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11 months, 2 weeks ago

Narcissism: Impeding Healthcare Quality and Organisational Effectiveness

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  • Up to ~5% of American and British citizens grapple with narcissism, which is characterised by self-centeredness and a lack of empathy
  • Narcissists disrupt organisations and relationships through hindering collaboration, discouraging teamwork, exploiting others, and displaying an exaggerated sense of self-worth, all while lacking empathy
  • Narcissists are drawn to healthcare for admiration, control and validation, which can pose a threat to the delivery of quality care
  • Narcissism's impact on efficiency and productivity often goes unnoticed by many healthcare leaders, despite the underlying harm it causes
  • Vigilance in identifying and effectively managing narcissistic traits within healthcare settings is necessary to preserve the integrity of patient-centred care and collaboration among healthcare professionals
 
Narcissism: Impeding Healthcare Quality and Organisational Effectiveness
 
 
Abstract

In the landscape of 2024, where the healthcare sector is strained by the aftermath of the Covid-19 pandemic, the challenges faced by healthcare executives are multifaceted. The surge in demand for care, driven by aging and chronically ill populations, collides with a diminishing supply of health professionals, creating a significant imbalance. Amidst this, many healthcare organisations grapple with declining workplace productivity and escalating gross margins. Such issues are further complicated by the struggle of human resource executives to foster collaboration, enhance teamwork, and improve employee satisfaction in the face of weak corporate cultures. A critical and often overlooked aspect contributing to the complexity of healthcare delivery is narcissism: a silent force that permeates the industry. The warning from Rob Behrens, the UK's Parliamentary and NHS ombudsman, sheds light on the impact of narcissistic tendencies among health professionals. The revelation of daily failings linked to narcissism raises concerns, supported by data indicating ~11,000 avoidable deaths in NHS England annually. An investigation conducted by the UK's Times Health Commission in 2023 emphasises the urgency of addressing narcissism within the healthcare system. As the Commission examined the future of health and social care, it uncovered a landscape fraught with challenges such as the aftermath of the Covid-19 pandemic, budget constraints, an A&E crisis, mounting waiting lists, health inequalities, obesity, and the challenges posed by an aging population. The extensive evidence sessions with diverse stakeholders, including senior doctors, nurses, midwives, hospital managers, scientists, business leaders, politicians, and health experts, provided a comprehensive understanding of the issues at play. Narcissists are attracted to healthcare, and narcissism, is identified as a rising concern with suggestions of a potential "narcissism epidemic" in Western economies. The prevalence of narcissistic personality disorder (NPD) in up to ~5% of the US and UK populations is alarming, with important implications for healthcare providers and the delivery of care. Early recognition and mitigation of narcissistic tendencies are critical to safeguard both care providers and patients. In the face of unprecedented challenges within the healthcare sector, recognising and actively addressing narcissism becomes necessary to strengthen the resilience of healthcare delivery. Unveiling the subtle yet impactful consequences of narcissistic tendencies and integrating targeted mitigation strategies into healthcare management are central to our suggestions. This proactive approach not only ensures a more robust operational framework but also paves the way for a patient-centric future, where the wellbeing of individuals takes centre stage in the evolving landscape of healthcare.
 
In this Commentary

This Commentary has three sections. Part 1: Decoding Narcissism, describes the condition, highlights some early warning signs, points to its incidence rates in the US and UK, and draws attention to the impact of narcissism on individuals and relationships. Part 2: Narcissism in Healthcare, discusses the prevalence and challenges of narcissism in healthcare settings, examining its impact on team dynamics, and patient-provider relationships. Part 3: Mitigating the Negative Effects of Narcissism, describes early warning signs and suggests key human resource strategies to alleviate the adverse effects of the disorder and considers some ethical implications of NPD for healthcare delivery. Takeaways emphasise: (i) early recognition of NPD and a proactive approach to its mitigation, (ii) professional help, and (iii) continuous learning and empathy development.  
 
Part 1
Decoding Narcissism
 
In recent years, the spotlight on narcissism has intensified, prompting discussions within the healthcare community. Narcissistic Personality Disorder (NPD) is a mental health condition characterised by a pervasive pattern of self-importance, a constant need for admiration, and a lack of empathy for others. More specifically, characteristics of the condition include: (i) a grandiose sense of self-importance and an exaggeration of one's talents and achievements, (ii) a preoccupation with fantasies of success, power, brilliance, beauty, or ideal love, (iii) an excessive need for admiration and a constant seeking of validation from others, (iv) a lack of empathy, (v) a sense of entitlement, (vi) a tendency to take advantage of others to achieve personal goals, often without regard for their wellbeing, (vii) a pervasive sense of envy toward others and a belief that others are envious of oneself, and (viii) arrogance.
 
People with the condition often engage in a behaviour referred to as gaslighting. This is a manipulative tactic that makes others doubt their own perceptions, memories, or sanity. Narcissists subtly or overtly distort facts, deny events, or present alternative narratives to undermine the confidence and reality of their victims. This can lead the person being gaslit to question their own judgment and feel confused, ultimately reinforcing the narcissist's control over them. Gaslighting is a harmful behaviour that undermines trust and can have enduring effects on the mental wellbeing of the individual experiencing it. The term gaslighting comes from a 1944 American movie, Gaslight, which is based on a 1938 play by Patrick Hamilton and stars Ingrid Bergman. The movie tells the story of a narcissist that drives his wife insane.
 
It is important to note that while everyone may exhibit some narcissistic traits at times, which are characterised by expressions of pride, egotism, and vanity, it does not mean that a person is a narcissist.  Individuals with the disorder display these traits consistently and to a degree that manifests as antisocial behaviour expressing callousness, remorselessness, and selfishness, with little empathy, and the condition impairs their functioning in various professional and personal aspects of life.

Narcissism casts a significant shadow over the psychological landscape. The condition affects up to ~5% of the American (~17m) and British (~3.4m) populations. The overwhelming majority of people with the disorder are males (~75%). Despite a prevalence among Afro-Americans (~12.5%) and Hispanics (~7.5%), ~87% of diagnosed Americans are Caucasian. However, such disparities could reflect access to therapy and treatment. A demographic breakdown reveals a higher incidence of the condition among young adults aged 20 to 34, with declining rates in those aged ≥50. Challenges in relationships are evidenced in the US statistics, with ~9.6% of narcissists being single, ~7.3% divorced or separated, and ~4.9% married. A higher percentage of narcissism is observed among mental health patients (~6%), forensic analysts (~6%), military personnel (~20%), and first-year medical students (~17%). These trends invite reflection on the socio-cultural factors contributing to the manifestation of narcissistic traits and emphasises the importance of tailored interventions across diverse demographics.

The causes of the disorder are rooted in a complex interplay of inherited traits, distinct personality characteristics, neurobiological influences, and environmental factors, all of which remain elusive. Notably, parent-child relationships marked by excessive adoration or criticism are believed to be contributory factors. The contemporary shift towards individualism, amplified by the omnipresence of social media, is also implicated in the increase of the disorder. A study published in the May 2021 edition of Personality Neuroscience suggests a connection between narcissism and heightened sensitivity to ego threats and emphasises social and emotional processing challenges and alterations in the brain's salience network as factors influencing the interpersonal dynamics of individuals with the condition. As society, organisations, families, and individuals grapple with these shifts, comprehending the ramifications of NPD's rise and impact becomes important. Here we discuss the negative influence of the condition on healthcare.
 
Part 2
Narcissism in Healthcare

In healthcare, the interplay between narcissism and health professionals is a complex and much debated subject. While quantifying the prevalence of narcissistic traits within healthcare institutions is challenging, studies suggest an affinity between narcissists and professions offering authority, recognition, and control: qualities inherent in certain healthcare roles. This proclivity can manifest in behaviours with potential repercussions on workplace dynamics and the delivery of care. John Banja's 2005 publication, Medical Errors and Medical Narcissism, illustrates how healthcare professionals, driven by a need to preserve their self-esteem, might hesitate to acknowledge and disclose medical errors.
 
The manifestation of narcissistic traits in healthcare professionals can divert their focus towards personal recognition, hindering collaboration with colleagues and impeding empathetic connections with patients. Identifying and addressing narcissistic traits in healthcare settings becomes imperative to cultivate a positive and collaborative environment. The inclination of narcissists to prioritise self-promotion over collaboration adds complexity to patient care, where emotional understanding and connection are necessary.
 
NPD casts a shadow on the dynamics between healthcare providers and their patients or collaborators, leaving an indelible mark on the relationships within the healthcare landscape, be it the collaboration and innovation-driven realm of MedTechs or the intricate doctor-patient connections. Healthcare professionals navigating narcissistic traits may find it challenging to comprehend and empathise with the emotions and experiences of colleagues and patients. This difficulty can create a perceived lack of compassion, posing a threat to trustworthy collaborative relationships within healthcare teams and compromising the balance in patient-provider connections.
 
The influence of narcissism on healthcare delivery is multifaceted, creating various disruptions. Providers swayed by narcissistic tendencies may prioritise personal validation over patient-centred care, challenging the importance of focusing on the patient's wellbeing in decision-making processes. Effective communication and empathy, critical elements in healthcare, may become casualties of narcissistic traits, impacting the informed consent process, and necessitating heightened ethical considerations to ensure respectful and informed patient consent. Maintaining appropriate boundaries becomes a struggle, giving rise to ethical concerns related to potential exploitation or invasion of patient privacy.
 
Beyond individual interactions, narcissism can also permeate collaborative efforts and teamwork, with ethical dilemmas emerging when personal interests overshadow collective goals. This compromises patient care and safety as collaboration and synergy take a back seat to self-centred motives. A culture of openness and accountability, vital for addressing concerns and errors in healthcare, faces hindrance, impacting care quality and the ability to rectify issues. Additionally, the prioritisation of personal recognition over equitable resource distribution raises ethical concerns regarding the fair and just use of healthcare resources. Thus, the ripple effect of narcissistic traits extends across a wide range of healthcare relationships and collaborations, demanding a nuanced approach to ensure the wellbeing of both providers and patients.
 
Part 3
Mitigating the Negative Effects of Narcissism

Early intervention plays an important role in addressing NPD and preventing its potentially harmful behaviours. Identifying early signs within oneself requires careful attention to behavioural patterns and interpersonal dynamics. Key indicators include feelings of grandeur, an inflated sense of achievements, and an incessant need for admiration. Additionally, individuals should assess their ability to understand and connect with the emotions and experiences of others, scrutinise their excessive need for praise and validation, and be cognisant of defensiveness or emotional reactions to feedback.
 
Similarly, recognising early signs in colleagues involves observing their interactions with others, noting potential signs such as a lack of genuine connection, self-promotion, and difficulties collaborating. Communication styles, domination in conversations, and reluctance to listen are red flags. Assessing their teamwork, prioritisation of personal goals over team goals, and conflicts with colleagues can provide further insights. Observing consistent patterns over time is important due to the enduring nature of the disorder's traits.
 
It is essential to emphasise that occasional narcissistic traits do not equate to NPD. However, if concerns persist, seeking professional help early enhances the likelihood of positive outcomes. Professional intervention fosters self-awareness and serves as a foundation for positive change. Therapy guides individuals through self-exploration, offering tools to navigate challenges, manage stress, and improve relationships. Early intervention is critical in mitigating the potential harm narcissistic traits can inflict on relationships.
 
Creating a positive work environment involves open communication, clear goals, and team-building activities. Acknowledging and appreciating team efforts, empowering members, embracing diversity, and establishing effective conflict resolution mechanisms contribute to a positive workplace. Leaders play a crucial role by exemplifying positive behaviour and encouraging constructive feedback, promoting collaboration, employee satisfaction, and increased productivity.
  
Addressing NPD in healthcare delivery raises ethical concerns, requiring a focus on patient-centred care, effective communication, professional boundaries, and a collaborative, ethical healthcare culture. Healthcare professionals and organisations must embrace these challenges, guided by ethical principles to ensure quality patient care. Human resources play a crucial role in fostering psychological safety: a culture where team members freely express ideas, admit mistakes, and contribute without fear. This openness supports innovation, risk reduction, and inclusivity, serving as a game-changer for team dynamics and performance. Properly managed, psychological safety leads to fewer mistakes, increased creativity, enhanced team performance, improved diversity, and greater organisational resilience. It is not a luxury but a necessity for thriving teams, encouraging open communication, building trust, and emphasising team dynamics over individual skills.
 
Takeaways

Successfully addressing the challenges posed by NPD requires a comprehensive and proactive strategy. Recognising the early signs and intervening promptly is essential to mitigate the negative impacts on personal relationships, work environments, and healthcare delivery. Seeking professional help, fostering self-awareness, and developing effective coping mechanisms serve as foundational pillars for cultivating healthier interpersonal dynamics. Building resilience against narcissistic challenges necessitates a commitment to continuous learning, empathy development, and the establishment of robust boundaries. Organisations, too, can benefit by promoting awareness, education, and proactive management of narcissism, thereby reducing associated stigma, and fostering open conversations about mental health. Education is a key component, targeting healthcare professionals to recognise early signs of the disorder and understand its impact on individuals, relationships, and healthcare delivery. Proactive management involves creating supportive environments, implementing interventions, and cultivating a culture of empathy and collaboration. Prioritising mental health, advocating for accessible resources, and adopting a compassionate and informed approach can collectively address the challenges associated with NPD, contributing to a more empathetic and understanding society.
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4 years, 3 months ago

Narcissism and a second more devastating wave of CoVID-19

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  • The CoVID-19 pandemic has been controlled by government policies that restrict individual behaviour 
  • Even if the accelerated vaccine development goes to plan and is successful, government restrictions will be necessary for some time yet 
  • Recent research suggests that, at the height of the CoVID-19 pandemic, people with narcissistic and other “dark” personality traits flouted public health restrictions  
  • Research has also shown that the coronavirus can be spread by a relatively small group of individuals who break public health protocols 
  • Could a small group of asymptomatically infected individuals with narcissistic traits trigger a renewed and significantly more devastating outbreak of CoVID-19?
  
Narcissism and a second more devastating wave of CoVID-19
 
 
Research suggests that in early 2020, at the height of the CoVID-19 pandemic, people with narcissistic and other “dark” personality traits, (Machiavellianism and psychopathy) flouted public health restrictions, such as social distancing, stay-at-home measures, mask-wearing and hand washing, introduced to prevent the spread of the coronavirus.
 
The fastest and deepest global economic shock in history

The outbreak of CoVID-19 in December 2019 started an epidemic of acute respiratory syndrome in humans in Wuhan, China, which quickly became a pandemic responsible for the fastest and deepest global economic shock in history. In a matter of weeks, stock markets collapsed, credit markets froze, huge bankruptcies occurred, unemployment rose above 10% and annual GDP rates contracted by 8% or more. In the absence of either a vaccine or a therapy, the social and behavioural sciences were used by governments to help align human behaviour with the recommendations of epidemiologists and public health experts to reduce the impact of the coronavirus outbreak. 
 
Measures were successful and as nations regained control of the virus’s transmission and reduced the burden on their healthcare systems, restrictions were relaxed or removed to re-energise damaged economies and encourage more viable lifestyles with the virus still in circulation. In many countries, this increased the incidence levels of CoVID-19, hospitalisations and deaths; and governments had no alternative but to re-instate selected restrictions on people’s behaviours.
 
Now, some ten months after the initial outbreak, governments throughout the world are bracing themselves in the knowledge that a relatively small group of people who flout restrictions could cause the coronavirus to return, which some analysts suggest could be more devastating than the impact of its initial outbreak. This is because healthcare systems have been significantly weakened and are struggling to cope with huge backlogs of patients whose treatments have been delayed because of the coronavirus, economies have been damaged, and the annual winter flu epidemic is expected in most Western developed nations.
 
In this Commentary

This Commentary describes the findings of three recent studies, which examine the relationships between the Dark Triad traits (i.e., narcissism, Machiavellianism and psychopathy) and behaviours related to the COVID-19 pandemic. Findings suggest that, at the height of the pandemic in March and April 2020, people with narcissistic and psychopathic personality traits were more likely to ignore rules, such as hand washing, social distancing, staying-at-home and mask-wearing and therefore could have become super spreaders of the disease. The Commentary focusses on narcissistic traits. We begin by underlining some of the challenges of developing and manufacturing a CoVID-19 vaccine at scale, which is safe and effective. We then describe Narcissistic Personality Disorder (NPD) and the R number, which governments have used to explain how well the virus is being controlled. We also describe the lesser known K metric, which is critical to epidemiologists’ attempts at understanding how CoVID-19 is actually transmitted. We then briefly describe the concepts of super spreaders and super-spreading events, which help to explain how a relatively small group of people can have a significant impact on the transmission of the coronavirus. Brief descriptions of the findings of three recent research studies follow. These suggest that people with narcissistic and other “dark” personality traits, break public health restrictions. Finally, we draw attention to the limitations of the studies and provide some “takeaways”.
 
Developing and scaling vaccines is challenging

Although scientists look likely to produce a CoVID-19 vaccine much faster than anyone could have predicted, and governments have pre-purchased about 4bn doses of these for delivery at the end of 2020, developing a safe and effective vaccine at scale is challenging. The failure rate of vaccines that reach advanced clinical trials is as high as 80%. Some CoVID-19 vaccines in production that receive regulatory approval might only provide partial or temporary protection, others might require more than one dose to be effective. So, even if the accelerated vaccine development goes to plan and is successful, it is not altogether clear whether this would secure protection for enough people throughout the world to halt the spread of the virus in the medium term. Thus, it seems reasonable to assume that, behavioural techniques to slow or stop the spread of the coronavirus will be needed for some time yet, and people with narcissistic personality traits could reduce the effectiveness of these endeavours.
 
Narcissistic Personality Disorder

Narcissism is a pattern of grandiosity, a need for admiration and a lack of empathy. The condition has its genesis  in Greek mythology, and a beautiful and proud young man called Narcissus, the son of the river god Cephissus and the nymph Liriope. Many fell in love with Narcissus, but he only showed them disdain and contempt. When Nemesis, the goddess of retribution and revenge, learned of this she decided to punish Narcissus for his behaviour and led him to a pool where he saw his reflection in the water and fell in love with it. Narcissistic personality disorder (NPD) is rare. Although the term NPD has been used since 1968, only in 1980 was it officially recognized in the third edition of the Diagnostic and Statistical Manual of Mental Disorders, which is a taxonomic and diagnostic manual published by the American Psychiatric Association. Notwithstanding, in all probability we all know someone with narcissistic tendencies, which we often dismiss as just a “big ego” problem. And, if we are honest, at some point in our lives, we have demonstrated some narcissistic traits. The signs and symptoms of NPD include: (i) having an exaggerated sense of self-importance and a sense of entitlement, (ii) wanting constant, excessive admiration, (iii) expecting to be recognized as superior even without achievements that warrant it, (iv) exaggerating achievements and talents, (v) believing that you are superior and desiring to associate with equally ‘special’ people, (vi) having an inability or unwillingness to  recognize the needs and feelings of others, (vii) expecting special favours and unquestioning compliance, and (viii) taking advantage of others to get what you want. Although research in social and personality psychology has added significantly to our general understanding of narcissism, it has been one of the least studied personality disorders, mainly because of its low societal urgency and health costs. The causes of NPD are unknown, and the condition remains a controversial diagnosis. Some researchers think that overprotective or neglectful parenting styles may have an impact. Genetics and neurobiology also may play a role in the development of NPD. Given the challenges of diagnosing the condition, prevalence rates vary significantly. For instance, in the US, reported prevalence in the general population varies from 0.5% to 5%. NPD is less frequently identified in psychiatric settings, but more often seen in private clinical settings and applied to higher-functioning patients.
 
R number

In early 2020, during the height of the coronavirus crisis, politicians throughout the world and public health officials constantly referred to the R or R0 number to indicate the spread of the virus. As a consequence, most people now know that R refers to the average number of people one person with coronavirus is likely to infect. R is calculated through a combination of data and modelling, which includes hospital and intensive care admissions, people testing positive, deaths and surveys of people’s contacts. R indicates whether the number of infected people is increasing or decreasing. When R is above 1, the virus will grow exponentially in a population with no immunity. At 1, the disease remains steady. Below 1, the virus will gradually infect fewer people, until the epidemic dries up. However, in real life, some people with the disease infect many others, while others with the coronavirus do not spread the disease at all. This means that the R number hides significant differences between individuals and their impact on virus transmission.
K number

To compensate for this, epidemiologists use an additional metric referred to as K, which describes the pattern of CoVID-19 transmission. K is the statistical value, which indicates  the variability in the number of new coronavirus cases that each person has infected. A high K value (>5), tells us that most people are generating similar numbers of secondary cases. A low value for K (>1)  tells us that a small number of infected people can trigger significant numbers of new cases relatively quickly.
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Key to controlling CoVID-19

Epidemiologists believe the K number, or the role played by variable transmission of the coronavirus, is critical to controlling its spread. Notwithstanding, what makes controlling the transmission of the coronavirus more challenging is the fact that many highly infectious people are asymptomatic. According to research findings of a paper published in the June 2020 edition of The Annals of Internal Medicine, 40% to 45% of those infected by CoVID-19 display no signs or symptoms of the disease at all, which suggests that, “the virus might have a greater potential than previously estimated to spread silently and deeply through human populations”. Thus, understanding why and how the virus is transmitted is key to gaining control of the CoVID-19 pandemic and stopping a second wave of cases.
 
Super-spreaders

As we have suggested, there is wide variability in the behaviours of infected individuals and their subsequent roles in spreading the coronavirus. A paper published in the June 2020 edition of Wellcome Open Research analysed the spread of CoVID-19 from China and estimated the K value to be as low as 0.1.  This suggested that 80% of new coronavirus cases were caused by only about 10% of infected individuals. An infected individual who breaks the rules is likely to generate significantly more secondary cases that an infected person who does not broach public health protocols. The Wellcome paper demonstrates how a relatively small number of infected people who flout government guidelines could become ‘super-spreaders’ and cause CoVID-19 to quickly rebound, even if locally eradicated. Thus, identifying and tracking super-spreaders, is fundamental to preventing future outbreaks.
 
Super spreading events

Super spreaders are responsible for super spreading events, which are not well understood and are challenging to study. Although there is no universally agreed definition of a super spreading event, it is generally assumed to be an incident in which someone passes on the virus to six or more people. Examples of super-spreading events of CoVID-19 include outbreaks in Seoul nightclubs in South Korea,  meat packing plants in the US and overcrowded clothes factories in the UK.
 
Three studies

We now turn to the findings of three recent research studies, which suggest that some super-spreaders of CoVID-19 might be people with specific personality traits. The first study we describe is entitled, “Adaptive and Dark Personality Traits in the Covid-19 Pandemic”. It is published in the June 2020 edition of the Journal of Social Psychological and Personality Science and was carried out by Pavel Blagov, who is the director of the Personality Laboratory at Whitman College, USA. The second and third studies are Polish and both published in the July 2020 edition of  Journal of the International Society for the Study of Individual Differences. One is entitled “Adaptive and maladaptive behavior during the COVID-19 pandemic”, and was conducted by researchers from SWPS University of Social Sciences and Humanities, Poland. The third study is entitled, “Who complies with the restrictions to reduce the spread of COVID-19?”, which was carried out by researchers from the University of Warsaw.
 
The Whitman College Study

In late March 2020, Blagov surveyed 502 American adults, to assess their personalities and gauge how compliant they were with public health protocols for reducing the impact of CoVID-19 such as; social distancing, wearing protective gear or following basic hygiene rules. While the majority of participants reported adherence to public health restrictions, some did not. The  study found that individuals with the so-called "Dark Triad" personality traits (narcissism, Machiavellianism and psychopathy) were more likely to purposely disregard protocols intended to reduce the spread of the coronavirus. The respondents who showed disinterest in the recommended health procedures scored higher on sub-traits of meanness and disinhibition. According to Blagov, it is possible that rule breakers become super-spreaders of CoVID-19 and “have a disproportionate impact on the pandemic by failing to protect themselves and others”.  

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At the height of the pandemic, narcissists and others with dark personality traits tended to act contrary to public health recommendations. They showed less inhibition to risk and disregarded other people's safety; manifestations of which included, not covering themselves when sneezing or coughing in public, touching communal facilities, not staying at home, not keeping their distance from others and not washing their hands frequently. The  study concludes that, “there may be a minority of people with particular personality styles (on the narcissism and psychopathy spectrum) that have a disproportionate impact on the pandemic by failing to protect themselves and others.”
The  SWPS Study

These findings are supported by the  SWPS study, which is based on an online survey of 755 people (332 male and 423 female) between 15th and 29th March 2020, which was during the first month of the national CoVID-19 lockdown in Poland. The cohort was middle class with ages ranging from 18 to 78, (M = 45.83, SD = 14.98). Over 40% of the participants had either a high school or a university education.  Findings suggest that people with narcissistic or psychopathic tendencies were more likely to hoard essentials during lockdown mainly because they had a heightened sense of entitlement, which manifested itself in being greedier and more competitive.

Also, researchers suggest that participants with narcissistic personalities tend to be self-centred and lack empathy, and therefore more likely to exploit other people. People with psychopathic tendencies may be more cruel, deceitful and manipulative while coming across superficially charming.  According to Bartłomiej Nowak, the lead author of the study, narcissists are: (i) more impulsive, (ii) focused on self-interest, (iii) tend toward risk-taking and (iv) less likely to comply with measures to reduce the spread of the coronavirus.
 
The Warsaw Study

The Warsaw study set out to use the CoVID-19 pandemic to understand who complies with public health restrictions  to reduce the spread of the coronavirus. Researchers hypothesised that narcissistic and psychopathic personality traits of rivalry and lack of empathy may be associated with less compliance towards government imposed coronavirus restrictions. The study was based on an online survey carried out between 14th and 30th April 2020, which was at the height of the coronavirus crisis in Europe. There were 263 participants (27.8% male, 71.5% female, 0.8% “other”) aged between 18 and 80  (M = 28.96, SD = 10.64) and about half (49%) had a university education. 
 
The study’s findings support those of the previous two studies described above. Researchers found that compliance with public health guidelines to control CoVID-19 was low among participants who had narcissistic tendencies. Participants scoring low on agreeableness and high on aspects of narcissism and psychopathy were less likely to comply with public health restrictions. People with narcissistic traits had a sense of entitlement and perceived the restrictions as the Government forcing its will upon them.
 
Limitations of the studies

All three studies have limitations, which include being based upon relatively small samples. Data are cross sectional rather than time series and collected at the beginning of public health restrictions when it seems reasonable to assume that “people may be more likely to engage in prevention and adhere to restrictions”. The US and Poland are both developed economies with different cultures that might not be relevant for other regions of the world and, in the case of the two Polish studies, participants were drawn from a relatively homogeneous group.
 
Takeaways

Findings of the three studies described in this Commentary are not sufficiently robust to definitively say that people with narcissistic traits are super-spreaders of CoVID-19. Not everyone who defies coronavirus restrictions does so because of dark personality characteristics. Indeed, there are many factors at play in understanding behaviours during the coronavirus pandemic. Notwithstanding, from the evidence presented in the three papers, it seems reasonable to suggest that people with narcissistic tendencies, and who are asymptomatically infected with the coronavirus, could become super-spreaders and have a disproportionate impact on the transmission of CoVID-19.
 
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