Narcissism and Gender in Leadership


A little bit of narcissism can make a leader. “Too much” can be a problem. On the nature of leadership from a psychological perspective.


Disclaimer: Although this piece relates to certain Presidential races, it is not meant to suggest an endorsement of any candidates.

There are many theories and characteristics of leadership.1 Here, we explore narcissism and gender and consider them from a psychological perspective. Today, we have both female and male candidates vying for candidacy as President of the United States in their respective parties. In the American Psychiatric Association (APA), 2 candidates for President were announced-the current President is a woman; our longer-term Medical Director and CEO is a man. These and other “elections” should be of particular interest to psychiatrists.

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Freud discussed narcissism, especially that of minor differences.2 He applied this concept not only to personal relationships, but to the aggression of somewhat similar adjoining communities toward each other.

In a political race, it is the character of narcissism of those running for a great position like President that matters. Here it was what Heinz Kohut3 later presented in his self-psychology that is most relevant.

Narcissism can be considered both the fuel and fire of leadership. Certainly, it fuels the fire to want to be a President. Narcissism is flamed by the idealization and/or mirroring responses of followers. A healthy dose of narcissism is necessary to lead and relates to the traits of ambition and courage.

When coupled with authority and control, however, narcissism can lead to an abuse of power. It is difficult to maintain the enthusiastic and/or symbiotic lock and key of a leader and organization over long periods. There are inevitable failures and disappointments of unkept promises, as well as fantasies that cannot be met. This progression leads to a loss of idealization and mirroring praise of leader by followers.

“Too much” narcissism can lead to other leadership problems. For example, even a mild degree of excessive narcissism is likely to cause a leader to have difficulties cooperating with other leaders, and to contribute to problems in the transfer of power to a successor.

Malignant narcissism renders a leader susceptible to self-esteem injuries and/or narcissistic rage when his need to be idolized is not adequately met. At worst, the malignant narcissism of a beloved leader combined with regressive tendencies of an unstable organization or country can lead to the scapegoating of outsiders-best illustrated by Hitler and Nazi Germany. Thankfully, this fairly rare phenomenon is ultimately likely to cause the leader and the organization to fail, but only in the wake of much destruction.

New research seems to confirm the relevance and accuracy of Kohut’s theories. Ong and colleagues4 suggest that those with a strong degree of narcissism may appear to be good leaders early on but often soon fall out of favor. To avoid this, their charisma should be combined with some other characteristics, such as empathy.

One classic interview question posed in the most recent Republican debate seems to have worked as a barometer for narcissism. The question was “What is your biggest weakness?” Most didn’t answer the question, though one candidate did say that he trusts too much, and if let down, he never ever forgives.

Clearly, as ethical psychiatrists, we should refrain from endorsing a US President (and hence my disclaimer). We failed miserably once when some of us narcissistically and publicly claimed that Presidential candidate Barry Goldwater was paranoid. This faux-pas led to the so-called “Goldwater Rule” not to comment publicly on someone whom we had not personally evaluated.


One of the oldest philosophies of leadership is the Great Man Theory, established by Aristotle and others. In an evolutionary sense, this was called Great “Man” because of early patriarchal political dominance (although women used other ways to exert power and influence).

Over the last century, leadership has slowly but surely expanded to women outside of the home. Newer brain research has suggested that some women are different kinds of leaders than men.5

Although the brains of men and women have more similarities than differences, the hormonal influences on the female brain tend to confer verbal agility and the establishment of deeper relationships. Conflictual relationships, when they occur, seem to be more readily addressed by women.

Dovetailing onto this biology, a socio-cultural analysis suggests that women tend to resolve ethical dilemmas based on the ethics of care, whereas men tend to do so more on principles of justice.6 “Care” is part of the essence of psychiatry, so it may help explain our plethora of women leaders. Other traits more common to men may explain why men have exclusively dominated the highest position in the White House, at least to date.

Internationally, women have served as Presidents of several countries, including England, India, and Germany. Perhaps modern day Germany is an example of the biological and socio-cultural tendencies of a woman President breeding success.

As far as the relationship of gender to narcissism, full-blown narcissistic personality disorder is be about 3 times more common in men than in women.7 Gender expression tends to differ and follow social norms. However, if a woman were socialized more by male mentors, she would arguably be more likely to display characteristics of a typical male leader.

Assessing leadership
Situational Leadership Theory comes into play here. It considers that the type of leadership varies with the situational demands. A stern and structured military leader is as appropriate as a consensus-building diplomat. Different styles of leadership may be required in everyday life versus crisis leadership during a disaster.

Nonetheless, in a given situation, the particular individual who will lead successfully can vary greatly and seem unpredictable to some extent. The common key seems to be true to yourself, which is reflected in the obvious personality differences in our leaders.

For the Presidential election in psychiatry, we should know what we need. Some of the most obvious problems in our field are own own diminishing leadership and clinical roles in the mental health care field. Most distressing over my career has been the continuing 20-plus year lifespan gap between the most seriously mentally ill and the average citizen.8

Although I don’t know the percentage of psychiatrists who vote in our national Presidential elections, the percentage of voters in APA elections seems low, as though voting doesn’t matter. It does, and perhaps appreciating the aspects of narcissism and gender will help us be more involved and make a wise choice-in any election.


1. van Vugt M, Ahuja A. Naturally Selected: The Evolutionary Science of Leadership. New York: Harper Collins; 2011.
2. Freud S. On Sexuality: Three Essays on the Theory of Sexuality and Other Works. Penquin Freud Library; 1991.
3. Siegel AM. Heinz Kohut and the Psychology of the Self. New York: Routledge; 1996.
4. Ong CW, Roberts R, Arthur CA, et al. The leader ship is sinking: A temporal investigation of narcissistic leadership. J Pers. 2014;Dec 8.
5. Brizendine L The Female Brain. New York: Morgan Road Books; 2006.
6. Gilligan C. In a Different Voice: Psychological Theory and Women’s Development. Cambridge, Mass: Harvard University Press; 1982.
7. Vaknin S. Malignant Self Love: Narcissism Revisited. Czech Republic: Narcissus Publications; 2015.
8. Suetani S, Whiteford H, McGrath J. An urgent call to address the deadly consequences of serious mental disorders. JAMA Psychiatry. October 28, 2015. Accessed November 11, 2015.

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