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. 2026 Feb 15;13(2):e70455. doi: 10.1002/nop2.70455

The Current Status of the Dark Triad and Light Triad Personality Traits in Preclinical Nursing Students and Their Impact on Sympathy

Yanan Zheng 1,2, Chao Wen 3, Die Hu 4,✉
PMCID: PMC12907451  PMID: 41693082

ABSTRACT

Aims

To explore the current status of the dark triad and light triad among preclinical nursing students and their impact on sympathy.

Design

This was a descriptive cross‐sectional study.

Methods

Data were collected from 414 preclinical nursing students using the Trait Sympathy Scale, Dirty Dozen, and Light Triad Scale.

Results

In the dark triad traits, nursing students scored highest on the narcissism dimension. In the light triad traits, the highest scores were observed in the humanitarianism dimension. Trait sympathy scores were significantly negatively correlated with Machiavellianism and psychopathy scores but significantly positively correlated with narcissism (which may be related to the prosocial characteristics of narcissism among nursing students) and all dimensions of the light triad. Multiple regression analysis indicated that humanitarianism, Kantianism, narcissism, and psychopathy were predictors of sympathy among preclinical nursing students.

Patient or Public Contribution

No patient or public contribution.

Keywords: dark triad, light triad, preclinical nursing students, sympathy

1. Introduction

Sympathy refers to an individual's ability to feel sadness and concern for others in distress, also known as compassion, which is a key social emotion (Clark 2010). This emotional response serves as an important source of humanitarianism, promoting altruistic and prosocial behaviours (Chang et al. 2024; Jinping and Daohan 2019). It also contributes to enhancing individuals' communication skills and reducing aggressive behaviours (Jeong and Seo 2022; Abdollahi et al. 2023). Although related, sympathy is not synonymous with empathy. The latter focuses more on assuming responsibility and adopting a positive attitude to help others, emphasising understanding issues from others' perspectives rather than simply expressing emotional understanding or goodwill (Wang and Qiao 2016). Compared to the cognitive and behavioural aspects emphasised by empathy, sympathy is relatively simpler and more foundational, focusing more on emotional experiences. It often serves as a prerequisite for empathy—only by emotionally resonating with others can one understand and adopt their perspective (Decety and Meyer 2008; Jankowiak‐Siuda et al. 2011). Nursing students are the future workforce of clinical nursing. In the field of nursing education, their level of empathy directly determines the professional and humanistic qualities of future clinical nursing practice, thereby influencing healthcare quality. Although extensive research has been conducted on empathy (Yang, Peng, and Yang 2023; Jing et al. 2023; Yang, Zhang, et al. 2023), less attention has been paid to its prerequisite—sympathy. During their academic years, nursing students often lack sufficient understanding of clinical nursing and patient characteristics. This leads to a certain gap between their perception of empathy and its practical application, which may result in less targeted empathy training. However, exploring nursing students' sympathy levels and their influencing factors at this stage, and implementing targeted educational and practical interventions, can help gradually develop empathy during future clinical practice. This approach is more practical for fostering humanistic qualities in nursing students. Moreover, sympathy represents the initial emotional motivation for responding to patients' suffering and is closely associated with caring behaviours, patient trust, and satisfaction with nursing services (Zarrinkolah et al. 2025). Therefore, emphasising sympathy in early nursing education may provide a necessary emotional foundation for the subsequent development of empathy and humanistic nursing practice.

Numerous factors influence sympathy, with research suggesting that personality is a key determinant (Yang, Hagiwara, et al. 2023a). The dark triad, a cluster of antisocial personality traits, includes Machiavellianism, narcissism, and psychopathy. Individuals exhibiting these traits are often characterised by competitiveness, emotional coldness, apathy, self‐righteousness, arrogance, and other negative personality traits (Paulhus and Williams 2002). The dark triad is relatively prevalent among medical students (Zheng et al. 2020). In contrast, the light triad represents positive personality traits, also referred to as light personality. It includes faith in humanity, humanitarianism, and Kantianism, reflecting traits such as faith in human goodness, respect for others' value and dignity, and sincerity rather than treating others as mere tools, making it a more positive counterpart to the dark triad (Kaufman et al. 2019). Shaping nursing students' light triad traits and mitigating the negative effects of the dark triad during their academic years is crucial for enhancing their professional and humanistic qualities. Previous studies have shown that both the dark triad and the light triad have predictive value for sympathy and prosocial behaviours (Castagna and Hart 2024; Sharpe et al. 2024). Based on these, this study hypothesises that dark triad traits may be negatively associated with sympathy, whereas light triad traits may be positively associated with sympathy.

Research on sympathy among nursing students is still limited, with most existing studies focusing on empathy and its related factors (Wei et al. 2025) rather than on sympathy itself. Among the few studies addressing sympathy, the emphasis has largely been on emotional or behavioural aspects (Xu and Zhang 2023; Park et al. 2019), with relatively little attention given to the role of personality traits in shaping sympathy, especially among nursing students. Therefore, to enhance the development of humanistic qualities in nursing education, this study wants to address the following research questions: what is the current status of the dark triad and light triad among nursing students, and how are dark triad and light triad traits associated with sympathy? Accordingly, this study aims to examine the current status of the dark triad and light triad traits in nursing students and their impact on sympathy. It is hypothesised that the dark triad and light triad traits are associated with sympathy. A survey was conducted in May 2024 involving 414 third‐year undergraduate nursing students from Gannan Medical University (Cathala and Moorley 2018).

2. Materials and Methods

2.1. Participants

Using cluster sampling, all third‐year undergraduate nursing students (four‐year program) at Gannan Medical University were selected, totalling 433 individuals who were scheduled to commence clinical internships at affiliated hospitals in early June. Based on this study's aim, third‐year undergraduate nursing students were selected because they had completed the full theoretical nursing curriculum and possessed a certain understanding of the nursing profession, clinical environments, nurse–patient relationships, and humanistic care. At the same time, they had not yet begun clinical internships, so assessing their sympathy levels could inform subsequent curriculum adjustments and humanistic guidance during clinical supervision, thereby fostering nurses with stronger humanistic care. In contrast, first‐ and second‐year students mainly studied basic medical courses and had limited overall knowledge of nursing, so assessing their sympathy levels would provide little useful information for educational reform. Fourth‐year students were already engaged in clinical internships and approaching graduation; even if their sympathy levels were low, meaningful educational interventions would be difficult to implement. Therefore, third‐year students were included as the most appropriate group for this study (Shorten and Moorley 2014). A total of 433 questionnaires were distributed, 429 were returned (response rate: 99.08%), and 414 were valid (validity rate: 96.50%). Among the respondents, 68 were male and 346 were female, with an age range of 19 to 24 years.

2.2. Questionnaires

2.2.1. Trait Sympathy Scale

The Trait Sympathy Scale, originally developed by Lee (2009) and localised by Wang et al. (2019) according to Chinese culture and language, can provide a comprehensive evaluation of sympathy levels in participants. The scale comprises 18 items across three dimensions: sympathy for vulnerable groups (6 items, assessing sympathy toward individuals such as the disabled, elderly, and children), sympathy for others' emotions (6 items, evaluating sympathy for others' suffering or negative emotions), and sympathy for animals (6 items, measuring sympathy toward small or weak animals). The scale employs a 7‐point Likert scoring system ranging from 1 (strongly disagree) to 7 (strongly agree). The sum of item scores constitutes the total score, with higher scores indicating greater sympathy levels in the respective dimensions and overall. This study utilised the total score to represent participants' overall sympathy level. The Cronbach's α for this scale in this study was 0.902. Confirmatory factor analysis showed that the model fit indices were CMIN/DF = 2.922, GFI = 0.913, CFI = 0.935, NFI = 0.905, and TLI = 0.922, indicating a good model fit and demonstrating good construct validity.

2.2.2. Chinese Version of Dirty Dozen

The Dirty Dozen, initially developed by Jonason and Webster (2010), was later localised and revised by Geng et al. (2015) according to Chinese culture and language. The scale contains 12 items scored on a 7‐point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). It assesses three dark personality traits: Machiavellianism (4 items, measuring the tendency to exploit, manipulate, deceive others, and prioritise practicality to achieve goals), psychopathy (4 items, evaluating traits of emotional coldness, impulsivity, and disregard for morality), and narcissism (4 items, assessing traits of self‐promotion, vanity, arrogance, and the tendency to demean others to elevate oneself). The total score for each dimension is calculated by summing the item scores, with higher scores indicating stronger tendencies in the respective dark personality traits. The Cronbach's α for this scale in this study was 0.802. Confirmatory factor analysis showed that the model fit indices were CMIN/DF = 2.612, GFI = 0.952, CFI = 0.968, NFI = 0.949, and TLI = 0.957, indicating a good model fit and demonstrating good construct validity.

2.2.3. Light Triad Scale

The Light Triad Scale, originally developed by Kaufman et al. (2019), was localised and revised by Wang et al. (2022) according to Chinese culture and language. It consists of 12 items scored on a 5‐point Likert scale from 1 (strongly disagree) to 5 (strongly agree). The scale assesses three positive personality traits: humanism (4 items, evaluating respect for others' dignity and values), Kantianism (4 items, measuring sincerity, egalitarianism, and a tendency to treat others as ends rather than means), and faith in humanity (4 items, assessing belief in human kindness). The sum of item scores constitutes the dimension scores, with higher scores reflecting stronger expressions of the corresponding traits. The Cronbach's α for this scale in this study was 0.708. Confirmatory factor analysis showed that the model fit indices were CMIN/DF = 2.703, GFI = 0.948, CFI = 0.955, NFI = 0.932, and TLI = 0.940, indicating a good model fit and demonstrating good construct validity.

2.3. Study Procedure

A pilot test was conducted to evaluate the feasibility, clarity, and reliability of the questionnaire. A sample of 30 third‐year nursing students completed the pilot survey. The results were consistent with expectations, demonstrating satisfactory reliability and clarity of the instrument. Based on these findings, a large‐scale survey was subsequently carried out among the full sample of nursing students. After obtaining informed consent, questionnaires were distributed during class breaks and collected on‐site. The authors of this study served as principal investigators, providing standardised and unified instructions. The same investigator was responsible for both distribution and collection to ensure consistency in explanations provided to participants. Before administering the questionnaires, the investigators briefly introduced the concepts of sympathy, the dark triad, and the light triad, emphasising that the results were solely intended to assess personality tendencies without moral judgement. Participants were assured that their responses would remain anonymous, used solely for academic research, and kept confidential. This reassurance aimed to alleviate concerns about potential moral implications of questions related to compassion, coldness, or humanitarianism. Participants completed the questionnaires within 5–10 min. This study was approved by the Biomedical Research Ethics Committee of Gannan Medical University (Approval number: 2023630).

2.4. Data Analysis

All questionnaire data were double‐entered and cross‐checked to ensure accuracy. The dataset was carefully examined for completeness and consistency, and any responses with missing or invalid information were excluded. These procedures ensured that high‐quality and reliable data were included in the final analysis. Statistical analysis of the collected data was performed using SPSS 21.0. Based on the normal distribution of the variables, Pearson correlation analysis was employed to explore the relationships between nursing students' sympathy and the dark triad and light triad traits. Given the presence of significant correlations among variables and no multicollinearity being detected (VIF:1.043–1.746 < 10, tolerance values:0.573–0.959 > 0.1), multiple linear regression analysis was then employed to examine the association between dark triad, light triad traits and sympathy. p < 0.05 was considered as a statistically significant difference.

3. Results

3.1. General Characteristics of Trait Sympathy, Dark Triad, and Light Triad in Pre‐Clinical Nursing Students

The Trait Sympathy Scale scores for 414 preclinical nursing students were 96.68 ± 15.28. In the Dirty Dozen, the scores for Machiavellianism, psychopathy, and narcissism were 7.77 ± 4.57 (1.94 per item), 7.70 ± 4.20 (1.93 per item), and 17.89 ± 5.40 (4.47 per item), respectively. In the Light Triad Scale, the scores for faith in humanity, humanitarianism, and Kantianism were 14.36 ± 4.57 (3.59 per item), 16.63 ± 2.91 (4.23 per item), and 14.67 ± 2.83 (3.67 per item), respectively.

3.2. Relationships Between Sympathy, Dark Triad, and Light Triad in Preclinical Nursing Students

The total score of the Trait Sympathy Scale among 414 preclinical nursing students was significantly negatively correlated with the Machiavellianism and psychopathy dimensions of the Dirty Dozen, while exhibiting a significant positive correlation with the narcissism dimension of the Dirty Dozen and all three dimensions of the Light Triad Scale (faith in humanity, humanitarianism, and Kantianism). Detailed results are shown in Table 1 and Figure 1.

TABLE 1.

Correlation between sympathy, dark triad, and light triad in preclinical nursing students.

Machiavellianism Psychopathy Narcissism Faith in humanity Humanitarianism Kantianism
Sympathy −0.302** −0.375** 0.212** 0.257** 0.422** 0.383**
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Note: **p < 0.01.

FIGURE 1.

FIGURE 1

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Scatter plot showing the correlation between sympathy, dark triad and light triad. Panels (A–F) present scatter plots depicting the correlations between sympathy and Machiavellianism, psychopathy, narcissism, faith in humanity, humanitarianism, and Kantianism, respectively.

To further explore the influence of the Dark Triad and Light Triad on sympathy, a stepwise multiple linear regression analysis was conducted. The scores for Machiavellianism, psychopathy, and narcissism from the Dirty Dozen, as well as faith in humanity, humanitarianism, and Kantianism from the Light Triad Scale, were considered as independent variables, with the total score of the Trait Sympathy Scale as the dependent variable. The results revealed that humanitarianism, Kantianism, and narcissism significantly positively predicted the total score of the Trait Sympathy Scale, while psychopathy showed a significant negative predictive effect (F = 43.176, p < 0.001). Detailed results are presented in Table 2.

TABLE 2.

Regression analysis of dark triad and light triad on sympathy in preclinical nursing students.

Variables B SE β t p
Constant 58.842 5.355 — 10.989 < 0.001
Humanitarianism 0.939 0.274 0.179 3.424 0.001
Psychopathy −0.856 0.166 −0.236 −5.166 < 0.001
Kantianism 1.280 0.264 0.237 4.840 < 0.001
Narcissism 0.562 0.119 0.198 4.712 < 0.001
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Note: ΔR 2 = 0.290.

4. Discussion

4.1. The Dark Triad and Light Triad of Preclinical Nursing Students: Prominence of Narcissism and Humanitarianism

The results of this study revealed that among the Dark Triad traits, nursing students scored highest on narcissism compared to Machiavellianism and psychopathy, consistent with findings from previous research on medical students (Zheng and Liu 2020). This may be because, while narcissism involves self‐aggrandisement, it also reflects a strong need for admiration and positive evaluation from others, making it more ‘pro‐social’ than the other Dark Triad traits (Zhu and Jin 2021). Meanwhile, nursing education and its cultural environment emphasise interpersonal interaction, teamwork, and continuous feedback. This may reinforce individuals' attention to others' evaluations and recognition (Wong and Shorey 2022), potentially promoting the expression of narcissistic traits. However, manipulative or cold traits, such as Machiavellianism and psychopathy, are not aligned with the norms and values advocated by the nursing profession and thus less likely to manifest. The results indicate that leveraging these traits through strategies such as appreciation, recognition, and fostering a sense of responsibility may be an effective approach to enhancing their professional qualities. In the Light Triad traits, nursing students scored highest on humanitarianism, reflecting the emphasis placed by medical education institutions on fostering humanitarian values, particularly at the theoretical level. However, this also suggests that there is still a need to strengthen practical education focused on Kantianism, which avoids the ‘objectification’ of patients, and on fostering a deeper faith in humanity. Overall, these results indicate that narcissism and humanitarianism are prominent traits among preclinical nursing students.

4.2. The Predictive Role of Dark Triad and Light Triad in Sympathy Among Preclinical Nursing Students

Sympathy differs from empathy, yet a lack of sympathy often precludes the ability to genuinely empathise with others' emotional experiences. Therefore, targeted education aimed at enhancing sympathy during undergraduate nursing education is crucial for fostering empathy in future clinical practice. Our findings reveal that humanism, Kantianism, and narcissism positively predict nursing students' sympathy, while psychopathy has a negative predictive effect. Generally, individuals who value others' dignity and worth and interact with sincerity are more likely to exhibit genuine sympathy toward others' misfortunes. Conversely, those seeking recognition or possessing narcissistic tendencies may express sympathy to showcase their ‘uniqueness’, which may gradually evolve into habitual behaviour. However, individuals with cold, morally indifferent psychopathic traits often struggle to feel sympathy and may even disparage those who are unfortunate. These findings suggest that specific personality traits and their associated behavioural tendencies may influence the development of sympathy. Personality is shaped by an interplay of environmental, genetic, and experiential factors. As nursing students are in a stage of socialisation, their personalities remain highly malleable. Academic pressure, clinical exposure, and other factors can significantly influence their personality traits (Zhang and Tu 2017). For example, appropriate education in the humanities could enhance positive traits of the Light Triad, whereas academic stress might reinforce the utilitarian aspects of Machiavellianism. Additionally, complex patient‐provider dynamics may exacerbate cold and self‐centred psychopathic tendencies or amplify narcissistic traits focused on achievement and recognition. When these traits are amplified, nursing students with pronounced narcissistic tendencies may prioritise tasks in which they excel to gain recognition, potentially overlooking patients' immediate needs. Students with psychopathic tendencies may show a lack of empathy during team discussions, resulting in patient concerns being neglected. Those with pronounced Machiavellian traits may focus on personal gain or strategic manipulation, which could undermine collaboration and patient‐centred care. These suggest the need for medical schools to not only cultivate nursing students' sympathy, empathy, and other professional qualities but also provide targeted education addressing their existing Dark Triad and Light Triad traits, particularly prominent characteristics such as narcissism and humanism. Strategies may include assisting nursing students in developing career plans, understanding their personal growth trajectories, and enhancing their sense of responsibility. Educational efforts could also focus on interpersonal relationships, fostering respect for others, and clarifying personal meaning and value. Establishing incremental goals and promoting self‐realisation through respecting others and achieving objectives could satisfy practical and self‐recognition needs, ultimately enhancing sympathy. This approach may improve the professional qualities and role adaptability of nursing students. Furthermore, targeted educational strategies, such as scenario‐based simulations (Cho and Kim 2024), peer feedback (Yoong et al. 2023), role‐playing (Basit et al. 2023), and small‐group work (Wong 2025), can reduce the potential negative impact of dark triad traits. These approaches encourage students to reflect and shift their focus from self‐centred concerns toward patient‐centred care, promoting professional behaviours that align with empathy, compassion, and collaborative practice in clinical settings.

5. Conclusion

This study found that certain traits of the ‘Dark Triad’ and the ‘Light Triad’ in nursing students without clinical internship experience can partially predict sympathy levels. These findings suggest that targeted education tailored to students' individual traits is crucial for enhancing sympathy and empathy. These findings may inform policy decisions in nursing education programs by highlighting the need to integrate personality‐ and empathy‐related training in the early stages of nursing education. Based on students' bright triad and dark personality traits (notably narcissism and humanitarianism), suggest taking measures including career planning, interpersonal guidance and phased goal‐setting to enhance their responsibility, values and thereby improve sympathy. Additionally, targeted education—such as scenario simulation, peer feedback, role‐playing and group cooperation—can mitigate the negative impacts of dark traits, shifting students from self‐centredness to patient‐centredness to better demonstrate sympathy. However, this study has several limitations. First, its cross‐sectional design precludes causal inferences. Second, the sample was limited to students from a single medical university, with relatively homogeneous demographic characteristics, restricting the generalisability of the results. Third, the data were collected via self‐report questionnaires, which may be subject to social desirability or response biases. Future studies should conduct multicentre empirical research on a larger scale to improve the representativeness of the findings. Moreover, incorporating nursing students with internship experience could provide insights into how practical exposure and educational interventions contribute to the development of humanistic qualities in the nursing profession.

Author Contributions

Yanan Zheng and Die Hu: writing – original draft. Chao Wen: investigation and resources. Yanan Zheng and Die Hu: writing – review and editing; project administration; supervision. All authors have read and agreed to the published version of the manuscript.

Funding

This work was funded by the Department of Education of Jiangxi Province (Jiangxi Province Education Science ‘14th Five‐Year Plan’ 2023 general topics (23YB228); University Humanities Project of Jiangxi Province in 2022 (22Y1716)).

Disclosure

Statistics Statement: The authors have checked to make sure that our submission conforms as applicable to the Journal’s statistical guidelines. Yanan Zheng is a statistician on the author team. The authors affirm that the methods used in the data analyses are suitably applied to their data within their study design and context, and the statistical findings have been implemented and interpreted correctly. d. The authors agrees to take responsibility for ensuring that the choice of statistical approach is appropriate and is conducted and interpreted correctly as a condition to submit to the Journal.

Ethics Statement

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Biomedical Research Ethics Committee of Gannan Medical University (Approval number: 2023630).

Consent

Informed consent was obtained from all subjects involved in the study.

Conflicts of Interest

The authors declare no conflicts of interest.

Acknowledgements

The authoring team would like to thank the participants in the present study.

Zheng, Y. , Wen C., and Hu D.. 2026. “The Current Status of the Dark Triad and Light Triad Personality Traits in Preclinical Nursing Students and Their Impact on Sympathy.” Nursing Open 13, no. 2: e70455. 10.1002/nop2.70455.

Data Availability Statement

The data presented in this study are available on request from the first author. The data are not publicly available due to privacy reasons.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data presented in this study are available on request from the first author. The data are not publicly available due to privacy reasons.

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