Selfies, narcissism and oral health a cross - sectional study among adolescents and young adults in Mangaluru - India.

Background

Selfies have been defined as “a photograph that one has taken of oneself, typically one taken with a smartphone or webcam and shared via social media” and are a continuing growing trend among Millennials (Generation Y).¹ Selfies are now correlated with uploading the same on social media platforms, mainly because of the global saturation of smartphones with cameras and the indispensable integration of this with the presence of Social networking sites (SNS), applications such as Facebook, Twitter, WeChat, Tumblr, Snapchat and Instagram. Selfies, as a new social trend, warrant greater academic consideration, and the intention behind selfie taking is still an enigma in the field of psychology, which warrants further exploration of the intent behind this behavior. Not much is known about selfie addiction in general, and selfies, in particular, have come under increased scrutiny because of their disbursing nature, and experts in the field of psychology and communication are trying to investigate this phenomenon in detail.² Over the past few years, the triple digital revolution of social networks, the internet, and mobile phones has increased the use and popularity of selfies.

Narcissism refers to the personality trait of an extraordinary self-awareness and adoration often referred as “self-love that shut out everyone else”.³ The word “narcissism” is typically associated with increased self-worth, feelings of grandiosity, dominance, admiration seeking, and privilege (entitlement), which forms a part of narcissism called the grandiose narcissism, but there also is a less prominent trait called Vulnerable narcissism which includes self-absorption, self-consciousness, social insecurity, and defensiveness. Together they revolve on the fundamental idea of self-centered egocentric behavior; they initially appeared as the “two faces” of narcissism and show up as radically distinct personality traits.⁴

Personality and its developmental aspects among individuals are extending the frontiers in psychology. Studies have shown efficient integration between the Big Five personality traits and various dimensions of SNSs, such as communication patterns and social media language, along with a wealth of vocabulary.⁵ Additionally, there is a direct association between the Dark Triad and personality traits, as mentioned earlier. Psychological traits could also be related to selfie posting behavior. Therefore, selfies are no longer considered merely technological artifacts. Instead, it is considered a means of communication and a purposeful symbolic gesture narcissism and selfie behavior is closely associated.⁶

Adolescence is described as a transitional phase between childhood and adulthood, with a biological beginning (puberty) and a social ending. Adolescents are a susceptible group; they are the connect between young and old and are often the population that is routinely under scrutiny because of their diverse physical and psychological traits.¹

Oral health depends on factors such as well-being, self-satisfaction and, most importantly, oral health habits such as the frequency of tooth brushing, flossing and dental visits. A study conducted on the influence of narcissism on oral health status showed that good/excellent self-rated oral health status was associated with high levels of narcissism.⁷

The study was envisaged with the aim and objective of assessing correlations between perceived health perceived oral health, selfie-taking behavior, narcissism and oral health status using a standard questionnaire among a population of college students in Mangaluru, Karnataka.

Methods

This Analytical Cross-sectional study was carried out in the city of Mangaluru, located on the west coast of Karnataka, India in the district of Dakshina Kannada. The study was conducted from 2021 (June – August) as part of an oral health screening programme at the college (Department of Business Studies) as part of the institutional health screening programme in a single college in the city old Mangalore. The students from the Department of Business Studies were the participants in the study. A Convenient sample was obtained and all students from the department who were eligible for study were included in the study.

Eligibility criteria: Individuals who declined to give their consent were excluded from the study. The study comprised participants who were present during the study process and could communicate in English as the questionnaire was in English only.

Participants who were receiving psychiatric therapy or who were suffering from generalised anxiety disorders, who mentioned it in the questionnaire were excluded from the study.

Ethics: The approval was obtained from the Institutional Ethics Committee. [Protocol No: 18018]. Permission was obtained from the head of the institution of the college. Participants provided written informed consent before answering the questionnaire and undergoing an oral examination. Participants in need of urgent oral care were referred to the institution for oral emergency care.

Results

The study included a sample of 163 participants, 159 of whom completed the study, with a response rate of 97%, 96 (60.3%) of whom were males and 63 (39.7%) of whom were females. The sample had a mean age of 18.03 years, with a 4.3-year standard deviation, 71.1% had visited a dentist before this study was conducted. The mean monthly family income of participants was Rs 20810 (SD 7300).

The Pearson chi-square test was used to assess the associations between selfie-taking behaviour, perceived general health, perceived oral health, dental caries experience, and the plaque index. The associations between selfies taken per day and perceived oral health was statistically significant (p value 0.047*), but there was no association with other variables, as described in Table 1.

The Pearson correlation coefficients between total narcissism, grandiose narcissism, vulnerable narcissism, dental caries, perceived oral health, and the plaque index showed a statistically significant positive correlation between perceived oral health and vulnerable narcissism and total narcissism, but there was no statistically significant correlation between grandiose narcissism or dental caries experience and plaque scores. However, a significant negative correlation was observed between grandiose narcissism and the plaque index. The correlations between all the covariables are detailed in Table 2. Further evaluation between selfie behaviour and covariables revealed a positive significant correlation between gender and selfie behaviour.

Independent t tests were used to assess differences between selfie-taking behavior and differing traits of narcissism. The test demonstrated no significant association between the various traits of narcissism and selfie behavior, as presented in Table 3.

Binary logistic regression models were constructed for the prediction of perceived oral health, DMFT index, presence or absence of caries and plaque, traits of narcissism, gender, and selfie-taking behaviour. The odds were significant for perceived oral health and grandiose fantasy. Plaque Scores showed significant corelations between indifference, manipulativeness, thrill seeking and age. Multiple charts for binary logistic regressions are collated with only odds ratios, and unstandardised regression rates for better understanding and presented in Table 4.²¹

Tables 5 and 6 show the results of forward stepwise binary logistic regression for the prediction of poor perceived oral health and plaque indices using the traits of narcissism, gender, and selfie behaviour. The step forward binary regression demonstrated a significant odds ratio for grandiose narcissism followed by selfie-taking behavior as the key variable associated with plaque behaviour.

Discussion

Adolescence is a period of profound physical, psychological, and behavioral transformation during which adolescents form habits and behaviors that they carry into adulthood. In addition, there are more specific risk factors linked to poor dental health at the period. Adolescents constitute a major part of the population, yet there are still limited studies regarding the population, especially in dental settings.¹²

The main objectives of the study were to evaluate the associations between perceived health, perceived oral health, selfie-taking behavior, narcissism and oral health status in an adolescent population in Karnataka, India. Multiple studies have assessed the association between selfie-taking behaviour and narcissism,^12,13 and studies have also demonstrated the effect of narcissistic personality disorders on oral health.^4,7,14

The instrument used for this study was a validated version of the short Form of Five-Factor Narcissism Inventory with the following characteristics: a Cronbach’s alpha of 0.8, a split half of 0.8 and a test-retest reliability of 0.71 (p<0.01), as tested by the authors on a population similar to that used in the study. The Five-Factor Narcissism Inventory Short Form (FFNI-SF) was created because the original Five-Factor Narcissism Inventory (FFNI) was too lengthy and unworkable for general usage. The 60-item FFNI-SF assesses the three higher order elements of narcissism anger, extraversion, and neuroticism as well as the same 15 characteristics that can be combined to produce grandiose and vulnerable narcissistic presentations. Sherman et al.⁹ reported that the sixty items of the FFNI-SF may still be used to measure the original FFNI’s constituents in a valid and reliable manner, boosting the instrument’s efficiency while maintaining its validity and reliability.¹¹ Narcissism has been explored in terms of subtypes rather than as a singular construct. Grandiose (the overt kind) and vulnerable (the covert type) are two of the most discussed forms of pathological narcissism.¹⁰

The associations between selfie taking behaviour and perceived general health, perceived oral health, dental experience and plaque scores were significant only between selfie behaviour and perceived oral health. There have been limited studies in literature that have examined selfie behaviour in terms of perceived health, perceived oral health and dental status in a population, which is understandable because selfies and oral health were considered unrelated phenomena or because no close associations are observed between them; however, recently, the upsurge in social media and its close association with selfie behaviour have led investigators to scrutinise this phenomenon on the whole. Studies in South Africa^15,16 have pointed out that dental health, especially perceived dental health, is closely related to selfie behaviour, as people with malocclusion are averted from smiling in selfies; hence, this may explain the association between these two factors. Adolescents lead a carefree life with less importance to health, a healthy lifestyle and well-being; hence, they usually have positive perceptions of health as generally being positive regardless of what they might be going through; hence, there might be no association with perceived health and other factors.

A positive correlation was observed between total narcissism, vulnerable narcissism and perceived oral health. Research has shown that there are two main narcissistic variants, namely, grandiose and vulnerable narcissism. The primary difference between the two variants is self-regulation. Grandiose narcissists typically use overt techniques to control their ego, such as discounting others and enhancing their own worth, whereas vulnerable narcissists typically depend on social acceptance to control their delicate ego. Vulnerable types are more likely to recognise and counteract challenges to their self-image. Hence, there may be a positive correlation between perceived oral health and vulnerable narcissism, and people with high levels of vulnerable narcissism may experience dissatisfaction from their narcissistic demands for approval and achievement.¹⁷

They are also more self-vigilant and conscious about self-presentation. Hence, oral health, especially the aesthetic part of the face, is important for these subtypes, which can also be a reason for such correlation.¹⁸

Narcissism has a close relationship with oral health parameters. The present study revealed a positive correlation between grandiose fantasy and perceived oral health. Participants with grandiose fantasy¹⁹ have closely studied the effects of grandiose fantasy on personality traits and believe that people with grandiose fantasy tend to feel better for themselves. It is also proposed that grandiose fantasising is highly prevalent in both traits of narcissism, hence the reason for a better perception of oral health.²⁰ The traits such as indifference, manipulativeness and thrill seeking was positively related to the plaque index, where higher plaque index scores were observed in subjects with indifference, manipulativeness and thrill seeking. Compared with individuals with other personalities, individuals with narcissistic personalities who are exploring oral health behaviors are less likely to visit dentists for check-ups or for tooth cleaning and scaling.⁷

Conclusion

This research establishes a significant correlation between the act of taking selfies and several psychological and social factors. Since adolescents and young adults make up a significant portion of the population and, if ignored, could eventually pose a major threat to public health, the correlations and association of these parameters with the various stages of development in the adolescent population serve as a foundation for additional research. This study revealed a positive correlation between perceived oral health and selfie-taking behaviour. However, no associations were found between selfie-taking behavior, narcissism, perceived oral health, mean DMFT score and mean plaque score. Further studies are required to assess selfie taking behaviour and oral health.