bushman & Baumeister, 1998; Bushman
pathological narcissism is more strongly related to violence. et al., 2009; Jones & Paulhus, 2010; Twenge & Campbell,
2003; Vaillancourt, 2013). Furthermore, effect sizes were com-
Narcissism and aggression following an ego threat. No studies car- parable across studies; four studies reported Pearson’s r ranging
ried out with clinical populations examined the relationship from .25 to .37. Three studies reported Beta; however, varia-
between narcissism and violence following an ego threat. tions in their analysis made it difficult to directly compare these
results.
Mediating variables. No clinical studies controlled for the effect Three studies found no interaction between narcissism and
of self-esteem, gender, or previous violence. ego threat: two of which were reported in Kirkpatrick, Waugh,
Valencia, and Webster (2002) and one in Vaillancourt (2013).
Antisocial personality disorder/psychopathy. Coid (2002) was
Although Kirkpatrick’s studies had relatively high-quality rat-
the only study that controlled for antisocial personality disorder
ings, both used the same methodology and defined aggression
and psychopathy. After controlling for the confounding effects
as the quantity of hot sauce allocated to an opponent’s food.
of these, narcissism was a significant predictor of violence
Similarly, Vaillancourt’s study, which had a relatively low-
toward other inmates and staff.
quality rating, used student evaluations of teaching as a mea-
Gender. Although no studies controlled for gender, it was sure of aggression. In contrast, studies that did find an effect
possible to compare the results of studies that had an all-male predominantly used administration of noise blasts as a measure
sample to those with an all-female sample. Three studies were of aggression. As suggested previously, this may indicate a
carried out with a male-only sample, and each of these found a difference in effect based on the type or severity of the
significant relationship between narcissism and violence aggression.
(Beasley & Stoltenberg, 1992; Cale & Lilienfeld, 2006; Coid, Six studies found that in the presence of positive feedback,
2002). Similarly, the only study that looked at a female-only narcissism was unrelated to violence (Barry et al., 2006; Bush-
sample of inmates at a high secure unit also found a significant man & Baumeister, 1998; Bushman et al., 2009; Jones & Paul-
relationship between narcissism and violence (Warren et al., hus, 2010; Vaillancourt, 2013) and one study found that there
2002). Furthermore, the effect size (OR ¼ 4.92–7.57) reported was a significant relationship between narcissism and violence
by Warren et al. (2002) was comparable to studies with male- following positive feedback (Bushman et al., 2009). Bushman
only samples (OR ¼ 1.21–11.46). This would suggest that in had a relatively high-quality rating and the largest sample size
clinical samples the relationship between narcissism and vio- of studies looking at positive feedback, which may account for
lence is consistent across genders. the effect reaching significance.

Narcissism and displaced aggression following an ego threat. Three

Evidence From Student Samples studies looked at displaced aggression and narcissism in the
Narcissism and aggression. Six studies examined the relationship presence of an ego threat. Two found a main effect of narcis-
between narcissism and violence within a student population. sism (Martinez, Zeichner, Reidy, & Miller, 2008; Twenge &
Of these, four found a significant effect of narcissism (Lobbes- Campbell, 2003), and one did not report on the main effect of
tael et al. 2014; Maples et al., 2010; Reidy et al., 2010; Terrell, narcissism (Bushman et al., 2009). Two studies found that
Hill, & Nagoshi, 2008), one study did not find an effect narcissism significantly predicted displaced aggression follow-
(Maples et al., 2010), and one did not find a significant rela- ing an ego threat (Martinez et al., 2008; Twenge & Campbell,
tionship when analysis was carried out with a mixed-gender 2003); one study found no such relationship (Bushman et al.,
sample (73% female), but when carried out only with males, 2009). The reason for this inconsistency is difficult to deter-
the relationship was significant (McIntyre et al., 2007). mine. Each of these studies used the same measure of aggres-
sion (noise blast) and a similar experimental design. In terms of
Narcissism and direct aggression following an ego threat. Ten stud- methodology, Bushman had a larger sample size and the high-
ies looked at the effect of an ego threat on the relationship est quality rating of the three studies, perhaps making his find-
between narcissism and direct aggression. In contrast to the ing more reliable.
above findings with clinical populations, only two studies with
student populations found a significant main effect of narcis-
sism (Barry et al., 2006; Bushman & Baumeister, 1998), four
Mediating Variables
found no effect (Jones & Paulhus, 2010; Kirkpatrick, Waugh, Gender. Four studies with mixed samples reported on the effect
Valencia, & Webster, 2002; Vaillancourt, 2013), and four did of gender. Neither of Twenge and Campbell (2003) studies
not report on the main effect of narcissism (Bushman & Bau- found a significant interaction between narcissism and gender.
meister, 1998; Bushman et al., 2009; Twenge & Campbell, Their samples were 48% and 49% female, respectively, and
2003; Vaillancourt, 2013). they used the administration of noise blast as a measure of
In contrast, seven studies found an interaction between nar- violence. In contrast, McIntyre et al. (2007) found no signifi-
cissism and ego threat in that narcissism was related to cant relationship between narcissism and aggression when

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Lambe et al. 15

analysis was carried out with a mixed-gender sample (73% examining more severe violence (e.g., homicide) reporting
female) but found a significant relationship when only the higher ORs. Second, the review found a relationship between
male sample was analyzed. Similarly, Terrell and colleagues narcissism and increased aggression among student samples.
found that when the sample was split by gender there was a Thus, this result does not appear to be an artifact of studying
significant correlation between narcissism and aggression very violent samples or student samples.
among males but not females. Again, there was a difference Third, the review found that the relationship between nar-
in the measurement of aggression across these four studies. cissism and aggression in student samples was strongest fol-
Both studies by Twenge and Campbell (2003) used the admin- lowing an ego threat. Of the 10 studies that looked at narcissism
istration of noise blasts as a measure of aggression, while both and aggression following an ego threat, only 2 of the 6 studies
Terrell, Hill, and Nagoshi (2008) and McIntyre at al. (2007) that reported a main effect for narcissism found a significant
used attacks during competitive computer games as a measure effect, whereas 7 out of 10 found a significant interaction
of aggression. This may suggest a gender difference in the between narcissism and ego threat. Hence, in nonclinical sam-
type of aggression or conditions under which it will be ples, narcissism is most strongly associated with aggression
expressed. following negative feedback (i.e., an ego threat). This is in line
with cognitive and psychodynamic models of violence (dis-
Self-Esteem. Ten studies adequately controlled for self-esteem. cussed below).
Of these, eight found that self-esteem did not account for the Forth, we found that while narcissism was related to aggres-
relationship between narcissism and violence alone or in the sion following negative feedback, studies consistently (six out
presence of an ego threat (Bushman & Baumeister, 1998; of seven) reported no link between narcissism and aggression
Bushman et al., 2009; Jones & Paulhus, 2010; Martinez following positive feedback. It is unclear whether this is
et al., 2008; McIntyre et al., 2007; Twenge & Campbell, because positive feedback negates the effect of narcissism on
2003). In contrast, Kirkpatrick et al.’s (2002) first study did aggression or an ego threat is necessary to produce a relation-
not find a main effect for narcissism but after controlling for ship. This finding may have clinical implications for reducing
self-esteem found narcissism negatively predicted aggression. violence and aggression in those high in narcissism. These are
However, in their second study, using the same methodology, discussed below.
they found a significant positive relationship between narcis- Finally, there was some limited evidence to suggest that
sism and aggression before controlling for self-esteem and no narcissism also led to increased displaced aggression following
relationship when self-esteem was added to the analysis. As an ego threat. Thus, those high in narcissism may aggress not
there were no differences in methodology between the original only toward those who delivered the ego threat but toward
and replication study, and considering the overall pattern of innocent bystander. This finding is less robust as only three
findings across the literature, it would suggest that the original studies explored displaced aggression, and the findings were
result was an anomalous finding. It may also indicate that the mixed. None of these results of this review were accounted for
allocation of hot sauce, used by Kirkpatrick, is not a reliable by self-esteem, supporting the view that narcissism offers
measure of aggression. something additional to understanding the impact of an ego
threat on violence and aggression.
Antisocial personality disorder (PD)/Psychopathy. Jones and Paul-
hus (2010) was the only study to control for measured psycho-
pathy. They allowed it to compete with narcissism in a
Limitations of the Literature
regression analysis, and no main effect for narcissism or psy- No clinical studies to date have adequately controlled for pre-
chopathy was found. However, the interaction between narcis- vious violence, while only one study controlled for psychopa-
sism and ego threat was significantly related to aggression, thy, both of which are known predictors of violence. Similarly,
while the interaction between psychopathy and ego threat was studies with students did not adequately control for confound-
not significant. ing variables such as previous violence or gender.
Another limitation of this research relates to the measure-
ment of narcissism, most commonly the NPI. The majority of
Discussion studies used self-report measures of narcissism. The NPI, like
The findings from this review, summarized in Table 5, suggest all self-report measures, is open to impression management,
that narcissism is relevant in understanding aggression and meaning that individuals may tailor their responses by giving
violence. The review had four main findings. First, the review socially desirable answers. In addition, there is some evidence
found that narcissism was consistently (six studies out of from this review that different measures of narcissism give
seven) related to violence in clinical samples. ORs ranged from different results. This may be because of the different emphasis
1.21 to 11.46, suggesting that narcissism is associated with some measures place on aspects of narcissism. The HSNS
between a 1.2- and 11-fold increase in violence. Narcissism (Hendin & Cheek, 1997) focuses more on symptoms of vulner-
was a greater predictor of more severe violence, and this may ability and hypersensitivity, while the NPI and SCID-II focus
have accounted for the range of ORs, the 1.2-fold increase more on boisterous, self-aggrandizing, vain, and interperson-
relating to mild or moderate forms of violence and studies ally exploitative behavior (Hendin & Cheek, 1997; Wink,

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16 TRAUMA, VIOLENCE, & ABUSE

Table 5. Summary of Findings Across All Studies With Clinical and Student Samples, in Order of Their Quality Rating.

Association Found: Association Found: Narcissism

Narcissism and Ego Threat

Study Yes No Yes No Quality Rating

Is narcissism related to aggression/violence
Clinical samples
Warren et al. (2002) Yes 6
Wiehe (2003) Yes 6
Beasley and Stoltenberg (1992) Yes 5
Coid (2002) Yes 5
Goldberg et al. (2007) No 5
Cale and Lilienfeld (2006) Yes 4
Svindseth, Nottestad, Wallin, Roaldset, and Dahl (2008) Yes 4
Student samples
McIntyre et al. (2007) Yesa 5
Terrell, Hill, and Nagoshi (2008) Yes 4
Lobbestael, Baumeister, Fiebig, and Eckel (2014) Yes 4
Reidy, Foster, and Zeichner (2010) Yes 2
Maples et al. (2010), Study 1 Yes 2
Maples et al. (2010) Study2 No 2

Is narcissism related to aggression/violence following an ego threat

Student Samples
Direct aggression
Jones and Paulhus (2010) No Yes 7
Bushman and Baumeister (1998), Study 1 Yes Yes 6
Bushman et al. (2009), Study 1 Yes 6
Bushman and Baumeister (1998), Study 2
Kirkpatrick, Waugh, Valencia, and Webster (2002) Study 1 No No 6
Kirkpatrick et al. (2002) Study 2 Yes No 6
Barry, Chaplin, and Grafeman (2006) Yes Yes 5
Bushman et al. (2009), Study 2 No Yes 5
Vaillancourt (2013), Study 1 Yes 5
Vaillancourt (2013), Study 2 No No 5
Twenge and Campbell (2003), Study 3 Yes 4
Displaced aggression
Bushman et al. (2009), Study 1 No 6
Bushman and Baumeister (1998), Study 2
Twenge and Campbell (2003), Study 4 Yes Yes 5
Martinez, Zeichner, Reidy, and Miller (2008) Yes Yes 4

Note. Question not examined and/or reported on; shading ¼ two papers reporting on same sample.
a
In McIntyre et al. (2007), relationship between narcissism and violence was only significant for the male sample not in the mixed-gender sample.

1991). This is indicative of the complex and multifaceted consistent results, while results of studies using the application
nature of narcissism and highlights the need for future research on hot sauce were less reliable.
to address some of the difficulties in defining and measuring
narcissism.
Variations in the measurement of aggression/violence
Strengths and Limitations of This Review
across studies may account for some of the variability across The strengths of this systematic review are that it was compre-
findings. Of the studies that did not find an effect of narcissism hensive, structured, and protocol-driven with an explicit meth-
and violence following an ego threat, two used allocation of hot odology. Twenty papers reporting on 25 studies were included
sauce as a measure of aggression and one used student evalua- from a wide geographical area. The review team included clin-
tions of teaching. In contrast, the majority of studies that did ical researchers, meaning that practical recommendations were
find an effect defined aggression as duration and intensity of a considered in this context.
noise blast or an electric shock administered to opponent. In order to avoid the biases associated with self-report mea-
Research validating different measures of violence/aggression sures of aggression (Baumeister, et al., 2003; Thomaes &
would be of value. Based on the findings of this review, the use Bushman, 2011), we included only objective measures of
of a noise blast or electric shock seemed to give the most aggression. This may limit the generalizability of these finding

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Lambe et al. 17

as measures used, particularly with student samples, had a promising, more research is needed in this area particularly
limited set of operationalization of aggression, for example, looking at adult and offender populations. Altering self-views
shock, intensity of noise blasts. Aggressive behavior was also will be more challenging with these groups, as they are likely to
between relative strangers with limited opportunities to retali- be well developed and deeply ingrained in patterns of mala-
ate against the aggressor and few opportunities for responses daptive behavior compared to adolescents.
other than aggressive behavior. Nevertheless, findings from While interventions promoting stable self-views may have
these studies were consistent with those using clinical samples the potential of reducing violence, programs or approaches that
measuring ‘‘real-world’’ incidences of aggression and violence are perceived as an ego threat may result in an increase in
(e.g., domestic violence, incidences of violence against violence among those high in narcissism. Prison staff and clin-
inmates). This is in line with other studies that have shown that icians working with violent individuals who are high in narcis-
experimental studies of aggressive behavior have external sism should be aware of this potential relationship. The nature
validity (Anderson, Lindsay, & Bushman, 1999). of narcissism is likely to leave the other feeling that the indi-
This study excluded gray literature, which increases the risk vidual needs to be ‘‘brought down a peg or two’’—though
of publication bias, as published studies tend to have larger effect based on the findings, this is likely to increase aggression and
sizes. Cochrane review protocols recommend that gray literature violence. This may be a helpful factor to consider in risk assess-
is included, but this recommendation related to reviews of ment protocols. However, many of these implications are spec-
randomized controlled trials, which are of a superior methodo- ulative and have been extrapolated from studies with
logical quality and less prone to bias than correlational and undergraduates; experimental studies with clinical samples are
cross-sectional studies included here. Therefore, on balance, it required to confirm these conclusions.
was decided to prioritize the quality of methodology and exclude
gray literature (which is not always peer-reviewed), but the
limitations of this decision are acknowledged.
Implications for Future Research
Future studies would benefit from addressing a number of
methodological issues. This could be achieved by adequately
Implications for Clinicians and Policy Makers controlling for confounding variables, such as previous vio-
The results of this review indicate that narcissism is a helpful lence, the presence of psychopathy or antisocial personality
construct in understanding violence. This is in line with sug- disorder, and gender. All of which are known predictors of
gestions that it is not high self-esteem alone that leads to vio- violence.
lence but rather high self-esteem that defends against All the studies looking at the relationship between narcis-
underlying self-doubts or an unconscious lower self-esteem sism and violence following an ego threat were carried out with
that leads to increased risk of violence. As such, narcissism a student population. As stated previously, there are problems
could be a useful alternative to self-esteem in understanding with generalizing findings based on student samples (Peterson,
violence and aggression. The findings also support both psy- 2001), and although there is strong evidence of a relationship
choanalytical (Gilligan, 1996) and cognitive (Walker & Bright, between narcissism and violence in forensic populations, the
2009b) models of violence, which suggest that those with a lack extent to which situational factors (e.g., ego threat) are impor-
of stable or healthy self-esteem are vulnerable to humiliation tant in precipitating aggressive or violent behavior in the pres-
and therefore aggress to restore a sense of self-worth and pride. ence of high narcissism is unknown, as such violent acts may or
The relationship between narcissism and aggression following may not have been the result of an ego threat. Conducting
an ego threat provides support for these models in that those research in prisons presents a number of challenges, including
with high levels of narcissism were more likely to act aggres- negotiating the regulatory, research and ethical frameworks
sively following an ego threat than those who were low in required by the prison service, as well as the logistical difficul-
narcissism. These findings may also suggest a need to extend ties of accessing prisons and prisoners. However, although
traditional cognitive models of violence (e.g., Novaco’s) and challenging in both design and execution, it would be a valu-
resulting anger management programs to include the factors able avenue for future research.
that leave some individuals more vulnerable to anger-evoking
stimuli.
Factors that mediate the effect are of significant interest.
Implications for Practice, Policy, and Future Research
The difference in aggression following positive or negative  Narcissism may be a useful factor to consider when
feedback suggests that rehabilitation programs that seek to assessing risk of aggression and violence. In clinical
build more realistic and stable self-esteem may be helpful in samples, it is associated with between a 3- and 11-fold
reducing violence. There has not been much research looking at increase in violence with risk increasing with severity of
how this would be effectively done. Thomaes, Bushman, de violence. Findings from student samples would also sug-
Castro, Cohen, and Denissen (2009) found that an intervention gest that risk of violence in those high in narcissism
where adolescent students had to write a self-affirmative para- increases following an ego threat.
graph reduced incidences of aggression and violence for  These findings support the cognitive model of violence
1-week follow-up compared to a control group. Although (Walker & Bright, 2009b) and suggest that rehabilitation

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18 TRAUMA, VIOLENCE, & ABUSE

programs that seek to build more realistic and stable self- adequately controlling for confounding variable such
esteem may be helpful in reducing violence, whereas as previous violence, gender, psychopathy, and antiso-
treatment programs that are perceived as an ego threat cial PD.
or lower the individuals feelings of self-worth may lead to  The field would also benefit from more studies system-
increased risk of violence in those high in narcissism. atically testing out assumptions put forward by the mod-
 This study highlights a number of areas requiring future els of violence, thereby allowing us to build up a more
research. Experimental studies with clinical samples are complete picture of the mechanisms underpinning vio-
required to confirm the relationship between narcissism, lence. This will hopefully one day culminate in more
ego threat, and violence demonstrated in student sam- effective psychological interventions aimed at reducing
ples. Future studies would be greatly improved by violence and aggression.

Appendix A
Study Selection Flowchart

Web of Science: 1749

PsycINFO: 1083
PubMed: 615
Cochrane Review: 282
Embase: 900
DARE: 0
Total: 4029

Duplications: 284
(Web Of Science 343;
Web of Science: 1406 Embase 190; Pubmed 94)
PsycINFO: 1083
PubMed: 521
Cochrane Review: 282
Embase: 710
DARE: 0
Total: 2596

Excluded based on title

and abstract: 3829

173: Full text articles assessed

for eligibility

Inclusion criteria was refined to include

only objective measures of violence.
Excluded 152
Review of researchers’ library,
reference sections of included
Reasons for exclusion
studies and Google Scholar: 1
Self report: 78
Didn’t analyse r/ship between aggression
and narcissism: 19
20 papers reporting on Didn’t adequately measure aggression: 18
25 unique samples Didn’t adequately measure narcissism: 15
Adolescent sample: 7
Only looked at a subscale of the NPI: 5
Not in English: 3
Sexual violence: 2
Aggression against self: 1
Letter/Editorial: 2
Case study: 1
Same data as used in an included study: 1

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 Appendix B

Table B1. Quality Rating for Each Study Listed in Alphabetical Order.

Selection Comparability Outcome

Sample Control Valid Measure Previous Antisocial PD / Assessment Statistics Quality

Study Size Type Selection Group of Risk Factor Age Gender Self-Esteem Violence Psychopathy of Outcome Described Rating
Barry, Chaplin, and Grafeman (2006) 120 UG 0; SOC 1 1; NPI 0 1 0 nr nr 1 1 5
Beasley and Stoltenberg (1992) 84 F 1; REP 1 1; NPI 0 0 0 nr 0 1 1 5
1; MCMI
Bushman et al. (1998) Study 1 260 UG 0; SOC 1 1; NPI nr 1 1 nr nr 1 1 6
Bushman and Baumeister (1998) Study 2 280 UG 0; SOC 1 1; NPI nr 1 1 nr nr 1 1 6
Bushman et al. (2009) Study 2 132 UG 0; SOC 0 1; NPI nr 1 1 nr nr 1 1 5
Cale and Lilienfeld (2006) 96 F 1; REP 0 1; NPI 0 0 0 0 0 1 1 4
Coid (2002) 81 F 1; REP 0 1; SCID-II 0 0 0 0 1 1 1 5
Goldberg et al. (2007) 76 P 1; REP 1 1; NPI 0 0 0 nr nr 1 1 5
Jones and Paulhus (2010) 82 UG 0; SOC 1 1; NPI 0 1 1 nr 1 1 1 7
Kirkpatrick Waugh, Valencia, and Webster 88 UG 0; SOC 1 1; NPI 1 0 1 nr nr 1 1 6
(2002) Study 1
Kirkpatrick et al. (2002) Study 2 88 UG 0; SOC 1 1; NPI 1 0 1 nr nr 1 1 6
Lobbestael, Baumeister, Fiebig, and Eckel 100 UG 0; SOC 0 1;NPI 0 1 0 0 0 1 1 4
(2014) 1;HSNS
Maples et al. (2010) Study 1 108 UG 0; SOC 0 1; SCID-II 0 0 0 nr nr 1 0 2
Maples et al. (2010) Study 2 134 UG 0; SOC 0 1; SCID-II 0 0 0 nr nr 1 0 2
Martinez, Zeichner, Reidy, and Miller (2008) 94 UG 0; SOC 1 1; NPI 0 0 1 nr nr 1 0 4
McIntyre et al. (2007) 176 UG 0; SOC 0 1; NPI 0 1 1 nr nr 1 1 5
Reidy, Foster, and Zeichner (2010) 137 UG 0; SOC 0 1; NPI 0 0 0 nr 0 1 0 2
Svindseth, Nottestad, Wallin, Roaldset, and 186 P 1; REP 1 0; NPI-21 0 0 0 nr nr 1 1 4

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Dahl (2008)
Terrell, Hill, and Nagoshi (2008) 150 UG 0; SOC 0 1; NPI 0 1 0 0 nr 1 1 4
Twenge and Campbell (2003) Study 3 31 UG 0; SOC 0 1; NPI 0 1 1 0 nr 1 0 4
Twenge and Campbell (2003) Study 4 61 UG 0; SOC 1 1; NPI 0 1 1 0 nr 1 0 5
Vaillancourt (2013) Study 1 176 UG 0; SOC 1 1; NPI 0 1 1 0 nr 1 0 5
Vaillancourt (2013) Study 2 160 UG 0; SOC 1 1; NPI 0 1 1 0 nr 1 0 5
Warren et al. (2002) 161 F 1;REP 1 1; NPI 1 0 0 nr 0 1 1 6
Wiehe (2003) 153 F 1;REP 1 1; HSNS 1 0 0 nr nr 1 1 6

Note. 1 ¼ criteria fulfilled; 0 ¼ criteria not fulfilled; nr ¼ variable not measured/reported; REP ¼ representative sample; SOC ¼ sample of convenience; NPI ¼ Narcissism Personality Inventory; MCMI ¼ Millon Clinical
Multiaxial Inventory; SCID-II ¼ Structured Clinical Interview for DSM-III for axis II personality disorder; DSM ¼ Diagnostic and Statistical Manual of Mental Disorders; DSM-IV NPD ¼ narcissistic personality disorder; PD ¼
personality disorder; HSNS ¼ Hypersensitivity Narcissism Scale; UG ¼ undergraduate; F ¼ forensic; P ¼ psychiatric.

19
20 TRAUMA, VIOLENCE, & ABUSE

Declaration of Conflicting Interests DiGiuseppe, R., & Tafrate, R. C. (2003). Anger treatment for adults: A
The author(s) declared no potential conflicts of interest with respect to meta-analytic review. Clinical Psychology: Science and Practice,
the research, authorship, and/or publication of this article. 10, 70–84.
Fernandez, E. (Ed.). (2013). Treatments for anger in specific popula-
tions: Theory, application, and outcome. Oxford, England: Oxford
Funding University Press.
The author(s) received no financial support for the research, author- Gifford, J., & Gifford, R. (2000). Fish 3: A microworld for studying
ship, and/or publication of this article. social dilemmas and resource management. Behaviour Research
Methods, Instruments, and Computers, 32, 417–422.
Gilligan, J. (1996). Violence: Our deadly epidemic and its causes.
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Journal of Neuropsychiatry and Clinical Neurosciences, 3, S52–S56. Author Biographies
Svindseth, M. F., Nottestad, J. A., Wallin, J., Roaldset, J. O., & Dahl, Sinead Lambe, BSc, MSc, DClinPsy, is a clinical psychologist work-
A. A. (2008). Narcissism in patients admitted to psychiatric acute ing in complex adult mental health with Avon and Whiltshire National

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22 TRAUMA, VIOLENCE, & ABUSE

Health Service (NHS) Trust. Her clinical work focuses on trauma and Emily Garner, BSc, DClinPsy, is a clinical psychologist working in
the impact of childhood emotional, physical, and sexual abuse. She adult mental health within Avon and Wiltshire Mental Health Partner-
also works as part of a dialectical behavior therapy team. She com- ship NHS Trust. She works across crisis mental health services and
pleted her doctoral research at the University of Bath, which focused early intervention in psychosis, delivering short-term interventions for
on complex adult mental health. She has had a number of papers acute distress and longer term therapy with a focus on Cognitive
published in peer-reviewed journals and by national and international Behavior Therapy (CBT). She has previously worked in forensic psy-
organizations. chology and her doctoral research, completed at the University of
Bath, focused on violence.
Catherine Hamilton-Giachritsis, AFBPsS; Health and Care Profes-
sions Council registered forensic psychologist and clinical psycho- Julian Walker, PhD, DClinPsy, BSc, CPsychol, AFBPsS, CSci, is a
logist, is a reader in psychology at the University of Bath, UK. She consultant forensic clinical psychologist, director of research and
has varied experience in both clinical practice and academic settings. development (R&D) for Avon and Wiltshire Mental Health Partner-
She spent several years working in Children and Family Services ship NHS Trust, and honorary research fellow at the University of
undertaking child/parenting assessments and providing expert Bristol. In his role as R&D director, he helped establish Bristol Health
witness testimony in child protection cases, as well as working with Partners and is actively involved in several health integration teams
families with suspected or known child maltreatment. She also has an that aim to improve care pathways through research, service user
extensive body of research published in peer-reviewed journals and by involvement, and collaboration with commissioners. Clinically, he
national and international organizations. Her work focuses on child works in a service for high-risk offenders with personality disorder
maltreatment and trauma and risk assessment, considering both vic- which he helped commission and expand as part of the National
tims (e.g., the impact of online sexual abuse on victims, homicidal Personality Disordered Offender Strategy. He also works on payment
bereavement) and offenders (e.g., harmful sexual behavior, online by results for the Department of Health and was NHS England
grooming) and always has an applied element, such that it has impact Commissioning Reference Group Chair for Forensic Pathways until
on the day-to-day life of individuals. She has undertaken international April 2015. His publications include a cognitive model of violence and
consultancy and led European and nationally funded research, work- the Maudsley Violence Questionnaire; his primary research interests
ing collaboratively with a variety of nongovernmental organizations relate to personality disorder, prisons, violence, and medium secure
and other organizations, such as the World Health Organization, the unit outcomes. He is currently part of a national research project
National Society for the Prevention of Cruelty to Children, Escaping looking at the evaluation of the National Personality Disordered
Victimhood and the Child Exploitation and Online Protection Centre. Offender Strategy.

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