Published February 2, 2006 in issue 0505 of the HooK.

By JOHN HONG, MD [email protected]

How do you read this advertisement? "It's All About ME"

One of my best friends says this all the time, and so when he showed me this ad, I thought it was all about-- him. However, it's a vacation ad for Maine (ME).

In the show Medium, the psychic heroine keeps getting a message from the grave about who the killer was: "It was me, it was me." However, "ME" stood for "medical examiner."

Are we all that egocentric?

Q: "How many psychiatrists does it take to change a light bulb?"

A: "Zero. The light bulb has to want to change."

I had a medical school classmate with true narcissistic personality disorder (NPD) who ironically went into psychiatry; he would have answered, "Are there other psychiatrists besides me?"

Fewer than one percent of the population has NPD, but a lot more have narcissistic traits: 1) Grandiose sense of self-importance (all of Wall Street, Capitol Hill, Hollywood, and Naomi Campbell); 2) Preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love (The Apprentice); 3) Believes he or she is "special" and unique-- can be understood only by other special or high-status people (The Hiltons); 4) Requires excessive admiration (Anna Nicole Smith); 5) Sense of entitlement (Teenagers-- and actually a lot of adults); 6) Interpersonally exploitative (David Sedaris); 7) Lacks empathy (George Bush-- oops, did that slip out?); 8) Often envious of others or believes that others are envious of him/her (LaToya Jackson); 9) Arrogant behaviors or attitudes (Michael Eisner).

Narcissistic personality disorder requires at least five traits but also a pattern of behavior that is inflexible and leads to significant distress or social impairment. The way I look at it, narcissistic traits are irritating to others-- and NPD is unbearable for most.

For example, when Sandra Bernhard's pregnant character on Roseanne asks, "Does this stroller make me look fat?" you have to laugh at that. But when Zsa Zsa Gabor slaps a police officer after she breaks the law, that's not funny.

If you noticed, most of my examples were performers, and NPD people are "dramatic, emotional, and erratic." In a different country, it might be considered "eccentric," but here in the States, it is called "pain in the tuckus."

As a physician, working with a patient who has NPD can be both a blessing and a curse. Because the patient is focused on himself, it can be easy to have him take his medications and follow instructions because it's "all about me." On the other hand, the slightest perceived glitch can mean 20 slashes with a wet noodle.

"What do you mean you won't give me that prescription?! Do you know who I am, Mr. Man-- oh, excuse me, Dr. Man?!"

"Patients? You're seeing other patients? I need you now, and I want what I want now!" (Veruca Salt from Willy Wonka and the Chocolate Factory beautifully sang, "Don't care how, I want it now!" before falling down the "Bad Egg" slide.) Some NPD won't take any advice a physician gives because they're lost in their own little-- er, big-- world and believe only they know the truth.

Can everything be medicated? No, but NPD patients sometimes can benefit from psychiatric medications like mood stabilizers, antipsychotics, anxiolytics, and antidepressants. Lexapro anybody?

I'm not sure how my NPD classmate is doing as a psychiatrist. I also had a friend with NPD who became a psychiatrist and interestingly lives in LA now. I fear their sessions with patients go like this, "Uh-huh, Uh-huh, Uh-- Okay, I have a facial in 10 minutes, so speed it up. You haven't told me anything that I haven't already experienced myself.

"Nurse! My throat feels like the Sahara. Get me Perrier. Do you like my watch? It's Cartier. Oh, time's up! See you next week."