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Age and gender differences in narcissism have been studied often. However, considering the rich history of narcissism research accompanied by its diverging conceptualizations, little is known about age and gender differences across various narcissism measures. The present study investigated age and gender differences and their interactions across eight widely used narcissism instruments (i.e., Narcissistic Personality Inventory, Hypersensitive Narcissism Scale, Dirty Dozen, Psychological Entitlement Scale, Narcissistic Personality Disorder Symptoms from the , Version IV, Narcissistic Admiration and Rivalry Questionnaire-Short Form, Single-Item Narcissism Scale, and brief version of the Pathological Narcissism Inventory). The findings of Study 1 (N = 5,736) revealed heterogeneity in how strongly the measures are correlated. Some instruments loaded clearly on one of the three factors proposed by previous research (i.e., Neuroticism, Extraversion, Antagonism), while others cross-loaded across factors and in distinct ways. Cross-sectional analyses using each measure and meta-analytic results across all measures (Study 2) with a total sample of 270,029 participants suggest consistent linear age effects (random effects meta-analytic effect of r = -.104), with narcissism being highest in young adulthood. Consistent gender differences also emerged (random effects meta-analytic effect was -.079), such that men scored higher in narcissism than women. Quadratic age effects and Age × Gender effects were generally very small and inconsistent. We conclude that despite the various conceptualizations of narcissism, age and gender differences are generalizable across the eight measures used in the present study. However, their size varied based on the instrument used. We discuss the sources of this heterogeneity and the potential mechanisms for age and gender differences.

In this study, we propose a new concept, brand awe, and explore its nature, underlying dimensions, and roles in relation to consumer responses. Brand awe is a specific mixture of emotions that cons...

Aims To evaluate patient management following stage pT1 colorectal cancer (CRC) diagnosis, and to determine if surgical resection improved outcome compared with local excision, within a population-based study. Methods Data were collected from the Northern Ireland Cancer Registry. Cases of stage pT1 CRC diagnosed from 2007 to 2012 were identified. Analyses were conducted using Cox proportional hazard models to calculate hazard ratios (HR) and 95% confidence intervals (CI) for cancer-specific and all-cause mortality for individuals undergoing formal surgery versus local excision. Results 394 patients with pT1 CRC were included. Of these, 37.1% were treated by local resection, 36.8% had biopsy followed by surgery and 26.1% had local excision followed by surgery. There were 60 deaths over a mean 4.8 years of follow-up, including 10 CRC-specific deaths. An additional 12 patients had a CRC recurrence or metastases during follow-up. Of the CRC-specific deaths or recurrences, 27.3% had local excision only. Individuals treated by formal surgery did not have a reduced risk of CRC-specific death (adjusted HR = 1.51, 95% CI 0.29, 7.89), but did have a reduced risk of all-cause mortality (adjusted HR = 0.51 95% CI 0.30, 0.87) compared with those undergoing local excision only. Conclusions Patients with stage pT1 CRC undergoing formal surgery had a reduced risk of all-cause mortality compared with those treated by local excision only. However, this was not explained by a reduced risk of recurrence/disease-free survival or CRC death, and suggests that the observed benefits may simply reflect selection of a healthier patient population in the formal surgery group.

Background Fifteen percent of US adults have chronic kidney disease (CKD). The effect of CKD on the development of different malignancies is unknown. Understanding the effect of CKD on the risk of development of cancer could have important implications for screening and early detection of cancer in these patients. Methods Adult CKD patients [estimated GFR (eGFR) 2] between January 2001 and December 2020 were identified in this single institution study. Patients were divided into four stages of CKD by eGFR. The incidence of cancer and time to development of the first cancer were identified. Multivariable models were used to compare the overall cancer incidence while considering death as a competing risk event and adjusting for relevant covariates (sex, race, diabetes, hypertension, CAD, smoking or not, BMI, and CKD stages). Separate multivariable models of the incidence of cancers were conducted in each age group. Multivariable Cox models were used to fit the overall death adjusting for relevant covariates. Patients were censored at the conclusion of the study period (December 31, 2020). Statistical analysis was performed with SAS software (version 9.4). Results Of the 13,750 patients with a diagnosis of CKD in this cohort, 2,758 (20.1%) developed a malignancy. The median time to development of cancer following a diagnosis of CKD was 8.5 years. Factors associated with the risk of developing cancer in CKD patients included increasing age, male sex and worsening chronic kidney disease, while diabetes was associated with a lower risk of malignancy. On multivariate analysis, the factors associated with increased mortality in patients who developed cancer included increasing age, diabetes and lower eGFR. Conclusion CKD is an increased risk factor for the development of various malignancies. Age appropriate cancer screening should be aggressively pursued in those with progressive CKD.

Key Points Question Does weekly testing of kindergarten through 12th grade students and staff improve detection of SARS-CoV-2 infection and understanding of the epidemiology of SARS-CoV-2 in urban public school settings? Findings In this quality improvement study, weekly school-based saliva polymerase chain reaction testing at 3 urban public schools was associated with increased case detection among staff and students compared with symptom-based strategies, exceeding county-level case rates. SARS-CoV-2 was detected in school wastewater samples each week as well as air and surface samples from choir classrooms. Meaning This study suggests that routine SARS-CoV-2 testing may identify infected staff and students who are not identified through conventional case detection and may provide insight into disease burdens of undertested communities., Importance Scalable programs for school-based SARS-CoV-2 testing and surveillance are needed to guide in-person learning practices and inform risk assessments in kindergarten through 12th grade settings. Objectives To characterize SARS-CoV-2 infections in staff and students in an urban public school setting and evaluate test-based strategies to support ongoing risk assessment and mitigation for kindergarten through 12th grade in-person learning. Design, Setting, and Participants This pilot quality improvement program engaged 3 schools in Omaha, Nebraska, for weekly saliva polymerase chain reaction testing of staff and students participating in in-person learning over a 5-week period from November 9 to December 11, 2020. Wastewater, air, and surface samples were collected weekly and tested for SARS-CoV-2 RNA to evaluate surrogacy for case detection and interrogate transmission risk of in-building activities. Main Outcomes and Measures SARS-CoV-2 detection in saliva and environmental samples and risk factors for SARS-CoV-2 infection. Results A total of 2885 supervised, self-collected saliva samples were tested from 458 asymptomatic staff members (mean [SD] age, 42.9 [12.4] years; 303 women [66.2%]; 25 Black or African American [5.5%], 83 Hispanic [18.1%], 312 White [68.1%], and 35 other or not provided [7.6%]) and 315 students (mean age, 14.2 [0.7] years; 151 female students [48%]; 20 Black or African American [6.3%], 201 Hispanic [63.8%], 75 White [23.8%], and 19 other race or not provided [6.0%]). A total of 46 cases of SARS-CoV-2 (22 students and 24 staff members) were detected, representing an increase in cumulative case detection rates from 1.2% (12 of 1000) to 7.0% (70 of 1000) among students and from 2.1% (21 of 1000) to 5.3% (53 of 1000) among staff compared with conventional reporting mechanisms during the pilot period. SARS-CoV-2 RNA was detected in wastewater samples from all pilot schools as well as in air samples collected from 2 choir rooms. Sequencing of 21 viral genomes in saliva specimens demonstrated minimal clustering associated with 1 school. Geographical analysis of SARS-CoV-2 cases reported district-wide demonstrated higher community risk in zip codes proximal to the pilot schools. Conclusions and Relevance In this study of staff and students in 3 urban public schools in Omaha, Nebraska, weekly screening of asymptomatic staff and students by saliva polymerase chain reaction testing was associated with increased SARS-CoV-2 case detection, exceeding infection rates reported at the county level. Experiences differed among schools, and virus sequencing and geographical analyses suggested a dynamic interplay of school-based and community-derived transmission risk. Collectively, these findings provide insight into the performance and community value of test-based SARS-CoV-2 screening and surveillance strategies in the kindergarten through 12th grade educational setting., This quality improvement study characterizes SARS-CoV-2 infections in staff and students in an urban public school setting and evaluates test-based strategies to support ongoing risk assessment and mitigation for kindergarten through 12th grade in-person learning.

The overarching aim of this study was to develop and validate a new scale (i.e., the Praise, Indulgence, and Status Parenting Scale [PISPS]) to measure modern parenting practices and behaviors consistent with instilling ideals of specialness (i.e., the notion that one is special), self-esteem, and status in children. In 2 studies on emerging adults (Study 1: N = 582, M(age) = 19.46; Study 2: N = 464, M(age) = 19.58), the PISPS was developed and validated using classical test theory (Study 1) and further refined using item–response theory (Study 2). Results from both studies indicated a 3-factor structure with factors differentially linked with correlates of interest including parenting strategies, self-esteem, narcissism, entitlement, and internalizing symptoms. Study 3 further validated the PISPS in a sample of parents (N = 638, M(age) = 35.79) reporting on their parenting and their child’s emotion regulation and symptoms of psychopathology. Overall, findings support the PISPS, its psychometric properties, and its unique contribution to child symptoms.

Adolescents spend a substantial and increasing amount of time using digital media (smartphones, computers, social media, gaming, Internet), but existing studies do not agree on whether time spent on digital media is associated with lower psychological well-being (including happiness, general well-being, and indicators of low well-being such as depression, suicidal ideation, and suicide attempts). Across three large surveys of adolescents in two countries (n = 221,096), light users (

Objectives: The Dark Triad traits (i.e., narcissism, psychopathy, Machiavellianism) capture individual differences in aversive personality to complement work on other taxonomies, such as the Big Five traits. However, the literature on the Dark Triad traits relies mostly on samples from English-speaking (i.e., Westernized) countries. We broadened the scope of this literature by sampling from a wider array of countries. Method: We drew on data from 49 countries (N = 11,723; 65.8% female; Age Mean = 21.53) to examine how an extensive net of country-level variables in economic status (e.g., Human Development Index), social relations (e.g., gender equality), political orientations (e.g., democracy), and cultural values (e.g., embeddedness) relate to country-level rates of the Dark Triad traits, as well as variance in the magnitude of sex differences in them. Results: Narcissism was especially sensitive to country-level variables. Countries with more embedded and hierarchical cultural systems were more narcissistic. Also, sex differences in narcissism were larger in more developed societies: Women were less likely to be narcissistic in developed (vs. less developed) countries. Conclusions: We discuss the results based on evolutionary and social role models of personality and sex differences. That higher country-level narcissism was more common in less developed countries, whereas sex differences in narcissism were larger in more developed countries, is more consistent with evolutionary than social role models.

Historical conceptualizations have framed personality disorders (PDs) as unchanging and ego-syntonic. However, recent evidence suggests that individuals with PD traits may have some insight into their personality and consider those traits to be somewhat ego-dystonic. To replicate and extend previous findings, participants (N = 328) self-reported their PD trait levels, likability of those traits, impairment, capability for change, and desired trait levels. The results demonstrated that individuals with PD traits tolerate but still dislike those traits, believe that they cause them problems, and are interested in reducing them. Level of PD trait did not relate to perception of capability for change. Likability and impairment moderated most of the relations between actual PD trait and desired level. That is, there was a stronger correlation between actual and desired levels among individuals who liked the trait more; there was also greater agreement between actual and desired levels among individuals who found the traits less impairing. For 2 of the traits-Negative Affectivity and Detachment-individuals who felt more capable of changing these traits demonstrated greater agreement between their actual and desired levels. These data suggest that individuals with PD traits do not generally see them as particularly likable and see them as impairing; such impressions may have important implications for where individuals ultimately prefer to reside on these PD trait domains. (PsycINFO Database Record

There is an ongoing debate regarding the nature of narcissism such that some argue that narcissistic individuals oscillate between grandiose and vulnerable states, whereas others argue these dimensions are stable traits (e.g., grandiose individuals remain in grandiose states). Scales sensitive to fluctuations in narcissistic states are necessary to address this question. The current study (N = 1,613 across three samples) validates the newly developed Narcissistic Vulnerability Scale (NVS), a brief (11-item) adjective-based measure of vulnerable narcissism. Expert ratings were used for item selection. The NVS's factor structure was evaluated along with its correlations with measures of grandiose and vulnerable narcissism, five-factor model traits, and self-esteem. A subset of NVS items were also evaluated using an ecological momentary assessment design. Results indicate the NVS is a unidimensional measure of vulnerable narcissism that could be used in either trait-oriented or state-oriented analyses, the latter of which may be particularly well suited to answering the most pressing questions in the study of narcissism. (PsycINFO Database Record

Due to increased empirical interest in narcissism across the social sciences, there is a need for inventories that can be administered quickly while also reliably measuring both the agentic and antagonistic aspects of grandiose narcissism. In this study, we sought to validate the factor structure, provide representative descriptive data and reliability estimates, assess the reliability across the trait spectrum, and examine the nomological network of the short version of the Narcissistic Admiration and Rivalry Questionnaire (NARQ-S; Back et al., 2013). We used data from a large convenience sample (total N = 11,937) as well as data from a large representative sample (total N = 4,433) that included responses to other narcissism measures as well as related constructs, including the other Dark Triad traits, Big Five personality traits, and self-esteem. Confirmatory factor analysis and item response theory were used to validate the factor structure and estimate the reliability across the latent trait spectrum, respectively. Results suggest that the NARQ-S shows a robust factor structure and is a reliable and valid short measure of the agentic and antagonistic aspects of grandiose narcissism. We also discuss future directions and applications of the NARQ-S as a short and comprehensive measure of grandiose narcissism. (PsycINFO Database Record

Narcissism is broadly described as a grandiose sense of self, feelings of entitlement, and a need for attention and admiration. Theorists have long suggested that to maintain an overly positive self-image, individuals with narcissistic features often self-enhance (Leary, 2007) and exhibit distorted (John & Robins, 1994) self-perceptions. Despite this theoretical link, little is known about its relationship to response style, particularly in regard to underreporting or defensiveness. Nevertheless, response style has been extensively studied in psychopathy, narcissism's closest neighbor, due to concerns that psychopathic individuals may lack insight into their traits and/or may be unwilling to admit to perceived faults or difficulties. Given the limited research on this topic, we examined narcissism's relation to response style in multiple samples (i.e., two undergraduate samples; one incarcerated sample) with several well-validated measures of response validity and narcissism. Across samples, the findings indicate that narcissism is not characterized by response invalidity, at least not in low-stakes research settings; in fact, vulnerable features of narcissism were found to be negatively associated with underreporting and a defensive response style. Implications for the present findings are discussed. (PsycINFO Database Record

Objective: Theoretical conceptions of narcissism have long been characterized by two seemingly opposing poles: grandiosity and vulnerability. The goal of the current study was to investigate the extent to which traits associated with one profile are perceived to co-occur with the other within an individual. Method: Lay raters (n = 862; 56% female; 80% Caucasian; mean age = 37) recruited from Amazon's MTurk and assigned to one of four conditions in which they rated how often a series of narcissistic traits were displayed by a prototypical grandiose narcissist, vulnerable narcissist, a close friend, or themselves. Vulnerable narcissism items were specifically worded to assess internalizing vs. externalizing-based emotional responses. Results: Results suggest that grandiosely narcissistic individuals are seen as responding angrily to ego-threatening situations, while vulnerably narcissistic individuals are seen as responding with a broader array of negative emotions including anger, sadness, and shame. In contrast, vulnerably narcissistic individuals were not rated as consistently demonstrating behaviors, attitudes, or cognitions associated with grandiose narcissism. Conclusions: Grandiose and vulnerable narcissistic individuals both exhibit anger in response to ego threat, but sadness/shame responses are much more characteristic of vulnerable narcissism. This article is protected by copyright. All rights reserved.

Orth, Trzesniewski, and Robins (2010) concluded that the nationally representative Americans' Changing Lives (ACL) cohort-sequential study demonstrated moderate to large age differences in self-esteem, and no birth cohort (generational) differences in the age trajectory. In a reanalysis of these data using 2 different statistical techniques, we find significant increases in self-esteem that could be attributed to birth cohort or time period. First, hierarchical linear modeling analyses with birth cohort as a continuous variable (vs. the multiple group formulation used by Orth et al.) find that birth cohort has a measurable influence on self-esteem through its interaction with age. Participants born in later years (e.g., 1960) were higher in self-esteem and were more likely to increase in self-esteem as they aged than participants born in earlier years (e.g., 1920). However, the estimated age trajectory up to age 60 is similar in Orth et al.'s results and in the results from our analyses including cohort. Second, comparing ACL respondents of the same age in 1986 versus 2002 (a time-lag design) yields significant birth cohort differences in self-esteem, with 2002 participants of the same age higher in self-esteem than those in 1986. Combined with some previous studies finding significant increases in self-esteem and positive self-views over time, these results suggest that cultural change in the form of cohort and time period cannot be ignored as influences in cross-sectional and longitudinal studies. (PsycINFO Database Record

Research on narcissism has shown it to be multidimensional construct. As such, the relations the larger construct bear with certain outcomes may mask heterogeneity apparent at the more basic trait level. This article used the Five Factor Narcissism Inventory, a Five-Factor Model–based measure of narcissism that allows for multiple levels of analysis, to examine the relative importance of narcissistic traits in relation to aggression, externalizing behavior, and self-esteem outcomes in two independent samples. The relative importance of the narcissism factors was determined through the use of dominance analysis—a relatively underused method for determining relative importance among a set of related predictors. The results showed that antagonism, compared with agentic extraversion and neuroticism, was the dominant predictor across all forms of aggressive behavior. Additional analyses showed that subscales within the broader factor of antagonism also showed differential importance relative to one another for certain aggression outcomes. The results are discussed in the context of the relation between narcissism and aggression and highlight the utility of using extensions of regression-based analyses to explore the heterogeneity within personality constructs.

The present study hypothesized that there exist two distinct groups of entitled individuals: grandiose-entitled, and vulnerable-entitled. Self-report scores of entitlement were collected for 916 individuals using an online platform. Model-based cluster analyses were conducted on the individuals with scores one standard deviation above mean (n = 159) using the five-factor model dimensions as clustering variables. The results support the existence of two groups of entitled individuals categorized as emotionally stable and emotionally vulnerable. The emotionally stable cluster reported emotional stability, high self-esteem, more positive affect, and antisocial behavior. The emotionally vulnerable cluster reported low self-esteem and high levels of neuroticism, disinhibition, conventionality, psychopathy, negative affect, childhood abuse, intrusive parenting, and attachment difficulties. Compared to the control group, both clusters reported being more antagonistic, extraverted, Machiavellian, and narcissistic. These results suggest important differences are missed when simply examining the linear relationships between entitlement and various aspects of its nomological network.

Public discourse is often caustic and conflict-filled. This trend seems to be particularly evident when the content of such discourse is around moral issues (broadly defined) and when the discourse occurs on social media. Several explanatory mechanisms for such conflict have been explored in recent psychological and social-science literatures. The present work sought to examine a potentially novel explanatory mechanism defined in philosophical literature: Moral Grandstanding. According to philosophical accounts, Moral Grandstanding is the use of moral talk to seek social status. For the present work, we conducted six studies, using two undergraduate samples (Study 1, N = 361; Study 2, N = 356); a sample matched to U.S. norms for age, gender, race, income, Census region (Study 3, N = 1,063); a YouGov sample matched to U.S. demographic norms (Study 4, N = 2,000); and a brief, one-month longitudinal study of Mechanical Turk workers in the U.S. (Study 5 , Baseline N = 499, follow-up n = 296), and a large, one-week YouGov sample matched to U.S. demographic norms (Baseline N = 2,519, follow-up n = 1,776). Across studies, we found initial support for the validity of Moral Grandstanding as a construct. Specifically, moral grandstanding motivation was associated with status-seeking personality traits, as well as greater political and moral conflict in daily life.

Both academic and popular literatures have repeatedly contended that emerging adults are the most narcissistic and entitled age-group in modern times. Although this contention is fiercely debated, the message that emerging adults are narcissistic and entitled has saturated popular culture. Despite this saturation, relatively little empirical work has examined how emerging adults might react to such labels. Across three studies in five samples in the U.S., the present work sought to address this deficit in research. Results from cross-sectional samples of university students at two universities, as well as an online convenience sample of web-using adults (Study 1), indicated that emerging adults believe their age-group and the one following them (e.g., adolescents) to be the most narcissistic and entitled age-groups, that they have generally negative opinions of narcissism and entitlement, and that they respond negatively to being labeled as narcissistic and entitled. Additionally, results from adult web-users revealed that, while all age groups tend to view adolescents and emerging adults as more narcissistic and entitled than older age-groups, these opinions are more exaggerated among members of older age-groups. Finally, across two experimental studies (Studies 2 & 3), results indicated that emerging adults react negatively to labeling of their age-group as narcissistic and entitled, but no more negatively than they do to potentially related undesirable labels (e.g., oversensitive). Collectively, these results indicate that emerging adults are aware of and somewhat distressed by messaging that casts their age-group as the most narcissistic and entitled age-group ever.

The Five-Factor Narcissism Inventory (FFNI) is a self-report measure of the traits linked to grandiose and vulnerable narcissism, as well as narcissistic personality disorder (NPD), from a five-factor model perspective (FFM). In the current studies, the factor structure of the FFNI was explored and the results supported the extraction of three factors: Antagonism (e.g., Arrogance), Neuroticism (e.g., Need for Admiration), and Agentic Extraversion (e.g., Authoritativeness). In Study 2, the FFNI factors manifested convergent validity with their corresponding Big Five domains and diverging relations with measures of grandiose and vulnerable narcissism, NPD, and self-esteem. Ultimately, the FFNI factors help explicate the differences between various expressions of narcissism such that all are related to Antagonism but differ with regard to Neuroticism (relevant to vulnerable narcissism and NPD) and Agentic Extraversion (relevant to grandiose narcissism and NPD). The results also highlight the complex relation between self-esteem and the traits that comprise narcissism measures.

There is broad consensus that there are at least two different dimensions of narcissism: vulnerable and grandiose. In this study, the authors use a new trifurcated, three-factor model of narcissism to examine relations between aspects of narcissism and an array of clinically relevant criteria related to psychopathology, the self, authenticity, and well-being. Neurotic and antagonistic aspects of narcissism emerged as the most clinically relevant dimensions of narcissism, bearing relations with outcomes relating to interpersonal guilt, insecure attachment styles, cognitive distortions, maladaptive defense mechanisms, experiential avoidance, impostor syndrome, weak sense of self, inauthenticity, low self-esteem, and reduced psychological well-being. Grandiose narcissism was not correlated with most forms of psychopathology and was even positively associated with life satisfaction. Nevertheless, a surprising link was found between grandiose narcissism and multiple indicators of inauthenticity. Implications for the appropriate conceptualization, assessment, and treatment of pathological narcissism are discussed.

Objective Despite decades of work on narcissism, there remain many active areas of exploration and debate including a clear and consensual description of its underlying components. Understanding narcissism's factor structure is necessary for the precise measurement and investigation of specific psychological and behavioral processes. The aim of the current study was to explore the structure of narcissism by examining it at varying hierarchical levels. Method Participants recruited from Amazon's Mechanical Turk (N = 591) completed 303 narcissism items encompassing 46 narcissism scales and subscales. Criterion variables measuring the five-factor model, self-esteem, aggression, and externalizing behavior were also collected. Results A series of factor analyses reveal the factor structure of narcissism at a range of specificities. No more than five meaningful factors (i.e., Grandiosity, Neuroticism, Antagonism, Distrustful Self-reliance, Attention-seeking) were identified and the most parsimonious model appears to be a three-factor structure. Narcissism scales that effectively capture each of the identified factors are identified. Factors diverged in their associations with criterion variables. Conclusions A three-factor model (i.e., Agentic Extraversion, Narcissistic Neuroticism, Self-centered Antagonism) seems to be the most parsimonious conceptualization. Larger factor solutions are discussed, but future research will be necessary to determine the value of these increasingly narrow factors.

Mixed findings exist as to whether personality pathology involves a critical lack of awareness and insight. Research questions about insight and awareness in personality pathology are typically assessed via comparing self- and informant reports of traits. However, recent studies have measured insight by asking individuals to evaluate additional questions about impairment and desire to change. The present study uses a variety of approaches to examine these issues, including investigations of convergence between self- and informant reports (N = 197 dyads; correlations and comparisons of means) of personality psychopathology, desired trait levels, and perceptions of impairment. Convergence was observed between levels of self- and informant-reported traits, desired traits, and impairment. However, individuals rated themselves higher on pathological trait levels and impairment than did their informants. Furthermore, individuals with relatively higher pathological traits desired higher levels of these traits (but lower than their actual scores) than individuals with lower scores; on the actual measurement scale, however, these higher scorers rated their desired level below the neutral point. Overall, individuals with pathological personality traits possess a reasonable degree of insight into their actual trait levels and associated impairment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Despite a growing interest in the use of self-report measures of narcissism among student, community, and clinical samples, the research on narcissism in prison samples is sparse, despite elevated rates of narcissism in these samples. The current study examined the relations between commonly used measures of grandiose narcissism (Narcissistic Personality Inventory-13 [NPI-13]), vulnerable narcissism (Hypersensitive Narcissism Scale [HSNS]), and narcissistic personality disorder (NPD; Personality Diagnostic Questionnaire [PDQ]) in a sample of adult male offenders (N = 179). The NPI-13 and PDQ NPD scales overlapped substantially with one another and manifested similar empirical profiles (rICC = .81), with both being substantially correlated with interview-based symptoms of NPD, entitlement, psychopathy, and externalizing behaviors. Conversely, the HSNS manifested more limited relations with other measures of NPD and related traits (e.g., entitlement), as well as externalizing behaviors, and was more strongly related to internalizing symptoms. Consistent with previous work, NPD appears to be a blend of grandiose and vulnerable narcissism as the PDQ's empirical profile overlapped with that of the HSNS (rICC = .51), which was not true for the NPI-13 (rICC = .18). Analyses of the incremental validity of the 3 measures suggested that the NPI-13 was particularly successful in accounting for unique variance in these relevant criteria. These results underscore the benefit of utilizing multiple measures to distinguish empirical correlates of grandiose narcissism, vulnerable narcissism, and NPD. (PsycINFO Database Record

In nationally representative yearly surveys of United States 8th, 10th, and 12th graders 1991-2016 (N = 1.1 million), psychological well-being (measured by self-esteem, life satisfaction, and happiness) suddenly decreased after 2012. Adolescents who spent more time on electronic communication and screens (e.g., social media, the Internet, texting, gaming) and less time on nonscreen activities (e.g., in-person social interaction, sports/exercise, homework, attending religious services) had lower psychological well-being. Adolescents spending a small amount of time on electronic communication were the happiest. Psychological well-being was lower in years when adolescents spent more time on screens and higher in years when they spent more time on nonscreen activities, with changes in activities generally preceding declines in well-being. Cyclical economic indicators such as unemployment were not significantly correlated with well-being, suggesting that the Great Recession was not the cause of the decrease in psychological well-being, which may instead be at least partially due to the rapid adoption of smartphones and the subsequent shift in adolescents' time use. (PsycINFO Database Record

Although there is evidence that experts agree on the traits that characterize narcissism, this agreement may be due, in part, to the influence of the operationalizations based on the American Psychiatric Association's series of Diagnostic and Statistical Manuals of Mental Disorders (American Psychiatric Association [APA], 1980, 1994, 2013). Because these trait descriptions are important in shaping conceptualizations and serving as empirical criteria for construct validation, we explored their generalizability. In Study 1, we collected lay ratings (N = 1,792) of prototypical cases of narcissism across 15 different categories (e.g., gender, age, occupational status) on the 30 traits of the five-factor model (FFM). There was good agreement within and across rating categories and the trait profiles were quite similar to existing ratings made by academicians and clinicians. In Study 2 (N = 603), we examined the degree to which various scores from the Five-Factor Narcissism Inventory-Short Form (FFNI-SF; Sherman et al., 2015) provided empirical matches to these FFM profiles (mean lay ratings from Study 1; existing expert-based and meta-analytically derived profiles). In general, scores from the FFNI-SF grandiose scale, as well as the empirically derived FFNI-SF Antagonism and Agentic Extraversion components yielded FFM profiles closely aligned to the various consensus profiles. These results are generally consistent with a burgeoning literature that suggests that the FFNI/FFNI-SF is a promising tool for the study of narcissism given its comprehensiveness, flexibility, and ties to the predominant model of personality. (PsycINFO Database Record

The Five-Factor Narcissism Inventory (FFNI; Glover, Miller, Lynam, Crego, & Widiger, 2012) is a 148-item self-report inventory of 15 traits designed to assess the basic elements of narcissism from the perspective of a 5-factor model. The FFNI assesses both vulnerable (i.e., cynicism/distrust, need for admiration, reactive anger, and shame) and grandiose (i.e., acclaim seeking, arrogance, authoritativeness, entitlement, exhibitionism, exploitativeness, grandiose fantasies, indifference, lack of empathy, manipulativeness, and thrill seeking) variants of narcissism. The present study reports the development of a short-form version of the FFNI in 4 diverse samples (i.e., 2 undergraduate samples, a sample recruited from MTurk, and a clinical community sample) using item response theory. The validity of the resultant 60-item short form was compared against the validity of the full scale in the 4 samples at both the subscale level and the level of the grandiose and vulnerable composites. Results indicated that the 15 subscales remain relatively reliable, possess a factor structure identical to the structure of the long-form scales, and manifest correlational profiles highly similar to those of the long-form scales in relation to a variety of criterion measures, including basic personality dimensions, other measures of grandiose and vulnerable narcissism, and indicators of externalizing and internalizing psychopathology. Grandiose and vulnerable composites also behave almost identically across the short- and long-form versions. It is concluded that the FFNI-Short Form (FFNI-SF) offers a well-articulated assessment of the basic traits comprising grandiose and vulnerable narcissism, particularly when assessment time is limited.

Given advantages of freely available and modifiable measures, an increase in the use of measures developed from the International Personality Item Pool (IPIP), including the 300-item representation of the Revised NEO Personality Inventory (NEO PI–R; Costa & McCrae, 1992a) has occurred. The focus of this study was to use item response theory to develop a 60-item, IPIP-based measure of the Five-Factor Model (FFM) that provides equal representation of the FFM facets and to test the reliability and convergent and criterion validity of this measure compared to the NEO Five Factor Inventory (NEO-FFI). In an undergraduate sample (n = 359), scores from the NEO-FFI and IPIP–NEO–60 demonstrated good reliability and convergent validity with the NEO PI–R and IPIP–NEO–300. Additionally, across criterion variables in the undergraduate sample as well as a community-based sample (n = 757), the NEO-FFI and IPIP–NEO–60 demonstrated similar nomological networks across a wide range of external variables (rICC = .96)....

Objective Increasing attention has been paid to the distinction between the dimensions of narcissistic grandiosity and vulnerability. We examine the degree to which basic traits underlie vulnerable narcissism, with a particular emphasis on the importance of Neuroticism and Agreeableness. Method Across four samples (undergraduate, online community, clinical-community), we conduct dominance analyses to partition the variance predicted in vulnerable narcissism by the Five-Factor Model personality domains, as well as compare the empirical profiles generated by vulnerable narcissism and Neuroticism. Results These analyses demonstrate that the lion's share of variance is explained by Neuroticism (65%) and Agreeableness (19%). Similarity analyses were also conducted in which the extent to which vulnerable narcissism and Neuroticism share similar empirical networks was tested using an array of criteria, including self-, informant, and thin slice ratings of personality; interview-based ratings of personality disorder and pathological traits; and self-ratings of adverse events and functional outcomes. The empirical correlates of vulnerable narcissism and Neuroticism were nearly identical (MrICC = .94). Partial analyses demonstrated that the variance in vulnerable narcissism not shared with Neuroticism is largely specific to disagreeableness-related traits such as distrustfulness and grandiosity. Conclusions These findings demonstrate the parsimony of using basic personality to study personality pathology and have implications for how vulnerable narcissism might be approached clinically.

The similarity between narcissism and self-esteem seems intuitive, as both capture positive perceptions of the self. Empirical evidence suggests that these constructs are moderately correlated and share some common factors, but the exact nature of their relation is uncertain, as there are critical differences in their connections to other important variables. In the current undertaking, we provide a broad, relatively comprehensive comparison of the nomological networks of grandiose narcissism and explicit self-esteem. Pooling data from 11 existing samples (N=4711), we examined the relations of narcissism and self-esteem to developmental experiences, individual differences, interpersonal functioning, and internalizing as well as externalizing psychopathology. Results suggest that both constructs are strongly and positively related to agentic traits, such as extraversion and assertive interpersonal approaches but differ in relation to agreeableness/communion. In terms of functionality, self-esteem emerged as an adaptive construct that is strongly and negatively associated with internalizing psychopathology and generally unrelated to externalizing behaviors. Although narcissism bore only small relations to internalizing psychopathology, it was uniquely and positively related to interpersonal antagonism, pathological personality traits, and externalizing behaviors. Thus, narcissism and self-esteem share a core of extraversion and a tendency towards behavioral activation and approach but differ with regard to their view of others in relation to the self. Narcissism, unlike high self-esteem, was related to more callous, grandiose, entitled, denigrating, and aggressive views of and attitudes towards others that likely partially explain narcissism’s stronger links to maladaptive outcomes.

Two dimensions of narcissism exist, grandiose and vulnerable, which are thought to be associated with distinctly different patterns of interpersonal behavior. Social network analysis is a way of quantifying and analyzing interpersonal interactions that may prove useful for characterizing the networks associated with these narcissism dimensions. In the current study, participants (N = 148) completed scales assessing both narcissism dimensions and a measure of the five-factor model of personality. Egocentric network information about participants' 30 closest friends and family members (i.e., "alters") was also obtained. Both narcissism dimensions were characterized by negative perceptions of the individuals who comprise one's social networks, and many of these relations were mediated by individuals' higher levels of antagonism. Grandiose narcissism also interacted with alter centrality (i.e., importance to the network) such that individuals low on grandiose narcissism were less likely to perceive central alters in a negative light and were more attuned to central alters than were individuals high on grandiose narcissism. Overall, both narcissism dimensions were associated with perceiving one's overall social environment negatively because of the high levels of antagonism that characterize both narcissism dimensions. Individuals high on grandiose narcissism, however, appear to be more insensitive to the relative importance of individuals in their social networks.

Impulsivity has been consistently associated with pathological gambling (PG), but the diversity of definitions and measures of impulsivity has led to ambiguity with regard to which indices are independently relevant. Toward clarifying this relationship, the current study examined indices from an array of commonly-used impulsivity measures in relation to PG severity in an adult community sample of frequent gamblers (N = 353). These included both survey assessments and behavioral tasks. Using a factor analytic approach, four latent factors were identified among 19 indices and were designated reward sensitivity, punishment sensitivity, delay discounting, and cognitive impulsivity. All four latent variables were positively and independently related to PG severity, albeit at a trend level for cognitive impulsivity in a combined model. These findings reveal four generally independent domains of impulsivity that are related to PG severity, clarify which assessment measures aggregate in each domain, and illustrate the importance of measurement specificity in studying impulsivity in relation to PG and other psychiatric disorders.

Objective: Alcohol misuse is substantially infl uenced by social factors, but systematic assessments of social network drinking are typically lengthy. The goal of the present study was to provide further validation of a brief measure of social network alcohol use, the Brief Alcohol Social Density Assessment (BASDA), in a sample of emerging adults. Specifi cally, the study sought to examine the BASDA's conver- gent, criterion, and incremental validity in relation to well-established measures of drinking motives and problematic drinking. Method: Participants were 354 undergraduates who were assessed using the BASDA, the Alcohol Use Disorders Identifi cation Test (AUDIT), and the Drinking Motives Questionnaire. Results: Signifi cant associations were observed between the BASDA index of alcohol-related social density and alcohol misuse, social motives, and conformity motives, supporting convergent validity. Criterion-related validity was supported by evidence that signifi cantly greater alcohol involvement was present in the social networks of individuals scoring at or above an AUDIT score of 8, a vali- dated criterion for hazardous drinking. Finally, the BASDA index was signifi cantly associated with alcohol misuse above and beyond drinking motives in relation to AUDIT scores, supporting incremental validity. Conclusions: Taken together, these fi ndings provide further support for the BASDA as an effi cient measure of drinking in an individual's social network. Methodological considerations as well as recommendations for future investigations in this area are discussed. (J. Stud. Alcohol Drugs, 74, 810-815, 2013)

Despite widespread use, the South Oaks Gambling Screen (SOGS) has been criticized for excessive false positives as an indicator of pathological gambling (PG), and for items that misalign with PG criteria. We examine the relationship between SOGS scores and PG symptoms and convergent validity with regard to personality, mood, and addictive behaviors in a sample of 353 gamblers. SOGS scores correlated r = .66 with both DSM-IV and DSM-5 symptoms, and they manifested similar correlations with external criteria (intraclass correlation of .95). However, 195 false positives and 1 false negative were observed when using the recommended cut point, yielding an 81% false alarm rate. For uses with DSM-IV criteria, a cut point of 10 would retain high sensitivity with greater specificity and fewer false positives. For DSM-5 criteria, we advocate a cut point of 8 for use as a clinical screen and a cut point of 12 for prevalence and pseudo-experimental studies.

The Diagnostic and Statistical Manual of Personality Disorders (4th ed., American Psychiatric Association, 2000) personality disorders (PDs) that will be included in the DSM-5 will be diagnosed in an entirely different manner; the explicit criterion sets will be replaced with impairments in self and interpersonal functioning and personality traits from a 25-trait dimensional model of personality pathology. From a trait perspective, narcissistic personality disorder (NPD), the focus of this study, is assessed using 2 specific traits: grandiosity and attention seeking. Using a sample collected online from Amazon's Mechanical Turk (MTurk; N=306), we examined the relations among traits from a new measure of DSM-5's trait model--the Personality Inventory for DSM-5 (PID5; Krueger, Derringer, Markon, Watson, & Skodol, in press)--and grandiose and vulnerable narcissism. The 25 traits from PID5 captured a significant portion of the variance in grandiose and vulnerable factors, although the 2 specific facets designated for the assessment of NPD fared substantially better in the assessment of grandiose rather than vulnerable narcissism. These results are discussed in the context of improving the DSM-5's ability to capture both narcissism dimensions.

Background In patients with locally advanced or low rectal cancers, long-course chemoradiotherapy (LCCRT) is recommended prior to surgical management.1 The need for restaging afterwards has been questioned as it may be difficult to interpret imaging due to local tissue effects of chemoradiotherapy. The purpose of this study was to determine if restaging affected the management of patients receiving long-course chemoradiotherapy for rectal cancer. Methods A retrospective review of patients with rectal cancer discussed at the South Eastern Health and Social Care Trust Lower Gastrointestinal Multi-Disciplinary Team Meeting (LGIMDT) in 2013 who had received long-course chemoradiotherapy was performed. Patients were identified from the Trust Audit Department, LGIMDT notes and patient records. Imaging results and outcomes from meetings were obtained through the Northern Ireland Picture Archiving and Communications System® (NIPACS) and Electronic Care Record® (ECR). Data including patient demographics, initial radiological staging and LGIMDT discussion, restaging modality and result, outcome from post-treatment LGIMDT discussion and recorded changes in management plans were documented using a proforma. Results Seventy-one patients with rectal cancer were identified as having LCCRT in 2013 (M:F 36:35; age range 31 - 85 years). Fifty-nine patients were restaged following long-course treatment with computed tomography (CT) and magnetic resonance imaging (MRI). Twelve patients did not undergo restaging. Data was not available for 6 patients, one patient underwent emergency surgery, two patients were not fit for treatment, one failed to attend for restaging and two patients died prior to completion of treatment. Of the 59 patients restaged, 19 patients (32%) had their management plan altered from that which had been proposed at the initial LGIMDT discussion. The most common change in plan was not to operate. Ten patients had a complete clinical and radiological response to treatment and have undergone intensive follow-up. Nine patients had disease progression, with 3 requiring palliative surgery and 6 referred for palliative care. Conclusion Of those patients who were restaged, 32% had their management plan altered from that recorded at the initial LGIMDT discussion. Seventeen per cent of patients in this group had a complete clinical and radiological response to treatment. Fifteen percent demonstrated disease progression. We recommend, therefore, that patients with rectal cancer be restaged with CT and MRI following long-course chemoradiotherapy as surgery may be avoided in up to 27% of cases.

Narcissistic personality disorder (NPD) shows high rates of comorbidity with mood, anxiety, substance use, and other personality disorders. Previous bivariate comorbidity investigations have left NPD multivariate comorbidity patterns poorly understood. Structural psychopathology research suggests that two transdiagnostic factors, internalizing (with distress and fear subfactors) and externalizing, account for comorbidity among common mental disorders. NPD has rarely been evaluated within this framework, with studies producing equivocal results. We investigated how NPD related to other mental disorders in the internalizing-externalizing model using diagnoses from a nationally representative sample (N = 34,653). NPD was best conceptualized as a distress disorder. NPD variance accounted for by transdiagnostic factors was modest, suggesting its variance is largely unique in the context of other common mental disorders. Results clarify NPD multivariate comorbidity, suggest avenues for classification and clinical endeavors, and highlight the need to understand vulnerable and grandiose narcissism subtypes' comorbidity patterns and structural relations.

The Narcissistic Grandiosity Scale (NGS) is a short adjective-based measure of narcissistic grandiosity (Rosenthal, Hooley, & Steshenko, 2007). The NGS has already shown promise as a measure of grandiose narcissism, but it has never been the subject of a formal validation study. In the current study (N = 870 across 3 samples), the factor structure of NGS was examined and item response theory analyses were used to generate abbreviated versions of the scale. The NGS scales' relations to measures of grandiose and vulnerable narcissism, the five-factor model (FFM), the interpersonal circumplex, self-esteem, and the Personality Inventory of the Diagnostic and Statistical Manual for Mental Disorders-Fifth Edition (DSM-5, PID-5) were assessed. The correlation profile of the NGS was also correlated with expert ratings of prototypical cases of narcissistic personality disorder using both the FFM and PID-5 trait profiles. Overall, the NGS was found to be a unidimensional measure of narcissistic grandiosity with good convergent, discriminant, and criterion validity. The abbreviated versions of the NGS manifested strong reliability and associations entirely consistent with the full version. (PsycINFO Database Record

Some scholars have called for the replacement of the Narcissistic Personality Inventory (NPI) with more narrow scales measuring grandiosity and entitlement instead. In the current study, the authors examined the relations among the NPI and measures of grandiosity and entitlement, as well as in relation to a measure of the Five-Factor Model (FFM). The NPI manifested significant correlations with the alternative scales of entitlement and grandiosity and relatively similar patterns of correlations with the FFM traits. Of note, the NPI manifested significant incremental validity in the prediction of several FFM traits that are central to the conceptualization of narcissism. These findings suggest that some caution must be used before assuming that these lower-order scales can be used to replace the NPI in the assessment of narcissism.

A recent meta-analysis (S. Vazire & D. C. Funder, 2006) suggested that narcissism and impulsivity are related and that impulsivity partially accounts for the relation between narcissism and self-defeating behaviors (SDB). This research examines these hypotheses in two studies and tests a competing hypothesis that Extraversion and Agreeableness account for this relation. In Study 1, we examined the relations among narcissism, impulsivity, and aggression. Both narcissism and impulsivity predicted aggression, but impulsivity did not mediate the narcissism-aggression relation. In Study 2, narcissism was related to a measure of SDB and manifested divergent relations with a range of impulsivity traits from three measures. None of the impulsivity models accounted for the narcissism-SDB relation, although there were unique mediating paths for traits related to sensation and fun seeking. The domains of Extraversion and low Agreeableness successfully mediated the entire narcissism-SDB relation. We address the discrepancy between the current and meta-analytic findings.

There is a lack of consensus surrounding the conceptualization of narcissism. The present study compared two measures of narcissism-one used in clinical settings (Personality Diagnostic Questionnaire, PDQ-4+; Hyler, 1994) and one used in social-personality research (Narcissistic Personality Inventory, NPI; Raskin & Terry, 1988)-across two samples. Sample 1 (N=271) was composed of undergraduates, whereas Sample 2 (N=211) was composed of parents of the Sample 1 participants. The scales were significantly interrelated but manifested divergent relations with general personality traits, personality disorders (including expert prototypal ratings of narcissism), recollections of parenting received, and psychological distress and self-esteem. PDQ-4 narcissism captured an emotionally unstable, negative-affect-laden, and introverted variant of narcissism; NPI narcissism captured an emotionally resilient, extraverted form. The clinical and social-personality conceptualizations of narcissism primarily share a tendency to use an antagonistic interpersonal style. Implications for the DSM-V are discussed.

Recent research and theory suggest that mindfulness, or enhanced attention and awareness in the present moment [Brown and Ryan, 2003], may be linked to lower levels of ego-involvement and, as a result, may have implications for lowering hostility and aggressive behavior. Accordingly, we conducted two studies to examine the potential aggression-mitigating role of mindfulness. In Study 1, we found that dispositional mindfulness correlated negatively with self-reported aggressiveness and hostile attribution bias. In Study 2, participants made mindful before receiving social rejection feedback displayed less-aggressive behavior than did rejected participants not made mindful. Discussion centers on potential mechanisms by which mindfulness operates to reduce aggressive behavior. Aggr. Behav. 34:486–496, 2008. © 2008 Wiley-Liss, Inc.

In a series of 412 patients with Klinefelter's syndrome observed over periods ranging from 1 to 20 years, the frequency of hypostatic ulceration, deep vein thrombosis and pulmonary embolism was found to be raised. The prevalence of past or present hypostatic ulceration was 6%, which is 20-50 times higher than in the general population. The incidence of deep vein thrombosis in subjects aged between 30 and 70 years was 22.8 cases per 10,000 patient-years at risk. In community studies the incidence of this condition is around 4 new cases per 10,000 men per year. The frequency of pulmonary embolism was 16 cases per 10,000 patient-years at risk, compared with an expected figure of 0.9 to 3 cases per 10,000 men per year.

This study examined the construct validity of narcissistic personality disorder (NPD) by examining the relations between NPD and measures of psychologic distress and functional impairment both concurrently and prospectively across 2 samples. In particular, the goal was to address whether NPD typically "meets" criterion C of the DSM-IV definition of Personality Disorder, which requires that the symptoms lead to clinically significant distress or impairment in functioning. Sample 1 (n = 152) was composed of individuals receiving psychiatric treatment, whereas sample 2 (n = 151) was composed of both psychiatric patients (46%) and individuals from the community. Narcissistic personality disorder was linked to ratings of depression, anxiety, and several measures of impairment both concurrently and at 6-month follow-up. However, the relations between NPD and psychologic distress were (a) small, especially in concurrent measurements, and (b) largely mediated by impaired functioning. Narcissistic personality disorder was most strongly related to causing pain and suffering to others, and this relationship was significant even when other Cluster B personality disorders were controlled. These findings suggest that NPD is a maladaptive personality style which primarily causes dysfunction and distress in interpersonal domains. The behavior of narcissistic individuals ultimately leads to problems and distress for the narcissistic individuals and for those with whom they interact.

The issue of Americans' levels of narcissism is subject to lively debate. The focus of the present research is on the perception of national character (PNC) of Americans as a group. In Study 1, American adults (N = 100) rated Americans as significantly more narcissistic than they perceived themselves and acquaintances. In Study 2, this finding was replicated with American college students (N = 322). PNC ratings of personality traits and externalizing behaviors revealed that Americans were perceived as disagreeable and antisocial as well. In Study 3, we examined the broader characteristics associated with PNC ratings (N = 183). Americans rated the typical American as average on a variety of characteristics (e.g., wealth, education, health, likability) and PNC ratings of narcissism were largely unrelated to these ratings. In Study 4 (N = 1,202) Americans rated PNCs for different prespecified groups of Americans; as expected, PNC ratings of narcissism differed by gender, age, and occupational status such that American males, younger Americans, and Americans working in high-visibility and status occupations were seen as more narcissistic. In Study 5 (N = 733), citizens of 4 other world regions (Basque Country, China, England, Turkey) rated members of their own region as more narcissistic than they perceived themselves, but the effect sizes were smaller than those found in the case of Americans' perceptions of Americans. Additionally, members of these other regions rated Americans as more narcissistic than members of their own region. Finally, in Study 6, participants from around the world (N = 377) rated Americans as more narcissistic, extraverted, and antagonistic than members of their own countries. We discuss the role that America's position as a global economic and military power, paired with a culture that creates and reifies celebrity figures, may play in leading to perceptions of Americans as considerably narcissistic.

Despite narcissism’s relation with interpersonal dysfunction, surprisingly little empirical research has been devoted to understanding narcissism’s effect on intimate relationships in general or marital relationships in particular. The current study addressed this gap using longitudinal data from a community sample of 146 newlywed couples assessed 6 times over the first four years of marriage. First, we examined partner characteristics associated with higher levels of narcissism to determine the degree to which couples were matched on narcissism and related traits. Second, we examined how narcissism predicted the trajectory of marital quality over time, testing narcissism’s association with initial levels of relationship functioning (the intercept) and changes in relationship functioning (the slope). Results indicated a small degree of homophily but otherwise no clear pattern of partner characteristics for individuals higher in narcissism. Hierarchical linear modeling indicated that wives’ total narcissism and entitlement/ exploitativeness scores predicted the slope of marital quality over time, including steeper declines in marital satisfaction and steeper increases in marital problems. Husbands’ narcissism scores generally had few effects on their own marital quality or that of their wives. These findings are notable in indicating that the effects of personality characteristics on marital functioning may take some time to manifest themselves, even if they were present from early in the marriage. Future research into the mediating psychological and interpersonal processes that link wives’ narcissism with poorer marital functioning over time would be valuable.

In four large, nationally representative surveys (N = 11.2 million), American adolescents and emerging adults in the 2010s (Millennials) were significantly less religious than previous generations (Boomers, Generation X) at the same age. The data are from the Monitoring the Future studies of 12th graders (1976-2013), 8th and 10th graders (1991-2013), and the American Freshman survey of entering college students (1966-2014). Although the majority of adolescents and emerging adults are still religiously involved, twice as many 12th graders and college students, and 20%-40% more 8th and 10th graders, never attend religious services. Twice as many 12th graders and entering college students in the 2010s (vs. the 1960s-70s) give their religious affiliation as "none," as do 40%-50% more 8th and 10th graders. Recent birth cohorts report less approval of religious organizations, are less likely to say that religion is important in their lives, report being less spiritual, and spend less time praying or meditating. Thus, declines in religious orientation reach beyond affiliation to religious participation and religiosity, suggesting a movement toward secularism among a growing minority. The declines are larger among girls, Whites, lower-SES individuals, and in the Northeastern U.S., very small among Blacks, and non-existent among political conservatives. Religious affiliation is lower in years with more income inequality, higher median family income, higher materialism, more positive self-views, and lower social support. Overall, these results suggest that the lower religious orientation of Millennials is due to time period or generation, and not to age.

Background It is traditionally taught that a pneumatic tourniquet is contraindicated for trans-tibial amputations in patients with peripheral arterial disease. However, tourniquets are used successfully during total knee arthroplasty in elderly patients. Vascular patients undergoing a trans-tibial amputation have a high perioperative mortality and morbidity—notably the need for wound revision or a higher amputation level. We hypothesised that a tourniquet, used during amputation, would reduce blood loss and subsequent complications without compromising healing. Methods This was a prospective non-randomized study of 89 adult patients who underwent a trans-tibial amputation between January 2001 and December 2003. The endpoints were: haemoglobin levels, the need for blood transfusion, perioperative morbidity, revision rate and mortality. Patients were divided into two groups: a group with a pneumatic tourniquet ( n =42) and a group without ( n =47). Results The haemoglobin fall was 14.8% in the non-tourniquet group and 5.6% in the tourniquet group, with a higher need for transfusion in the non-tourniquet group. The revision rate was 14.3% in the tourniquet group and significantly higher in the non-tourniquet group (38.3%). Mortality was similar in both groups: 7.1% for the tourniquet and 6.4% for the non-tourniquet group. Conclusion The use of a pneumatic tourniquet is safe and significantly reduces both blood loss and transfusion requirements during trans-tibial amputation. A pneumatic tourniquet reduces revision rates by over 50%, with subsequent cost savings.

Objective. To assess the accuracy of hand held Doppler (HHD) as a rapid screening test for selecting varicose vein patients for duplex imaging. Design. Prospective single blind study of consecutive patients in a randomised trial. Materials. Use of hand held Doppler and duplex ultrasound scanners. Methods. One thousand two hundred and eighteen legs (943 patients) were examined by HHD and then duplex. HHD examiners recorded whether they would normally have requested duplex. Results. HHD results of one Clinical Assistant (166 limbs) were significantly poorer than all others and his results were excluded from analysis. Duplex would not have been requested in 645 of 1052 (62%) limbs. Among these HHD missed significant reflux in the long saphenous vein in 18 (3%) and the short saphenous in 25 (4%). Reasons for requesting duplex were popliteal fossa reflux (202); recurrent (94) or atypical (86) varicose veins; and possible previous thrombosis (67). Differences were observed between staff and units in requests for duplex; and in thoroughness and style of duplex reporting. Conclusions. Selective use of HHD can avoid duplex imaging for many patients, with a low failure rate for detecting correctable venous reflux. Observed variations between individuals and units in results of HHD and duplex imaging have implications for the increasing use of duplex by clinicians.

Narcissistic entitlement impedes forgiveness in ways not captured by other robust predictors (e.g., offense severity, apology, relationship closeness, religiosity, Big Five personality factors), as demonstrated in 6 studies. Narcissistic entitlement involves expectations of special treatment and preoccupation with defending one's rights. In Study 1, entitlement predicted less forgiveness and greater insistence on repayment for a past offense. Complementary results emerged from Study 2, which used hypothetical transgressions, and Study 3, which assessed broad forgiveness dispositions. Study 4 examined associations with the Big Five, and Study 5 extended the findings to a laboratory context. Study 6 demonstrated that entitlement predicted diminished increases in forgiveness over time. Taken together, these results suggest that narcissistic entitlement is a robust, distinct predictor of unforgiveness.