The word "narcissist" has become a popular choice to describe all sorts of perceived personality flaws, and many times it is used incorrectly. A person may have narcissistic tendencies but not the full-blown disorder. There is a narrow border between a conceited, boastful individual and one who has a true narcissistic condition. Plastic surgeons have an inordinate amount of contact with patients with this disorder because of what we do. The nature of cosmetic surgery deals with the process of altering one's appearance in an effort to look better. Patients with narcissistic personality disorder are drawn to our offices not so much to improve their looks, but more importantly to garner attention from others.
Narcissistic personality disorder is a mental disorder in which people have an inflated sense of their own importance and a deep need for admiration. Those with this disorder believe that they are superior to others and have little regard for other people's feelings. But behind this mask of ultra-confidence lies fragile self-esteem, vulnerable to the slightest criticism.
Sigmund Freud and other psychoanalysts of his time coined the phrase "narcissist" after the character in Greek mythology, Narcissus. He was the pathologically self-absorbed young man who fell in love with his own reflection in a pool. Freud believed that we all have some degree of "healthy narcissism" within our personality to garner self-esteem. Freud suspected that the personality disorder was simply a magnified extreme manifestation of this healthy narcissism. A highly confident individual with strong self-esteem is not a narcissist, but the line drawn between that person and a narcissist can be quite narrow.
My perception of Freud's "healthy narcissism" is what I call "healthy vanity." A person with healthy vanity has a high-level of self-assurance and a solid comfort with himself or herself. You try to look and feel your best because of pride and self-esteem. Healthy vanity allows you to be able to see and work with your good and bad points to the best of your ability. It means having a realistic and healthy view of yourself (good and bad!) and others around you. Healthy vanity means that you don't value yourself more than you value others! A person with healthy vanity may spy their reflection in a mirror while passing by and comment, "Hey, I look pretty darn good today!" A narcissist will look in the mirror and say, "I don't know what I would do if I weren't so good-looking!" Healthy vanity is a positive and healthy trait.
My mother had a large dose of healthy vanity. She lived well into her 90s and never missed her weekly trip to the hairdresser, because she always wanted to look her best. She conceded that she was getting on in years, but that time spent each week on herself made her feel better and, more importantly, more confident. Self-esteem should not have an age barrier!
A narcissist, on the other hand, is someone obsessed with looks, status or anything that can be lorded over others who are less fortunate. They often monopolize conversations, have a sense of entitlement, and can become angry and controlling if they perceive that they are not getting what they want or deserve. They have to have the best of everything, the most expensive car, and socialize in perceived elite circles. They can be perfectionists to a fault, and expect constant praise and admiration. Narcissists are often notoriously unable to understand that their inflated views of themselves verge on the pathological.
Our super competitive society feeds this disorder. Many patients diagnosed with narcissistic personality disorder are first seen by plastic surgeons. A study performed in 1999 examining 133 patients requesting cosmetic surgery of the face revealed that 25 percent of these patients had extreme narcissistic tendencies!
It is for this reason that plastic surgeons must carefully evaluate each patient and rule out this disorder before operating on them. Pointed questions during the initial interview with a new patient can be instrumental in determining whether the patient is a realistic candidate with realistic expectations for cosmetic surgery or one with extreme narcissistic tendencies who will never be satisfied with the operation, no matter how successful. It is so important to understand exactly each prospective patient's motives and expectations for surgery. Patients who mention extremes with regard to their reason for requesting surgery raise a red flag. One example is the petite and attractive young lady who presents for breast augmentation and desires DDD sized implants so that she will turn heads when she walks into a room. She already has a fine figure but just wants to do something to be noticed, not for her, but for an external quality. Or the chap who has a small bump on his nose and just wants 1.4 mm removed (no more, no less!) and expects a guarantee of perfection with the postoperative result.
Cosmetic surgery is not the treatment for people with severe narcissistic tendencies, and they must be referred to qualified mental health professionals to deal with the abnormality. Narcissism is a psychological issue that should be addressed. It is, at the very least, a serious personality flaw, or, in worst cases, a recognized psychological disorder. Its antisocial aspects can have an extremely negative effect on a sufferer's daily life, personal relationships, and performance at work.
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My mother is a narcissist, but she's vain about being a eco-hippie. Whenever I read a description of narcissism it throws me off a little bit until I remember that NPD is about status and in my mother's world, status comes from how organic you can be. It's difficult to explain, because she has worthy and noble goals, but sustainable eco-living is her Gucci. I'm just glad that I broke away, because the damage that mothers with NPD do to their daughters is pretty brutal.
Thanks for the article, I'm always interested in the hallmarks of NPD.
That said, there are no doubt some plastic surgeons who, as in any profession, let their greed run their business and don't take appropriate precautions.
The ones with the most narcissistic personalities turn into a Dr.'s nightmare, they also keep going back for more work and trying different Dr.s
The others have someting changed that has bothered them for years, but did not define them, not too different than people I know in their 40s and 50s who were fitted for braces. Their families, and themselves did't have enough money to have before.
Narcissistic Personality Disorder (NPD) is a pattern of self-centered or egotistical behavior that shows up in thinking and behavior in a lot of different situations and activities. People with NPD won't (or can't) change their behavior even when it causes problems at work or when other people complain about the way they act, or when their behavior causes a lot of emotional distress to others (or themselves? none of my narcissists ever admit to being distressed by their own behavior -- they always blame other people for any problems). This pattern of self-centered or egotistical behavior is not caused by current drug or alcohol use, head injury, acute psychotic episodes, or any other illness, but has been going on steadily at least since adolescence or early adulthood.
NPD interferes with people's functioning in their occupations and in their relationships:
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The above an informative description of 'grandiosity' per usage in discussing this NPD. All good stuff. I'll just give the link:
http://www.halcyon.com/jmashmun/npd/dsm-iv.html
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If the government attempted to enact a law requiring psychological pre-screening before plastic surgery to rule out the narcissists, how do you think your colleagues would lobby? For or against?
I'd bet against.
These doctors depend upon having a steady stream of narcissists to keep their wallets plump.