Many people know someone who’s obsessed with their looks. In today’s beauty-centric culture, it’s not unusual to see someone gaze often into the mirror, whether primping and posing or fretting over a real or imagined flaw.
Those who perceive that’s something horribly wrong with one or more areas of the body and just can’t be convinced otherwise may suffer from a recognized disorder called BDD, or body dysmorphic disorder. A good many find their way to plastic surgery consultations—the rate of patients with BDD is estimated to be 7 to 15 percent.
Many plastic surgeons have become fairly adept at spotting a prospective patient with BDD tendencies. But there’s another personality disorder that may be a little more difficult for those without experience in psychology to recognize: narcissistic personality disorder (NPD).
The term “narcissist” arose during Sigmund Freud’s time—chosen for the young man of myth who fell in love with himself when staring at his reflection in a pool of water. According to Dr. Robert Tornambe, writing last month in the Huffington Post, a dose of narcissism is good for all of us, contributing to our confidence and self esteem.
Those with NPD carry narcissism to an extreme. They may believe they are the best at everything and have a need to lord this over everyone else. They can be very difficult to interact with—monopolizing conversations, belittling and criticizing others, exerting control and becoming angry if resisted. They tend to feel entitled to what others work to earn and many are extreme perfectionists. They expect to be admired.
It’s no surprise, then, that those with NPD may seek out cosmetic surgery to become even more perfect and garner increasing attention from others. In this, they often differ from most patients with BDD. Those with BDD are frequently concerned with one body part that actually is less flawed than they perceive—or not flawed at all. The red flag may go up right away for a plastic surgeon in this case.
In plastic surgery consultation, patients with NPD may present with a more general desire for self-improvement. At first, it may seem that a patient like this is no different from average people who want to look younger, sculpt away fat deposits, regain a pre-childbirth body or other similar motivation.
Therefore it’s critical that the doctor inquire deeply into the patient’s goals. Tornambe suggests asking very pointed questions. He recommends surgeons listen carefully as the patient discusses his or her expectations for surgery—on the alert for motives that could be related to attention-seeking or a quest for general perfection.
While patients with BDD and NPD may seek cosmetic surgery for slightly different reasons, plastic surgeons’ goals should be the same for both: advise them to seek counseling instead of plastic surgery. When a patient with a disorder like this makes it through the consultation and into the surgical suite the outcome is predictable. No matter how successful the procedure is, the patient—and therefore the surgeon—will not be happy with the result.
References:
http://www.huffingtonpost.com/robert-tornambe-md/plastic-surgery-narcissism_b_782293.html
http://mentalhealth.about.com/cs/personaltydisordrs/l/blpdfacial.htm
http://psychcentral.com/disorders/sx36.htm
http://www.apa.org/monitor/sep05/surgery.aspx
http://emedicine.medscape.com/article/291182-overview