INTRODUCTION

The term of narcissism can be described as “one’s capacity to maintain a relatively positive self-image through a variety of self-, affect-, and field-regulatory processes, and it underlies individuals’ need for validation and affirmation as well as the motivation to overtly and covertly seek out self-enhancement experiences from the social environment” (1). In terms of clinical practice, pathological narcissism is characterized in the DSM-IV-TR (2) by a list of features including grandiose sense of self-importance together with an excessive need for the admiration of others, arrogance, a sense of uniqueness and entitlement, a lack of empathy, envy, and a tendency to exploit others.

Several studies (3,4) have showed that there are two types of narcissism, which might be described as “grandiose narcissism” and “vulnerable narcissism”. Grandiose narcissism refers to the term of overt narcissism, whereas vulnerable narcissism corresponds to covert narcissism or hypersensitive narcissism (5). The overt form is characterized particularly by lack of empathy, lack of vicarious personal distress, keeping social affirmation; being control-oriented, detached, sufficient, intrusive, dominant, assertive, aggressive, self-centered (6), self-assured, rebellious, exhibitionist; having poor impulse control, strong power orientation (7), primary psychopathy, physical and verbal aggressiveness, and psychological distress (8). On the other hand, the covert type harboring anxiety, social anxiety, and loneliness is related to high cognitive capacity for fantasy (6); being socially detached, distrustful, socially inhibited, and reliant on others (9). Moreover, it is associated with interpersonal sensitivity and depression (7), secondary psychopathy, anger, hostility, lack of self-confidence, being overtly inhibited, introverted and hypersensitive (8). Furthermore, since individuals with vulnerable narcissism show their sensitivity to evaluations by other people via covert behaviors, vulnerable narcissism is associated with the affective and cognitive features of aggression rather than being a verbal type of it. It was also found that due to their hypersensitiveness to others’ evaluations, vulnerable narcissistic people have a greater tendency to be aggressive in a rejection condition as compared to those with low levels of vulnerable narcissism (5). These two dimensions of narcissism also differ with regard to their underlying personality traits. In particular, grandiose narcissism is associated with high extraversion, low agreeableness, and low neuroticism, whereas vulnerable narcissism is associated with high neuroticism, low agreeableness, and low extraversion. Finally, they differ according to associated outcomes: while grandiose narcissism might result in some externalizing symptoms, vulnerable narcissism might bring out internalizing ones (4).

Therefore, overlooking hypersensitive narcissism may lead to a possible diagnostic bias, because narcissistic pathology might either go undiagnosed or may be misdiagnosed as a different personality disorder (3) such as avoidant and/or dependent personality disorder. For instance, while dependency in close relationships, inadequacy feelings, and pseudo humbleness that are frequently present in hypersensitive narcissism might be considered as dependent personality features, the symptoms of reference due to oversensitivity to social cues, prominent social anxiety, and inability to trust other people may be misdiagnosed as avoidant personality features (10).

Some researchers have argued that the advancement of knowledge about narcissism has been obstructed by the reliance on a single, potentially inappropriate measure of narcissism: the Narcissistic Personality Inventory (NPI) developed by Raskin and Terry (11). The NPI successfully assesses narcissism in a manner that is consistent with its operationalization as a personality disorder. However, much criticism of the NPI has been raised due to a number of different concerns, such as its overlap with self-esteem and its inclusion of content tangential to narcissism (e.g., leadership). Moreover, its structural validity and dimensionality, its convergent validity with other measures of narcissism, and whether it measures a healthy or pathological variant of narcissism have all been questioned (12). Rosenthal and Hooley (13) contended that caution is needed in interpreting the literature on narcissism derived from the use of the NPI. Therefore, NPI scores should not be considered as a perfect measure of the latent trait of narcissism (8). In the light of this information, in order to overcome the current ambiguities about the conceptualization and measurement of narcissism, Hendin and Cheek (14) proposed a new measure of hypersensitive narcissism, the Hypersensitive Narcissism Scale (HSNS). This measure has been found to have an adequate reliability and a near-zero correlation with the NPI, which indicates a good discriminant validity in delineating between overt and covert narcissism.

In essence, there has been a significant need for the assessment of narcissism’s particular features which should be identified in a discriminative manner. The aim of the current study was to develop a Turkish version of the HSNS and to introduce psychometric properties (i.e., reliability and validity) of the HSNS into Turkish psychology literature. Specifically, it was expected that the HSNS would be differentiated from the NPI in terms of its sensitivity in measuring various parts of narcissism. Therefore, a zero correlation between the HSNS and the NPI was expected to be found. Moreover, with regard to the dimensions of the Basic Personality Traits Inventory (BPTI) developed by Gencoz and Oncul (15), it was hypothesized that the HSNS would be negatively correlated with extraversion and agreeableness but positively correlated with the neuroticism dimension.

METHOD

Statistical analyses were conducted with the scores from 300 university students. Of the participants, 213 (71.0%, n=300) were females, and 87 (29.0%, n=300) were males. The mean age of participants was 22.72 years (SD=3.41), whereas 76.7% of them were between the ages of 18 and 24, 20.3% of them were between 25 and 30 years old, and the remaining 3.0% were between the ages of 31 and 46. The majority (72.7%) of the respondents was undergraduate students (n=218), whereas there were 62 (20.7%) graduate and 20 (6.6%) postgraduate students.

Measures

The Hypersensitive Narcissism Scale (HSNS): The HSNS developed by Hendin and Cheek assesses covert narcissism (14). This new measure of hypersensitive narcissism was derived by correlating the items of Murray’s Narcissism Scale (16) with an MMPI-based composite measure of covert narcissism. The measure consists of 10 items (e.g., “I can become entirely absorbed in thinking about my personal affairs, my health, my cares or my relations to others;” “My feelings are easily hurt by ridicule or the slighting remarks of others”), which determined one factor, covert narcissism, with responses made on scales ranging from 1 (very uncharacteristic) to 5 (very characteristic). Acceptable reliability (α=0.629) and construct validity were established (r=0.63) for the original version. Basically, the new HSNS and the MMPI-based composite showed similar patterns of correlations with the Big Five Inventory, and both measures correlated near-zero with the NPI, which assesses overt narcissism (14). Similarly, in a study conducted with the Italian sample the internal consistency of the HSNS was also adequate (α=0.71) (10).

Basic Personality Traits Inventory (BPTI): The BPTI was developed by Gencoz and Oncul (15) to measure basic personality traits that are specific to Turkish culture in accordance with the Five Factor Model of Personality (FFM). The inventory consists of 45 items (e.g., ‘‘Timid”, “Self-disciplined”, “Sincere”, “Nervous”) that are rated on a 5-point Likert-type scale (from 1: very uncharacteristic to 5: very characteristic). The BPTI revealed six separate personality factors, described as extraversion, conscientiousness, agreeableness, neuroticism, openness to experience, and negative valence. Extraversion has been defined in terms of positive affectivity (17) and positive social interactions (18,19). Similarly, agreeableness has been characterized in terms of high quality in social interactions (20). Moreover, agreeableness was found to be negatively associated with social anxiety and state-trait anxiety variables. Conscientiousness signifies goal-directed behavior (21,22) and acquirement of strategies to cope with frustration coming from objects and tasks (23), while openness to experience reflects the flexible part of the personality structure (21) and was found to be positively associated with self-esteem and positive affect. On the other hand, neuroticism is consistently implied to be associated with proneness to psychological distress (21,24-26), negative affectivity (26), and maladaptive coping strategies (27). Though being a relatively new dimension, findings related to negative valence also indicate its negative contribution to psychological wellbeing (15,28).

The internal reliability coefficients for these six factors were fairly strong, ranging between 0.71 and 0.89. Besides, the item-total correlation coefficients for these six factors ranged between 0.32 and 0.77. The test-retest reliability coefficients for six factors were found to be ranging between 0.71 and 0.84.

Narcissistic Personality Inventory (NPI): The NPI is a 40-item scale that measures overt narcissism as a personality trait. Ames, Rose, and Anderson (29) created a short version of the NPI using of 16 items. This short version (NPI-16) is composed of six dimensions, namely, authority, superiority, exhibitionism, entitlement, self-sufficiency, and exploitativeness. In this scale, each item offers two options. The participant is asked to choose the one that fits most closely. The NPI-16 was standardized for a Turkish population by Atay (30). In this standardization study, it was demonstrated that Cronbach’s alpha level is increased (α=0.65) when one item (“I always know what I am doing / Sometimes I am not sure of what I am doing”) is removed. Thus, NPI-15 has greater internal consistency than NPI-16. For this reason, the 15-item short version is used in this study (containing items such as “When people compliment me I sometimes get embarrassed / I know that I am good because everybody keeps telling me so”, “I prefer to blend in with the crowd / I like to be the center of attention”). As mentioned above, a near-zero correlation between the NPI and the HSNS was found, which points to a good discriminant validity in delineating between overt and covert narcissism.

Procedure

The study consisted of two steps. In the first step, permission to translate the HSNS into Turkish and to use it in the current study was obtained from the developers of the scale via e-mail and approval of the ethics committee of the university was received. Afterwards, the English version of the HSNS was translated into Turkish by two of the authors with advanced proficiency in both languages. Then, another author with a command of both languages and was blind to the original version of the scale translated the Turkish text back into English. Lastly, essential editing was done by all authors of the study, examining the compatibility of the translated text with the original version (see Appendix A).

In the next step, the data were collected via online forms for the relevant scales and demographic variables. After receiving informed consent, the participants were administered the questionnaires in random order. After application, they were informed about the aim of the study.

Statistical Analysis

In the present study, the Statistical Package for Social Sciences (SPSS), version 20 was used for statistical analyses. Firstly, in order to examine the factor structure of the Turkish version of the HSNS, factor analyses were conducted. Reliability analyses were performed and Cronbach’s Alpha was calculated. To test the construct validity of the HSNS, correlation analyses were conducted between the scale and the NPI. To assess the discriminative validity of the scale, the same analyses were performed between the BPTI and the scale.

RESULTS

Data Cleaning

For the variables used in the analyses, assumptions of normality, linearity, and homoscedasticity were met. Moreover, multicollinearity and singularity issues were not detected in the dataset.

Psychometric Properties and Factorial

Structure

Initially, the factorability of the 10 HSNS items was examined. Well-recognized criteria for the factorability of a correlation were used. Firstly, the Kaiser-Meyer-Olkin measure of sampling adequacy was 0.72, above the commonly recommended value of 0.6. Secondly, Bartlett’s test of sphericity was significant (χ2[45]=305.78, p<0.001).

Principal axis factoring (PAF) was performed as an extraction method. The motivation behind this extraction was to discover the minimum number of factor axes needed to position the HSNS items reliably. The initial eigenvalue indicated that one factor that had only been extracted explained 17.27% of the variance.

A total of two items were removed since they did not contribute to the simple factor structure and failed to meet a minimum criterion of having a primary factor loading of 0.30 or above. These items were the first (“I can become entirely absorbed in thinking about my personal affairs, my health, my cares or my relations to others”) and the fourth one (“I dislike sharing the credit of an achievement with others”) (see Appendix B). This elimination process was also assured by item-total statistics, which pointed out that if the fourth item was deleted, Cronbach’s alpha would increase from 0.64 to 0.66, and if the first item was deleted, the reliability of the whole scale would remain the same.

For the final stage, PAF of the remaining eight items was conducted, with one factor explaining 20.71% of the variance afterwards. All items in this analysis had loadings over 0.30. The factor loading matrix for this final solution is presented in Table 1. The item content of the newly designed Turkish version of the HSNS reflected the hypersensitivity and vulnerability that Wink (31) had associated with covert narcissism as a specific term.

The reliability analysis, using Cronbach’s alpha, demonstrated that the eight-item Turkish version of the HSNS was a reliable scale (α=0.66). Item-total statistics are presented in Table 2.

Convergent and Discriminant Validity of the

HSNS

Analysis of the eight items of the Turkish version of the HSNS in relation to subscales of the BPTI and the Turkish version of the NPI revealed both significant and nonsignificant correlations that were difficult to interpret through each item. Therefore, as a scale, the eight- item HSNS’ relationships between the NPI and the exploitativeness/entitlement (E/E) subscale of the NPI were assessed. According to correlational analysis, it was found that the relationship between the eight-item HSNS and the NPI was not significant (r=0.01, p=0.85); hence, the current data replicated the main finding of previous studies that measures of covert narcissism tend to be uncorrelated with the total NPI (14,33). At this point, it is crucial to report that the discriminant validity of the eight-item Turkish version of the HSNS was established through this analysis. However, a contrasting finding that the HSNS was negatively correlated with E/E subscale of the NPI was also pointed out (r=-0.22, p<0.001).

In addition, to ensure further validity (i.e., convergent and discriminant validity), the eight-item Turkish version of the HSNS, the Turkish version of the NPI, and the E/E subscale of this NPI were run through correlational analysis with the subscales of the BPTI (see in Table 3). There were significant negative correlations between the HSNS and the BPTI subscales of extraversion and agreeableness and significant positive correlations between the HSNS and the subscales of neuroticism and negative valence. It should be noted that the HSNS scores were not significantly related with the BPTI subscales of conscientiousness and openness to experience. Furthermore, there were significant positive relationships between the NPI and the BPTI subscales of extraversion, agreeableness, and openness to experience, while there was a significant negative relationship between the NPI and the BPTI subscale of neuroticism. Similarly, there were significant positive relationships between the E/E subscale of the NPI and the BPTI subscales of extraversion, conscientiousness, agreeableness, and openness to experience, in contrast to significant negative relationships between the E/E subscale and the BPTI subscales of neuroticism and negative valence. This suggested that the more an individual becomes overtly narcissist and has characteristics of exploitativeness and entitlement, the more he/she becomes extraverted, agreeable, open to new experience, and the less he/she behaves in a neurotic manner. Moreover, individuals having exploitativeness and entitlement characteristics might demonstrate characteristics of higher conscientiousness and less negative valence.

DISCUSSION

In line with the predictions, the current study revealed that the reliability and validity of the eight-item Turkish version of the HSNS were adequate. This investigation hypothesized that the eight-item Turkish version of the HSNS would not be correlated with the NPI. The findings from the current study confirmed this hypothesis by demonstrating a zero-association between the HSNS and the NPI, suggesting that the former was different from the NPI since it pointed out distinct parts of narcissism. However, this hypothesis was not supported, as a significant negative association was found with the eight-item HSNS and the E/E subscale of the NPI. This finding, which was unexpected, suggested that when an individual shows more characteristics of covert narcissism, the probability of entitlement and exploitative-typed behaviors would decrease. On the other hand, as it was hypothesized, this study showed that there were significant negative correlations between the HSNS and agreeableness and extraversion dimensions of the BPTI. Moreover, the close link between the HSNS and various subscales of the BPTI was supported by the current study’s finding demonstrating a positive link between the HSNS and neuroticism and negative valence dimensions of the BPTI. In other words, when covert narcissism of an individual increases, he/she might become less extraverted, less agreeable and might show more neuroticism and negative valence. The contrasting findings between the HSNS and the NPI together with its subscale in terms of many subscales of the BPTI should be noticed when considering the discriminant validity of the new Turkish version of the HSNS.

As mentioned, the E/E subscale of the NPI is only a relatively weak or indirect measure of the covert narcissistic tendencies of vulnerability and hypersensitivity that were emphasized by Wink (31). However, this interpretation is not consistent with the moderate negative correlation between E/E and covert narcissism as assessed by the current HSNS in this study. There may be two explanations for this unexpected finding. First of all, it could be a result of coping mechanisms used by individuals with vulnerable narcissism. According to Young’s Schema Theory, an individual with personality problems develops early maladaptive schemas that are self-defeating and emotional patterns repeating over their lifetime (33). Corresponding to these schemas, there are three schema coping styles called overcompensation, avoidance, and surrender. Specifically, individuals using avoidance as a coping style tend not to experience the schema, so that it is never activated. However, individuals with an overcompensation coping style are likely to think, feel, behave, and relate as though the opposite of the schema were true. In addition, Young et al. (33) stated that people with NPD usually use overcompensation and avoidance as coping styles. Regarding various coping styles utilized in different situations to cope with the same schema, while individuals with grandiose narcissism may use overcompensation as a coping strategy, vulnerable narcissistic people adopt avoidant coping to deal with their fragility. The second explanation may be the fact that people with covert narcissism can experience feeling of inadequacy resulting from their inadequate defenses. In the E/E subscale, a tendency to manipulate, to get respect and attention, and satisfaction from others are measured. These tendencies require a grandiose sense of self that is dominant in overt narcissism. With the sense of grandiosity, people with overt narcissism can manipulate, get angry, and maintain self-importance in interpersonal relationships in order to deal with the feeling of inadequacy. However, in covert narcissism, people cannot sustain the feeling of grandiosity in their interpersonal relationship; their defenses fail. This leads to narcissistic injury with feelings of shame, anxiety, depression, and inadequacy (34). Therefore, this feeling of inadequacy cannot be handled with grandiosity in covert narcissism. It may require social inhibition, poor interest in social interaction, and low agreeableness (10). Another unexpected result indicating the positive association between E/E and agreeableness was inconsistent with the literature. This result may be examined in further research as a part of cultural differences.

This research, which has been inspired by renewed attention to hypersensitive narcissism in the literature, has the potential to improve contemporary narcissism research, which has sometimes been limited by exclusive reliance upon the measurement of overt narcissistic tendencies via the NPI. Obviously, a significant and useful consequence of this new interest in hypersensitive narcissism was the development of the HSNS by Hendin and Cheek (14). By showing that the Turkish version of the HSNS is a reliable and valid scale, this study makes a good point for improvement of narcissism research.

In conclusion, the results of this study supported the reliability and construct validity of the HSNS as a measure of hypersensitive narcissism; they also evidenced the existence of selected personality features that may be useful in differentiating hypersensitive narcissism from grandiose narcissism. Consistent with previous observations, the results showed that hypersensitive and grandiose dimensions represent dissociable aspects of narcissistic personality that share a common core of low cooperativeness but are characterized by distinct temperament profiles.

Another crucial issue is the diagnosis being a crucial tool for the therapists both for understanding a particular patient’s etiology, current state and prognosis, and for selecting the appropriate treatment approach for this particular patient. Schurman (35) investigated the association between social phobia, shame, and hypersensitive narcissism. In that study, it was found that social phobia is related to both hypersensitive narcissistic features and shame, meaning that social phobia might be misdiagnosed by clinicians, while the actual clinical picture of the patient is more likely to be covert narcissism. Therefore, this scale may be used as a differential tool for establishing the correct diagnosis and may affect the clinicians’ evaluation and treatment plans.

However, it must be stressed that the results of these findings should be considered in the light of several limitations. Although the samples involved in the present study were moderately large, they were convenient study groups rather than random samples. These aspects inherently limit the generalizability of the findings. Another limitation of the present study was that the analysis did not include any re-test reliability statistics. While the reliability coefficients between the HSNS and the BPTI were satisfactory in the current study, this might result from the fact that the BPTI was a scale that was developed specifically for Turkish culture, whereas the HSNS was only adapted to the Turkish language rather than the culture. As a suggestion for future studies, it is highly recommended to conduct a comparison study between longer and shorter version of the scale (36). Bearing these limitations in mind, the results of this study suggest that the HSNS is a reliable and valid instrument that could be useful in the process of differentiating hypersensitive narcissism from other constructs.

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