A Closer Look at Narcissism in Plastic Surgery

Narcissistic personality disorder (NPD) has a high prevalence (20%-40%) in patients obtaining cosmetic surgeries and interventions, compared with around 4% to 8% in the general population. At its core, narcissistic pathology is the result of poor identity formation (sense of self) and poor self-esteem. Patients with NPD tend to use idealization and devaluation in their interactions with others, have difficulty with empathy, and are highly sensitive to criticism or perceived threat to self. As a result, they tend to evoke a variety of emotional reactions in the physicians who treat them. Recognition of these reactions are important as they may suggest underlying narcissistic pathology and cue the physician to be vigilant with the use of strong boundaries while providing validation and avoiding confrontation with a challenging group of patients.